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By MaryAnn Custer MS, FNP S. Pneumoniae 60,000 cases / year in 2000, 37,000 in 2002 Death in 14% of Hospitalized Adults *Pneumococcal Vaccine Up to 25 days (dust), Glass 1-11 days , 7 days in Sputum CAP Influenza 3-4 Million Cases / Year in the US 6th Leading Cause of Overall Death Highest in Children < 5, and Elderly 5th Leading Cause of Death in the Elderly Prevention – Immunization TB Causes more Deaths Worldwide than Any Other Infectious Disease Spread Person to Person - Aerosolized Droplets Up to 70 days in Carpet, Clothes 45 days, Sputum 6-8 months C – Difficile Spore Forming Organism Opportunistic Pathogen Fecal-oral Transmission May survive for extended periods outside Host Listeria Opportunistic Pathogen Usually assoicated with food Survives well in Soil, Water, Food, Feces MRSA Methicillin Resistent Staphylococcus Aureus HA MRSA – Hospital Associated ~ 1961 - 50-70% Estimated Cost to Treat Between $3.2 – $4.2 billion/year Joint Commission National Patient Safety Goals and Institute for Healthcare Improvement 5 Million Lives Campaign Respiratory, Urine, Wound Infections CA MRSA – Community Associated – mid to late ‘90s Skin and Soft Tissue Direct and Indirect Transmission Survival in Hospital Environment 1 – 56 days Norovirus Cruise Ships – 2002 Previously Known as Norwalk – like Viruses. Changed in 2002 1968 – 1972 Outbreak of “Winter Vomiting Disease” in Norwalk, OH Acute gastroenteritis – “stomach flu” or “24 hour bug” Explosive vomiting, watery (non bloody) diarrhea, abd cramps, HA, body aches, low-grade fever. 24-60 hours #1 Cause of Foodborne Illness in US, causing about 2/3 of all foodborne illness – 23 million infections, 50,000 hospitalizations, 300 deaths / year. Transmission fecal-oral (food and water) – Direct & Indirect, also airborne (inhale and swallow droplets) Highly transmissible – as few as 10 viral particles may cause infection. Only the “Common Cold” is reported more frequently. Virus is stable on environmental surfaces – Non enveloped virus. Quats work by disrupting the viral envelope and are ineffective on non enveloped viruses. “Getting Back to the Basics” Cleaners and Disinfectants Hand Hygiene Products Precision Blend System Gloves, Masks, Gowns Mops, Buckets, & Cleaning Cloths Waste, and Biohazard Containers Reduce the Risks of Disease Transmission through…. PREVENTION Epidemiologic Triangle Environment Causal Agent Susceptible Host Alter the Environment HAND HYGIENE Observe Standard Precautions Combination of Universal Precautions and Body Substance Isolation. Wear personal protective equipment in accordance with OSHA’s standards, and facility recommendations: Gloves, Goggles, Mask, Fluid Resistant Gown. NOTE: GLOVES ARE A MINIMUM DURING CLEANING AND DISINFECTION Cleaning and Disinfection of Equipment & Environmental Surfaces Choosing the Correct Chemical Germicide Definitions A "disinfectant" is a substance that destroys or eliminates a specific species of infectious or other public health microorganism, but not necessarily bacterial spores, in the inanimate environment. * A "sanitizer" is a substance that significantly reduces the bacterial population in the inanimate environment, but does not destroy or eliminate all bacteria or other microorganisms. * (* EPA March 2002) Two Levels of Disinfection for Environmental Services Intermediate Disinfection (ILD) – Inactivate Mycobacterium Tuberculosis var. Bovis in addition to all other organisms below it. ex. 3% Hydrogen Peroxide, 70% Isopropyl, Phenolics, Iodophors, and the other ready to use tuberculocidal solutions Low-Level Disinfection (LLD) – Inactivate most forms of bacteria, some fungi, some viruses. ex. Quaternary Ammonium Solutions DESCENDING ORDER OF RESISTANCE TO GERMICIDAL CHEMICALS Sterilization BACTERIAL SPORES Bacillus Subtilis Clostridium Sporogenes MYCOBACTERIA Mycobacterium Tuberculosis Var. Bovis ‘TB’ HLD High Level Disinfection ILD Intermediate Level NONLIPID OR SMALL VIRUSES Poliovirus Coxsackie Virus Hepatitis A Virus Rhinovirus ‘Common Cold’ FUNGI Trichophyton Spp. ‘Nail Fungus’ Cryptococcus Spp. Candida Spp. ‘Yeast’ LLD Low Level VEGETATIVE BACTERIA Pseudomonas Aeruginosa Staphylococcus Aureus ‘Staph’ Salmonella Choleraesuis ‘Gastroenteritis’ LIPID OR MEDIUM-SIZED VIRUSES Herpes Simplex Virus ‘Cold Sores’ Cytomegalovirus ‘CMV’ Respiratory Syncytial Virus ‘RSV’ Hepatitis B Virus ‘HBV’ Human Immunodeficiency Virus ‘HIV’ (Adapted From Bond & Favaro, 1991) Recommending Chemical Germicides