CDC Nursing Home Infection Prevention Exam

How many Americans does the 15,600 CMS provide to each year?

3 million Americans

Skin and Soft Tissue Infections

95% of skin infections are treated with antibiotics (more than 50% of antibiotics prescribed ordered by off-site provider, less than 50% had documented follow-up evaluation ithin 48 hours which all requires regular evaluations - scabies and bed bugs are common causes of infections and outbreaks in nursing homes)

Clostrodium difficile - C.Diff

A germ (bacterium) that causes diarrhea and colitis (an inflammation of the colon), commonly transmitted through bacterial spores - symptoms include diarrhea, belly pain, and fever; treatment includes antibiotics (often included in AR) CONTACT PRECAUTIONS NEEDED

Susceptible Host

A person likely to get an infection or disease - depends on persons characteristics like age

Tuberculosis

A serious infectious disease caused by Myobacterium tuberculosis, national incidence is low but there are populations with high rates like those over 65, approx. 90% of cases among older adults are from reactiviation of latent infection

Antibiotic Stewardship

A set of commitments and actions designed to optimize treatment of infections while decreasing adverse events and harms associated with antibiotic use - measure antibiotic prescribing, ensure prompt initiation of the right antibiotics when needed, ensure right drug, dose, duration, are selected when antibiotic is started

OSHA Staff Education

Circumstances to wear PPE, donning, doffing, failure/ breech, safely discarding PPE - employees must be offered training upon hire, annually, when new products are introduced, when new policies are written, and in response to deviations

How to Collect a Sample for Urinalysis

Cleanse sampling port with disinfectant, access sampling port with sterile syringe or needle (drainage bag should only be accessed for non-culture related analysis)

Staphylococcus aureus

Colonizes anteriors nose and skin of about 30% of adults (common cause of skin, soft tissue, and wound infections) - skin abscess, cellulitis, wound infections with purulent drainage, can cause invasive bloodstream infections in indwelling residents

Semi-Critical Equipment

Comes into Contact with mucous membrane and noninstact skin. Ex: cuticle and nail clippers. Requires high-level disinfection complete elimination of all microorganisms, except small number of bacterial spores

Non-Critical Equipment

Comes into contact with intact skin like BP cuffs, stethoscopes, rehab. equipment and walking aids -> low to intermediate disinfection

Peripheral Inserted Central Catheter (PICC)

Common in nursing homes, inserted in peripheral vein (upper arm, threated into a central vein) can be left in for weeks -> months (inserted by radiologists or nursing specialists)

CDRSS

Communicable Disease and Reporting Surveillance System

CDS

Communicable disease service

When Putting Resident on TBP, HCP Should...

Communicate with resident the reasons for initiating precautions, PPE staff will be using, whether resident has limitations, inform resident when TBP has been modified, signage in front of resident room should explain TBP but NO PERSONAL INFORMATION/ DIAGNOSIS

Norovirus

Highly contagious, spreads by direct contact, alcohol-based hand rubs may not be effective - can get it from having direct contact with an infected person, consuming contaminated food or water, touching contaminated surfaces and then putting your unwashed hands in your mouth - single type of virus that causes gastroenteritis CONTACT PRECAUTIONS NEEDED

How Antibiotic Resistance Happens

Lots of germs, a few drug resistant, antibiotics kill illness which also kills good and bad bacteria, drug-resistant bacteria grows and starts to takeover, bacteria give their drug -resistance to others increasing the problem

Spatial Separation

Maintaining physical distance from individuals with respiratory infection to prevent exposure/ transmission of pathogens; if visitation with RI cannot be postponed: wear a mask, perform hand hygiene, avoid common areas, restrict visit to just resident's room, keep visit brief - staff can demonstrate how to cover a cough, assist with wearing a facemask, identify supply locations, send letters to families to educate them on the cold/flu season with presentations and handouts

Meters

Makers for device to consider: design features, capacity for cleaning population that is using the device: dedicate meters to individual residents when possible, if meter needs to be shared (clean and disinfect after each use) use recommended manufacturer instructions (if not provided, it should not be shared)

TB Environmental Controls

Measures to prevent the spread of and decrease the concentration of particles of TB in air - dilute or remove contaminated air through ventilation, secondary controls = manage airflow within or near TB to filter the air, resident with positive TB should be placed in an AIIR

Comprehensive Surveillance

Tracking every infection event (may reduce opportunities for analyzing infection data and implementing prevention)

Calculating Performance Monitoring

Tracks adherence to IPC practices (# of times practice is performed correctly/ total # of opportunities to perform practice) x 1,000 = percent adherence

Unsafe Injection Practices

Transmission of viral and/or bacterial pathogens (can potentially expose thousands of patients to bloodborne pathogens) - leads to risks of CMS certification, damaged reputations, referral to licensing boards for disciplinary action, malpractice suits filed by residents

Enterobacteriaceae (CRE)

are a large order of different types of bacteria (germs) that commonly cause infections both in healthcare settings and in communities. Examples of germs in the Enterobacterales order include Escherichia coli (E. coli) and Klebsiella pneumonia CARBAPENEM RESISTANCE

