Infection control
When washing with soap and water
-Remove rings, jewelry, and watches -Pre-wet hands with running water (lukewarm) -Use an appropriate amount of soap -Rub all surfaces of the hands and wrists for 20 seconds (sing Happy Birthday twice) -Rinse thoroughly under running water -Close the faucets with paper towels -Dry hands by patting with a disposable towel
Personal Reliabilityy and Accountability rules to follow
-Report all unprotected exposures, such as accidental needle sticks or blood/bodily fluid splashes to the eyes and mouth -Get vaccinated ANNUALLY! -Stay home from work when you are sick. When you become ill while at work, you should go home.
Four categories of infections account for approximately three quarters of HAIs in the acute care hospital setting including:
-Surgical site infections -Central line-associated bloodstream infections -Ventilator-associated pneumonia -Catheter-associated urinary tract infections
Multi Drug Resistant Organisms
-The more antibiotics are used, the more common resistant strains of bacteria become -Multi-Drug Resistant Organisms (MDROs) have increased in prevalence in US hospitals over the last three decades.
Second Choice drugs
-When an infection is resistant to the antibiotic of choice, other antibiotics must be used instead -Less effective against the bacteria -More toxic to the patient -More expensive
The Bloodborne Pathogen Standard
-a federal regulation administered by OSHA (Occupational Health and Safety Administration) in 1991. -Goal is to eliminate or minimize occupational exposure to Hepatitis Viruses, Human Immunodeficiency Virus (HIV), and other bloodborne pathogens by using personal protection equipment- Gloves, eye protection, gowns
Health care associated infections
-are infections that patients acquire while receiving treatment -occur in all settings of care -account for an estimated 1.7 million infections and 99,000 associated deaths each year -affect 5 to 10% of hospitalized patients annually and they add nearly $28-33 billion to health care costs.
Bloodborne diseases
-are those which are transmitted through the blood or other body fluids -
TRANSMISSION BASED ISOLATION PRECAUTIONS
-designed for patients documented or suspected to be infected or colonized with organisms that require additional precautions beyond the standard precautions necessary to interrupt transmission --The precautions may be combined for diseases that have multiple routes of transmission. These precautions are always to be used in addition to standard precautions.
Droplets are generated during ?. How far can they travel? And how do they enter another person
-during coughing, sneezing, talking, etc. -Travel a short distance through the air (usually up to three feet, rarely up to 10) -Droplets may land on the mucous membranes of a nearby person's eyes, nose, or mouth
Contact precautions are indicated for ?
-indicated for any patient regardless of organism who has uncontrolled/uncontained secretions/excretions/drainage -Additionally, specific other diseases/colonizations also require contact precautions These include: a. VRE b. MRSA c. C Diff d. MDRO's e. ESBL producing gram negatives f. Carbapenemase producing gram negatives
The Needle Stick Safety and Prevention Act
-mandated that the 1991 Bloodborne Pathogen Standard (29 CFR 1910.1030) be revised to strengthen the requirements related to the use of safety-engineered sharp devices -The revised standard clarifies the need for employers to select safer needle devices and to involve employees in identifying and choosing these devices. The updated standard also requires employers to maintain a log of injuries from contaminated sharps.
PP helps prevent the spread of microorganisms between...
-patients to health care workers and health care workers to patients
Regulated medical waste includes
-sharps, infectious cultures, bulk blood/blood products, body parts, and pathological waste. -Any item soaked with blood that is dripping
There are two tiers of isolation precautions used in the hospital
-standard -transmisison based
How do airborne diseases enter a person
-through the respiratory tract via the droplet nuclei or small particles (less than 5um) -may be dispersed over long distances by air currents and suspended in air and may be inhaled by susceptible individuals who have not had face-to-face contact with (or been in the same room with) the infectious individual. -may be dispersed over long distances by air currents and suspended in air and may be inhaled by susceptible individuals who have not had face-to-face contact with (or been in the same room with) the infectious individual.
STANDARD ISOLATION PRECAUTIONS
-used routinely for the care of all patients regardless of diagnosis or presumed infection status and organism
Standard precautions apply to the patient's ?
Blood Bodily fluids Secretions and excretions (except sweat) Non-intact skin Mucous membranes
Workers in the health care industry and related occupations are at risk of occupational exposure to bloodborne pathogens via
Blood and semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid
Current CDC guidelines for hand washing
Soap and water Alcohol-based hand rubs Alcohol based hand rubs do not kill Clostridium Difficile!
how do we handle medical waste
must be collected, stored, and shipped in leak-proof containers and disposed of by off-site incineration (which must be tracked).
When are standard precautions to be used
must be used in the care of all patients, every time and every encounter.
When are standard precautions used
must be used in the care of all patients, regardless of their diagnosis or organism, at all times, and for every encounter
Should you wear PPE equipment when not providing a care to a patient
no
The single most important factor for preventing the spread of infection is
proper hand hygiene
Exposures to blood borne pathogens/fluids that carry them can occur via
via needle stick injury, exposure to mucous membranes, or non-intact skin.
