Download AHRQ Safety Program for Long-Term Care: HAIs/CAUTI

AHRQ Safety Program for Long-Term Care: HAIs/CAUTI
Clean Equipment & Environment
Knowledge and Practice
Training Module # 2 for the LTC Core Team
Current as of July 2015
Learning Objectives
Upon completion of this session facility team leads and core team
members will be able to:
•
describe the chain of infection and identify key strategies to break
the chain;
•
explain catheter care and maintenance strategies facility staff can
use to prevent residents from acquiring a catheter-associated
urinary tract infections (or CAUTIs);
•
explain the role of the environment as a place where pathogens can
become a source of infection for residents and staff; and
•
summarize strategies to improve cleaning and disinfecting practices
using the training materials for all facility staff.
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Protecting Residents Against Infection
The Chain of Transmission: 6
Links
Each link stands for something (or someone) that
helps pass on an infection.
An infection can be passed from one person to
another person as long as the links of the chain
are joined together.
Siedlaczek G. SJMHS
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Breaking the Chain of Infection
The Role of LTC Facility Staff
The Chain of Transmission: 6 Links
How Can HCW Break the Chain of
Infection?
Education
• Hand hygiene
• Gloves
• Clean rooms
• Disinfect surfaces
• Proper medical device care
and maintenance
Siedlaczek G. SJMHS
Ensure residents have:
• Good personal hygiene
• Covered cuts/wounds
• Isolation when necessary
• No unnecessary antibiotics
• Proper waste disposal
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The Usual Bacteria Suspects:
Multidrug-resistant Organisms (MDROs) Common in LTC
Residents with a indwelling catheter are more likely to have one
of these MDROs
Mody L, et al. Clin Infect Dis 2011;52:654-51
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Front-line Staff Training Recap
•
Microbes can enter an indwelling urinary catheter’s closed
system during insertion, care and maintenance of the
catheter and drainage bag
•
Conduct routine hygiene of the resident and remember hand
hygiene
•
Stabilization devices reduce irritation that may increase the
risk for serious infection
•
Urine measuring devices should never be shared, and should
be cleaned and dried between use
6
Entry Pathways for Microbes
• Aseptic technique plays a
key role in preventing
catheter or drainage bag
contamination
• Routine hygiene is
important
• Disinfect the port before
obtaining a urine culture
• Check catheter, tubing and
drainage bag for
disconnection, kinks
7
Hand Hygiene
Good
Plain soap
Better
Antimicrobial
soap
Best
Alcohol-based
hand rub
8
Protecting Residents Against Infection
Role of Clean Equipment and Environment
Factors associated with increased risk of infection in
residents include1:




Lower level of cleanliness
Higher frequency of odors
High turnover rate of nurses
Fewer certified nurses’ aides/100 beds
Zimmerman S, et al. JAGS 2002;50:1987-95.
9
MRSA and the Environment
Methicillin-resistant Staphylococcus aureus
(MRSA) is a growing problem in LTC
• A study of 10 long-term care facilities
found MRSA present on 16% of surfaces
tested.
Methicillin-resistant
Staphylococcus aureus
MRSA
• MRSA was more often present in
residents’ rooms that were cleaned less
frequently and for less time
Murphy CR, et al. JAGS 2012;60:1012-18
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Survival of Select Microbes on
Environmental Surfaces
Microorganism
Survival on Environmental
Surfaces
Bacteria
Clostridium difficile (C. diff.) spore
> 1 yr.
Vancomycin-resistant Enterococci
(VRE)
5 days – 4 months
Methicillin-resistant Staphylococcus
aureus (MRSA)
7 days – 7 months
Viruses
Hepatitis B virus (HBV)
> 1 week
Human immunodeficiency virus (HIV)
3-4 days
Norovirus
8 hrs – 7 days
Kramer A. BMC ID 2006; McFarland L, et al. AJIC 2007
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MDROs Can Hang Around
represents positive VRE culture sites – ready for next patient?
