Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
IPRO HAI LAN Reducing C-difficile Transmission in a Community Hospital Contributors Presented by Jessica Hayashi MS RN CIC Samaritan Hospital Mary Beth Farley BS RN CIC St. Mary’s Hospital Tom Wright Manager EVS Samaritan Hospital Martha Luzinas MT ICP Albany Memorial Hospital 5/23/2017 C-difficile: What it Is • Clostridium difficile infection, or C. difficile, is an infection in your colon caused by a spore forming bacteria. • If the C. difficile bacteria grow rapidly, this can disrupt the healthy balance of the colon. • This can cause the lining of the colon to swell, which leads to an infection. C-diff: How is it Transmitted • The bowel movement of a person with a C. difficile infection contains C. difficile bacteria. • Infected people who do not wash their hands after having a bowel movement can spread the infection. • C. difficile bacteria may also be on surfaces, such as the tops of tables. • A person can pick it up on their hands and ingest it. C-diff Incidence in the US: All Onset • September 2, 2011 / 60(34); C-diff Onset: Inpatient vs. Outpatient • FIGURE 1. Percentage of Clostridium difficile infection (CDI) cases (N = 10,342), by inpatient or outpatient status at time of stool collection and type/location of exposures* — United States, Emerging Infections Program, 2010 http://www.cdc.gov/mmwr/preview/mmw rhtml/mm6109a3.htm?s_cid=mm6109a3_w #fig1 The Hospital Problem • Patients are admitted with C-diff and increase risk to others. • C-diff spores persist in the environment. • Uninfected patients ingest spores from environment and become ill with C-diff. What Increases Risk to Patients • • • • • • Antibiotics Hospital stay Age Medical conditions Dormant infection Antacids C-diff: Trajectory Symptoms • • • • • • Fever Cramping pain in your abdomen Diarrhea Nausea or vomiting Dehydration Possible ileus Samaritan Hospital: HO C-diff 2012-2013 12 10 8 6 4 2 C-diff policy in compliance with recommendations Review best practices with Nursing and EVS Special cause analysis: admitting assessment and prompt CDIF_facIncHOCount CDIF_HOIncRate 0 NHSN data analysis Oct. 2013 Bundle Strategies: Antimicrobial Use Restrictions • Antimicrobial stewardship program • Minimize the frequency and duration of antimicrobial therapy and the number of antimicrobial agents prescribed • Discontinue therapy with the inciting antimicrobial agent(s) as soon as possible Bundle Strategies: Diagnosis and Treatment • Diagnosis o Unformed stool- being done • GDH Glutamate Dehydrogenase (antigen screen) • EIA immunoassay- confirms toxigenic A/B o Consider patient with ileus • Need more education to staff • Treatment o Per medical management o Usually Flagyl and Vanco PO o Fidaxomicin -mild to moderate disease Bundle Strategies: Contact Isolation • Suspected or confirmed cases with “soap and water” hand wash reminder • Private room or cohort o If patient identified as positive while in a semi private consider moving the room mate to another room • Precautions maintained for duration of admission • Alert to Housekeeping • Use PPE when entering the patient room o Glove use only when indicated, not in hallway • http://www.cdc.gov/HAI/toolkits/Environmental-Cleaning-Checklist-10-6-2010.pdf Bundle Strategies: Hand Hygiene Efficacy of Handwashing Methods for Removal of C. difficile on Hands of Experimentally Inoculated Volunteers counts Method Warm water & soap Cold water & soap Warm water & antibacterial soap Antiseptic hand wipe Alcohol hand rub Decrease in mean colony Log10 CFU/mL -0.09 95%CI 1.76 1.76 1.47 – 2.05 1.29 – 2.23 1.36 0.59 0.99 – 1.73 0.25 – 0.92 -0.58 – 0.41 Oughton MT, et al. 47th ICAAC Meeting, 2007 C-diff: Environmental Cleaning • Disposable rectal thermometers • Virocept (H2O2) room cleaning • Bleach equipment wipes • Ensure commode cleaning • Ensure equipment that is not dedicated gets cleaned o with bleach or other effective cleaner o before leaving the patient room. C-diff: Environmental Cleaning Troy Acute Care Terminal Cleaning Check list Date:______________ Time:___________________ Initials:___________________ *perform hand hygiene and don PPE before entering room Evaluate the following priority sites for each patient room: High-touch Room Surfaces Bed rails / controls Overbed table IV pole (grab area) Call box / button (including cord) Telephone Bedside stand Chair(s) Top/outside trash can and hamper Room sink (if present) Room light switch(es) Room door knob (front and back) Sanitizer and soap dispenser Outside needle box/cup holder Replace cubicle / room curtains Suction containers (non-disposable portion) Patient locker/closet Bathroom door knob / plate (front and back) Bathroom light switch (es) Bathroom handrails by toilet Bathroom sink Toilet seat / raised seat Toilet flush handle Toilet bedpan cleaner Discard toilet tissue & replace with new roll Commode Cleaned Additional items that may be present in some rooms: High-touch surface Cleaned Hovermat (air mat and pump) IV pump Monitor touch screen/leads Compression Pump machine (leg pumps) Not Present in Room • Daily clean of high touch surfaces o Updated check list for EVS with pictures o Cell phones! o Terminal clean at d/c or if you do discontinue precautions before discharge, clean room with appropriate cleaner. Not present in room *Remove PPE and perform hand hygiene when room complete. * Remove isolation sign 8/22/13 Prevention Strategies: Lessons Learned • Thorough admission assessment and testing where indicated • Presumptive isolation for symptomatic patients pending CDI confirmation • Soap and water hand washing before exiting the room o Reminder signs • Extended use of Contact precautions beyond duration of diarrhea (eg 48 hours) • Bleach cleaning or other approved product • Consider universal glove use on units with high CDI rates CDC HICPAC 2007 except for extended isolation Resources • Centers for Disease Control • IPRO HAI Resources • Healthcare Infection Control Practices Advisory Committee (HICPACC) • Agency for Healthcare Research and Quality (AHRQ) • Association for Professionals in Infection Control (APIC) • Society for Healthcare Epidemiology (SHEA) • Troy Acute Care, St. Peter’s Health Partners Thank You Questions?