Transcript AHRQ Safety Program for Long-Term Care: CAUTI website

AHRQ Safety Program for Long-Term Care: HAIs/CAUTI
Clean Equipment and Environment
Promotes Safe Resident Care
Training Module # 2 for All Long-term Care Staff
Current as of July 2015
Learning Objectives
Upon completion of this session, long-term care staff will be able to:
•
Describe the chain of infection and identify key strategies to
break the chain
•
Explain catheter care and maintenance strategies that facility
staff can use to prevent residents from acquiring catheterassociated urinary tract infection (CAUTIs)
•
Explain the role of the environment as a place where pathogens
can become a source of infection for residents and staff
•
List the important steps when using environmental disinfectants
2
Protecting Residents Against Infection
The Chain of Transmission:
Six Links
Each link stands for something (or
someone) that helps pass on an
infection.
An infection can be passed from one
person to another person as long as the
links of the chain are joined together.
Siedlaczek G. SJMHS
3
Breaking the Chain of Infection:
The Role of LTC Facility Staff
The Chain of Transmission: 6 Links
How Can You Break the
Chain of Infection?
Education
•
•
•
•
•
Hand hygiene
Gloves
Clean rooms
Disinfected surfaces
Proper medical device care
and maintenance
Ensure residents have:
Siedlaczek G. SJMHS
•
•
•
•
•
Good personal hygiene
Covered cuts/wounds
Isolation precautions
No unnecessary antibiotics
Proper waste disposal
4
Indwelling Urinary Catheter:
Entry Pathways for Microbes
Bladder
• Entry during
insertion
• Bacteria movement
up the catheter
Urethra
(Urinary tract
entrance)
Urine Collection Bag
• Breaks in the catheter
tubing or collection bag
• Contamination of the
catheter tubing or
collection
bag
Figure Source: Dennis G. Maki and Paul A. Tambyah. Engineering Out the Risk of Infection with Urinary Catheters.
Emerg Infect Dis, Vol.
7, No. 2, March-April 2001.
http://www.cdc.gov/ncidod/eid/vol7no2/makiG1.htm; CMS, State Operations Manual, 2014.
5
Entry Pathways for Microbes:
Urine Collection Opening
• Sterile technique is important when
inserting urinary catheters
• Routine hygiene is important (e.g.,
cleansing the area around the
urethra during bathing or
showering)
• Disinfect port with alcohol swab for
15 seconds before obtaining a urine
culture
• Check site for possible
disconnection of catheter from
drainage bag
Catheterout.org
• System may become an open system
if the outlet is left unclamped
6
Indwelling Urinary Catheter:
Stabilization Devices Can Help Prevent Microbe Entry
Catheter Stabilization Devices
Seal over junction
between catheter and
drainage bag.
7
Hand Hygiene
Good
Plain soap
Better
Antimicrobial
soap
Best
Alcohol-based
hand rub
8
Case Review of an Outbreak
The case of the common urinometer
• A LTC facility has an outbreak of MDR-Serratia marcescens
UTIs
• Risk factors
– Use of common measuring device between residents with indwelling
urinary catheters
– Hands of HCWs contaminated with outbreak strain after use of device;
they helped pass the microbes between residents
• The outbreak stopped after the measuring device was
disinfected between each use
• Dedicate one device per resident
Rutala WA, et al. Am J Med 1981;70:659-73.
9
Role of Clean Equipment and Environment:
Protecting Residents Against Infection
Factors associated with increased risk of infection in residents include1:
 Lower level of cleanliness
 Higher frequency of odors
 High turnover rate of nurses
 Fewer certified nurses’ aides/100 beds
Microorganism
Survival on Environmental Surfaces
Bacteria
Clostridium difficile (C. diff.) spore
> 1 yr.
Methicillin-resistant Staphylococcus aureus (MRSA)
7 days – 7 months
Viruses
Human immunodeficiency virus (HIV)
3-4 days
Norovirus
8 hrs – 7 days
Zimmerman S, et al. JAGS 2002;50:1987-950.
Kramer A. BMC ID 2006; McFarland L, et al. AJIC 2007
10
MDROs Can Hang Around
represents positive VRE culture sites – ready for next patient?
Vancomycin-resistant Enterococci (VRE) detected on surfaces indicated –
cultures done AFTER discharge cleaning/disinfection
Duckro AN, et al. Arch Intern Med 2005;165:302-7
11
Disinfection of the Environment & Equipment
Why is it important to disinfect surfaces in the LTC
facility?
• Surfaces that are touched frequently increase the
chance that microorganisms could be spread to
residents or staff
• While surfaces may look clean, pathogens may be
lurking
What can you do?
• Cleaning/disinfection offers extra margin of safety
• Disinfectant kills bacteria and viruses that can’t be
seen
• Focus disinfection on surfaces that are touched a lot
12
Commonly Touched Areas in the LTC Facility
Let’s Chat!