Latent TB Infection

Does not have symptoms, cannot spread bacteria to others, skin test (interferon-gamma) is usually positive, chest radiograph is typically normal and sputum exam is negative

Pocket-sized ABHR

Allows staff members to perform hand hygiene when they cannot access a wall-mounted dispensar or sink

Single-use Auto-disabling Fingerstick

Disposable, prevents reuse through auto-disabling feature (recommended in healthcare settings)

Varicella-Zoster Virus

Also known as the chickenpox - a highly contagious viral infection causing an itchy, blister-like rash on the skin AIRBORNE PRECAUTIONS NEEDED

Antibiotic Use

Disrupts normal bacteria and allows resistant bacteria to increase

Infection Rate Calculation

(Number of events/ number of resident-days at risk) x constant (K) = infection rate

Safest Practice for Syringes

Always enter a medical container with a sterile needle and syringe, even when obtaining additional doses of medication for the same resident

Antibiotic Time Out Policy

Documents reassessment and decisions to de-escalate or continue treatment 2-3 days after an antibiotic start

Antibiotic Resistance

Ability of bacteria to avoid killing effects in an antibiotic, results in an increase in mortality, long hospitalizations, increase in cost, using antibiotics increases risk to get resistant pathogens

Why are nursing homes susceptible to infection?

Age of residents, invasive devices, medications, functional impairment, communal living, group activities, and comorbid conditions (chronic diseases)

AIIR

Airborne Infection Isolation Room

If SARS-CoV-2 is detected...

All residents in facility should be tested - respiratory symptoms alone are not sufficient enough to identify infection - can use nasopharyngeal swab but Nucleic Acid Amplification Tests (NAATs) are preferred

Antibiotics and Unintended Harms

Allergies, side effects, drug interactions, sometimes an increase in adverse events, polypharmacy associated with greater risk of adverse events - antibiotic use for c.diff can disrupt microbiome and create an environment for resistant bacteria (increase risk for c.diff infection)

Viral Gastroenteritis

An inflammation of the stomach and intestine lining that causes stomach symptoms such as vomiting and diarrhea

AR

Antimicrobial Resistance

Fluorescent Markers

Applies to surfaces before cleaning, prescence of using special lighting, prescence after cleaning indicates not clean. Decisions about products: EPA-registered should claim hospital-grade disinfectant on the label

Steps for Surveillance

Assess the population, select outcome and process measures, use surveillance definitions, collect data, calculate and analzye rates, apply risk stratification methodology, and report/ use surveillance information

How often should an IPC risk assessment matrix be performed?

At least annually

Additional Strategies for WSM

Avoid splash contamination in med. preparation areas, eliminate reservoirs of contaminated preparation areas. C/D sink bowls and surfaces, avoid fountains in resident care areas, and use appropriate water

Waterborne Pathogens

Bacteria found naturally in the environment, municipalities treat water with disinfect to decreased level of pathogens

A Streptococcus

Bacteria that causes Strep Throat - spread by direct contact with discharges from the nose and throat of infected people or by contact with infected wounds or sores on the skin. The risk of spreading the infection is highest when a person is ill, such as when people have "strep throat" or an infected wound

Mycobacterium tuberculosis

Bacteria that causes tuberculosis - the bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain. Not everyone infected with TB bacteria becomes sick AIRBORNE PRECAUTIONS NEEDED

Streptococcus pneumoniae

Bacterial - most frequently diagnosed cause of bacterial pneumonia - other causes -> staphylococcus aureus, gram-negative bacteria are assocuated with pneumonia in residents with underlying conditions

Threshold Rate Should...

Be high enough to incorporate natural variation and low enough to prompt early action

Hand Hygiene Performed When...

Before touching a resident, before clean or aseptic procedure, after body fluid exposure risk, after touching resident or resident's surroundings

Surveillance Definitions for CAUTIs

Both 1 and 2 must be present: 1) at least 1 of the following signs and symptoms (fever, rigors, new-onset hypotension, with no alternate sit of infection, acute change in mental status, leukocytosis, new onset suprapubic pain, tenderness, purulent discharge from around catheter or acute pain, swelloing, tenderness of the epididymis, testes, or prostate) 2) urinary catheter speciman culture with at least 10^5 cfu/mL of any organism

Element 7: WSM

Document and communicate program activities

Pathogens Can Survive for Long Periods of Time

C.diff spores (5 months), Enterococcus Species (5 days -> 4 months), Norovirus (8 hours -> 7 days), Escherichla coli (1.5 hours -> 16 months), Hepatitis B (more than 1 week), Staphylococcus aurerus (7 days -> 7 months)

Device-related infections

CAUTIs, CLABSIs

Reusable Single-Resident

Can be more than once but on 1 resident like insulin pens, fingerstick devices, personal razors, nail clippers, and toothbrushes

Multiresident

Can be used for more than 1 resident after processing (podiatry equipment, rehab. equipment, blood pressure cuffs, pulse oximeters) clean after each use, reusable single (visibly soiled) -> contact time: the time a disinfectant should be in a direct contact with the item that is being disinfected to ensure pathogens are killed

