How Pathogens Spread in the Healthcare Setting: Understanding the Basics. Objectives

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1 How Pathogens Spread in the Healthcare Setting: Understanding the Basics Healthcare-Associated Infections: A Practice-Oriented Update Tom Talbot, MD MPH Assistant Professor of Medicine and Preventive Medicine Chief Hospital Epidemiologist Vanderbilt University School of Medicine April 21, 2010 Objectives Review how pathogens are spread to patients and healthcare workers in the healthcare setting Understand which modes of spread are more important than others True or False: Contaminated Products are the Most Common Source of Pathogens that Cause Healthcare-Associated Infections. A. True B. False

2 Sources of Pathogens Patient s normal flora Healthcare worker s flora Infected person Open wound Uncontrolled secretions Contaminated products

3 Who is the Person Circled? A. Louis Pasteur B. Alexander Fleming C. Ignaz Semmelweis D. William Osler Transmission of Pathogens in the Healthcare Setting: Healthcare Worker s Hands Ignaz Semmelweis Vienna, 1847 Deaths from puerperal fever: on ward attended by MDs/students Required washing of hands in antiseptic chlorinated lime solution before attending to laboring patients Mortality rates: 12.2% 2.3%

4 After Hand Hygiene

5 True or False: Hand Hygiene Should be Performed After You Remove Gloves Following Patient Care. A. True B. False What About Gloves? Gloves can have microperforations that allow bacteria to pass May contaminate hands during removal Transmission of Pathogens in the Healthcare Setting: The Environment

6 Some pathogens survive for some time on surfaces MRSA, VRE, C. difficile, hepatitis B Environmental Contamination VRE (n = 17) C. diff (n = 9) Eckstein BC et al BMC Infect Dis 2007,7:61+

7 Call button after cleaning X X X X X X X X C. difficile recovered from 83% of dirty surfaces C. difficile recovered from 67% of clean surfaces Dubberke ER et al Am J Infect Control 2007;35:315+ What About...

8 Transmission of Pathogens in the Healthcare Setting: Respiratory Droplets Spread of Respiratory Pathogens Some pathogens can be spread by various sizes of particles that travel in the air Larger droplets Pertussis (whooping cough) Influenza Smaller aerosols M. tuberculosis

9 Transmission of Pathogens in the Healthcare Setting: Improper Aseptic and Sterile Practices Clean vs. Dirty

10 Crnich CJ, Maki DG CID 2002;34:1232+ Brief Factual Description: Attending physician for ICU failed to maintain sterile technique for insertion of an arterial line. MD came from another patient's room, did not wash hands, did not place sterile gloves on and inserted arterial line in this patient. RN asked MD to put gloves on and mind the sterile field and MD refused. Transmission of Pathogens in the Healthcare Setting: Sharps and Needlestick Injuries

11 Sharps Injuries Can result in spread of infection to healthcare workers Bloodborne viruses: HIV Hepatitis B Hepatitis C Sharma GK et al Acad Med 2009;84:1815+ HCWs with documented and possible occupationally acquired AIDS/HIV infection, by occupation, as of December Occupation Documented Possible Nurse Laboratory worker, clinical Physician, nonsurgical 6 12 Laboratory technician, nonclinical 3 - Housekeeper/maintenance worker 2 13 Technician, surgical 2 2 Embalmer/morgue technician 1 2 Health aide/attendant 1 15 Respiratory therapist 1 2 Technician, dialysis 1 3 Dental worker, including dentist - 6 Emergency medical technician/paramedic - 12 Physician, surgical - 6 Other technician/therapist - 9 Other healthcare occupation - 5 Total

12 HCV: Occupational Transmission Sulkowski MS et al. JAMA 2002;287:2406 HCV: Occupational Transmission (4%) Sulkowski MS et al. JAMA 2002;287:2406 Hepatitis B Hepatitis C HIV Cases Transmitted to Patients from Infected Providers 375 reported cases 15 reported cases 9 reported cases

13 For Medication Administration, You May Reuse the Syringe As Long As You Use a Different Needle. A. True B. False Transmission of Pathogens in the Healthcare Setting: Unsafe Injection Practices Nevada 2008 Jan: Cluster of HCV infections All underwent endoscopy at same site Investigation ensued 39,562 potentially exposed patients 6 cases of hepatitis C identified Patients who had procedure at Endoscopy Center A 28 million times risk of HCV

14 Single-use equipment reused 3x if possible

15 Nursing Home Outbreak: Mississippi deaths from acute Hep B 15/158 residents (9%) with acute Hep B Among those w/ routine glucose monitoring: 37% vs. 1% (RR 39.0) Glucometer not cleaned between pts Multi-dose insulin vials not labeled Staff reported seeing reuse of lancets & needles Webb R et al MMWR Weekly Rep 2005;54:9+ Transmission of Pathogens in the Healthcare Setting: News of the Weird

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