Download The Chain of Transmission

AHRQ Safety Program for Long-Term Care: HAIs/CAUTI
Clean Equipment and Environment:
Knowledge and Practice
Training Module # 2 for the LTC Core Team
Current as of July 2015
Learning Objectives
After completing this session, facility team leaders and core team
members will be able to:
•
Describe the chain of infection and identify key strategies to break the
chain
•
Explain catheter care and maintenance strategies that facility staff can
use to prevent residents from acquiring a catheter-associated urinary
tract infection (or CAUTI)
•
Explain the role of the environment as a place where pathogens can
become a source of infection for residents and staff
•
Summarize strategies to improve cleaning and disinfecting practices using
the training materials for all facility staff
2
Protecting Residents Against Infection
The Chain of Transmission:
Six Links
Each link stands for something (or someone)
that helps pass on an infection.
An infection can be passed from one person to
another person as long as the links of the
chain are joined together.
Siedlaczek G. SJMHS
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Breaking the Chain of Infection:
The Role of LTC Facility Staff
The Chain of Transmission: Six Links
How Can HCW Break the Chain
of Infection?
Education
•
•
•
•
•
Hand hygiene
Gloves
Clean rooms
Disinfected surfaces
Proper medical device care and
maintenance
Ensure residents have:
•
•
•
•
•
Good personal hygiene
Covered cuts/wounds
Isolation when necessary
No unnecessary antibiotics
Proper waste disposal
Siedlaczek G. SJMHS
4
The Usual Bacteria Suspects:
Multidrug-resistant Organisms (MDROs) Common in LTC
Residents with an indwelling catheter are more likely to
have one of these MDROs
Mody L, et al. Clin Infect Dis 2011;52:654-51
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Front-line Staff Training Recap
•
Microbes can enter an indwelling urinary catheter’s
closed system during insertion, care and maintenance
of the catheter and drainage bag
•
Conduct routine hygiene of the resident and
remember hand hygiene
•
Stabilization devices reduce irritation that may
increase the risk for serious infection
•
Urine measuring devices should never be shared and
should be cleaned and dried between use
6
Entry Pathways for Microbes
• Aseptic technique plays a key
role in preventing catheter or
drainage bag contamination
• Routine hygiene is important
• Disinfect the port before
obtaining a urine culture
• Check catheter, tubing and
drainage bag for
disconnection, kinks
7
Hand Hygiene
Good
Plain soap
Better
Antimicrobial
soap
Best
Alcohol-based
hand rub
8
Protecting Residents Against Infection:
Role of Clean Equipment and Environment
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
Zimmerman S, et al. JAGS 2002;50:1987-95.
9
MRSA and the Environment
• MRSA is a growing problem in LTC
• A study of 10 long-term care facilities
found MRSA present on 16% of
surfaces tested
Methicillin-resistant
Staphylococcus aureus
MRSA
• MRSA was more often present in
residents’ rooms that were cleaned
less frequently and for less time
Murphy CR, et al. JAGS 2012;60:1012-18
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Survival of Select Microbes on
Environmental Surfaces
Microorganism
Survival on Environmental
Surfaces
Bacteria
Clostridium difficile (C. diff) spore > 1 yr.
Vancomycin-resistant Enterococci 5 days – 4 months
(VRE)
Methicillin-resistant
Staphylococcus aureus (MRSA)
7 days – 7 months
Viruses
Hepatitis B virus (HBV)
> 1 week
Human immunodeficiency virus
(HIV)
3 – 4 days
Norovirus
8 hrs – 7 days
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
12
Is It Really Clean?
Experience With Fluorescent Marker in LTC
% Removed
90%
78%
80%
68%
70%
60%
50%
% Removed
40%
30%
27%
20%
10%
0%
Baseline
2 months
6 months
Applegate D, et al. Evaluation of environmental cleaning in LTC Facilities, ID Week 2012
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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 LTC front-line staff 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
14
What Role Does Leadership Play in
Cleaning and Disinfecting Practices?
Let’s Chat!
What can leadership do to make
disinfection a priority and easily
accessible to staff?
