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Preventing & Controlling
the Spread of Infection
Contributors:
Alice Pong M.D., Hospital Epidemiologist
Chris Abe, R.N., Senior Director Ancillary and Support Services
Objectives
Review the magnitude of Hospital
Acquired Infections (HAI) within health
care
Identify the various components of
Standard Precautions and Transmission
Based precautions
Discuss importance of hand hygiene in
the healthcare setting
Discuss multidrug resistant organisms
Identify prevention strategies
Common Types of Hospital Acquired
Infections (HAI)
Urinary Tract Infection (UTI)
Most common infection, mean cost = $1,257
Pneumonia (VAP)
2nd most common, mean cost = $22,875
Surgical Site Infection (SSI)
Mean cost = $17,944
Blood Steam Infection (CA-BSI)
Mean cost = $18,432
Standard Precautions:
Handwashing And Use Of Personal Protective Equipment (PPE) when there is risk of contact with body fluids
Standard Precautions apply to all patients, all the time
.
Hand Hygiene must be performed when:
Hands are visibly dirty or contaminated
Before contacting a patient or entering the patient’s
room
Before putting on gloves
Before performing an invasive procedure
Before eating
After contact with a patient, body fluids, non-intact
skin, contaminated surfaces, or leaving the patient’s
room
After removing gloves
After using the restroom
Hand Sanitizer
Hand sanitizer offer many advantages over traditional hand washing. Hand sanitizer: is more effective at killing most bacteria than standard hand washing
with soap
Reduce the time needed for hand disinfection and kill bacteria faster
is more accessible, especially when a water source (e.g. sink) is not available
is less damaging to skin than soap and water and may actually improve skin condition
However hand sanitizer: is not effective at removing dirt and debris. If hands are visibly dirty,
hand washing with soap and water should be performed.
is not effective at removing spores such as those associated with C. difficile. If caring for a patient with C. difficile, hand washing with soap and water should be performed.
is potentially flammable and hands should be dry before proceeding with patient care activities.
Special Note
on LPs / Epidural placement
Always wear a mask when performing a lumbar puncture to
obtain a specimen or during placement of an epidural. This
protects you and your patients!
Not wearing a mask during this type of procedure can lead to
spinal infections.
Reports of postpartum women with bacterial meningitis caused
by Streptococcus salivarius (a common non-pathogenic oral
bacterium) have been linked to breaches in infection control
practices during epidural placement. Some of these cases
have ultimately led to death. (MMWR January 29, 2010 / 59(03);65-69)
Transmission-Based Precautions
(a.k.a Isolation Precautions)
These extra measures are taken for patients known or suspected to be infected or colonized with a transmissible organism(s)
Precautions are determined by the condition of the patient and the organism involved.
Transmission Based Precautions
The CDC recognizes 3 categories of
isolation
Contact – prevents transmission of
microorganisms spread by direct or indirect
contact with the patient or their environment
Droplet – prevents transmission of organisms
spread by close contact with respiratory
secretions via air.
Airborne – prevents transmission of
organisms that are infectious over long
distances when suspended in air
Precautions always follow
mode of transmission…
Contact Rotavirus, RSV, Shigella,
Drug resistant
Pseudomonas, viral
meningitis
Standard Precautions plus:
gown and gloves for patient
and environmental surface
contact
Droplet Pertussis, Influenza A,
Meningococcal disease,
Mycoplasma
Standard precautions plus:
wear a surgical mask when
within six feet of patient
Airborne Varicella, Measles,
Tuberculosis (pulmonary)
Standard precautions plus:
negative airflow room
required. If susceptible to
varicella stay away or if no
choice wear a surgical mask.
For pulmonary TB and
measles, N95 mask required
Precautions Examples of Diagnosis Precautions
Precaution & What You’ll Need
Airborne
Precautions
Airborne/
Immunity
Precautions
Droplet
Precautions
Contact
Precautions
Private room
Negative pressure
12 air exchanges per
hr
Door closed
Special N95 mask
(for pulmonary TB)
Standard mask on
patient for transport
Private room
Negative pressure
12 air exchanges per
hr
Door closed
Personnel are not to
enter unless they are
immune (have had
illness or vaccinated).
Mask not required for
immune personnel
Standard mask on
patient for transport
Private Room
Door closed
Standard mask
Standard mask on
patient for transport
Private Room or
cohort
Gowns for direct
contact with patient or
environment
Gloves
Masks for cough
inducing procedures
Clean equipment if
used between patients.
Patient specific
equipment if possible.
The Facts: Preventing Influenza
Preventing Influenza transmission in the hospital setting is dependant on staff staying home if sick, good hand hygiene, and vaccination rates among healthcare providers.
Vaccination is key: since a person can shed the influenza virus 24 hours before
onset of symptoms and up to 7 days after symptom onset.
40% of persons infected with the influenza virus may be asymptomatic.
In 2007, Senate Bill 739 requires all physicians to sign an attestation documenting receipt of the vaccine or declining the vaccine with an acknowledgement of the negative impact this could have on the community.
Multi-drug resistant organisms (MDRO)
MDRO are bacteria that are resistant to one or more
class of antimicrobial agents and usually are resistant to
all but one or two commercially available antimicrobial
agents.
MDRO bacteria include methicillin resistant
Staphylococcus aureus (MRSA), vancomycin resistant
enterococci (VRE) and Gram negative bacteria such as
extended spectrum beta-lactamase [ESBL]-producing
bacteria, Stenotrophomonas, Burkholderia species, and
some strains of Acinetobacter.
Clinical Importance of MDROs
Clinical manifestations are similar to infections caused by susceptible pathogens however options for treatment are much more limited.
Suboptimal or prolonged broad spectrum antimicrobial use may lead to suppression of normal flora and/or colonization with the MDRO. Patients are also at higher risk of complications related to C. difficile disease.
MDRO infections and colonization are associated with increases in length of stay, costs and mortality
Promote a culture of safety and be a
role model
Wash your hands frequently, following the rules of when to wash. For the safety of everyone in the health care setting, do not be afraid to speak up when you notice others who are not following appropriate hand washing and disinfection procedures…speak up and hold those around you accountable.
Colleagues, trainees, and other staff watch what you do and research has shown that the actions of clinicians influence the behavior of others. Show your colleagues that hand hygiene is an important part of quality care.
Your patients watch you too and our actions send a powerful message. Show your patients that you are serious about their health and their safety.
Thank You
for Preventing the Spread of
Infection…..