Pulmonary TB

Can present with chronic cough that lasts more than 3 weeks with sputum production, hemoptysis, shortness of breath, and pain when breathing (pleuritic chest pain). Constitutional: fever. night sweats, fatigue, loss of appetite, unexplained weight loss

Biofilm

Can protect bacteria from the killing effects of antibiotics and allow them to multiply, develop, and share resistance

Tunneled Catheter

Can remain for months to years, inserted by surgeons, idiologists, catheter travels under skin before into vein, used for meds, specialized procedures like hemodialysis

Reusable Fingerstick

Can remove or replace lancet after each use, only for 1 resident

IPC Risk Assessment Matrix

Capacity to detect readiness to prevent - the higher the score, the higher the risk (0= not likely to occur, 3+ very likely to occur) How likely is this to occur? What is the harm from the event and impact of care? What is the risk level?

CAUTI

Catheter-associated Urinary Tract Infection

Upper Respiratory Infections (URI)

Cause inflammation of nasal passages, throat symptoms include runny nose, sneezing, congestion, sore throat, difficulty swallowing, dry cough, swollen/tender lymph nodes in the neck

Lower Respiratory Tract Infections (LRTIs)

Cause inflammation of the bronchi and lungs; pneumonia causes inflammation within the alveoli of the lungs. InfluenzaL common cause of viral LRTI outbreaks in nursing homes - symptoms include cough with or without sputum production, dyspnea (shortness of breath), pleuritic chest pain, abnormal breathing, tachypnea, hypoxemia. Constitutional signs: fever, headache, fatigue, loss of appetite, delirium or other changes in mental status

Group A Streptococcus

Cause pharyngitis, cellulitis, and necrotiziwng fascilitis (flesh eating bacterial disease) - in nursing homes causes pneumonia, and wound infections (spreads through direct and indirect contact and droplets) 1 CASE IS ENOUGH FOR AN OUTBREAK AND NOTIFY PUBLIC HEALTH

Measles

Caused by a virus found in the nose and throat of an infected child or adult - symptoms don't appear until 10 to 14 days after exposure. They include cough, runny nose, inflamed eyes, sore throat, fever, and a red, blotchy skin rash. there's no treatment to get rid of an established measles infection AIRBORNE PRECAUTIONS NEEDED

Human Metapnuemovirus

Causes outbreaks of respiratory illness among nursing home staff (signs of respiratory infection) - isolation, droplet and contact precautions, enhanced environmental cleaning, cessation of group activities, increased emphasis on identifying, and increased emphasis on hand hygiene

CMS

Centers for Medicare and Medicaid Services

CLABSI

Central-line Associated Bloodstream Infection

Diagnostic Workup for Pneumonia

Complete blood count with differential, pulse oximetry, chest x-ray

CEOHS

Consumer, Environemtnal, and Occupational Health Services (made up of Environmental and Occupational Health Surveillance, Food and Safety Public Protection, and Environmental and Occupational Health Assessment)

Inter-Facility Infection Control Transfer

Contact information of resident, MDROs history, signs, symptoms, and current devices (date of insertion), TBP, antibiotic use and vaccination history, name and role of who filled out the documentation

Mode of Transmission

Contact, droplet, and airborne

Scabies

Contagious skin disease transmitted by the itch mite, commonly through sexual contact OUTBREAK RELATED - CONTACT PRECAUTIONS

Proper Disposal of Needles and Syringes

Containers should be compliant with the OSHA Bloodborne pathogens standard (closable, puncture-resistantm leak-proof, and labeled and color-coded)

How Pathogens Enter the Body Through CVC

Contamination at the time of insertion, migration from skin along outside of catheter, contamination of external components, implanted ports have decreased risk of CLABSI, hematogenous spread from distant infection site

PI of the QAPI

Continuous srudy of processes to prevent or decrease the likelihood of practice failures or harms during care

Accessing Lines

Cover open lumens with sterile end caps, injection parts or needless connectors when CVC is not in use

Health Insurance Probability and Accountability Act (HIPAA)

Covered healthcare provider may use or disclose protected health information for treatment purposes, info regarding individual maybe used or disclosed for the treatment of other persons - permits info sharing with public health professionals for the purpose of preventing and controlling disease, injury and disability

Indwelling Medical Devices

Creates a portal and biofilm formation

Documenting CVC

Document every resident, date of insertion, indication, assessment, and daily assessment of the dressing, exit site, and line should be documented in mecial record (dressing should be clean, dry, intact, CVC is securely in place, CVC is properly functioning, palpate CVC site through the dressing to identify tenderness, visually inspect if transparent dressing is in place) - gauze should be changed every 2 days

Water System Management

Decreases the risk of water serving as a source of infections in healthcare facilities, identifites both hazardous conditions and corrective actions that decrease the spread of waterborne pathogens

Element 4: WSM

Define control measures and points for monitoring water monitoring

Hand Hygiene Template

Definition, purpose or rationale, responsibility, policy considerations, evidenced-based guidelines

Element 2: WSM

Describe the building's water system

Low-Level Disinfection

Destorys all vegetative bacteria (except tubercle bacili) and most viruses (not bacterial spores) - hosptial disinfectants registered under the EPA with HBV, HIV label claim

Outcomes Measures of Surveillance

Detects outbreaks, monitor staff adherence (identifies risk assessments and improvement opportunities)

Nucleic Acid Amplification

Detects the genetic material and has faster results - uses a swab to collect cells from inside of the nasal cavity

Read Medication Label

Determine whether label says single-use/single-dose, can only be used on a single resident as part of single injection and procedure

What are the IPC Core Activities?

