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Healthcare Associated Infections (HAI)
and the Infection Control Precaution
Manual Update
Maureen Spencer, RN, M.Ed., CIC
Infection Control Coordinator
Elements of Performance
for IC.3.10
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Standard IC.3.10 Based on risks, the hospital establishes
priorities and sets goals for preventing the development of
health care-associated infections within the hospital.
Rationale for IC.3.10
The risks of HAIs within a hospital are many, while resources
are limited. An effective IC program requires a thoughtful
prioritization of the most important risks to be addressed.
Priorities and goals related to the identified risks guide the
choice and design of strategies for infection prevention and
control in a hospital. These priorities and goals provide a
framework for evaluating the strategies.
Elements of Performance
for IC.3.10
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Elements of Performance for IC.3.10
1. Priorities are established and goals related to preventing the
acquisition and transmission of potentially infectious agents are
developed, based on the risks identified.
These goals include but are not limited to the following:
2. Limiting unprotected exposure to pathogens throughout the
hospital
3. Enhancing hand hygiene
4. Minimizing the risk of transmission of infections associated
with the use of procedures, medical equipment, and medical
devices
Centers for Disease Control (CDC)
Definitions of HAI
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Surgical Site Infection (SSI)
Urinary Tract Infection
Pneumonia
Bacteremia (primary)
Gastrointestinal System Infection
Cardiovascular System Infection
Other
Other infections include skin infection (other than incisional
wound infection), lower respiratory tract infection (excluding
pneumonia), eye, ear nose, throat, and mouth infection.
Risk Factors and Surgical Infections
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The strength of the association between potential risk factor, or the
composite risk index, and a patient’s risk of developing a SSI was
summarized by Culver, et al.
SSI rates ranged from 1.5 SSI’s per 100 operations for patients with
none of the risk factors, to a high of 13.0 for patients with all 3 risk
factors present.
The presence of each additional risk factor nearly doubles the SSI risk
.
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Patients who develop surgical site infections
 are sixty percent more likely to spend time in an ICU,
 five times more likely to be readmitted to the hospital
 And have twice the incidence of mortality
Significant Changes - 2004
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New Hand Hygiene Policy
MRSA – changed to 3 negative cultures from nares obtained
on three separate days
VRE – changed to 3 negative rectal/stool cultures obtained 3 separate
days
New Precaution Signage
Elimination of Contact “C” for Clostridium difficile and Contact “V” for
VRE. Both are included in the category of Contact Precautions.
Droplet Precautions includes Sudden Acute Respiratory Syndrome
(SARS)
Revised - Employee Health Program, Blood & Body Fluid Exposure,
Pregnant Workers and Communicable Diseases
Categories of Precautions
Techniques depend on the mode of
transmission
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Modes of Transmission:
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Direct contact with blood and bodily fluids (HIV, HBV)
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Indirect contact with contaminated items and patient care
equipment and the environment (MRSA, VRE)
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Droplet nuclei (Influenza)
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Airborne route (TB)
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Vector (West Nile Virus)
Categories of Precaution
Techniques
Standard
 Contact
 Droplet
 Airborne
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Precautions are used for both colonized
and infected patients
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Colonization:
The complex process of new organisms
becoming a part of the endogenous flora of
an area of the body with no signs of active
infection
Infection:
The presence of signs and symptoms of a
host/pathogen response (fever, drainage,
cough, purulence, inflammation, etc.)
Standard Precautions
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Applies to everyone
Hand washing
Gloves, masks and gowns when deemed
necessary to protect you
Cleaning patient care equipment between
patient use
Environmental controls
Careful handling of linen
Appropriate patient placement
Precaution Materials
*Precaution Gowns
*Vinyl Gloves
*Masks
*N95 Respirators
*Private Room
*Precaution Cart
*Signage – new Red signs
*Dedicated Equipment
(stethoscope, sphgmanometer,
commodes)
*Cal Stat Alcohol Hand Rub
*Red Bags for Infectious Waste
Disposal
Contact Precautions
Contact
- MRSA, VRE, C.Difficile, Abscess,
Cellulitis, Herpes Zoster, Impetigo,
Staph aureus wound infections,
Streptococcus wound infections
- Significant fecal incontinence
No longer Contact V and Contact C
Contact Precautions Techniques
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Gloves for
EVERYONE
entering the
room –
including
physicians,
visitors, family
members
Contact Precautions
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Gown if you will touch
or be close to the
patient’s bed (within 3
feet of the bed)
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Mask is only indicated if
you are likely to be
sprayed or splashed
during irrigation or
suctioning
Contact Precautions Techniques
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Contact Precautions:
Inside the Room:
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Covered linen hamper
Red lined trash container
Cal Stat Alcohol Hand Rub
Stethoscope and Blood Pressure Equipment
Disposable Thermometers
Red Bags for disposal of contaminated
dressings and items used in patient care
MRSA contamination in precaution
rooms
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Ref: Boyce, Infec Cont Hosp Epid 1977
70% of rooms had environmental
contamination when the patient was
colonized or infected
42% of nurses’ gloves cultured were
contaminated after touching environmental
surfaces WITHOUT touching the patient!
