Download Routine Practices (2010)

Routine Practices
Protecting You
Protecting the Patient
Protecting the Public
Infection Prevention & Control
The Mission
Protect the Patient
Protect the Worker
Protect the Public
From exposure to disease causing organisms.
It’s everybody's responsibility!
2
Impact of Hospital Acquired Infections
on the Patient & Family
“At any one time approximately 1 in 10 patients in
acute care hospitals have a hospital-acquired
infection (HAI)”
Economic - lost productivity
Additional 5 days of lost work
Social -
disruption of family life
Twice the time spent doing post-hospital care at home
Personal -
pain, suffering, loss function → life
Additional 6 to 13 days returning to normal ADL’s
In the UK, 13% of patients with HAI died compared with 2% of patients
who did not present with an HAI in hospital
3
Healthcare Costs
The Socio-Economic Burden of Hospital
Acquired Infection
Nursing Care
Medical Time
33%
Operations & Consumables
41%
Paramedics & Specialist
Nurses
Antimicrobials
Other Drugs
4%
4%
2%
Laboratory & Other Tests
4%
6%
6%
Additional Bed Days
4
Communicable Infections of
Concern
Skin & soft tissue
→ S.aureus
→ GAS
5
Communicable Infections of
Concern
Gastrointestinal
→ Noroviruses
→ C.difficile
→ E.coli 0157:H7
→ Campylobacter
→ Rotavirus
6
Communicable Infections of
Concern
Respiratory
→ RSV
→ Influenza
→ Pertussis
→ TB
→ MRSA pneumonia
7
Troubling Clinical Issues
Antibiotic Resistant Organisms (AROs)
„
Virulence factors disable cell mediated defenses
Serious and invasive infections
„
Limited antibiotic choices
„
C.difficile
„
„
„
Toxin producing > tissue damage
Pressured by antibiotics
Added morbidity > extends hospital stay
8
Troubling Environmental Issues
Environmental contamination is greatest in
the presence of infection or incontinence
1.
2.
3.
4.
5.
6.
Overcrowding & clutter
Insufficient dedicated toileting facilities
Inadequate cleaning & housekeeping measures
Inconsistent application of appropriate precautions
Staffing levels
Patient compliance with Infection Control measures
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Who’s Got What – Can You Tell?
10
Routine Practices
Routine Practices are to be applied at all
times, by all staff, regardless of the patient's
presumed infection status.
11
Routine Practices
also known as Standard Precautions
are more encompassing then previous
Bloodborne Pathogen Precautions or Universal
Precautions
based on the assumption that all blood and
certain body fluids (urine, feces, wound drainage,
sputum) contain organisms (bacteria, virus, or
fungus)
Routine Practices reduce exposure (both volume
and frequency) of blood/body fluid to the health
care provider
12
What are Routine Practices?
Risk Assessment
Risk Reduction
Education
13
Risk Assessment
14
Risk Assessment
•Fever/Cough with or without a rash?
•Skin/Soft tissue infection?
•Diarrhea illness, NYD? (with or without vomiting)
15
Risk Assessment
No risk of Infectious
Disease?
„
Continue Routine
Practices
Risk of Infectious
Disease?
„
Continue Routine
Practices and add
Additional Precautions
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Risk Reduction
1. Hand Hygiene and Respiratory/Cough Etiquette
2. Use of Personal Protective Equipment (gloves,
gown, mask) when/where appropriate
3. Placement of patients
4. Cleaning and disinfection of equipment and care
items
5. Healthy workplace practices (e.g. immunization)
6. Handling of sharps and laundry
7. Management of waste (e.g. biohazard waste
disposal)
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Hand Hygiene
Method
Social
Solution
Alcohol based hand rub
Task
For Routine Practices
or
Hygienic hand
disinfection
Soap and Water (if visibly soiled
and/or contact with spores)
An alcohol based hand rub
or
Soap and Water (if visibly soiled
and/or following contact with
spores) followed by alcohol based
hand rub
Aseptic (Surgical scrub)
A 2 minute antiseptic wash (i.e.
chlorhexidine (CHG 4%)) and dry
on sterile towels
In high risk areas (e.g. when
Additional Precautions are
implemented) and during
outbreaks as directed by Infection
Prevention and Control
Prior to surgical and other invasive
procedures
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Cough/Respiratory Etiquette
19
Personal Protective Equipment
20
Contamination Rates
Pathogen
Contamination
rate(s) of health
care workers’
hands (%)
Duration of
persistence on
hands
Duration of
persistence on
inanimate
surfaces
C. Difficile
14-59
unknown
1 day (vegetative
cells) to 5 months
(spores)
E. Coli
unknown
6-90 minutes
2 hours to 16
months
MRSA
up to 16.9
unknown
1 month to 7
months
Rhinovirus
up to 65
unknown
2 hours to 7 days
VRE
up to 41
up to 60 minutes
5 days to 4 months
“Yeasts” including
Candida spp.