What are some examples of commonly touched
surfaces in your facility?
• Door handles
• Bedside table
• Call button
• Light switches
• Telephone
• Bedside
commode
• Bed rail
• Tray table
13
Disinfection in LTC Facilities:
Read the Label First!
Follow Instructions for Use – Check the label on
disinfectants for the following key safety steps:
 Precautions you should take when applying the
product, such as wearing gloves
 If the disinfectant is safe for the surface
 Whether the disinfectant needs to be diluted with
water before use
 How to apply the disinfectant to a surface
 How long you need to leave it on the surface to be
effective (contact time)
 If the surface needs to be cleaned first and rinsed
after using
14
Disinfectant Wipes
Keep It Wet—The surface being disinfected needs to be wet long
enough to meet the contact time stated on the label.
Cover the Surface Well—Choose the right size wipe based on
the size of the surface.
•
•
Small wipes are fine for bedside tables
Larger wipes for larger areas, like mattress covers
Keep the Cover Closed and Secure After Use—Keep the top of
the dispenser closed to prevent the wipes from drying out.
• Also think about where the dispenser is stored – can residents
access the wipes?
15
Improving Cleaning and Disinfection
Let’s Chat!
1. Where are your cleaning and disinfection supplies?
2. What would help remind you to clean and disinfect surfaces
thoroughly?
3. What is your role in ensuring surfaces are clean and disinfected?
16
Wrap-Up
•
Clean environment and clean equipment keep residents safe.
•
Know how to safely and properly use disinfectants utilized at
your facility.
READ THE LABEL!
•
Clean and disinfect surfaces that are touched a lot and any
time you see a surface that is soiled with body fluids.
•
Follow routine catheter care and maintenance to prevent
catheters from becoming an entry portal for bacteria.
17
Take the Pledge…
18
Stay Updated with Useful Resources
1.
AHRQ Safety Program for Long-Term Care: CAUTI website
Login information
Username: ltcsafety
Password: ltcsafety
2.
TeamSTEPPS® for Long-Term Care
3.
Take the Pledge…
19
References
Applegate, D. Simpson, K. Wesley, C. Carling, P. (2012). Evaluation of environmental cleaning in Long Term Care Facilities. IDSA ID Week 2012,
Poster No. 1605. Retrieved from https://idsa.confex.com/idsa/2012/webprogram/Paper35775.html
Fowler K. Catheterout. Retrieved from http://catheterout.org
State Operations Manual. Appendix A - Survey Protocol, Regulations and Interpretive Guidelines for Hospitals. Centers for Medicare and
Medicaid Services (CMS). (2015, July 10). Retrieved from https://www.cms.gov/Regulations-andGuidance/Guidance/Manuals/Downloads/som107ap_a_hospitals.pdf
Duckro, A.N. Blom, D.W. Lyle, E.A. Weinstein, R.A. Hayden, M.K. (2005). Transfer of vancomycin-resistant enterococci via health care worker
hands. Archives of Internal Medicine 165, 302-307.
Kramer, A. Schwebke, I. Kampf, G. (2006). How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect
Diseases. 6(130), retrieved from http://www.biomedcentral.com/content/pdf/1471-2334-6-130.pdf.
McFarland, L.V. Beneda, H.W. Clarridge, J.E. Raugi, G.J. (2007). Implications of the changing face of Clostridium difficile disease for health care
practitioners. American Journal of Infection Control. 35(4), 237-253.
Maki, D.G. Tambyah, P.A. (2001). Engineering out the risk of infection with urinary catheters. Emerging Infectious Diseases. 7(2), 342-347.
Retrieved from http://www.cdc.gov/ncidod/eid/vol7no2/makiG1.htm
Mody, L. Bradley, S.F. Galecki, A. Olmsted, R.N., Fitzgerald, J.T. Kauffman, C.A. Saint, S. Krein, S.L. (2011). Conceptual model for reducing
infections and antimicrobial resistance in skilled nursing facilities: focusing on residents with indwelling devices. Clinical Infectious
Diseases. 52(5), 654-651.
Murphy, C.R. Eells, S.J. Quan, V. Kim, D. Peterson, E. Miller, L.G. Huang, S.S. (2012) Methicillin-resistant Staphylococcus aureus burden in
nursing homes associated with environmental contamination of common areas. Journal of American Geriatric Society. 60(6), 1012-1018.
Siedlaczek, G. Infection Prevention & Control Services. [Powerpoint slide]. Retrieved from
http://www.stjoeschelsea.org/documents/meded/InfectionPrevent.pdf
Zimmerman, S. Gruber-Baldini, A.L. Hebel, J.R. Sloane, P.D. Magaziner, J. (2002). Nursing home facility risk factors for infection and
hospitalization: importance of registered nurse turnover, administration, and social factors. Journal of American Geriatric Society. 50(12),
1987-1995.
20