Download Infection Control and Prevention of Healthcare

Slide 1
Infection
Control and
Prevention of
HealthcareAssociated
Infection (HAI)
Recommendations for the
Control and Prevention of HAI
Welcome to the Infection Control and Prevention of Healthcare-Associated Infection
(HAI) course. This course will help you understand how to control and prevent infections
from occurring in the healthcare environment and reduce the risk of healthcareassociated infections for our patients, visitors and staff.
The course will cover the primary types of HAIs identified in The Joint Commission’s
National Patient Safety Goal number 7- Surgical Site Infections, Central LineAssociated Blood Stream Infections, Multi-Drug Resistant Organisms, and Catheter
Associated Urinary Tract Infections.
Slide 2
Course Information
Course Title:
Infection Control and Prevention of Healthcare-Associated Infection (HAI)
Regulations/Standards:
The Joint Commission National Patient Safety Goal 7: Reduce the risk of
healthcare-associated infections.
Approximate Time to Complete:
25 Minutes
Content Version:
Clinical Staff
Intended Audience:
Clinical Staff
Technical Specifications:
Date Revised:
Flash Player 9, Internet Explorer 6, Headphones or speakers are
recommended but not required
February 1, 2013
Contact Information
Please forward any content questions or concerns to
the Subject Matter Expert:
Infection Control and Prevention
484-884-1180
Please call the Help Desk at 610-402-8303 with any technical issues.
The Infection Control and Prevention of HAI course fulfills the training requirements set
by The Joint Commission. The course should take approximately 25 minutes to
complete. If you have any questions, please contact the appropriate number listed on
this screen. Remember, all technical questions should go to the Help Desk at 610-4028303.
To review the navigational features of the course, click on the Navigation tab at the top
of the screen.
Slide 3
Objectives
Upon completion of this course, you should be able to:
Identify strategies that can reduce the risk of developing
a surgical site infection
List the key elements in the Central Line Bundle
Discuss key facts about specific multi-drug resistant
organisms in the healthcare setting
Explain methodologies that can help decrease the likelihood of
developing a Catheter Associated Urinary Tract Infection
Upon completion of this course, you should be able to:
•Identify strategies that can reduce the risk of developing a surgical site infection
•List the key elements in the Central Line Bundle
•Discuss key facts about specific multi-drug resistant organisms in the healthcare
setting
•Explain methodologies that can help decrease the likelihood of developing a Catheter
Associated Urinary Tract Infection
If you feel you have already mastered the content described in the course objectives
and would like to demonstrate your knowledge, you may click the “Demonstrate
Knowledge” button and move directly to the course test. You must earn a score of at
least 80% on the test to successfully pass this course.
However, it is recommended that you review the content as it has been updated. To
continue onto the course content, please select the next button located at the bottom of
the screen.
Slide 4
Healthcare-Associated Infections
Healthcare-Associated Infection
(HAI): An infection that a patient develops
while receiving treatment for medical or
surgical conditions. The infection can not be
present or incubating at the time of admission
to the hospital.
HAIs must be reported to the Patient Safety
Authority, the Pennsylvania Department of
Health and the Centers for Medicare and
Medicaid Services (CMS).
What is a healthcare-associated infection? A healthcare-associated infection is an
infection that a patient develops while receiving treatment for medical or surgical
conditions. To be considered a healthcare-associated infection, the infection can not be
present or incubating at the time of admission to the hospital. Healthcare-associated
infections must be reported to the Patient Safety Authority, the Pennsylvania
Department of Health and the Centers for Medicare and Medicaid Services.