Vancomycin-resistant Enterococci (VRE) detected on surfaces indicated –
cultures done AFTER discharge cleaning/disinfection
Duckro AN, et al. Arch Intern Med 2005;165:302-7
12
Is It Really Clean?
Experience With Fluorescent Marker in Long-term Care
% Removed
90%
78%
80%
68%
70%
60%
50%
% Removed
40%
30%
27%
20%
10%
0%
Baseline
2 months
6 months
Applegate D, et al. Evaluation of environmental cleaning in LTC Facilities, ID Week 2012
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Disinfection of the Environment & Equipment
Why is it important to disinfect surfaces in the LTC
facility?
• Surfaces that are touched frequently increase the chance
that microorganisms could be spread to residents or staff
• While surfaces may look clean, pathogens may be
lurking
What can LTC front-line staff do?
• Cleaning/disinfection offers extra margin of safety
• Disinfectant kills bacteria and viruses that can’t be seen
• Focus disinfection on surfaces that are touched a lot
14
What Role Does Leadership Play in Cleaning and
Disinfecting Practices?
Let’s Chat!
What can leadership do to make disinfection
a priority and easily accessible to staff?
15
Examples of Surfaces that are Frequently Touched
• Door Handles
• Call Button
• Telephone
• Bed Rail
• Tray Table
• Bedside table
• Light Switches
• Bedside commode
Challenges and Solutions to Ensuring a Clean and
Disinfected Environment for Residents and Staff
Let’s Chat!
• What cleaning and disinfecting challenges do you
experience in your facility?
• What solutions do you propose to address these challenges
in your facility?
• How can you support a culture of safety around cleaning and
disinfection?
17
Get Prepared to Engage LTC Staff in Skills Practice
Obtain the cleaning products and read the instructions on the
labels.
• What PPE needs to be worn?
• What’s the contact time?
• How do you properly store the cleaning product?
• How do you properly dispose the cleaning product?
18
Engagement Activity
How Clean is it Really?
Fluorescent marker; if present after
cleaning indicates need to repeat.
Adenosine triphosphate (ATP); measures level of
soil on a surface
Environmental cultures;
surface sampling for bacteria
19
Wrap-Up
•
Clean environment and equipment keep residents safe and things
that may look clean can still have germs on them
•
Know how to safely and properly use disinfectants utilized at your
facility
•
READ THE LABEL!
•
Clean and disinfect surfaces that are touched a lot and any time you
see a surface that is soiled with body fluids
•
Follow routine catheter care and maintenance to prevent catheters
from becoming an entry portal for bacteria
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Take the Pledge…
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Stay Updated with Useful Resources
1. AHRQ Safety Program for Long-term Care: HAIs/CAUTI Project Website
Login information
Username: ltcsafety
Password: ltcsafety
2. TeamSTEPPS® for Long-term Care
3.
CatheterOut.org
4.
Take the Pledge… to Practice All Infection Prevention Skills
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References
Applegate D, et al. Evaluation of environmental cleaning in LTC Facilities, ID Week 2012
Catheterout.org
CMS, State Operations Manual, 2014
Dennis G. Maki and Paul A. Tambyah. Engineering Out the Risk of Infection with Urinary Catheters. Emerg Infect Dis, Vol. 7, No. 2,
March-April 2001. http://www.cdc.gov/ncidod/eid/vol7no2/makiG1.htm
Duckro AN, et al. Arch Intern Med 2005;165:302-7
Kramer A. BMC ID 2006; McFarland L, et al. AJIC 2007
Maki, D. and Tambyah, P. Engineering Out the Risk of Infection with Urinary Catheters. Emerg Infect Dis, Vol. 7, No. 2, March-April
2001. http://www.cdc.gov/ncidod/eid/vol7no2/makiG1.htm
Mody L, et al. Clin Infect Dis 2011;52:654-51
Murphy CR, et al. JAGS 2012;60:1012-18
Siedlaczek G. SJMHS
Zimmerman S, et al. JAGS 2002;50:1987-95. 2. Murphy CR, et al. JAGS 2012;60:1012-18.
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