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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 multifactorial requiring many cross – linkages •Epidemiologic Triangle: Healthcare Associated Infections • Healthcare associated infections (HAI) are the 4th leading cause of death in the U.S. after heart disease, cancer and stroke • There are: – 2 million annually – >100,000 deaths annually – 20-30% are preventable How Do HAI Stack Up Against Other Adverse Events? Adverse Events Hospital Acquired Infections • •5% of admissions have HAI • > 100,000 deaths annually • $4.6 billion excess $/yr •$600/Urinary Tract Infections (UTI) •$5000/pneumonia •Up to $50,000/Blood Stream Infections (BSI) •Increase Length of Stay •1-4 days/UTI, 7-8 days/BSI • • • • 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 Sites of Healthcare Acquired 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 • Confusion mental changes • Respiratory secretions • Abnormal breath sounds • Cloudy, painful, foul smelling freq. Urination • Temperature : <97 or >100.4 F. • Chills/ sweats • 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, nonspecific antibodies, t-cells for antigen binding • Specific Response: Production of antigenspecific 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: CHG, air dry Do not re-palpate Choose appropriate catheter Prevention of Healthcare Acquired Pneumonia • Patients at high risk for aspiration: –Ventilated patients –Patients with enteral tube –Patients with decreased gagreflex Interventions: –Maintain Head of Bed @ 30-45 degree angle if possible –Routinely check location of feeding tube –Routinely assess intestinal motility to avoid distention: bowel sounds, gastric volume before tube feeding Prevention of HA 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 with respiratory secretions •Use only sterile fluid for respiratory secretion removal (none when possible) •Replace gloves with clean pair after contact with contaminated body site and before contact with respiratory tract. Prevention of HA Pneumonia Cont. • Postoperatively: – Cessation of smoking – Encourage coughing and deep breathing, including use of incentive spirometer – Early ambulation – Pain control-analgesia and splinting – High risk patients: abdominal, head, neck or thoracic surgery and underlying respiratory disease are at higher risk for pneumonia 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 Intraoperatively: Sterile technique Limit trauma Limit traffic in room Postoperatively: Aseptic wound care Wound healed in 48-72 hours Sharps Injury Prevention: • Protect yourself and others- Use Sharps with Safety Features • BE PREPARED – Anticipate injury risks and prepare the patient and work area with prevention in mind. Use a sharps device with safety feature whenever it is available. Exposure • The definition of Exposure is Blood or other potentially infectious material in contact with non-intact skin or mucous membrane – needlestick or cut/poke with sharp blood bearing item – splash to eyes, nose, or mouth • • • • What to do if you have an exposure to a bloodborne pathogen Wash or flush area of exposure for 15 minutes Notify Manager/Director, Order Needlestick Profile Call Employee Health or if after 4:30 PM,Weekend or Holiday, Call Clinical House Supervisor Fill out incident report Standard Precautions: The Cornerstone of Infection Control • Mask • wear face masks and eye protection whenever there is a possibility of blood splashing into your face • Gloves • wear gloves whenever there is a possibility of coming in contact with blood or other potentially infectious materials (body fluids and tissues) • Gowns • wear full-body gowns whenever there is a possibility of blood splashing onto you Contact Precautions • GLOVES-worn whenever you enter the patient room; remove on exiting room • HANDWASHING-with soap and waterwhenever you remove gloves • Private Room • Dedicate Equipment • Gown for substantial contact Droplet Precautions • Private Room • Mask Needed • Gowns, Gloves, and Patient Equipment the same as for Standard Precautions • Transport: Patient must wear mask Airborne Precautions • Negative Pressure Room • Mask Required (for TB, N95 mask necessary) • Gowns, Eyewear, Gloves & Patient Equipment same as for Standard Precautions • Transport: notify receiving unit; place mask on patient Stay Safe!!!!