Developing policies and procedures, identifying, recording, correcting, IPC incidents, infection surveillance, investigating and reporting communicable diseases, conducting annual review, and establishment of antibiotic stewardship programs

5Bs of Antibiotic Prescription

Diagnosis, drug, dose, duration, and de-escalation

Point of Care Testing

Diagnostic testing that is performed at or near the site of resident care, portable handheld instrument used immediately for lab results like blood glucose level, to inform clinical management of a resident

Pathogen Transmission of Linens

Direct contact with intact skin, body substances, blood, stool, vomit, and other fluids - direct contact with contaminated linens, aerosols generated from sorting and handling contamined linens

Water Purpose in Healthcare Facilties

Drinking/Food preparation, environmental cleaning, resident care activities (bathing, toileting, personal hygiene), therapy equipment (ex: hydrotherapy), facility maintenance systems

Element 6: WSM

Ensure that the program is effective. Part 1: verification, Part : validation of effectiveness

Critical Equipment

Enters sterile tissue/ vascular system (surgical) must be cleaned and sterilized. Cleaning: manual/mechanical removable of visual soil (decreasing bioburden). Sterilization: destroys all microorganisms on the surface of an object

EVS

Environmental Services

Role of Infectionist Preventionist

Epidemiology, surveillance, common infectious diseases, pathogen transmission, diagnosis of infectious diseases. antimicrovbials, and treatment

Element 1: WSM

Establish a water management team

Outbreak Investigation

Establish existence of outbreak, develop hypothesis and case definition, conduct case finding, implement IPC measures, determine outbreak resolution,

Element 5: WSM

Establish interventions for when control measures not met

Components of CVC

Exit site (place where line penetrates the skin), lumens (channels that branch from the line), clamp (sealing device to close flow through tubing), hub (end piece of each lumen, products attach to hub to seal from environment)

Local Infections of CVCs

Exit site infection, tunnel infections within soft tissue along the path of the catheter, pocket site infections associated with implanted ports (pain/redness of skin, pus at exit site)

Direct Contact

Exposure or transmission of a communicable disease from one person to another by physical contact

Indirect Contact

Exposure or transmission of disease from one person to another by contact with a contaminated object - staff hands, resident care devices (blood pressure cuff, blood glucose meters), and contaminated PPE

Outbreak Summary

Facility info, case definition, outbreak period info, lab tests, staff info, resident outcome, facility outbreak control measures, and incidence of causes per day

Targeted Surveillance

Focuses on high-risk/ high-consequence infection events more detailed, helpful for large facilities

Epi Curve

Graphical display of number of cases occurring over time determining outbreak resolution - incubation period, period of contagiousness, and date of most recent case

Cohorting

Grouping residents who are colonized with same pathogen to one location to prevent transmission to unaffected (often used for MDRO transmission) designate work staff to that unit - maintain separation 2-3 feet apart, privacy curtain, dedicate equipment, increase frequency of cleaning and disinfection, promote staff adherence - limitations should be stopped when illness is resolved or when potential for transmission has decreased

Administration Sets

Groups of supplies that are used to infuse meds, blood, and other treatments through IV line (change sets, continuous infusions at least every 7 days - not more than that) infusion of blood, blood products, fat emulsions every 24 hours

Process Measures of Surveillance

Hand hygiene, PPE, safe injection practices, IPC practices during point of care blood testing, documenting duration and indication of new antibiotics

Handwashing Preferred When...

Hands are visibly soiled, suspected exposure to C.diff, during notavirus outbreaks, restroom breaks, and before eating or drinking

TB Disease

Has signs and symptoms, can spread to others, skin test is usually positive, bacteria is actively growing, chest radiograph may be abnormal and sputum exam is positive - most commonly affects the lungs (pulmonary TB) but can spread to other parts of the body (extrapulmonary TB) - particles are released through cough, sneeze, speaking and can stay suspended in the air (transmitted when person inhales)

HFSFO

Health Facility Survey and Field Operations

HOs

Health Officers

HCFs

Healthcare Facilities

HAIs

Healthcare-associated Infections

Central Venous Catheter (CVC)

Long, flexible, IV inserted in a large vein in the neck, chest, groin, or arm (terminates in major vessel like the superior vena cava) placed for longer durations or when meds are unsafe to administer into smaller peripheral veins

Urinary Catheter

Hollow tube that drains urine from bladder - types of catheter used depending on location of insertion/ length of time left in place

Surveillance Considerations of CLABSI

Identification of pathogen in the blood, prescence of CVC at time of bloodstream infection/ device in place on day of or before, no evidence of infection at another site that could be the source of a bloodstream infection

Element 3: WSM

Identify areas where legionella could grow and spread

ABHR Cannot be Placed Near...