15
Examples of Surfaces
That Are Frequently Touched
• Door handles
• Call button
• Telephone
• Bed rail
• Tray table
• Bedside table
• Light switches
• Bedside commode
Challenges and Solutions to Ensuring a
Clean and Disinfected Environment
Let’s Chat!
• What cleaning and disinfecting challenges do you
experience in your facility?
• What solutions do you propose to address these challenges
in your facility?
• How can you support a culture of safety around cleaning
and disinfection?
17
Get Prepared to Engage LTC Staff
in Skills Practice
Obtain the cleaning products and read the instructions
on the labels.
• What PPE needs to be worn?
• What’s the contact time?
• How do you properly store the cleaning product?
• How do you properly dispose of the cleaning
product?
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Engagement Activity:
How Clean Is it Really?
Fluorescent marker: if present after
cleaning, indicates need to repeat
Adenosine triphosphate (ATP): measures level of
soil on a surface
Environmental cultures:
surface sampling for bacteria
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Wrap-Up
•
Clean environment and clean equipment keep residents safe.
Things that may look clean can still have germs on them.
•
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: HAIs/CAUTI website
Login information
Username: ltcsafety
Password: ltcsafety
2. TeamSTEPPS® for Long-term Care
3.
CatheterOut.org
4.
Take the Pledge… to Practice All Infection Prevention Skills
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References
Applegate, D. Simpson, K. Wesley, C. Carling, P. (2012). Evaluation of environmental cleaning in Long Term Care Facilities. IDSA ID Week 2012,
Poster No. 1605. Retrieved from https://idsa.confex.com/idsa/2012/webprogram/Paper35775.html
Fowler K. Catheterout. Retrieved from http://catheterout.org
State Operations Manual. Appendix A - Survey Protocol, Regulations and Interpretive Guidelines for Hospitals. Centers for Medicare and
Medicaid Services (CMS). (2015, July 10). Retrieved from https://www.cms.gov/Regulations-andGuidance/Guidance/Manuals/Downloads/som107ap_a_hospitals.pdf
Duckro, A.N. Blom, D.W. Lyle, E.A. Weinstein, R.A. Hayden, M.K. (2005). Transfer of vancomycin-resistant enterococci via health care worker
hands. Archives of Internal Medicine 165, 302-307.
Kramer, A. Schwebke, I. Kampf, G. (2006). How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect
Diseases. 6(130), retrieved from http://www.biomedcentral.com/content/pdf/1471-2334-6-130.pdf.
McFarland, L.V. Beneda, H.W. Clarridge, J.E. Raugi, G.J. (2007). Implications of the changing face of Clostridium difficile disease for health care
practitioners. American Journal of Infection Control. 35(4), 237-253.
Maki, D.G. Tambyah, P.A. (2001). Engineering out the risk of infection with urinary catheters. Emerging Infectious Diseases. 7(2), 342-347.
Retrieved from http://www.cdc.gov/ncidod/eid/vol7no2/makiG1.htm
Mody, L. Bradley, S.F. Galecki, A. Olmsted, R.N., Fitzgerald, J.T. Kauffman, C.A. Saint, S. Krein, S.L. (2011). Conceptual model for reducing
infections and antimicrobial resistance in skilled nursing facilities: focusing on residents with indwelling devices. Clinical Infectious
Diseases. 52(5), 654-651.
Murphy, C.R. Eells, S.J. Quan, V. Kim, D. Peterson, E. Miller, L.G. Huang, S.S. (2012) Methicillin-resistant Staphylococcus aureus burden in
nursing homes associated with environmental contamination of common areas. Journal of American Geriatric Society. 60(6), 1012-1018.
Siedlaczek, G. Infection Prevention & Control Services. [Powerpoint slide]. Retrieved from
http://www.stjoeschelsea.org/documents/meded/InfectionPrevent.pdf
Zimmerman, S. Gruber-Baldini, A.L. Hebel, J.R. Sloane, P.D. Magaziner, J. (2002). Nursing home facility risk factors for infection and
hospitalization: importance of registered nurse turnover, administration, and social factors. Journal of American Geriatric Society. 50(12),
1987-1995.
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