Infection Control: AND DIRTY N A D I N E L E I S E, R R T

Transcription

1 Infection Control: GETTING DOWN AND DIRTY N A D I N E L E I S E, R R T

2 Disclosures: None

3 POLL EVERYWHERE Text gross to once to join... and then select A, B, C, etc when prompted If on tablet or ipad (without texting) respond at PollEv.com/gross

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5 Objectives: Emphasize the important impact of infection prevention in health care Recognize the role of viral and bacterial contamination in health care Illustrate how we can control cross-contamination of equipment Discuss implementation and advocacy for infection control practices

6 Hand Hygiene Hands are the main pathways of germ transmission during health care Hand hygiene is therefore the most important measure to avoid the transmission of harmful germs and prevent health care-associated infections World Health Organization, 2009

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9 Hand Hygiene Wash your hands with soap and water when hands are visibly dirty or soiled with blood or other body fluids If potential for spore-forming pathogens is strongly suspected or proven, including outbreaks of Clostridium difficile, hand washing with soap and water is the preferred means Use healing moisturizer

10 Hand Hygiene Clean your hands by rubbing them with an alcohol-based formulation, Sanitizer if hands aren t visibly soiled Sanitizers are faster, more effective, and better tolerated than soap and water

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12 PPE PERSONAL PROTECTIVE EQUIPMENT

13 Glove Use Before a sterile procedure When anticipating contact with blood or another body fluid, regardless of the existence of sterile conditions and including contact with non-intact skin and mucous membrane Contact with a patient (and his/her immediate surroundings) during contact precautions. World Health Organization, 2009

14 Gloves Off As soon as gloves are damaged(or nonintegrity is suspected) When contact with blood, another body fluid, non-intact skin and mucous membrane has occurred and has ended When contact with a single patient and his/her surroundings, or a contaminated body site on a patient has ended When there is an indication for hand hygiene. World Health Organization, 2009

15 Image courtesy of the World Health Organization

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17 Clean Hands!!! Donning PPE Personal Protective Equipment ANSWER: C Gown Mask Goggles Gloves

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19 Removing PPE ANSWER: B Gloves Goggles Gown Mask Clean Hands!!!!!

20 When should I wear eye protection? Infectious diseases can be transmitted through various mechanisms, among which are infections that can be introduced through the mucous membranes of the eye (conjunctiva) Infectious agents are introduced to the eye either directly (e.g., blood splashes, respiratory droplets generated during coughing or suctioning) or from touching the eyes with contaminated fingers or other objects

21 Eye Protection Viruses and bacteria than can cause conjunctivitis Adenovirus Herpes simplex Staphylococcus aureus Viruses that can cause systemic infections Hepatitis B and C HIV Herpes Rhinoviruses

22 Mask Protection Surgical masks are used for several different purposes, including the following: Placed on sick people to limit the spread of infectious respiratory secretions to others. Worn by healthcare providers to prevent accidental contamination of patients' wounds by the organisms normally present in mucus and saliva. Worn by workers to protect themselves from splashes or sprays of blood or bodily fluids; they may also keep contaminated fingers/hands away from the mouth and nose.

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24 N95 Respirators are designed to reduce a worker's exposure to airborne contaminants Respirators come in various sizes and must be individually selected to fit the wearer's face and to provide a tight seal. A proper seal between the user's face and the respirator forces inhaled air to be pulled through the respirator's filter material and not through gaps between the face and respirator.

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26 Viruses and Bacteria Cold Viruses: Most viruses remain on hands for a short period of time. The rhinovirus (a common cold), can remain infectious on hands after an hour and on surfaces for days. RSV: Can survive on work tops and door handles for up to 6 hours, on clothing and tissues for mins, and on skin for up to 20 minutes.

27 Viruses and Bacteria Flu Viruses: Can survive on hard surfaces for 24 hours. Infectious flu viruses can survive about 15 minutes. Flu viruses can also survive as droplets in the air for several hours, low temperatures increase their survival. Parainfluenza Virus (Croup): This virus can survive for up to 10 hours on hard surfaces and up to 4 hours on soft surfaces.

28 Viruses and Bacteria Norovirus: The Norovirus is distributed by small droplets in air and settles on surfaces. Norovirus can survive days or weeks on hard surfaces. C. difficile: A spore-based bacteria that also survive days or weeks on hard surfaces. Soap and water must be used to remove bacteria. One study was shown to have this bacteria survive 5 months on a surface!

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30 Viruses and Bacteria MRSA: Staphylococcus aureus bacteria can survive for days to weeks on surfaces. MRSA bacteria can live on surfaces longer than other bacteria because they survive better without moisture. Typically, MRSA bacteria survive longer on hard surfaces versus soft.

31 Viruses and Bacteria VRE: Vancomycin-resistant enterococci are hardy germs that can survive outside the body on surfaces such as toilet seats and door knobs from five days to several weeks, and on hands for several hours. A surface does not have to be visibly soiled to be contaminated. The bacteria are relatively easy to kill with disinfectants and good hand hygiene. VRE are not spread through the air.