Ignition sources (light switches, electrical outlets, and flames) - install to minimize leaks, spills, and place to prevent inappropriate access by vulnerable patients (create a schedule of responsibility to refill - refill dispensars by discarding old package and replacing with new) NEVER FILL UP OLD DISPENSAR

IPC Addresses Infectious-Related Risks

Implement OSHA standards, implement staff policies and procedures including work exclusion, adhereing to vaccine recommendations, educating training staff memebrs to protect themselves from pathogen transmission

Hand Lotion

Lotions should be selected that are compatible with the hand hygiene products that are used in the facility

Surgical Wounds

Incisions made through the skin and mucous membrane during procedure -> CDC classified these wounds based on severity

Policy and procedure template

Includes title, definition, purpose, rationale, date of last revision, date policy took effect, name and signature of person or committee responsible

Triggers of an Outbreak

Increase over baseline infection rate, sudden cluster of infections on a unit or during short period of time, single case of rare infection - the facility should take steos to diagnose and manage cases, document steps of investigation, comply with fed. state, and local authority

Droplet Transmission

Infected person coughs, sneezes, talks (influenza, rhinovirus, A Streptococcus)

"Gold Standard" for Displaying Surveillance Trends

Infection and adherence rates are typically displayed as line charts, an increase over the baseline should prompt an IP to investigate

Pseudomonas acinetobacter (MDR)

Infection will only cause mild symptoms, however, if a person is in a hospital or has a weakened immune system, the threat becomes very severe. In these situations, a Pseudomonas infection can be life-threatening MULTIDRUG RESISTANT

IZDP

Infectious and Zoonotic Disease Program

Peripheral IV

Inserted into a small vein usually in the arm or the hand only a few inches long, placed for short-term treatments

Performance Monitoring - Visual Assessment

Inspecting the cleanliness of a room after cleaning and disinfecting has been performed (not sufficient to ensure all surfaces properlu cleaned): other considerations: direct observation, fluorscent markers, ATP bioluminescence assay systems, culture - measures residual organic matter, both microbial and nonmicrobial, provides quantative results that can be used to track and document improvement in daily cleaning practices

Prevent Aspiration

Institute mouth care program, dental care evaluations, daily brushing of teeth and gums, and rinising mouth every day

Exemption to Aseptic Technique

Insulin pens are designed to be reused by the same resident with a different needle (pens should be labeled with residents name, DOB, MR#) if resident uses wrong pen, they need bloodborne tests

Pressure Ulcer

Localized damage to the skin and underlying soft tissue (due to prescence of intense, prolonged, pressure - over a bony prominenceoris related to a medical device)

HAI Constant

K = 1,000

CDI Constant

K = 10,000

Heparin Lock

Keeps IV open

Intermediate-Level Disinfection

Kills a wider range of pathogens than a low-level dis. not bacterial spores (EPA registered with tuberculcidal claim) -> non-critical equipment is mostly used in nursing homes: daily and few times a week

Enterobacteriaceae (ESBL)

Large order of different types of bacteria (germs) that commonl cause infections both in healthcare settings and in communities. examples of germs in the Enterobacterales order include Escherichia coli (E. coli) and Klebsiella pneumonia PENICILIN/CEPHALOSPORINS RESISTANT

Non-Tunneled CVC

Large-bore catheters inserted into subclavian, internal jugular, or femoral vein AVOID FV IF POSSIBLE - held in place by stitches, sutureless device, intended for short term use and not designed for outside of an acute care hospital

CDC Recommendations to Improve Antibiotic Stewardship

Leadership committment, accountability, drug expertise, action, tracking, reporting, education (7 core elements of antibiotic stewardship)

Multi-dose Vials

Liquid medication for injection/infusion, contain more than one dose of medications, contain a preservative to prevent bacterial growth (generally do not have effect on viruses or protect against contamination if staff do not follow safe injection practices) CDC recommends dedicating each multi-dose vial to one resident, if possible; if used for more than one resident, keep the vial in a dedicated medication prep. area to prevent contamination - if it enters a resident treatment area, dedicate the vial to that resident only (if sterility is compromised, questionable - discard vial) - assign a BUD (beyond use date) typically within 28 days of being opened unless date is listed on vial

Single-dose Medication

Liquid medication for injection/infusion, single resident as part of a single procedure/injection, labeled as single use/dose, lack an antimicrobial preservative (vials, ampules, bages of saline)

LHD

Local Health Department

Catheter-Associated Noninfectious Harms

Local pain/discomfort, nonbacterial urethral inflammation, urethral structures, mechanical trauma, decreased morbidity, and increased risk of falls

Transmissible Agents

Mucous membrane, blood, nonintact skin

Fingernails

Must be kept to 1/4 inch by the CDC, policies may address length or use of artifical nails (turn hand over and check nail length, if you can see nail extending past the finger tip, they are too long)