Clinically important examples of Multi-Drug Resistant Organisms (MDRO) include:
-Acinetobacter -Klebsiella Pneumoniae Carbapenemase (KPC) -C. Difficile
N95 respirator mask
-All health care staff must be fit tested for an appropriate N95 respirator mask. -N95= 95% efficient at filtering 1 um particles
Contact Precautions-Gloves Gowns and Hand antiseptics
-All health care workers entering a room must wear disposable gloves. -Gowns must be worn for all direct patient contact or anticipated contact of clothing with environmental surfaces and/or patient-care items that may be contaminated. -Hand hygiene must be practiced after glove removal.
Standard precautions protect heath care workers from exposure to a patient's ?
-Blood -Bodily fluids, secretions, and excretions (except sweat) -Non-intact skin -Mucous membranes
Routes of transmission
-Direct contact -droplet -airborne
Antibiotic resistance affects:
-Drug choice -patient health -the health care system
Important blood borne diseases include
-HIV/AIDS -Hep B -Hep C
What are the standard precations that must be used in the care of all patients
-Hand hygeine -goives -mask, eye protection, face shield, gown -patient-care equipment and linens -environmental care -bloodborne pathogens -patient placement -disposal of waste -handling of medical waste -specimen collection
When should hands be washed
-Hands should be washed or decontaminated before and after each direct patient contact. -It is appropriate for patients to ask or remind health care providers to practice hand hygiene!
Clinically important examples of resistant organisms include
-Methicillin-resistant Staphylococcus aureus (MRSA) -Vancomycin-resistant Enterococci (VRE) -Drug-resistant Streptococcus pneumoniae (DRSP) -Multi drug-resistant Mycobacterium tuberculosis (MDR-TB)
Examples of droplet diseases
-Mumps -Haemophilus pneumoniae type B -Mycoplasma pneumonia -Rubella -Influenza (seasonal and novel H1N1) -Meningococcal meningitis -Pertussis -Parvovirus B19
Contact Precaution-Patient care equipment
-Non-critical equipment should be dedicated to a single patient or cohort on Contact Precautions -If this is not possible, equipment should be cleaned and disinfected between patients.
Employers require yearly ? to make sure you are free from TB
-PPD -Chest X ray
HAI can be very costly in terms of
-Patient Life and health -health care dollars
Contact Precaution-Patient transport
-Patient transport should be limited as much as possible
Contact Precautions-Patient Placement
-Patients on Contact Precautions are isolated in private rooms or cohorted..
Strategies for preventing the spread of antibiotic resistance.
-Preventing infection -Diagnosing and treating infection effectively -Using antibiotics prudently -Preventing spread of infection
When decontaminating hands with an alcohol waterless rub
-Remove jewelry -Apply the amount of rub recommended by the manufacturer -Rub all surfaces of the hands and wrists until hands are dry
which patients are placed on Droplet Precautions
Droplet Precautions are to be used, along with Standard Precautions, in the care of all patients with a diagnosed or suspected droplet-transmitted disease.
2nd highest percentage of HAIS 3rd 4th
2=surgical site infections 3=bloostream infections 4=pneumonia
Many HAIs are related to ?, especially
Invasive procedures -Catheterization -IV line placement
Respiratory Protections (Transmission-based Precautions: Airborne Precautions)
Health care staff must wear personal respirators whenever they enter an airborne isolation room or negative pressure room. Health care staff must wear N95 personal respirators, to which they have been previously fit tested, whenever they enter.
Patients on Droplet Precautions -Masks
Health care staff should use surgical masks whenever caring for or working within 3 to 6 feet of a patient on Droplet Precautions.
Patients with resistant infections tend to have
Lengthier illness Higher medical bills Greater risk of death
? of all bacteria that cause HAI are found to be resistant to one or more commonly used antibiotics.
More than 70%
Patients on Droplet Precautions-Patient Transport
Patient transport should be limited as much as possible.
Patient transport (Transmission-based Precautions: Airborne Precautions)
Patient transport should be limited as much as possible. Patients should only leave an Airborne Precautions room only for essential purposes (diagnostic tests, surgery, etc.). When patients leave Airborne Precautions rooms, they must wear a regular surgical mask.
Patient Placement (Transmission-based Precautions: Airborne Precautions)
Patients on Airborne Precautions are isolated in private rooms with special air handling and ventilation systems.
Patients on Droplet Precautions-Patient Placement
Patients on Droplet Precautions should be isolated in private rooms or cohorted. If a private room is not available and cohorting is not possible, patients should be placed at least 3 to 6 feet away from the nearest patient or visitor. Doors can be left open.
? comprise the highest percentage (34%) of HAIs
Urinary tract infections
One of the best techniques we have to prevent infection is
Vaccination
HAIs may be caused by
bacteria, viruses, fungi, or parasites that come from: a. Environmental sources (dust, medical equipment, doorknobs, etc.) b. Other patients c. Staff members d. Hospital visitors
All PPE is to be removed when ?
immediately after use
UTI infections are commonly associated with
indwelling urinary catheters