32 Viruses and Bacteria Pneumonia: Pneumonia is the second most common nosocomial infection in the United States and is associated with substantial morbidity and mortality. Pneumonia can be transferred via droplets or from touching a contaminated surface to mouth/nose contact.

33 Ventilator Acquired Events Deterioration in mechanically ventilated patients after a period of stability or improvement. A VAE is defined as at least 2 days of stable or decreasing ventilator settings followed by at least 2 days of increased ventilator settings. Pneumonia Fluid overload ARDS Atelectasis American Journal of Respiratory and Critical Care Medicine Volume 192 Number 12 December

34 VAP: Ventilator-Associated Pneumonia Carriage of oropharyngeal organisms upon passage of the endotracheal tube Bacteria can aggregate on the surface of the tube over time and form a biofilm. Bacterial can become dislodged by ventilation flow, tube manipulation, or suctioning and subsequently embolize into the lower respiratory tract and cause focal pneumonia Depressed host defenses secondary to the patient's severe underlying illness

35 VAP: Ventilator-Associated Pneumonia Patients receiving continuous, mechanically assisted ventilation have 6-21 times the risk for acquiring nosocomial pneumonia compared with patients not receiving ventilatory support. Studies indicate that the risk for developing ventilator-associated pneumonia can increase by 1% per day.

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37 Preventing VAP Decrease aspiration by the patient Gentle suctioning Oral care Aseptic techniques Preventing cross-contamination by health care workers Appropriate disinfection and sterilization of respiratory therapy devices Educating other staff, family, and patients

38 Did you disinfect that?

39 Disinfecting Equipment Disposable Nebulizers Rinse neb cup with sterile water after use Wipe mouthpiece and/or mask with alcohol pad Based on 2013 Cystic Fibrosis guidelines: Replace neb every 24 hours For CF population only

40 Disinfecting Equipment Holding Chambers (Spacers) There is published evidence (Cohen et al31) that bacterial contamination is common in spacer devices used in the home setting. The study investigated spacers used by 62 children with asthma 35% of the spacers and 25% of the masks were contaminated with microorganisms: P. aeruginosa, S. aureus, and Klebsiella pneumoniae.

41 Disinfecting Equipment Holding Chambers (Spacers) IPC guidelines suggest cleaned, disinfected, and air dried between each use Manufacturer guidelines recommend washing with soap and water weekly

42 Disinfecting Equipment Stethoscopes Table 1 Results of cultures from 100 stethoscopes Pub Med J Family Community Med Jan-Apr; 11(1):

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44 A Closer Look

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48 A Case Study 2014 (IPA) Infection Prevention Advocacy project Determine outcomes of covering high touch surfaces of respiratory equipment Results and conclusions Changes implemented

49 Transport Vent : Display and Handles 2014

50 2014 Bipap: Display and Handles

51 ICU Ventilator: Display and Handles 2014

52 The Amber Bag Trial

53 Post Intervention Transport Vent ICU Vent

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55 Procedural Changes wipes Stripping circuits Disinfecting high touch surfaces Moving dirty equipment in a timely manner to be processed

56 A CASE REVIEW

57 Hospital Acquired Infection (HAI) Case Review Developmentally delayed adolescent male admitted to hospital for pneumonia and respiratory failure due to peanut aspiration. 4-5 day history of cough with new onset fever. Complete left-side opacification. Bronchoscopy performed on day 1, 2, and 3, with removal of peanut, including skin and fragments in left main stem bronchus. Devices: Urinary catheter, ventilator, and central line

58 Hospital Acquired Infection (HAI) Case Review Day 1 tracheal aspirate grew usual oro-pharyngeal flora Day 3 tracheal aspirate culture results grew Achromobacter xylosoxidans (gram-negative, aerobic, motile, bacterium; generally found in wet environments) Treated with series of antibiotics Patient discharged (length of stay: approx. 1 month)

59 Moving Forward Why do we reinforce Infection Prevention? How will this change your practices? Have you learned anything new?

60 Reference List World Health Organization. (2009, August). HAND HYGIENE: WHY, HOW & WHEN? Retrieved from: Why_How_and_When_Brochure.pdf NIOSH. (2013, July 29). Centers for Disease Control and Prevention. Retrieved from: OSHA. (2009, May). Respiratory Infection Control: Respirators Versus Surgical Masks. Retrieved from: NHS. (2015, October 13). How long do bacteria and viruses live outside the body?. Retrieved from:

61 Reference List Mackenzie Health. (n.d.). Vancomycin-resistant Enterococci (VRE) Prevention. Retrieved from: id=222.php CDC. (1997, January 03). Guidelines for Prevention of Nosocomial Pneumonia. Retrieved from: htm Respiratory Care Journal. (2015, June 01). Device Cleaning and Infection Control in Aerosol Therapy. Retrieved from: Device Cleaning and Infection Control in Aerosol Therapy NCBI. (2004, Winter). BACTERIAL CONTAMINATION OF STETHOSCOPES. Retrieved from

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