Slide 5
Healthcare-Associated Infections
HAIs can be the result of:
Invasive medical devices (central line-associated
blood stream infections, catheter associated urinary tract
infections, ventilator associated pneumonia)
Surgery (surgical site infections)
Certain microorganisms present in healthcare
settings
Multi-Drug Resistant Organisms (Methicillin Resistant
Staphylococcus Aureus [MRSA], Vancomycin Resistant
Enterococci [VRE] and others)
Clostridium difficile (C. DIF)
Anyone who is a patient in a hospital is at risk for healthcare-associated infection. HAIs
occur in all settings of care, including acute care within hospitals, same day surgical
centers, home care, ambulatory outpatient care in health clinics, and long term care
facilities. HAIs are associated with a variety of causes, including (but not limited to) the
use of invasive medical devices such as catheters and ventilators, complications
following surgery, and the transmission of microorganisms present in healthcare
settings.
Slide 6
Just the Facts
Do you know the facts?
Number of HealthcareAssociated Infections
Each Year
Click each button on the
left to learn the answers.
Number of Patient
Deaths Caused by HAI
Each Year
You may be surprised by some of the facts related to healthcare-associated infections.
Do you know how many healthcare-associated infections occur in the United States
each year? What about the number of patient deaths that are caused by healthcareassociated infections each year?
Click each of the buttons to learn the facts.
Slide 7
Just the Facts
Number of HealthcareAssociated Infections
Each Year
1.7 million Healthcare-Associated
Infections occur each year in the
United States!
Number of Patient
Deaths Caused by HAI
Each Year
How many healthcare-associated infections occur each year in the United States?
1.7 million healthcare-associated infections occur each year in the United States!
Slide 8
Just the Facts
Number of HealthcareAssociated Infections
Each Year
99,000 deaths result from infection
that might have started after the
patient was hospitalized
Number of Patient
Deaths Caused by HAI
Each Year
How many patient deaths might be caused by healthcare-associated infections each
year?
About 99,000 deaths result from infection that might have started after the patient was
hospitalized.
Slide 9
Prevention of HAI
Hand Hygiene has long been recognized as the single most
effective way to prevent the spread of infection
Information on basic infection control measures and hand
hygiene practices are contained in another eLearning module
Prevention of HAI is also possible through the application of certain
best practices
In this module, we will address key practices to prevent:
Surgical Site Infections
Central Line-Associated Blood Stream Infections
Multi-Drug Resistant Organisms
Catheter Associated Urinary Tract Infections
Hand Hygiene has long been recognized as the single most effective way to prevent the
spread of infection. The prevention of HAI is also possible through the application of
certain best practices. In the following sections of this module, we will address the key
practices to prevent Surgical Site Infections (SSIs), Central Line-Associated Blood
Stream Infections (CLABSIs), Multi-Drug Resistant Organisms (MDROs), and Catheter
Associated Urinary Tract Infections (CAUTIs).
Slide 10
Surgical Site Infection
Surgical Site Infection
Prevention
Surgical site infections are one of the most frequently occurring types of healthcareassociated infections. Preventative actions can reduce your patient’s risk for developing
a surgical site infection.
In this brief section, you will learn about the strategies to reduce your patient’s risk for
developing a surgical site infection.
Slide 11
Surgical Site Infection (SSI)
Surgical Site Infection (SSI):
An infection that occurs after surgery in the part of the body where
the surgery took place.
Superficial incisional
Deep incisional
Organ/space
Develop in 1-3 out of every
100 patients who have
surgery
500,000 SSIs occur
each year
What is a surgical site infection? A surgical site infection is an infection that occurs after
surgery in the part of the body where the surgery took place. SSIs are classified as
superficial incisional, deep incisional, or organ/space. Superficial incisional surgical site
infections only involve the skin or subcutaneous tissue of the incision. Deep incisional
surgical site infections involve fascia and/or muscle layers. Organ/space surgical site
infections involve any part of the body that is opened or manipulated during the
operative procedure.
Surgical site infections develop in about 1 to 3 out of every 100 patients who have
surgery. Approximately 500,000 SSIs occur each year.
Slide 12
Strategies to Prevent SSIs
Microbiological
Characteristics
Patient
Characteristics
Surgical
Characteristics
Developing a surgical site infection relies on three factors:
Microbiological Characteristics
Patient Characteristics
Surgical Characteristics
Click on each button to learn more
The likelihood of developing a surgical site infection relies on a combination of three
factors – microbiological characteristics, patient characteristics, and surgical
characteristics.