Ref: Boyce, et. Al. SHEA 1998 Abstract
Results: 14 (40%) of 35 HCWs gowns were
culture + for MRSA on exiting room. Clothing
underneath was negative. 11 (69%) of 16
HCWs wearing freshly laundered lab coats
had detectable contamination. 3 of 11
developed positive hand cx after touching the
coat.
Lab Coats, Stethoscopes, Otoscopes, Gloves,
Gowns, Pagers, Cell Phones – contamination with
Staph aureus, MRSA and VRE
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Infect Control Hosp Epidemiol. 2001 Sep;22(9):560-4.
Contamination of gowns, gloves, and stethoscopes with vancomycin-resistant enterococci. Zachary
KC, Bayne PS, Morrison VJ, Ford DS, Silver LC, Hooper DC. Infectious Disease Division
Massachusetts General Hospital, Boston RESULTS: VRE were isolated from at least 1 examiner site
(gloves, gowns, or stethoscope) in 33 (67%) of 49 cases. Gloves were contaminated in 63%, gowns in
37%, and stethoscopes in 31%.
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J Hosp Infect. 2001 Aug;48 Suppl A:S64-8.
Stethoscopes and otoscopes--a potential vector of infection? Cohen HA, Amir J, Matalon A, Mayan R,
Beni S, Barzilai A. RESULTS: All the stethoscopes and 90% of the otoscope handles were
colonized by microorganisms. Staphylococci were isolated from 85.4% of the stethoscopes and 83.3%
of the otoscopes, with 54.5% and 45.2% respectively being S. Aureus. Methicillin-resistant S. aureus
were found in four each of the stethoscopes (7.3%) and otoscopes (9.5%)
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Docs' Cell Phones May Spread Hospital Infections - screened 124 hospital personnel for the germ
Acinetobacter baumannii - 12 percent of healthcare providers' cell phones were contaminated with the
bug not only on phones but also on 24 percent of the hands of the people tested, who included 71
physicians and 53 nurses.
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Infect Control Hosp Epidemiol. 2002 May;23(5):274-6.
Bacterial contamination of hospital pagers. Singh D, Kaur H, Gardner WG, Treen LB.
Microorganisms were isolated from all pagers; 21% yielded Staphylococcus aureus, of which 14% were
methicillin resistant. Cleaning with alcohol reduced the total colony count by an average of 94%.
Infect Control Hosp Epidemiol. 2003
May;24(5):362-86
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Society of Hospital Epidemiologist of America
guideline for preventing nosocomial
transmission of multidrug-resistant strains of
Staphylococcus aureus and enterococcus.
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CONCLUSION: Active surveillance cultures
are essential to identify the reservoir for
spread of MRSA and VRE infections and
make control possible using the CDC's longrecommended contact precautions.
Discontinuation of Precautions
for MRSA
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Three negative surveillance cultures
from nares obtained on separate days
Patient must be off mupirocin and
antibiotic therapy for MRSA
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One negative cultures from original site
of infection (urine, wound, g-tube,
sputum, etc.)
Discontinuation of Precautions
for VRE
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Three negative surveillance cultures
from rectal/stool specimen obtained on
separate days
Patient must be off antibiotic therapy for
VRE
One negative cultures from original site
of infection (urine, wound, g-tube,
sputum, etc.)
Droplet Precautions
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Influenza
Meningitis - Hemophilus
Meningococcemia
Mumps
Pertussis
Rubella
SARS
Droplet Precautions
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Private Room (does
not have to be a
negative pressure
room)
Masks for all
entering the room
Airborne Precautions
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Pulmonary Tuberculosis
Sputum AFP Positive
Chickenpox
Disseminated Herpes Zoster
Measles
Airborne Precautions
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Negative Pressure Isolation Room created
with the negative air filtration unit ordered
from Facilities – checked by Facilities while in
use
ICU – Room 8 - is first room of choice then
519 if ICU bed unavailable
N95 Respirator
Door must be kept closed
When transporting patient – place a surgical
mask on during transport
DIRECT TRANSMISSION FROM
HANDS MOST COMMON WAY
DISEASE IS TRANSMITTED
Most Important Control
Measure
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HAND HYGIENE
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Wash hands several
times a shift –
especially if you
have had gloves on
for more than 20
minutes –
organisms multiply
every 20 minutes
Use Cal Stat Alcohol Based
Hand Rub
Hand Cultures – before and
after the use of Cal Stat
Environmental Disinfection
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INTERMEDIATE LEVEL DISINFECTION
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STAT III TB disinfectant must be used in all Contact
Precaution rooms to clean bedside equipment and
environmental surfaces.
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PDI Sani Cloths are used for all other low level
disinfection – they are bactericidal, virucidal,
tuberculocidal (but will not disinfect Clostridium
difficile)
In Summary…..
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Healthcare-associated
infections are a major problem
in hospitals
Infection control measures,
such as precaution techniques
and hand hygiene have been
shown to prevent the spread of
nosocomial infections
Follow department-specific
infection control policies and
procedures
Report any problems
immediately
and…………