Download Infection Control

Infection Control
Student Orientation
Basic, but important, Principles of
Cross Transmission
• Presence of microorganisms on
hands or in environment does
not necessarily = cross
transmission or infection
• Infection is multi-factorial
requiring many cross – linkages
• Epidemiologic Triangle:
Tweeten SM. General principles of epidemiology. APIC Text, 2005
Healthcare associated infections
(HAI)are the 4th leading cause
of death in the U.S.after
heart disease,cancer and stroke
Hospital Acquired Infections
• >2 million annually
• >90,000 deaths annually
• 20-30% are preventable
How Do HAI Stack Up Against Other
Adverse Events?
• 3-7% of admissions have
an adverse drug event
• 140,000-180,000 deaths
annually
• $2 billion annually in
excess costs
• Cost > $3,000 each
• Increase LOS by average
of 2.2 days
•
•
•
•
•
•
•
•
•
5% of admissions have HAI
88,000 deaths annually
$4.6 billion excess $/yr
$600/UTI
$5000/pneumonia
Up to $50,000/BSI
Increase LOS
1-4 days/UTI, 7-8 days/SSI
7-21 days/BSI 7-30
days/pneumonia
Sites of Nosocomial Infections
Usual Causative Organisms
• Urinary tract:
E. Coli, Enterococcus species
• Lower Respiratory (pneumonia or bronchitis):
Klebsiella, Pseudomonas
• Surgical Wounds: Staphylococci, Site dependent
• IV: Staphylococci, not aureus
Symptoms of Infection
• abnormal labs
diarrhea vomiting
• temp : <97o>100o F.
• chills/ sweats
• Confusion
mental changes
• resp. secretions
abnormal breath sounds
• Cloudy, painful, foul
smelling freq. Urination
• cold extremities
• redness, warmth, swelling
rashes/boils
• pain
Normal Body Defenses
•
•
•
Mechanical: intact skin;
mucous production; cilia,
digestive enzymes, skin acidity
etc.
Nonspecific Responses: WBC
phagocytic response, fever,
inflammation, non-specific
antibodies, t-cells for antigen
binding
Specific Response: Production
of antigen-specific antibody,
immunoglobulins
The Hospitalized Patient: A
Human at Risk
• Break in the barrier of the skin
• Tubes crossing mucous membranes
• Medications altering the natural barriers of
digestive pH/immune function
• Decreased ability to use lung capacity
• Foreign microbial environment
• Disease processes of immune system
Prevention of IV Catheter
Related Infection
•
•
•
•
•
WASH HANDS
Wear Gloves
Cleanse Site: alcohol, air dry
Do not re-palpate
Choose appropriate catheter
Prevention of Nosocomial
Pneumonia
• Patients at high risk
for aspiration:
– Ventilated patients
– Patients with enteral
tube
– Patients with decreased
gag-reflex
• Interventions:
– Maintain HOB @ 3045o angle if possible
– Routinely check
location of feeding
tube
– Routinely assess
intestinal motility to
avoid distention: bowel
sounds, gastric vol.
before tube feed
Prevention of Nosocomial
Pneumonia Cont.
• Prevent Gastric
Colonization
•
•
•
•
Use agents for prophylaxis of
gastric ulcers which do not raise
the gastric pH
Wear gloves during suctioning
or contact w/respiratory
secretions
Use only sterile fluid for
respiratory secretion removal
(none when possible)
Replace gloves with clean pair
after contact w/ contaminated
body site and before contact
with respiratory tract.
Prevention of Nosocomial
Pneumonia Cont.
•
Postoperatively:
– Cessation of smoking
– Encourage coughing and
deep breathing, incl. use of
incentive spirometer
– Early ambulation
– Pain control- anlagesia and
splinting
– High risk patients:
abdominal, head, neck or
thoracic surgery; underlying
resp. disease
Prevention of Surgical Site
Infections
• Preoperative measures:
– Free of remote
infections
– Preparation of the
surgical site: prep
agent, non-invasive
removal of hair,
prophylactic antibiotics
Prevention of Surgical Site
Infections Cont.
• Intraoperatively:
– Sterile technique
– Limit trauma
– Limit traffic in room
Prevention of Surgical Site
Infection Cont.
• Postoperatively:
– Aseptic wound care
– Wound healed in 48-72
hours
Sharps Injury Prevention:
Examples of safetyEngineered sharps devices
Hepatitis B – United States, 1978-2000
Decline among
homosexual men
Decline among
IV drug users
30000
Cases
25000
20000
15000
10000
Hepatitis B vaccine licensed
5000
0
1978
1982
1986
1990
1994
1998
Exposure
• Define Exposure: Blood or other potentially
infectious material contact with non-intact
skin or mucous membrane
• > needlestick or cut/poke with sharp
bloodbearing item
• > splash to eyes, nose, or mouth
What to do if you have an exposure
to a bloodborne pathogen
• Call Employee Health
at 2-3297 for SJMH &
SJMSH
• Fill out green incident
form and report to ER
for SJMLH
The Hierarchy of Precautions
S tandard
P recautions
C ontact
D roplet
A irborne
P recautions P recautions P recautions
Standard Precautions: The Cornerstone
of Infection Control
Contact Precautions
• Used for organisms difficult to treat (ex.
Antibiotic Resistant Organisms-AROs)
• Organisms which are able to be spread by
environmental contamination
Antibiotic Resistant Organisms
• Methicillin Resistant
Staphylococcus aureus
(MRSA) (ICU
ONLY AND ONLY
FOR
UNCONTAINED
SITES)
• Vancomycin Resistant
Enterococcus (VRE)
Organisms Which Can Be Spread
Through Environmental Contamination
• Respiratory Syncytial
Virus
• Clostridium difficile in
a fecally incontinent
patient
Contact Precautions
• GLOVES- worn whenever you enter the patient
room; remove on exiting room
• HANDWASHING- whenever you remove your
gloves
Contact Precautions
• Private Room
• Dedicate Equipment
• Gown for substantial
contact
• (all except handwashing
apply only to HCWs)
Droplet Precautions
• Large organisms spread
by coughing, sneezing up
to 3 foot away
• Bacterial Meningitis
(Neisseria meningitidis;
Haemophilus influenza)
• Whooping Cough
(Bordetella pertussis)
Droplet Precautions
• Private Room
• Mask Needed
• Gowns, Gloves, and Patient Equipment the same as for
Standard Precautions
• Transport: Patient must wear mask
Airborne Precautions
• Illnesses where germs are expelled into the
air by coughing, sneezing, laughing, etc.
• Can be carried long distances in air and
spread to others
Airborne Precuations
• Mycobacterium
tuberculosis
• Chickenpox
(Varicella)
• Measles (Rubeola)
Airborne Precautions
• Negative Pressure Room
• Mask Required (for TB,
N95 mask necessary)
• Gowns, Eyewear , Gloves
& Patient Equipment same
as for SP
• Transport: notify receiving
unit; place mask on patient