Click on each button to learn more.
Slide 13
Strategies to Prevent SSIs
Microbiological
Characteristics
Patient
Characteristics
Surgical
Characteristics
Microbiological Characteristics:
Presence of bacteria near the surgical site
The amount of bacteria and other microorganisms that
are present depends on the location of the procedure
Fewer microorganisms are encountered during a joint
replacement surgery compared to surgeries that
involve the gastrointestinal system
Microbiological characteristics involve the presence of bacteria near the surgical site.
The amount of bacteria and other microorganisms that are present near the surgical site
is dependent upon the location of the procedure. For example, fewer microorganisms
are encountered during a joint replacement surgery compared to surgeries that involve
the gastrointestinal system.
Slide 14
Strategies to Prevent SSIs
Microbiological
Characteristics
Patient
Characteristics
Surgical
Characteristics
Patient Characteristics:
Diabetes
Obesity
Smoking
Weakened immune status
Remote skin infections
Patient characteristics include factors such as diabetes, obesity, smoking, weakened
immune status and remote skin infections. Patients with any of these characteristics are
at a greater risk for developing a surgical site infection.
Slide 15
Strategies to Prevent SSIs
Microbiological
Characteristics
Patient
Characteristics
Surgical
Characteristics
Surgical Characteristics:
Type of procedure
Duration of the procedure
Amount of damage caused to the tissue
Surgical characteristics include the type of procedure, the duration of the procedure,
and the amount of damage caused to the tissue.
Slide 16
Reducing Patient Related Risks
Encourage patients to:
Control their serum glucose levels
Lose weight
Stop smoking
Identify and treat any infections that
the patient may already have before
they have elective surgery
Decontaminate skin pre-operatively with chlorhexidine wipes
Decolonize nose pre-operatively with Mupirocin (topical antibiotic)
as directed by the surgeon
Patients can reduce their risk for developing a surgical site infection. Encourage your
patients to control their serum glucose levels, lose weight if they are obese, and stop
smoking. Patients who smoke get more infections than patients who don’t. You should
also identify and treat any infections that the patient may already have before they have
elective surgery. Decontamination of the skin with chlorhexidine wipes and nasal
decolonization with Mupirocin can also help to reduce the risk for developing a surgical
site infection.
Slide 17
Reducing Surgical Related Risks
Perform preoperative surgical scrub
incision site
Handle tissue carefully to reduce trauma
Minimize operative time as much as possible
Minimize operating room traffic
Control blood glucose level during and after the
procedure
Maintain perioperative normothermia
Procedure related risk factors can also be reduced. Follow these precautions to lower
your patients’ risk of developing a surgical site infection:
• Perform preoperative surgical scrub with an alcohol-based surgical hand antisepsis
product,
• Wash and clean the skin around the patient’s incision site with an appropriate
antiseptic agent,
• Handle tissue carefully to reduce trauma,
• Minimize operative time as much as possible,
• Minimize operating room traffic,
• Control blood glucose level during and after the procedure
• Maintain perioperative normothermia.
Slide 18
Reducing Surgical Related Risks
Minimize talking during the procedure
Adhere to dress code policies
emergent needs
Assure all instruments are properly
sterilized
Assure all equipment is decontaminated
Assure environmental decontamination is
performed
•
•
•
•
•
•
Minimize talking during the procedure
Adhere to dress code policies
Use “just in time” sterilization only for emergent needs
Assure proper sterilization
Assure all equipment is decontaminated
Assure environmental decontamination is performed
Slide 19
Reducing Surgical Related Risks
Antibiotic Prophylaxis
Deliver antibiotics within 1 hour before incision
2 hours for vancomycin and fluroquinolones
Use the recommended antibiotic
Discontinue antibiotics within 24 hours after surgery
Discontinue antibiotics within
48 hours for cardiothoracic
procedures in adult patients
Antibiotic prophylaxis also have an impact on reducing your patients’ risk for developing
a surgical site infection. Deliver antibiotics within one hour before the incision is to be
made. Vancomycin and fluroquinolones should be delivered within 2 hours. Only use
the recommended antibiotic. Discontinue use of antibiotics within 24 hours after surgery.