NHSN

Natioal Healthcare Safety Network

NIOSH

National Institute for Occupational Safety and Health

Reusable Respiratory Equipment

Nebilizers, reusable suction tubing ventilators -> should be cleaned, disinfected and dried

Infection Control Breaches

No separtion of clean/dirty counter space, contaminated instruments placed in close proximity to sertile - make sure there is complete inventory of all resident care equipment used in facility: policies should: identify type of equipment, identify the level of reprocessing required, specify who is responsible for reprocessing equipment

Calculating Infection Rate - Denominator

Number of days of risk each resident contributes during time

Calculating Infection Rate - Numerator

Number of infections occurring during timeframe

TB Testing

Nursing homes should conduct annual IPC risk assessments for TB, TB Skin Test (mantoux tuberculin skintest - TST), interferon-gamma release test (IGRA) both tests detect infection - residents should be screened within 72 hours of admission, there should be documentation of recent TB screening (with 3 months) test from another facility can be used for new residents

Competency Assessment

Observation of donning and doffing

OSHA

Occupational Safety and Health Administration: perform hazard assessment, identify and provide PPE, train employees for proper PPE use, review/update/ evaluate effectiveness of PPE (fit testing, reevaluate respiratory protection program)

Outbreak

Occurrence of more cases of a communicable disease than expected in a given area or among a specific group of people over time

Macro-aspirations

Of large amounts (food, liquid, vomit) can result in non-infectious inflammation of the lungs: tracheostomy, ventilator dependence, swallowing difficultues and diminished cough reflexes, feeding tubes, bad oral care

Micro-aspirations

Of small amounts of saliva colonized with bacteria can lead to pneumonia

Deep Thrombosis DVT

Often requires anticoagulation, most nursing homes report the capacity to provide IV therapy using CVC, PICC lines are one of the most frequently used CVC in nursing homes (indication for a PICC is IV antibiotic therapy)

Rhinovirus

One of a subgroup of viruses that cause the common cold in humans DROPLET PRECAUTIONS NEEDED

Serratia marcescens

Outbreak: Joint infections - site of contamination: multi-dose

Serrata marcescens

Outbreak: bloodstream infections - site of contamination: dialysis equipment

Acinetobacter and Psuedomonas

Outbreak: pneumonia - site of contamination: ventilator or nebulizer

Nontuberculous mycobacteria

Outbreak: skin and soft tissue infections: site of contamination: injectible meds

Pneumococcal conjugate

PCV13, Prevnar 13, vaccine (PPSV23 and Pneumovax23)

Standard Precautions

PPE, hand hygiene, injection and medication safety, respiratory hygiene and cough etiquette, environmental cleaning and disinfection, reprocessing of reusable medical equipment

Noninfectious Harms with CVCs

Pain/discomfort at the catheter site, challenges performing daily activities, venous thrombosis (blood clotting at the vein) - can occur in superficial or deep veins, results in pain and swelling of extremity

Pseudo Outbreak

Perceived increase that may not reflect change in disease - a change in surveillance data, testing practices, contaminationed samples

Case Definition

Person (age, gender, symptoms, diagnostic results), place (location: unit, floor, facility), time (period associated with illness onset)

Limit Unse of Indwelling Urinary Catheter

Place when appropriate, indications, prompty remove; use to relieve urinary retention/ bladder outlet obstruction, to promote healing of open sacral wound/ perineal wounds in residents, to manage prolonged immobilization, as a comfort measure during end of life care DO NOT PLACE SOLELY FOR MANAGEMENT OF INCONTINENCE - document for every resident with an IUC: the date of insertion, indication, and assessment of need

Intravenous Catheters (IV)

Placed to deliver fluids, medications, or blood products directly into the bloodstream

Prevalence of antibiotics

Point prevalence = # of residents on antibiotics/ total # of residents in facility x 100 = prevalence of antibiotics

Barriers to Safe Transition

Poor communciation outcomes, missing or incomplete inaccurate information in the written discharge document, differences in communication processes, lack of familiarity with sending or receiving facility, inadequate time for hand-offs, failure to get data from medical records, poor organization of sent data which causes: delays in treatment, inappropriate care plans, prolonged exposure, unnecessary medictations or devices, increased riak for readmission, frustration for residents and families, wasted resources

Potential Risks for POC Testing

Potential exposure to pathogens (Hep B, Hep C, HIV) for ex: using a fingerstick for more than 1 resident, blood glucose meter for more than 1 resident without disinfecting in between, and no hand hygiene

Recommended Safe IP

Preparation of injections in designated clean area, adherence to aseptic techniques, proper use of injection equipment, proper disposal of injection equipment, proper identification and handling of medication containers (single use, single dose, multi-dose containers)

Asymptomatic Bacteruria (ASB)

Prescence of bacteria in the urine without accompanying signs of infection (use testing to determine) - decreases unnecessary antibiotic use, decreases adverse events like C.diff infections - avoid cleaning the periurethral area with antiseptics to prevent CAUTI with catheter in place, irrigating drainage bag with antimicrobials/antiseptics, routinely prescribing antibiotics for prophylaxis

OSHA Standards

Prescribes safeguards to protect staff members who are exposed to blood and other infectious materials, describes facility actions that must be taken to prevent occupational exposures