23-81
1 hour
1 day to 5 months
Extract from Kampf, G., Kramer, A., Epidemiologic Background of Hand
21and Rubs,
Hygiene and Evaluation of the Most Important Agents of Scrubs
Clinical Microbiology Reviews, Oct 2004, pg. 865.
Education
Understand and demonstrate work
practices that reduce the risk of infection
„
„
„
„
hand hygiene
proper use of personal protective equipment
be immunized
do not come to work with a communicable
disease
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Education
Educate patients/residents/families about
hygiene and infection prevention and
control strategies (ie. Hand Hygiene)
23
Precautions
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Precautions
Additional Precautions are required for
interventions sustained over a period of
time, such as:
Diseases either suspected or confirmed during
their infectious state
Situations in which extensive contamination of the
patient’s environment is expected (e.g. an
incontinent patient with diarrhea which can’t be
contained within a diaper)
Patients infected or colonized with epidemiological
important organisms (e.g. MRSA, VRE)
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26
Contact Precautions
Micro-organism large & bound to skin or body substances
Transmission
•
Transferred through direct contact with colonized or infected host
tissue/secretions OR indirectly from a contaminated fomite
•
Transmission is completed when the care provider transfers the
organism from the fomite to their hands and then to another host or
another host has skin contact with the contaminated fomite
27
Contact Precautions
Prevention
•
Gown & gloves for all direct
care contact
•
Hand hygiene
•
Dedicated toilet & dedicate or
disinfect care assessment
equipment
•
Segregation or cohort
•
Housekeeping (bleach with
C.diff)
28
29
Droplet Precautions
Micro-organism > 5 microns in
size
Transmission
•
Transferred by aerosol of
respiratory secretions,
emesis or diarrhea through
forceful expulsion of these
•
Distance traveled about 2
meters
•
Acquisition through fecal
oral route by contact
transmission or through the
respiratory route
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Norovirus
The Norovirus is
transmitted primarily
through the fecal-oral
route
However, aerosolized
vomit has also been
impacted as a mode
of norovirus
transmission
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Droplet Precautions
Prevention
•
•
•
•
Surgical mask – Patient & HCW
Hand hygiene
Segregation of 1 to 2 metres
Gown & gloves
32
33
Airborne Precautions
Micro-organism is < 5 microns
in size
•
Expelled from the
respiratory tract by cough,
sneeze or laugh
Transmission
•
Transferred to another
host as the particles drift
through the air
•
Acquisition through the
respiratory route
Prevention
•
Negative air isolation/N95
mask
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Organize your work
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Summary
1. Always use Routine Practices
2. Apply appropriate Precautions as required
3. Consult your Infection Control Manual if any
questions
4. Learn your Infection Control Practitioner’s
name and number and call if you have any
questions
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FORMS and MORE FORMS!
ARO
„
Admission
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ARO screening
Identifies at risk populations (NOTE: now req’d
for every patient on entry to a LTC facility on VI)
Supports continued infection control
measures
Informs clinical decisions when infection is
250
present
200
150
CA-MRSA
HA-MRSA
Total
100
50
0
2002-2003 2003-2004 2004-2005 2005-2006
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ARO Screening
A N T IB IO T IC R E S IS T A N T O R G A N IS M S
[A R O s ]
S c r e e n in g Q u e s t io n n a ire fo r A d m is s io n s
F o r S a fe ty 1
st
H o s p ita ls
a d d re ss o g ra p h
Is th e A R O A le rt s h o w in g o n A d m is s io n F o rm ?
Yes
No
A . S c re e n in g Q u e s tio n s
Yes
P le a s e a s k th e fo llo w in g S c r e e n in g Q u e s tio n s :
1.