For adult patients undergoing cardiothoracic procedures, discontinue antibiotics within
48 hours.
Slide 20
Reducing Surgical Related Risks
Proper Hair Removal
Only remove hair if it will interfere with the operation
Proper hair removal can also reduce your patients’ risk for developing a surgical site
infection. Only remove hair if it will interfere with the operation. If hair removal is
necessary, use clippers.
Slide 21
Patient Involvement
Patient Safety Tips
for the Surgical Patient
How hospitals prevent SSIs
How patients can prevent SSIs
The Joint Commission requires hospitals to provide patients and their families with
education related to preventing adverse events in surgery. “Patient Safety Tips for the
Surgical Patient” includes information on the prevention of surgical site infections. This
document includes information on what hospitals are doing to prevent surgical site
infections and what patients can do to prevent surgical site infections. This health sheet
is intended for patients who are scheduled for surgery.
Slide 22
Documentation
Use Krames On-Demand
Outpatient Departments:
Intranet
Document in the medical record (Pre-admission database,
Ambulatory Surgery/Staging
Units Admission database, etc.)
Use Krames On-Demand to document your patient’s understanding of the information
provided in the “Patient Safety Tips for the Surgical Patient” health sheet.
For Outpatient departments who do not use Krames On-Demand, the “Patient Safety
Tips for the Surgical Patient” can be found on the LVHN Intranet. Documentation and
evaluation of the patient’s understanding should be done in the medical record.
Slide 23
Central Line-Associated Blood
Stream Infection
Central LineAssociated
Blood Stream
Infection
Prevention
In this section of the course, you will be introduced to key evidence-based practices to
prevent the incidence of central line-associated blood stream infections.
Slide 24
Central Line
A central line is a type of catheter (central venous catheter) that is:
Inserted through the skin
Terminates at or close to the heart or in one of the great vessels
Used for infusion, withdrawal of blood, or hemodynamic
monitoring
Examples of Central Lines:
Single, double, triple and quad lumen
catheters
Peripherally inserted central catheters
(PICC)
Umbilical catheters in newborns
Hickman and Broviac catheters
Tesio catheters
Port-A-catheters
A central venous catheter, also known as a central line is a flexible tube that is inserted
through the skin and ends at or close to the heart or in one of the great vessels. Central
lines can be used to administer infused solutions, withdraw blood and/or for
hemodynamic monitoring.
Slide 25
Central Line-Associated Blood Stream Infections
(CLABSIs)
A CLABSI is a blood stream infection that is associated with
the presence of a central line or an umbilical catheter in
newborns
• Approximately 200,000
CLABSIs occur in U.S.
hospitals each year
• 14,000 28,000 deaths
annually
• Increase mortality 4 to 20%
• Prolong hospital stay by 7
days
• Increase costs $3,700 to
$45,000
A central line-associated blood stream infection or (CLABSI) is a blood stream infection
that is associated with the presence of a central line or an umbilical catheter in
newborns. Central lines disrupt the integrity of the skin, making patients vulnerable to
bacterial and fungal infections, that lead to a central line-associated blood stream
infection. A blood steam infection can occur when bacteria or other germs travel down
the central line and enter the blood.
Approximately 200,000 CLABSIs occur in U.S. hospitals each year, resulting in 14,000
to 28,000 deaths annually. CLABSIs are very serious infections, increasing mortality
rates 4 to 20% and prolonging a patients hospital stay on average by 7 days. The
reported range for patient care cost attributed to CLABSI is $3,700 to $45,000 per
episode.
Slide 26
The central line bundle is a group of evidence-based interventions for patients with
central venous catheters that when implemented together, result in substantially better
outcomes than when implemented individually. The implementation of the central line
bundle improves patient outcomes by decreasing the incidence of central line
associated blood stream infections.