Airborne Precautions

Prevent transmission of agents contained in particles suspended in air that remain infectious overtime (long) - wear fit-tested NIOSH, N95 or higher, donned prior to room entry, removed at resident's point of entry

Maintaining a Closed System

Prevents bacterial contamination of tubing/ bag - do not disconnect the catheter from drainage after insetion, do not perform routine replacement of catheters

Pneumococcal vaccine

Prevents severe disease, hospital, death, recommends vaccination for adults 65+, adults younger than 65 with certain medical conditions like diabetes, chronic lung disease, and renal failure

Hand Hygiene

Process of cleaning your hands by using hand washing, antiseptic hand wash, antiseptic hand rub, or surgical hand antisepsis - in nursing homes, use alcohol-based hand rub (ABHR) and soap and water

Terminal Processing

Process of cleaning/disinfecting surfaces in a room after a patient has been discharged, 50% of increased touch surfaces are not properly cleaned

Stratification

Process of dividing or classifying into categories to assist with interpretation findings

Least Common LRTI

Pulmonary Legionella

Surveillance Definitions for Skin and Soft Tissue Infections

Pus is present at a wound, skin, and soft tissue site, new or increased prescense of at least 4 of the following: heat, redness, swelling, tenderness, pain, serous drainage, or 1 constitutional like fever

QAA

Quality Assessment and Assurance (Committee) - environmental services, clinical leadership, rehabilitation, services, pharmacy, laboratory, facility management, administration and nursing data

QAPI

Quality Assurance and Performance Improvement - uses data-driven systems approach of QAPI to record incidents (design and scope, governance and leadership, systematic analysis, performance improvement projects, feedback data systems and monitoring)

QIN-QIO Program

Quality Improvement Organization - provides consultation services to nursing homes at no cost and works with them on prevention projects

Antibiotic Starts

Rate of new antibiotic prescription initiated in nursing home during specific time frame (tracks effectiveness of stewardship) Rate calculation: # of new prescriptions / total # of resident-days x 1,000 = rate of new antibiotics initiated

Antibiotic days of Therapy

Rate of total antibiotic days in nursing home in time frame RC = sum of antibiotics DOT/ total # of resident days x 1,000 = rate of total antibiotics days

Alcohol-based Hand Rub (ABHR)

Reduces the number of pathogens on the hand, should be 60-95% alcohol concentrated which is most effective

REP

Regional Epidemiology Program

REHs

Registered Environmental Health Specialists

Viral Respiratory Infection

Residents with a positive test, antiviral treatment should be administered (works best within 1st 2 days of symptoms) when at least 2 or more residents are ill within 72 hours and 1 resident with confirmed influenza - intitate chemoprophylaxis for all non-ill residents

Droplet Precautions

Respiratory droplets over short distance: facemask (donned on entry, removed before exiting), eye protection (residents place in single person room)

Diabetic Ulcers

Results in nerve damagae (neuropathy), loss of sensation, and high risk of trauma, microvasular disease leads to a decrease in wound healing, vascular disease (peripheral arterial disease) and venous insufficiency

RCA

Root, Cause, Analysis - comprehesive review of an infection event or practice failure to determine all potential factors leading to occurrence (find out what happened, why it happened)

Microbiology Testing

Routine sputum culture not favored due to low yield and potential contamination unless facility has capacity to obtain quality specimens - urinary antigen tests available for pneumococcus and Legionella but tests can remain positive even after antibiotics

Direct Syringe Reuse

Same syringe and needle used to administer medications to multiple patients through heparin lock

Respiratory and Cough Hygiene

Set of measures intended to prevent transmission of respiratory pathogens, part of standard precautions, applies with anyone with respiratory symptoms (respiratory secretions), source control measures (hand hygiene), spatial separation, education to staff, residents and visitors, signs and symptoms of respiratory infection (possible fever) - Residents with asthma, allergic rhinitis (allergen reaction), or chronic obstructive lung disease may be harder to determine infection (supplies such as tissues and face masks should be available)

Injection Safety

Set of practices to perform injections in a manner that is safe for stadd, residents, and others

Legionella

Severe form of pneumonia commonly reported cause of water borne infection in nursing homes - transmitted by inhalation or aspiration: risk factors - age of 50 years old, chronic lung disease, smoking, impaired immunity. Outbreak: closed pipes (dead legs), without no water flow may contributed to Legionella growth in water systems - interventions include maintaining disinfect levels

Hand Hygiene Training

Should be offered upon hire, annually, when new products are introduced, when new policies/procedures are introduced, in response to deviations from recommended practices identified through monitoring - staff competency assessment follows, smell, consistency, color, dryness should be considered; other factors include - place in resident care areas, provide ABHR where sinks are not found, dispensar accessibility, in multi-resident rooms, and when staff input on accessibility

MRDO-Colonized Resident

Should be placed on contact precautons with consideration of a single room when there is evidence of ongoing MDRO transmission despite control efforts and when there are challenges with containing the sites of MDRO colonization

Engage PH Partners for Water Quality Concerns

Single case of Legionnaires disease, a rise in the rate of infections due to the same waterborne pathogen - health dept. can provide guidance for water quality concerns that cannot be resolved by the facility's water management team, information about waterborne infections in the community

Leg Bags

Small urine collection bags that are secured to the leg, may facilitate mobility, comfort, independence, increased risk of bacterial contamination, benefits may out weigh infection risk for some

Chain of Infection

Source of reservoir of infectious agent with portal exit, susceptible host with portal entry receptive to agent, mode of transmission for infectious agent

Pantoea aggiomerans

Species is a type of bacteria typically identified from environmental sources including water

QA of the QAPI

Specification of standards (indwelling urinary catheters)

If Unsafe Injection Practice Occurs...

