Infection Control. Student Orientation

Transcription

1 Infection Control Student Orientation

2 Basic, but important, Principles of Cross Transmission Presence of microorganisms on hands or in environment does not necessarily = cross transmission or infection Infection is multi-factorial requiring many cross linkages Epidemiologic Triangle: Tweeten SM. General principles of epidemiology. APIC Text, 2005

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4 Healthcare associated infections (HAI)are the 4th leading cause of death in the U.S.after heart disease,cancer and stroke

5 Hospital Acquired Infections >2 million annually >90,000 deaths annually 20-30% are preventable

6 How Do HAI Stack Up Against Other Adverse Events? 3-7% of admissions have an adverse drug event 140, ,000 deaths annually $2 billion annually in excess costs Cost > $3,000 each Increase LOS by average of 2.2 days 5% of admissions have HAI 88,000 deaths annually $4.6 billion excess $/yr $600/UTI $5000/pneumonia Up to $50,000/BSI Increase LOS 1-4 days/uti, 7-8 days/ssi 7-21 days/bsi 7-30 days/pneumonia

7 Sites of Nosocomial Infections Usual Causative Organisms Urinary tract: E. Coli, Enterococcus species Lower Respiratory (pneumonia or bronchitis): Klebsiella, Pseudomonas Surgical Wounds: Staphylococci, Site dependent IV: Staphylococci, not aureus

8 Symptoms of Infection abnormal labs diarrhea vomiting Confusion mental changes resp. secretions abnormal breath sounds Cloudy, painful, foul smelling freq. Urination temp : <97 o >100 o F. chills/ sweats cold extremities redness, warmth, swelling rashes/boils pain

9 Normal Body Defenses Mechanical: intact skin; mucous production; cilia, digestive enzymes, skin acidity etc. Nonspecific Responses: WBC phagocytic response, fever, inflammation, non-specific antibodies, t-cells for antigen binding Specific Response: Production of antigen-specific antibody, immunoglobulins

10 The Hospitalized Patient: A Human at Risk Break in the barrier of the skin Tubes crossing mucous membranes Medications altering the natural barriers of digestive ph/immune function Decreased ability to use lung capacity Foreign microbial environment Disease processes of immune system

11 Prevention of IV Catheter Related Infection WASH HANDS Wear Gloves Cleanse Site: alcohol, air dry Do not re-palpate Choose appropriate catheter

12 Prevention of Nosocomial Pneumonia Patients at high risk for aspiration: Ventilated patients Patients with enteral tube Patients with decreased gag-reflex Interventions: Maintain o angle if possible Routinely check location of feeding tube Routinely assess intestinal motility to avoid distention: bowel sounds, gastric vol. before tube feed

13 Prevention of Nosocomial Pneumonia Cont. Prevent Gastric Colonization Use agents for prophylaxis of gastric ulcers which do not raise the gastric ph Wear gloves during suctioning or contact w/respiratory secretions Use only sterile fluid for respiratory secretion removal (none when possible) Replace gloves with clean pair after contact w/ contaminated body site and before contact with respiratory tract.

14 Prevention of Nosocomial Pneumonia Cont. Postoperatively: Cessation of smoking Encourage coughing and deep breathing, incl. use of incentive spirometer Early ambulation Pain control- anlagesia and splinting High risk patients: abdominal, head, neck or thoracic surgery; underlying resp. disease

15 Prevention of Surgical Site Infections Preoperative measures: Free of remote infections Preparation of the surgical site: prep agent, non-invasive removal of hair, prophylactic antibiotics

16 Prevention of Surgical Site Infections Cont. Intraoperatively: Sterile technique Limit trauma Limit traffic in room

17 Prevention of Surgical Site Infection Cont. Postoperatively: Aseptic wound care Wound healed in hours

18 Sharps Injury Prevention: Examples of safety- Engineered sharps devices

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20 Hepatitis B United States, Decline among homosexual men Cases Hepatitis B vaccine licensed Decline among IV drug users

21 Exposure Define Exposure: Blood or other potentially infectious material contact with non-intact skin or mucous membrane > needlestick or cut/poke with sharp bloodbearing item > splash to eyes, nose, or mouth

22 What to do if you have an exposure to a bloodborne pathogen Call Employee Health at for SJMH & SJMSH Fill out green incident form and report to ER for SJMLH

23 The Hierarchy of Precautions S tandard Precautions Contact P recauti ons D roplet Precautions A irborne Precautions

24 Standard Precautions: The Cornerstone of Infection Control

25 Contact Precautions Used for organisms difficult to treat (ex. Antibiotic Resistant Organisms-AROs) Organisms which are able to be spread by environmental contamination

26 Antibiotic Resistant Organisms Methicillin Resistant Staphylococcus aureus (MRSA) (ICU ONLY AND ONLY FOR UNCONTAINED SITES) Vancomycin Resistant Enterococcus (VRE)

27 Organisms Which Can Be Spread Through Environmental Contamination Respiratory Syncytial Virus Clostridium difficile in a fecally incontinent patient

28 Contact Precautions GLOVES- worn whenever you enter the patient room; remove on exiting room HANDWASHING- whenever you remove your gloves

29 Contact Precautions Private Room Dedicate Equipment Gown for substantial contact (all except handwashing apply only to HCWs)

30 Droplet Precautions Large organisms spread by coughing, sneezing up to 3 foot away Bacterial Meningitis (Neisseria meningitidis; Haemophilus influenza) Whooping Cough (Bordetella pertussis)

31 Droplet Precautions Private Room Mask Needed Gowns, Gloves, and Patient Equipment the same as for Standard Precautions Transport: Patient must wear mask

32 Airborne Precautions Illnesses where germs are expelled into the air by coughing, sneezing, laughing, etc. Can be carried long distances in air and spread to others

33 Airborne Precuations Mycobacterium tuberculosis Chickenpox (Varicella) Measles (Rubeola)

34 Airborne Precautions Negative Pressure Room Mask Required (for TB, N95 mask necessary) Gowns, Eyewear, Gloves & Patient Equipment same as for SP Transport: notify receiving unit; place mask on patient