The Institute for Healthcare Improvement (IHI) defines the 5 key elements of the central
line bundle as:
1. Hand hygiene
2. Maximal barrier precautions upon insertion
3. Chlorhexidine skin antisepsis
4. Optimal catheter site selection, with avoidance of the femoral vein in adult
patients
5. Daily review of line necessity with prompt removal of unnecessary lines
The science behind the central line bundle is so well established that it should be
considered a standard of care.
Proper implementation of the central line bundle involves all members responsible for
the treatment and care of a patient with a central venous catheter.
In the prevention of all heath care associated infection including CLABSI, proper hand
hygiene has long been recognized as the single most effective way to prevent the
spread of infection. Proper hand hygiene before catheter insertion, (even when wearing
gloves) and during all care and maintenance is essential. Follow the CDC Guidelines for
Hand Hygiene and the World Health Organization 5 Moments for Hand Hygiene.
Observe the appropriate hand hygiene procedures by washing hands with soap and
water or using an alcohol based hand sanitizer.
Maximal sterile barrier precautions during the insertion of a central line substantially
reduces the incidence of CLABSIs. For the Operator and Supervisor placing the central
line and for all those assisting in the procedure, maximal barrier precautions means
strict compliance with hand hygiene and personal protective equipment protocols.
•
The Operator and Supervisor must wear full sterile attire including eye protection.
•
Assistants and all others in the room must wear hair covers and masks with face
shield or eye protection.
•
The patient’s head and body must be covered with a large sterile drape.
The proper preparation of the skin site for insertion of central line should include:
-
Prepare skin with 2% chlorhexidine gluconate (CHG) in 70% isopropyl alcohol
solution.
-
Apply CHG antiseptic solution, using a back an forth friction scrub for at least 30
seconds. Do not wipe or blot.
-
Allow antiseptic solution time to dry completely before puncture of the site.
CHG is used because it provides persistent bacterocidal activity.
In selecting a site for the central line the Physician must weigh the risk-benefit of site
selection for each individual patient.
In general the subclavian site is the preferred site for types of catheters that are used for
short term therapy because of the lower risk for CLABSI then the internal jugular vein.
A central line placed in the femoral site is more at risk for infection, especially in
overweight patients.
Daily review of central line necessity will prevent unnecessary delays in removing lines
that are no longer needed. Include daily review of line necessity in multidisciplinary
rounds.
The goal is to reduce the number of line days to reduce the risk of acquiring a CLABSI.
A central line that is no longer needed should be promptly removed.
Slide 27
Multidisciplinary Insertion Procedure Checklist
Utilize Central Line Checklist to document compliance with the
insertion criteria at the time of insertion
This creates a culture of safety and prevention
Empowers nurses to stop line placement if improper techniques
are used
Increases awareness of key components of proper insertion
Improves accountability and compliance with standard of care
Assures essential documentation is met
Shares responsibility
Physician/MLP (primary operator)
Nurse/MLP/Resident (recorder/observer)
During a procedure involving insertion of a central line a multidisciplinary insertion
procedure checklist is used. Utilize the Central Line Checklist to document compliance
with the insertion criteria at the time of insertion. Using the Central Line Checklist during
the procedure creates a culture of collaboration, patient safety, and prevention. The
checklist increases awareness of the key components of proper insertion and improves
accountability and compliance with standard of care.
Completion of the procedural checklist is a shared responsibility between the provider
inserting the central line and the nurse or other professional recording and observing
the procedure.
Slide 28
Line Care and Maintenance
Transparent, semi-permeable
dressing is preferred
Change transparent dressing every 7
days and whenever dressing is soiled
or non-adherent
Avoid antibiotic ointment at the
catheter insertion site
Utilize antimicrobial disc
Disinfect catheter hubs and injection
ports
Minimize manipulation of the catheter
Proper care and maintenance of the central line is essential to prevent CLABSIs. When
caring for a patient with a central line the preferred dressing is transparent and semipermeable. The benefits of a transparent, semi-permeable dressing include the ability to
evaluate the insertion site while the dressing is in place, the wicking of moisture away
from the skin, and less frequent dressing changes compared with standard gauze and
tape dressings.