Stop immediately, notify state and local health departments, notify affected resident and offer testing

Indwelling Catheter

Straight in and out, external, suprapubic, indwelling catheter-associated with infectious/ noninfectious harms

Performance Improvement Activities

Strengthen practices or helo address an IPC activity - prioritize high-risk, high-volume, or problem-prone areas, review the annual facility IPC risk assessment, review IPC surveillance

Situation, Background, Assessment and Request Recommendation (SBAR)

Structure helps to provide communication and documentation - algorithms based on published criteria can be used to determine when antibiotics should be initiated (manages infections consistent serves as a resource for antibiotic stewardship)

Line List

Summary of cases

Environmental Surface

Surfaces of resident care equipment, housekeeping surfaces (minimal hand contact - those with frequent hand contact or increasing touch)

Implanted Ports

Surgically placed, months to years, placed completely under the skin with no external parts visible, special needle used to access the port

Culture Based Diagnostic Testing

Takes time to grow the organism - normally uses a swab to collect cells from inside the mouth or nose/ uses a swab to collect pus from a wound

Incubation Period

Time from exposure to illness onset

Colonization Pressure

The higher the # of residents on a unit or facility that has an MRDO, greater the risk for uninfected residents

Bacterial Pneumonia

The leading cause of hospitalization/death in nursing home populations. Risk factors: most bacterial pneumonias develop when organisms that are colonizing the nose, mouth and throat and are contained in saliva are aspirated

Aseptic Technique

The manner of handling, preparing, and storing medications, injection equipment, supplies, syringes, needles, IV tubing, to prevent microbial contamination

Surveillance

The ongoing, systematic collection, analysis, interpretation, and dissemination of data

Airborne Transmission

The spread of an organism via droplets or dust - suspends in the air depending on infection

Resident Plan of Care

Therapy and care needs, resident safety, resident emotional well-being, minimize visitation with resident's family (communicate why precaution started, level of infectivity, the type of interaction that is okay) - PPE should be placed outside of resident's room

Resident-related Infections

UTI, pneumonia, skin/ soft tissue infections (SSTIs)

Dirty Unit

Unit on other precautions over standard precautions (ex: COVID-19 unit)

Clean Unit

Unit on standard precautions

Indirect Syringe Reuse

Unsafe practice of reusing a syringe with or without same needle, to obtain an additional dose of medications for resident -> introduces resident's blood into medication container and exposes other residents to that blood if medication from other container is administered to them

Cold Water Cycles

Use chemicals suitable for decreasing temp washing at concentrated - clean linen should be stored in areas designed to minimize dust, maintained at normal room temp and humidity ranges

Refridgerated Medications

Use in designated refridgerators, thermostat controlled, separate doors for refridgerator and freezer, keep storage log

Single-Use

Use once then discard like needles and syringes

Multi-dose Medication

Used for one or more residents may be allowed if certain precautionary practices are followed

Contact Precautions

Used to prevent transmission of infectious agents spread by direct or indirect contact - excessive excretions, extensive environmental contamination: gloves and gown donned upon entry and removed into resident's trash bin

Transmission Based Precautions

Used when standard precautions, alone, may not be sufficient enough to prevent pathogen transmission - implemented before pathogen is identified, ideally all residents put on TBP should be placed in a single room - if room is limited, prioritize patients suspected or known to have highly communicable pathogens (ex: influenza, norovirus) - if AIIR room not available, resident most likely needs to be transferred to another facility (during wait time, resident should be placed in single room and wear a facemask if cooperative)

VPDP

Vaccine Preventable Disease Program

Outbreak-related infections

Viral respiratory, viral gastroenteritis, scabies,

Hot Water Cycles

Wash with detergent at more than 160 degrees for 25 minutes

Documentation of Wounds

Wound type, location on the body, measurements, description, assessment for complications (ex: redness, swelling, drainage) every 7 days, clean supply cart should only be touched with clean hands

Staphylococcus aureus (MRSA)

about 20% of people are carriers, usually limited to skin infections, kills young, otherwise healthy individuals, has genes for toxins not found in other S, aureus strains METHICILIN RESISTANT

Enterococcus species (VRE)

formerly classified as part of the group D Streptococcus system - is a gram-positive, commensal bacterium inhabiting the gastrointestinal tracts of humans, like other species in the genus Enterococcus, E. faecalis is found in healthy humans and can be used as a probiotic VANOCOMYCIN RESISTANT