Download PATIENT SAFETY INFECTION PREVENTION and CONTROL

PATIENT SAFETY
INFECTION PREVENTION and CONTROL
The West Parry Sound Health Centre has a strong commitment to patient safety. With that goal at the
forefront the Infection Control Department is responsible for working with employees, visitors and patients
to control the spread of infections.
If you have any questions about the information below or about our hospital’s infection prevention and
control program, please contact Lorraine Vankoughnett, ext 2320.
Did you know that hand hygiene is the simplest way to prevent up to 50% of infections and illnesses?
Every year in Canadian hospitals 250,000 patients acquire one or more preventable infections. Older
patients, individuals with weak immune systems and patients who have been in hospitals over a long time
are highly vulnerable to these infections. Some of these infections are MRSA, VRE and C. difficile.
These infections can be transmitted through touch and we all play a role in ensuring that infections are
not transmitted through the hands of caring people.
Definitions:
Here are some definitions to help you understand infections.
Health Care-associated infection (HAI) or nosocomial infection is an infection occurring in a patient
during the process of care in a hospital or other health care facility if the infection is detected 72 hours
after admission and it is not likely the patient was exposed to the bacteria prior to the admission.
Community Acquired / Non-nosocomial infection is an infection that the patient presents with symptoms
of on admission or less than 72 hours after admission and has a positive laboratory test.
Resistant organisms are germs or bacteria that would normally have responded to antibiotics and have
now developed resistance to certain antibiotics. MRSA and VRE are two examples.
Surveillance is routinely done to check patients for MRSA and VRE by taking swabs from certain places
on the patient’s body on admission and at other times. If a patient has diarrhea a stool sample is tested
for C. difficile. New symptoms of fever, nausea, vomiting, diarrhea, and cough are investigated to rule out
the start of a new infection.
It is important to monitor for these types of infections because we do not want them to spread between
patients or from patient to visitor.
How do we control the spread of infections and improve patient safety?
Surveillance for Health Care-Associated infections.
Hand Hygiene Program and audits monitoring our practice.
On-Admission screening for antibiotic resistant organisms.
Screening for Febrile Respiratory and Enteric Illnesses at points of entry.
Environmental Cleaning and audits monitoring our practice.
Sterilization of Equipment
Single Use of Supplies
Personal Protective Equipment
Education, and
Additional Isolation precautions
What can patients do to help reduce their chances of infection?
Patients should always follow instructions given to them from their health care team.
Hand hygiene involves everyone in the health centre, including patients. Hand cleaning is one of the best
ways you and your health team can prevent the spread of many infections. Patients and their visitors
should also practice good hand hygiene before and after entering patient rooms.
More patient-specific information is available at www.ontario.ca/patientsafety and
www.oha.com/patientsafetytips and www.oha.com/cleanhandsprotectlives.
C.difficile Stats:
What is C. difficile? (See Fact Sheet for Patients)
C. difficile (Clostridium difficile) is a bacteria. C. difficile can be part of the normal bacteria in the large
intestine and is one of the many bacteria that can be found in stool (a bowel movement).
A C. difficile infection occurs when other good bacteria in the bowel are eliminated or decreased allowing
the C. difficile bacteria to grow and produce toxin. The toxin produced can damage the bowel and cause
diarrhea. C. difficile is one example of a hospital-acquired infection and is one of the most common
infections found in hospitals and long-term care facilities. C. difficile has been a known cause of health
care associated diarrhea for about 30 years.
How does the West Parry Sound Health Centre control the spread of C. difficile?
1. As part of the Infection Prevention and Control Surveillance program nurses continuously
monitor for signs and symptoms of infection including diarrhea.
2. Positive test results are monitored by the Infection Control Committee.
3. Nurses can independently order testing for C. difficile and initiate isolation precautions.
4. Quick (one hour) turn-around time for C. difficile testing.
5. Enhanced housekeeping protocols for isolation rooms.
Rate Calculation: Reported monthly.