The transparent dressing should be changed every 7 days and whenever the dressing
is soiled or non-adherent. Avoid using antibiotic ointment at the catheter insertion site as
it promotes fungal infections and antibiotic resistance (except when using dialysis
catheters). Instead, utilize antimicrobial discs.
When caring for a patient with a central line always, clean your hands and wear gloves
when changing the bandage that covers the area where the catheter enters the skin.
Disinfect the catheter hub openings with an antiseptic solution before accessing the
port.
In general, minimize the manipulation of the catheter.
Slide 29
Additional Prevention Measures
Educate and train providers who
insert lines
Use a standardized supply cart or
kit
Routine replacement of central
lines is not necessary
Replace central lines within 24
hours when adherence to aseptic
technique was not followed
during insertion
For More Information:
• LVHN Patient Care Services
Clinical Practice Guideline
•
LVHN Infection Control and
Prevention policy
Control in Intravenous
Additional measures to prevent CLABSIs include:
•Educate and train providers who insert lines
•Use a standardized supply cart or kit
•Routine replacement of central lines is not necessary
•Replace central lines within 24 hours when adherence to aseptic technique was not
followed during insertion
For more information please refer to the LVHN Patient Care Services Clinical Practice
Guideline “Central Catheter: Venous or Arterial” and the LVHN Infection Control and
Prevention policy “Requirements for Infection Control in Intravenous Therapy.” Both
policies can be found on the LVHN Intranet. On the LVHN Intranet home page select the
Resources menu and click on LVHN Policy & Procedure Manuals. On the LVHN Policy
and Procedure Manual page, select the Patient Care Manual or the Infection Control
and Prevention links.
Slide 30
Multi-Drug Resistant Organisms
Multi-Drug
Resistant
Organisms
(MDRO)
Recommendations
for the
Control and
Prevention of MDRO
In this section of the course, you will be introduced to the primary types of multi-drug
resistant organisms and learn infection control precautions to prevent the transmission
of MDROs in the healthcare environment.
Slide 31
Multi-Drug Resistant Organisms are microorganisms, mostly bacteria, that are resistant
to one or more classes of antimicrobial agents, or antibiotics.
Types of resistant organisms include:
•Clostridium difficile - (C. Diff)
•Methicillin-resistant Staphylococcus aureus - MRSA
•Vancomycin-resistant enterococci - VRE
•MDR Acinetobacter baumannii
•Carbapenem-resistant Enterobacteriaceae (Carbapenemase-producing
Enterobacteriaceae) - CRE
•Extended spectrum beta-lactamase producers - (ESBL)
Slide 32
Key Concepts in Transmission
Who Is At Risk?
Patients with severe disease
Underlying medical conditions, recent surgery, indwelling
medical devices such as urinary catheters or endotracheal
tubes or IVs
Hospitalized patients
Other Risk Factors:
Antibiotic use
Presence of larger number of colonized (organism is present but
not causing infection) patients
Contamination of healthcare workers hands and environmental
surfaces
Patients with severe disease and hospitalized patients are most at risk for contracting
an infection with an MDRO. This includes patients with underlying medical conditions,
patients who have recently had surgery, and patients with indwelling medical devices
such as urinary catheters or endotracheal tubes or IVs.
Other factors that increase the risk for getting an infection with an MDRO include:
•Antibiotic use,
•A large number of colonized patients, and
•The contamination of healthcare worker’s hands and environmental surfaces.
The treatment of MDROs is extremely challenging because there are few antibiotics that
can be used to eradicate these severely resistant organisms.
Severe cases of C. Diff and MDROs can result in death. Therefore, early
implementation of prevention efforts is key in preventing the spread of Multi-drug
resistant organisms. MDROs are spread by contaminated hands of healthcare
providers, contaminated medical equipment and other environmental surfaces in the
patient’s surroundings.
