Preventing & Controlling the Spread of Infection Contributors: Alice Pong M.D., Hospital Epidemiologist Chris Abe, R.N., Senior Director Ancillary and Support Services
Objectives Review the magnitude of Hospital Acquired Infections (HAI) within health care Identify the various components of Standard Precautions and Transmission Based precautions Discuss importance of hand hygiene in the healthcare setting Discuss multidrug resistant organisms Identify prevention strategies
Common Types of Hospital Acquired Infections (HAI) Urinary Tract Infection (UTI) Most common infection, mean cost = $1,257 Pneumonia (VAP) 2nd most common, mean cost = $22,875 Surgical Site Infection (SSI) Mean cost = $17,944 Blood Steam Infection (CA-BSI) Mean cost = $18,432
Standard Precautions: Handwashing And Use Of Personal Protective Equipment (PPE) when there is risk of contact with body fluids Standard Precautions apply to all patients, all the time.
Hand Hygiene must be performed when: Hands are visibly dirty or contaminated Before contacting a patient or entering the patient s room Before putting on gloves Before performing an invasive procedure Before eating After contact with a patient, body fluids, non-intact skin, contaminated surfaces, or leaving the patient s room After removing gloves After using the restroom
Hand Sanitizer Hand sanitizer offer many advantages over traditional hand washing. Hand sanitizer: is more effective at killing most bacteria than standard hand washing with soap Reduce the time needed for hand disinfection and kill bacteria faster is more accessible, especially when a water source (e.g. sink) is not available is less damaging to skin than soap and water and may actually improve skin condition However hand sanitizer: is not effective at removing dirt and debris. If hands are visibly dirty, hand washing with soap and water should be performed. is not effective at removing spores such as those associated with C. difficile. If caring for a patient with C. difficile, hand washing with soap and water should be performed. is potentially flammable and hands should be dry before proceeding with patient care activities.
Special Note on LPs / Epidural placement Always wear a mask when performing a lumbar puncture to obtain a specimen or during placement of an epidural. This protects you and your patients! Not wearing a mask during this type of procedure can lead to spinal infections. Reports of postpartum women with bacterial meningitis caused by Streptococcus salivarius (a common non-pathogenic oral bacterium) have been linked to breaches in infection control practices during epidural placement. Some of these cases have ultimately led to death. (MMWR January 29, 2010 / 59(03);65-69)
Transmission-Based Precautions (a.k.a Isolation Precautions) These extra measures are taken for patients known or suspected to be infected or colonized with a transmissible organism(s) Precautions are determined by the condition of the patient and the organism involved.
Transmission Based Precautions The CDC recognizes 3 categories of isolation Contact prevents transmission of microorganisms spread by direct or indirect contact with the patient or their environment Droplet prevents transmission of organisms spread by close contact with respiratory secretions via air. Airborne prevents transmission of organisms that are infectious over long distances when suspended in air
Precautions always follow mode of transmission Precautions Examples of Diagnosis Precautions Contact Droplet Rotavirus, RSV, Shigella, Drug resistant Pseudomonas, viral meningitis Pertussis, Influenza A, Meningococcal disease, Mycoplasma Standard Precautions plus: gown and gloves for patient and environmental surface contact Standard precautions plus: wear a surgical mask when within six feet of patient Airborne Varicella, Measles, Tuberculosis (pulmonary) Standard precautions plus: negative airflow room required. If susceptible to varicella stay away or if no choice wear a surgical mask. For pulmonary TB and measles, N95 mask required
Precaution & What You ll Need Airborne Precautions Airborne/ Immunity Droplet Precautions Contact Precautions Precautions Private room Negative pressure 12 air exchanges per hr Door closed Special N95 mask (for pulmonary TB) Standard mask on patient for transport Private room Negative pressure 12 air exchanges per hr Door closed Personnel are not to enter unless they are immune (have had illness or vaccinated). Mask not required for immune personnel Standard mask on patient for transport Private Room Door closed Standard mask Standard mask on patient for transport Private Room or cohort Gowns for direct contact with patient or environment Gloves Masks for cough inducing procedures Clean equipment if used between patients. Patient specific equipment if possible.
The Facts: Preventing Influenza Preventing Influenza transmission in the hospital setting is dependant on staff staying home if sick, good hand hygiene, and vaccination rates among healthcare providers. Vaccination is key: since a person can shed the influenza virus 24 hours before onset of symptoms and up to 7 days after symptom onset. 40% of persons infected with the influenza virus may be asymptomatic. In 2007, Senate Bill 739 requires all physicians to sign an attestation documenting receipt of the vaccine or declining the vaccine with an acknowledgement of the negative impact this could have on the community.
Multi-drug resistant organisms (MDRO) MDRO are bacteria that are resistant to one or more class of antimicrobial agents and usually are resistant to all but one or two commercially available antimicrobial agents. MDRO bacteria include methicillin resistant Staphylococcus aureus (MRSA), vancomycin resistant enterococci (VRE) and Gram negative bacteria such as extended spectrum beta-lactamase [ESBL]-producing bacteria, Stenotrophomonas, Burkholderia species, and some strains of Acinetobacter.
Clinical Importance of MDROs Clinical manifestations are similar to infections caused by susceptible pathogens however options for treatment are much more limited. Suboptimal or prolonged broad spectrum antimicrobial use may lead to suppression of normal flora and/or colonization with the MDRO. Patients are also at higher risk of complications related to C. difficile disease. MDRO infections and colonization are associated with increases in length of stay, costs and mortality
Promote a culture of safety and be a role model Wash your hands frequently, following the rules of when to wash. For the safety of everyone in the health care setting, do not be afraid to speak up when you notice others who are not following appropriate hand washing and disinfection procedures speak up and hold those around you accountable. Colleagues, trainees, and other staff watch what you do and research has shown that the actions of clinicians influence the behavior of others. Show your colleagues that hand hygiene is an important part of quality care. Your patients watch you too and our actions send a powerful message. Show your patients that you are serious about their health and their safety.
Thank You for Preventing the Spread of Infection..