Download Training Module # 2 for All Long-term Care Staff

AHRQ Safety Program for Long-Term Care: HAIs/CAUTI
Clean Equipment & Environment
Promotes Safe Resident Care
Training Module # 2 for All Long-term Care Staff
Current as of July 2015
Learning Objectives
Upon completion of this session long-term care staff 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 catheterassociated 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
•
list the important steps when using environmental disinfectants.
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Protecting Residents Against Infection
The Chain of Transmission: 6 Links
New
Resident
(Susceptible
Host)
Infectious
Agent
Each link stands for something (or
(Viruses or
Bacteria)
someone) that helps pass on an infection.
Resident
Chain
(Reservoirs)
of
Entry of
New
Resident
An infection can be passed from one
person to another person as long as the
Infection
Exit Resident
links of the chain are joined together.
(Portal of Exit)
(Entry Portal)
Mode of
Transmission
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 You Break the
Chain of Infection?
Education
•
•
•
•
•
Hand hygiene
Gloves
Clean rooms
Disinfect surfaces
Proper medical device care
and maintenance
Ensure residents have:
Siedlaczek G. SJMHS
•
•
•
•
•
Good personal hygiene
Covered cuts/wounds
Isolation precautions
No unnecessary antibiotics
Proper waste disposal
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Indwelling Urinary Catheter
Entry Pathways for Microbes
Bladder
• Entry during insertion
• Bacteria movement up
the catheter
Urethra
(Urinary tract
entrance)
Urine Collection Bag
• Breaks in the catheter tubing
or collection bag
• Contamination of the catheter
tubing or collection bag
Figure Source: 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; CMS, State Operations Manual, 2014.
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Entry Pathways for Microbes
Urine Collection Opening
• Sterile technique is important
when inserting urinary catheters
• Routine hygiene is important
(e.g., cleansing of the area
around the urethra during
bathing or showering)
• Disinfect port with alcohol swab
for 15 seconds before obtaining a
urine culture
• Check site for possible
disconnection of catheter from
drainage bag
• System may become an
open system if the outlet is
left unclamped
Catheterout.org
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Indwelling Urinary Catheter
Stabilization Devices Can Help Prevent Microbe Entry
Catheter Stabilization Devices
Seal over junction between
catheter and drainage bag.
7
Hand Hygiene
Good
Plain soap
Better
Antimicrobial
soap
Best
Alcohol-based
hand rub
8
Case Review of an Outbreak
The case of the common urinometer
• A LTC facility has an outbreak of MDR-Serratia marcescens UTIs
• Risk factors
– Use of common measuring device between residents with indwelling urinary
catheters
– Hands of HCWs contaminated with outbreak strain after use of device; they
helped pass the microbes between residents
• The outbreak stopped after the measuring device was disinfected
between each use
• Dedicate one device per resident.
Rutala WA, et al. Am J Med 1981;70:659-73.
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Role of Clean Equipment and Environment
Protecting Residents Against Infection
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
Microorganism
Survival on Environmental Surfaces
Bacteria
Clostridium difficile (C. diff.) spore
> 1 yr.
Methicillin-resistant Staphylococcus aureus (MRSA)
7 days – 7 months
Viruses
Human immunodeficiency virus (HIV)
3-4 days
Norovirus
8 hrs – 7 days
Zimmerman S, et al. JAGS 2002;50:1987-950.
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
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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 you 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
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Commonly Touched Areas in LTC Facility
Let’s Chat!
What are some examples commonly touched
surfaces in your facility?
• Door Handles
• Bedside table
• Call Button
• Light Switches
• Telephone
• Bedside commode
• Bed Rail
• Tray Table
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Disinfection in LTC Facilities
Read the Label First!
Follow Instructions for Use – Check the label on
disinfectants for the following key safety steps:
 Precautions you should take when applying the product,
such as wearing gloves.
 If the disinfectant is safe for the surface.
 Whether the disinfectant needs to be diluted with water
before use
 How to apply the disinfectant to a surface
 How long you need to leave it on the surface to be effective
(contact time)
 If the surface needs to be cleaned first and rinsed after using
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Disinfectant Wipes
Keep It Wet—The surface being disinfected needs to be wet long
enough to meet the contact time stated on the label.
Cover the Surface Well—Choose the right size wipe based on the size
of the surface.
•
•
Small wipes are fine for bedside tables
Larger wipes for larger areas, like mattress covers
Keep the Cover Closed & Secure After Use—Keep the top of the
dispenser closed to prevent the wipes from drying out.
• Also think about where the dispenser is stored – can residents access the
wipes?
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Improving Cleaning and Disinfection
Let’s Chat!
1.
Where are your cleaning and disinfection supplies?
2.
What would help remind you to clean and disinfect surfaces
thoroughly?
3.
What is your role in ensuring surfaces are clean and disinfected?
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Wrap-Up
•
Clean environment and equipment keep residents safe
•
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: CAUTI Project Website
Login information
Username: ltcsafety
Password: ltcsafety
2.
TeamSTEPPS® for Long-Term Care
3.
Take the Pledge…
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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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