Slide 33
Special Precautions for C. Diff
Special Precautions for C. Diff:
Practice strict hand hygiene
Gel upon entry, wash upon
exit
Wash with antibacterial soap
after patient contact and contact
Use Contact Isolation sign with
red dot
Click the Attachments tab above to download
the Hand Hygiene and Contact Isolation signs
To prevent the spread of MDRO infections, there are certain precautions that should be
followed. There are a few special precautions that you should keep in mind when caring
for a patient with Clostridium difficile (C. Diff) or Vancomycin-resistant enterococci
(VRE).
When caring for a patient with C. Diff, it is important to follow strict hand hygiene
practices. Wash your hands with antibacterial soap after patient contact. Remember to
gel upon entry and wash upon exit of all rooms with C. DIFF patients. Washing with
soap and water is preferred when caring for a patient with C. Diff. Use an alcohol-based
waterless hand sanitizer in addition to soap and water. Use contact Isolation sign with
red dot to indicate the patient has C. Diff.
You should also clean medical equipment and the patient room with a hospital approved
bleach solution. Clean C. Diff patient’s bathrooms more frequently.
Slide 34
Special Precautions for VRE
Special Precautions for VRE
Isolation precautions only required if patient has an open
draining wound, diarrhea, or are incontinent of urine or stool.
When caring for patients with VRE, isolation precautions are not required unless the
patient has an open draining wound, diarrhea, or are incontinent of stool or urine.
Slide 35
MDRO Precautions
1
2
3
4
5
6
7
Following precautions can help prevent the spread of infections.
Click on each of the numbered buttons above to learn more
about the precautions that you should take when caring for a
patient with a MDRO infection.
Now that you have learned the special precautions for C. Diff and VRE, let’s learn more
about the precautions that apply to all of the MDROs. Following these precautions can
help to prevent the spread of infection to yourself and to others.
Click on each of the numbered buttons to learn more about the precautions that you
should take when caring for a patient with an MDRO infection.
Slide 36
MDRO Precautions
1
2
3
4
5
6
7
Utilize Standard Precautions
plus Contact Precautions for
known or suspected cases.
Utilize Standard Precautions plus Contact Precautions for known or suspected cases.
Slide 37
MDRO Precautions
1
2
3
4
5
6
7
Private room or partnered
with another patient who is
infected with the same
resistant organism.
Patients with VRE only require
isolation precautions in the
presence of an open draining
wound, diarrhea, or are
incontinent of urine or stool.
Patients with MDROs should be assigned a private room, or partnered with another
patient who is infected with the same resistant organism.
Slide 38
MDRO Precautions
1
2
3
4
5
6
7
Hand hygiene before and
after patient contact
Alcohol-based waterless hand
sanitizer is preferred*
Use antibacterial soap and
water when hands are visibly
dirty
* EXCEPT for patients with C. Diff,
washing with soap and water is
preferred
Perform proper hand hygiene practices before and after all patient contact. It is
preferred that you use an alcohol-based waterless hand sanitizer to disinfect your
hands. The use of antibacterial soap and water is recommended if your hands are
visibly dirty. Remember, for patients with C. Diff, washing with soap and water is
preferred.
Slide 39
MDRO Precautions
1
2
3
4
5
6
7
Use dedicated medical equipment or single use items if
possible.
Disinfect items before using them with another patient.
Use dedicated medical equipment or single use items if possible. It is important to
disinfect items before using them with another patient.
Slide 40
MDRO Precautions
1
2
3
4
5
6
7
Wear gloves:
For all patient contact
When you will contact
room
Remove your gloves and
perform hand hygiene when
Gloves should be worn for all patient contact. Gloves should also be worn if you will
come into contact with environmental surfaces in the patient’s room, such as medical
equipment, bed rails, or doorknobs. Remove your gloves and perform hand hygiene
when you exit the patient’s room.
