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Infection Control REDUCING/PREVENTING HOSPITAL-ACQUIRED INFECTIONS— IT’S EVERYONE’S JOB Objectives Describe Standard and Isolation Precautions Describe transmission and control of MDROs Identify important infection control processes Identify risk factors for Hospital-Acquired Infections (HAI) Infection Control Web Page The Infection Control Web Page can be reached by going to: Kaleidascope Departments and Services Patient Care / Clinical Infection Control Take your questions to the Experts! Infection Control is Everyone’s Business Family/Visitors CNA/PCA/CMA Nutritionists Child Life Healthcare Associated Infections—Some sobering statistics: 7-10% patients develop HAI (This increases to 30% of critically ill patients) 1.7 million HAI Occur annually across the nation More than 99,000 deaths are attributed in part to hospital acquired infections Prevention and Control Methods— Quick, Easy and Simple Use of Standard Precautions Practicing good hand hygiene Use of Personal Protective Equipment, including gloves Attention to Environmental Controls Knowing when and how to use TransmissionBased Precautions Transmission-Based Precautions: CONTACT Precautions Transmission Based precautions: Contact Precautions used for patients with diagnosis of: C.. Difficile MRSA, VRE, ESBL Precautions include Private room Gloves Hand hygiene Gowns Transmission-Based Precautions: DROPLET Precautions Communicable diseases are passed on by droplet dispersion. These include: Upper respiratory infections (cold and flu) Neisseria meningitis Pertussis or whooping cough Adenovirus Precautions to prevent spread of droplet-borne diseases include: Private room Hand hygiene Use of surgical mask if within 6 feet of the patient. Airborne Isolation is a means of protecting against the spread of some diseases: These diseases include: Varicella Virus (Chicken pox, Disseminated Shingles)Surgical Mask M. tuberculosisN-95 respirator Mask Pandemic Flu Airborne Isolation Place in negative pressure room Wear respirator for TB, Pan flu Facilities Management (daily smoke test) Keep doors closed Mask patient for transport Communicate with other departments Instruct visitors: N-95 respirator use OSHA Reg’s-Fit testing Annually! Transporting Patients Transporting Patients on Special Precautions Droplet/Airborne: mask patient Contact: cover open areas Minimize travel off unit Off-unit procedures: last case of the day Hand Hygiene Culture plate showing growth of bacteria 24 hours after a nurse placed her hand on the plate When to Wash Your Hands Upon arriving Entering patient room Leaving patient room Between patients in same room After handling patient equipment Before/after handling specimens Before serving food After toileting Before donning gloves After glove removal Before leaving work Are alcohol-based hand rubs really effective? More than 20 published studies have shown that alcohol-based hand rubs are more effective than either plain soap or antibacterial soaps in reducing the number of live bacteria on the hands. Advantages of cleaning hands with alcoholbased hand rubs When compared to traditional soap and water hand washing, alcohol hand rubs have the following advantages: take less time to use can be made more accessible than sinks cause less skin irritation and dryness are more effective in reducing the number of bacteria on hands Kaleida Health makes alcohol-based hand rubs readily available to personnel has led to improved hand hygiene practices A 24-year-old man who had quadriplegia due to a traumatic spinal cord injury was found on routine surveillance cultures to have methicillin-resistant Staphylococcus aureus (MRSA) colonization of his anterior nares. He had no history of MRSA infection or colonization. To assess the potential implications of the patient's MRSA carriage for infection control, an imprint of a health care worker's ungloved hand was obtained for culture after the worker had performed an abdominal examination of the patient. The MRSA colonies grown from this handprint on the plate (CHROMagar Staph aureus). After the worker's hand had been cleaned with alcohol foam, another hand imprint was obtained, and the resulting culture was negative for MRSA (Panel B). These images illustrate the critical importance of hand hygiene in caring for patients, including those not known to carry antibiotic-resistant pathogens. This is the image………………………… January 15, 2009 Image of before (A) and after (B) using Alcohol based hand foam…… A. Before using hand foam B. After using hand foam When should you wash your hands with soap and water? Wash your hands with plain soap and water, or with antimicrobial soap and water if: your hands are visibly soiled (dirty) hands are visibly contaminated with blood or body fluids before eating after using the restroom after caring for patients with C diff Multi-Drug Resistant Organisms and Clostridium Difficile •C-DIFF •MRSA VRE So What’s The Fuss All About ? Drug resistant Pathogens are a growing threat 2 Million patients acquire a HAI 90,000 patients die as result of a HAI 50% -70% of S.aureus isolates are MRSA > 70% of bacteria that cause HAI’s are resistant to at least one antibiotic used for treatment Source: CDC Financial Impact of MRSA Annual cost to treat MRSA patients in the U.S. between $ 3.2 billion and $ 4.2 billion Extra cost associated: a blood stream infection $ 17,422 (MSSA $ 9,661) a surgical site infection $ 36,133 (MSSA $ 4,989) Source: Abramson,ICHE1999;20:408 Engelman et al. 2001;ICAAC Cosgrove et al Clin Inf Dis 2003;36:53-59 Cosgrove et al. ICAAC 2001 Kaye et al. ICAAC 2002 International Society of Pharmacoeconomics Outcome Research, 5/05 Cheng, J Hosp. Inf. 1988; 12:91-101 Wakefield, AJIC 1988; 16: 185-192 The inanimate environment is a reservoir of pathogens ~ Contaminated surfaces increase cross-transmission ~ Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+) Patient Environment. Hayden M, ICAAC, 2001, Chicago, IL. Eating and Drinking The previous slide displayed why it is so important not to eat or drink around the patients. OSHA Food Regulation and drink should not be consumed in patient care areas or areas where contamination with blood or other potentially infectious material could occur. Environmental Surfaces Toys and playroom surfaces should be disinfected as often as possible, but at least daily. Is someone designated to clean toys and surfaces on each floor??? Personnel Health Guideline The following are guidelines for personnel who have various diseases Disease Entity 1. Strep Throat 2. 3. Zoster a) Localized b) General Viral Upper respiratory infection Staff restrictions 1. Restrict working until 24 hours after start of antibiotics Zoster 2. a) b) 3. Cover lesions; restrict from caring for high risk patients Restrict from patient contact until lesions are dry/crusted Consider exclusion from care of high risk patients Personnel Health Guideline con’t Disease Entity 4. Conjunctivitis Staff Restrictions 4. Restrict from patient care until discharge ceases 5. HSV-1 a) Hand 5. HSV-1 a) Restrict until lesion(s) healed b) Evaluate worker for need to be restricted from care of certain patients b) Oro-facial Questions If you have any questions regarding how to prevent Hospital Acquired Infections, please contact the Infection Control Specialist at your own site. Preventing infection is – everyone’s job!