Number of new hospital acquired cases of C. difficile in our facility x 1000
Total number of patient days for the month (minus infant days)
For smaller facilities:
C. difficile rates may vary from month to month; the smaller the facility, the greater the rates will vary. This
is because a change in even one case in a small facility will cause the rate to go up or down considerably.
What is MRSA? (See Fact Sheet for Patients)
Methicillin-resistant Staphylococcus aureus (MRSA) is a type of bacteria that is resistant to certain or all
types of the beta-lactam classes of antibiotics such as penicillins and cephalosporins.
Colonization: The presence and growth of a microorganism in or on a body with growth and multiplication
but without tissue invasion or cellular injury. The patient will be asymptomatic.
A MRSA bacteremia case is a patient identified with a laboratory confirmed bloodstream infection of
MRSA. A blood stream infection is a single positive blood culture for MRSA
Rate Calculation: Reported quarterly.
Number of nosocomial patients with laboratory identification of MRSA bacteremia x 1000
Total number of patient days
What is Vancomycin-resistant Enterococci (VRE)? (See Fact Sheet for Patients)
Enterococci are bacteria that are normally present in the human intestines and in the female genital tract
and are often found in the environment. These bacteria sometimes cause infections. Vancomycin is an
antibiotic that is often used to treat infections caused by enterococci. In some instances, enterococci have
become resistant to this drug and thus are called vancomycin-resistant enterococci (VRE).
A VRE Bacteremia case is a patient identified with laboratory confirmed bloodstream infection with VRE
Bacteremia. A blood stream infection is a single positive blood culture for VRE.
Colonization: The presence and growth of a microorganism in or on a body with growth and multiplication
but without tissue invasion or cellular injury. The patient will be asymptomatic.
Rate Calculation: Reported quarterly.
Number of nosocomial patients with laboratory identification of VRE bacteremia x 1000
Total number of patient days
What is a Surgical Site Infection (SSI)? (See Fact Sheet for Patients)
A surgical site infection (SSI) occurs at the site of a surgical incision. Germs can get into the incision area,
and cause an infection. It can develop within 30 days of an operation, or sometimes even up to one year
if an implant (such as a knee or hip joint implant) is used.
Infections can be minor, or occasionally they can increase complications that result in a longer
length of stay in the hospital, or an increased readmission rate for patients. Post-operative SSIs are the
most common health care-associated infections in surgical patients
What is the West Parry Sound Health Centre doing to prevent SSIs?
The Health Centre follows a set of best practice guidelines in the form of “SSI bundles” from Safer
Healthcare Now! and the Institute for Healthcare Improvement (IHI). These “bundles” are a collection of
best practices (for example, administration of prophylactic antibiotics, clipping and not shaving of body
hair, etc.) that when used together, can reduce the chances of a patient contracting a surgical site
infection. Our hospital is committed to keeping our patients as safe as possible from infection. We have
incorporated many best practices to reduce our surgical site infections.
1. Use of prophylactic antibiotics when appropriate.
2. Clipping, not shaving of body hair.
3. Monitoring of patient’s blood sugars during surgery.
4. Maintenance of normal body temperature during surgery.
5. Strict reprocessing (sterilization) of equipment guidelines.
6. Hand Hygiene
Rate Calculation: Reported quarterly (The first report is for the month of March, 2009 only)
Hospitals that perform hip and/or knee replacement surgeries are required to report SSI-Prevention
percentages which reflects the prophylactic administration of antibiotics to the patient at a certain time
before their surgery.
# of Hip/Knee joint replacement surgeries
# of Hip/Knee joint replacement surgeries
who received antibiotics within 60 min of
+
who received vancomycin within 120 min of
skin incision
skin incision
________________________________________________________________
X 100%
Total number of patients during the reporting period who had a primary
knee/hip joint replacement surgical procedure
What is a Central-Line Associated Blood Stream Infection (CLI-BSI)?