Slide 41
MDRO Precautions
1
2
3
4
5
6
7
Wear a gown when:
There is a chance your clothing
will become contaminated
through contact with the patient
You will come in contact with a
drainage containing a MDRO
Wear a gown whenever there is a chance that your clothing will become contaminated
through contact with the patient or the patient’s environment. You should also wear a
gown if you will come into contact with a patient’s wound or other drainage containing a
MDRO.
Slide 42
MDRO Precautions
1
2
3
4
5
6
7
Carefully
with a hospital approved disinfectant solution*.
Frequently touched surfaces should be cleaned more often.
• For patients with C. Diff, clean medical equipment and
the patient room with hospital approved bleach solution.
• When possible, use ultraviolet light disinfection machine
-
Careful cleaning of the patient’s room and other medical equipment with a hospital
approved disinfectant solution will also help to prevent the spread of infections.
Frequently touched surfaces such as bed rails, over bed table, bedside commode,
surfaces in the patient’s bathroom, and doorknobs should be cleaned more often.
For patients with C. Diff you should also clean medical equipment and the patient room
with a hospital approved bleach solution. Clean C. Diff patients’ bathrooms more
frequently. When possible, use ultraviolet (UVC) disinfection machine“Tru-D” after
terminal cleaning of C. Diff patient rooms on discharge.
Slide 43
Prevent Catheter Associated Urinary Tract Infections (CAUTI)
Key elements of CAUTI Prevention
Use urinary catheters only when
necessary
Appropriate indications only
Alternatives to urinary
catheterization
Aseptic technique during catheter
insertion
Daily care of the urinary catheter
Remove when no longer needed
Measure and monitor CAUTI
Utilize nurse managed urinary
catheter removal protocol
Insert catheters only for appropriate indications. Alternatives to catheterization include
using the bladder ultrasound to avoid catheterization, considering external catheters
and applying adult briefs. Personnel should be trained on the correct technique of
aseptic catheter insertion. Use Standard Precautions during any manipulation of the
catheter or the collecting system. This includes performing hand hygiene and using
gloves for daily care. A securement device should be used to prevent catheter
movement. Maintain unobstructed urine flow by keeping the tube free from kinking, the
collecting bag below the level of the bladder at all times and emptying the collecting bag
regularly. Remove the catheter as soon as it is no longer needed. Surveillance is
conducted on all patients with urinary catheters and CAUTI infection rates are available
in HBI. Obtain order for foley insertion that includes nursing protocol to remove foley
catheter when no longer needed.
Slide 44
Patient Education
Patients and visitors should be educated on ways to prevent the spread of infection.
Educational materials on hand hygiene practices, respiratory practices, and contact
precautions can be found through Krames On-Demand.
This is an example of the handwashing tips for patients, family and friends.
This is an example of the education for preventing the spread of infection.
Slide 45
Test Your Knowledge
You should be able to:
Identify strategies that can reduce the risk of developing a
surgical site infection
List the key elements in the Central Line Bundle
Discuss key facts about specific multi-drug resistant organisms
in the healthcare setting
Explain methodologies that can help decrease the likelihood of
developing a Catheter Associated Urinary Tract Infection
To successfully complete this course, you
must earn a score of at least 80% on the
final test.
Click the Test button to start the final test.
Thank you for participating in the Infection Control and Prevention of HealthcareAssociated Infection course.
You should be able to:
•Identify strategies that can reduce the risk of developing a surgical site infection
•List the key elements in the Central Line Bundle
•Discuss key facts about specific multi-drug resistant organisms in the healthcare
setting
•Explain methodologies that can help decrease the likelihood of developing a Catheter
Associated Urinary Tract Infection
Click the Test button to continue on to the final test. In order to pass this course, you
must earn at least 80% on the test. You can go back and review any section of this
course by selecting the Outline tab, then selecting any of the topics listed. If you do not
pass the test on the first try, you can go back and try again. Good luck.
Slide 46
PROPERTIES
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Slide 47
Congratulations!
You have successfully completed the Infection Control and
Prevention of HAI course
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