H a v e yo u b e e n a d m itte d to h o s p ita l fo r 2 d a ys o r m o re (> 4 8 h o u rs ) in th e p a s t ye a r?
T h is in c lu d e s tra n s fe rs b e tw e e n h o s p ita ls & re a d m is s io n s .
2.
H a v e yo u re c e iv e d d ia lys is o r c h e m o th e ra p y in th e p a s t ye a r?
3.
H a v e yo u o r a m e m b e r o f yo u r h o u s e h o ld h a d a s k in in fe c tio n in th e p a s t ye a r th a t w a s
d iffic u lt to tre a t? E x a m p le : a b s c e s s o r b o il.
4.
H a v e yo u o r a m e m b e r o f yo u r h o u s e h o ld b e e n fo u n d to h a v e b a c te ria re s is ta n t to
a n tib io tic s , lik e M R S A /V R E ? C irc le if k n o w n .
5.
H a v e yo u u s e d s tre e t d ru g s o th e r th a n m a riju a n a w ith in th e p a s t 5 ye a rs ?
6.
H a v e yo u s p e n t tim e in a c o rre c tio n s fa c ility w ith in th e p a s t ye a r?
7.
D o yo u liv e o n th e s tre e t (h a v e n o fix e d h o m e a d d re s s )?
If Q u e s tio n n a ire n o t c o m p le te d , s ta te re a s o n & p ro c e e d to S e c tio n “ B ” :
P a tie n t u n c o o p e ra tiv e /r e fu s e d
P a tie n t c o g n itiv e ly im p a ire d /u n c o n s c io u s
S ig n a tu re :
U n it:
No
O th e r _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
D a te :
T im e :
B . A c tio n s
IF
If a n s w e rs to a ll 7 q u e s tio n s a b o v e is N O a n d th e re is N O
A R O A le rt o n A d m is s io n F o rm →
• If a n s w e r to a n y q u e s tio n a b o v e is Y E S o r
if A R O A le rt is p re s e n t o n A d m is s io n F o rm →
• If u n a b le to c o m p le te S c re e n in g Q u e s tio n n a ire →
THEN
N o L a b S p e c im e n s re q u ire d .
st
Im p le m e n t ro u tin e p re c a u tio n s (re fe r to S a fe ty 1 ).
•
•
•
C o lle c t a p p ro p ria te L a b S p e c im e n s
st
A s s e s s fo r in fe c tio n (re fe r to S a fe ty 1 )
Im p le m e n t a p p ro p ria te p re c a u tio n s → o b ta in L a b
S p e c im e n s
C . L a b S p e c im e n C o lle c tio n (S e p a ra te s w a b fo r e a c h A R O )
M R S A : If “ye s ” to a n y A R O s c re e n q u e s tio n o r u n a b le to c o m p le te q u e s tio n n a ire o r A R O a le rt fo r M R S A p re s e n t
C o lle c t s e p a r a te s w a b fro m e a c h s ite :
N a re s
R e c tu m
U n h e a le d o r d ra in in g w o u n d o r a b s c e s s
S to m a , in c lu d in g tra c h e o s to m y, s u p ra p u b ic c a th e te r a n d P E G tu b e s ite s
U rin e if c a th e te r in p la c e
D e v ic e in s e rtio n s ite if IN F L A M E D
a ls o c o lle c t s p u tu m (if p ro d u c tiv e c o u g h )
If “ye s ” to q u e s tio n s # 2 o r # 4 o r A R O a le rt fo r V R E p re s e n t
VRE:
R e c tu m a n d
O s to m y (if p re s e n t)
C o lle c t: S w a b fro m
E S B L : If th e re is a re c o rd o f c lin ic a l in fe c tio n w ith a n E S B L o r A R O a le rt fo r E S B L p re s e n t
U rin e s p e c im e n a n d s w a b fro m
R e c tu m a n d
D ra in in g w o u n d (if p re s e n t)
C o lle c t:
C O L L E C T IO N M E T H O D F O R S W A B S A B O V E
1.
2.
3.
M o is te n tip o f c u ltu re s w a b w ith c u ltu re m e d iu m .
U s e firm c irc u la r/tw is tin g m o tio n .
F o r n a re s , b ris k ly ru b th e m u c o u s m e m b ra n e s (b o th s id e s ) w ith o n e s w a b .
S ig n a tu re :
U n it:
D a te :
T im e :
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