(See Fact Sheet for Patients)
When a patient requires long-term access to medication or fluids through an IV, a central line is put in
place. A central line blood stream infection can occur when bacteria and/or fungi enters the blood stream,
causing a patient to become sick. The bacteria can come from a variety of places (e.g., skin, wounds,
environment, etc.), though it most often comes from the patient’s skin.
The Health Centre follows best practices on how to prevent bacteria from entering into a central line.
Patients in the ICU often require a central line since they are seriously ill, and will require a lot of
medication, for a long period of time.
1. Proper hand hygiene is used before contact with the central line
2. Sterile clothing is worn when inserting a central line and the patient is covered with a sterile
drape.
3. The patient’s skin is cleaned with “chlorhexidine” when the line is inserted.
4. The most appropriate vein is chosen.
5. The line is checked every day for infection.
6. The line is replaced as needed.
7. The line is removed as soon as no longer needed.
Rate Calculation: Reported quarterly.
Total # of ICU related BSIs after 48 hours of central line placement
X 1000
Total # of central line days for ICU patients 18 years and older
What is Ventilator Associated Pneumonia VAP? (See Fact Sheet for Patients)
Ventilator associated pneumonia (VAP) is defined as a pneumonia (lung infection) occurring in patients in
an intensive care unit (ICU), requiring, external mechanical breathing support (a ventilator) intermittently
or continuously, through a breathing tube for more than 48 hours.
VAP can develop in patients for many reasons. Because they are relying on an external machine to
breathe, their normal coughing, yawning, and deep breath reflexes are suppressed. Furthermore, they
may have a depressed immune system, making them more vulnerable to infection. ICU teams have many
ways to try to assist patients with these normal breathing reflexes, but despite this, patients are still at risk
for developing pneumonia.
The Health Centre uses best practices to prevent VAP:
1. Practicing good hand hygiene.
2. Keeping the head of the bed elevated at a 30-45 degree angle.
3. Discontinuing mechanical ventilation as soon as possible.
Rate Calculation: Reported quarterly.
Total # of ICU cases of VAP after 48 hours of mechanical ventilation X 1000
Total # of ventilator days for ICU patients 18 years and older
Hand Hygiene
Good hand hygiene is the single most effective way to reduce the risk of health care-associated
infections. The Health Centre participated in the MOHLTC’s provincial hand hygiene campaign, Just
Clean Your Hands. The program supports having alcohol-based hand rub at the point of care
to make it easier and faster for health care providers to clean their hands, ensuring effective hand
hygiene at the right times.
Patients and their visitors should also practice good hand hygiene before and after entering patient
rooms.
The Health Centre supports good hand hygiene by:
1. Participating in the MOHLTC’s infection and prevention and control core competencies
education program.
2. Following best practice documents for hand hygiene.
3. Education from orientation to continuing education on hand hygiene.
4. Alcohol-based hand rub at point of care.
5. Visual reminders: posters, cue cards, etc..
6. Ongoing hand hygiene audits with feedback to staff.
Rate Calculation: Reported annually.
# of times hand hygiene performed
X 100
# of observed hand hygiene indications
These percentages also reflect:
(i) Hand hygiene before initial patient/patient environment contact by combined health care
provider type (e.g., nurses, allied health professionals, physicians, etc.)
(ii) Hand hygiene after patient/patient environment contact by combined health care provider
type (e.g., nurses, allied health professionals, physicians, etc.)
Hand Hygiene Statistics:
C.difficile Statistics:
Methicillin-resistant Staphylococcus Aureus (MRSA) Stats:
Vancomycin-resistant Enterococci Stats:
Surgical Site Infection Prevention Percentage Stats:
Central-Line Associated Blood Stream Infection (CLI-BSI) Stats:
Ventilator Associated Pneumonia (VAP) Stats: