Lightning Overview: Infection Control Gary Preston, PhD, CIC, FSHEA Terry Caton, CIC Carla Ward, CIC 2012 Healthcare Management Alternatives, Inc.
Objectives At the end of this module you will know: How to report issues of Public Health significance Understand important prevention strategies for all patient care encounters Understand how prevention strategies affect outcomes How to partner with Infection Prevention collaboratively to prevent infections in the healthcare setting Know how to use the policies/procedures in place to manage Transmission Based Precautions (Contact/Contact Enteric, Droplet, Airborne) detailed in Lucidoc How to report and manage an exposure Know when I should not be at work because of communicable illness
Infection Surveillance What do I do if I identify an Infection of public health significance? Infection Prevention at (425) 261-4487 is available to assist with required reporting of conditions of public health significance If you have clinical questions, the IC & P staff can facilitate contact with a health officer at the local health jurisdiction (Snohomish County)
Infection Surveillance How does PRMCE identify Health Care Associated Infections? The Infection Control & Preventions staff conducts surveillance intended to identify healthcare associated infections (consistent with CDC Guidelines) and includes analysis of trends by organism, devices and procedures. We also attempt to identify any evidence of serial transmission, unusual organisms or increased incidence compared to our own experience and published benchmarks.
What can I do while providing care to my patients to prevent the development of Infection? General practices Hand hygiene Sanitation Focused practices: devices, procedures & medications Surgical procedures: SCIP / SCOAP Mechanical ventilation Central line placement & care Urinary catheter placement & care Antimicrobial stewardship: Clostridium difficile despite optimal tx?
Why is Cleaning Your Hands Important? Healthcare-associated pathogens are most often transmitted from patient to patient on the hands of healthcare workers Cleaning your hands before and after patient contact is one of the most important measures for preventing the spread of microorganisms in healthcare settings
When Should I do hand hygiene? Before and after patient contact Remember- perform hand hygiene before donning gloves Following any work likely to contaminate hands After removing gloves After using the rest room
Are hand disinfectants effective to cleanse my hands before and after providing care for a patient? Alcohol-based hand disinfectants are effective at reducing the amount of bacteria on hands Be sure that you rub your hands so that disinfectant gets to all areas of the hands Don gloves, if needed, after the disinfectant evaporates Do not use if visible soil or organic material is present on your hands
When is handwashing the better alternative? Use whenever hands visibly soiled or when a patient is in Contact Enteric Precautions How should I wash my hands? Use soap for 15 seconds Rinse hands well and dry with paper towel Use paper towel to turn off water
Routinely clean all equipment which travels from patient to patient. Disinfectant wipes are available in dispensers on all units Alcohol swabs can be used for small surfaces such as stethoscope diaphragms. ~ Contaminated surfaces increase cross-transmission ~ Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+) Patient Environment. Hayden M, ICAAC, 2001, Chicago, IL.
What Can I do to minimize the development of an infection in my patient after surgery? Important practices (SCIP/SCOAP) intended to reduce risk of surgical site infection include: Educate your patient about the risk of infection (document) Use hand hygiene Remove hair only with clippers (no shaving) Prepare skin with disinfectant (e.g.,chlorhexidine) Use antimicrobials appropriately: Choice / Route / Timing (blood & tissue levels at incision time / duration (minimize post-op)
What Can I do to minimize the development of an infection in my patient on a ventilator? Practices intended to reduce risk of ventilator-associated pneumonia include: Educate your patient about the risk of infection (document) Use hand hygiene Elevate head of bed 30-45 degrees Oral care regularly Evaluate continuing need daily. Discontinue ASAP Clean or replace equipment between uses especially between patients
What Can I do to minimize the development of an infection in my patient with a central line? Central line placement practices should include: Educate your patient about the risk of infection (document) Choose low risk site (non-femoral) Use hand hygiene Wear mask, cap, sterile gown, sterile gloves Use large drape Prep with chlorhexidine Evaluate continuing need for catheter daily. Discontinue ASAP Aseptically access for medication administration.
What Can I do to minimize the development of an infection in my patient with a central line? Appropriate urinary catheter management includes: Educate your patient about the risk of infection (document) Use hand hygiene Insert only for appropriate indication (document) Consider alternatives (intermittent, external) Inserted only by persons properly trained Insert aseptically Avoid disconnection Empty bag regularly, avoid backflow & secure to avoid trauma Urinary catheters should not be used for care provider convenience.
How do we assess care practices when an infection has been identified? Department level review of cases of healthcare associated infections identified by the Infection Prevention staff are conducted to determine whether or not the care standards intended to prevent infection were followed. If not, action plans to insure appropriate care are implemented.
Antimicrobial stewardship Guidelines for antimicrobial use and review of prescribing practices on a caseby-case basis help maintain optimal antimicrobial use. Review of outcomes such as Clostridium difficile infections help determine if infection occurred despite optimal therapy of the underlying, preceding infection.
When does my patient need precautions in addition to Standard Precautions? You can find details for management of each additional precaution category (Contact, Contact Enteric, Droplet, Airborne, Protective) in Lucidoc( PRMCE Electronic policy and procedure system) Additional information and disease specific Infection Control Plans can be found on the Infection Control Department webpage on the PRMCE Intranet
When should I start Contact Precautions on my patient? When your patient has been identified as having an organism present that can be transmitted by direct contact with patients or contaminated environment Indications include: Infection or colonization with multi-drug resistant organisms such as MRSA, VRE or ESBL Lice or scabies Shingles or rubella Incontinence or uncontained drainage
What changes when my patient is in Contact Precautions? Nursing staff places the proper sign on the door to provide instructions for everyone entering the room Nursing provides and documents patient and family education on how to comply with the precautions in place Everyone entering the room needs to gown and glove after performing hand hygiene Prior to moving a patient to another department or healthcare facility communicate the level of precautions in place to the receiving staff Epidemiology 24 Hour Consultation Line 261-4487
When should I start Contact Enteric Precautions on my patient? Indications include: Clostridium difficile infection Norovirus Stool Incontinence
What changes when my patient is in Contact Enteric Precautions? Follow the interventions for Contact Precautions with the following exceptions: Wash hands on EXIT from room Clean equipment using Bleach wipes Surfaces in contact with the patient need to be cleaned as usual followed by bleach disinfection
When should I start Droplet Precautions on my patient? When you suspect your patient has an infection transmitted by contact with droplets or environment contaminated with droplets Indications may include: Influenza Neisseria meningitidis Bordetella Pertussis (Whooping Cough) Respiratory Synctial virus (RSV)
What changes when my patient is in Droplet Precautions? Nursing staff places the proper sign on the door to provide instructions for everyone entering the room Nursing provides and documents patient and family education on how to comply with the precautions in place Everyone entering the room needs to wear a face shield after performing hand hygiene when within three feet of the patient Prior to moving a patient to another department or healthcare facility communicate the level of precautions in place to the receiving staff The patient needs to wear a mask if out of the room Epidemiology 24 hour consultation line 261-4487
When should I start Airborne Precautions on my patient? When you suspect your patient may have an infection transmitted by airborne particles Indications include: Rubella (measles) Varicella (Chicken pox) or Disseminated Zoster Pulmonary Tuberculosis Severe Acute Respiratory Syndrome (SARS) or other novel illnesses
What changes when my patient is in Airborne Precautions? Patient is placed in a negative pressure room Everyone (except screened family members) entering the room needs to wear a Positive Air Purifying Respirator after performing hand hygiene Nursing staff places the proper sign on the door to provide instructions for everyone entering the room Nursing provides and documents patient and family education on how to comply with the precautions in place Prior to moving a patient to another department or healthcare facility communicate the level of precautions in place to the receiving staff The patient needs to wear a mask if out of the room Epidemiology 24 hour consultation line 261-4487
Occupational Health Comprehensive infection prevention must include attention to the health of practitioners.
Occupational Health Tuberculosis screening Immunizations MMR/Varicella/Tdap/HBV/Influenza Exposure management Blood-borne pathogens & others Illness tracking & consultation
Occupational Health Tuberculosis screening New staff are tested consistent with CDC recommendations and WA State requirements. Annual re-testing of all healthcare workers is done during your birthday month. Those known to be positive reactors are asked to complete a symptom check annually.
Occupational Health Immunizations MMR/Varicella/Tdap/HBV/Influenza The Employee Health Office is available to provide you with any of the above immunizations you may be lacking. Please provide documentation of prior documentation.
Occupational Health Exposure management Call our Employee Health staff whenever you may have experienced a significant exposure to an infectious agent (bloodborne pathogen such as a needlestick injury or other exposure). Assessment and management can then be expedited. 24 hour Exposure Hotline (425)261-4485
Occupational Health Illness tracking & consultation Illness in health care staff can appear minor but present great risk to patients. Recent outbreaks of pertussis (whooping cough) were efficiently transmitted in clinics and hospitals by infected health care staff Our surveillance includes illness in staff in order that we might intervene quickly to prevent transmission and advise staff regarding the propriety of their assuming their usual duties.
Occupational Health Health Care Worker Illness Skin rashes Conjunctivitis (eye redness/infection) Fever Cough Upper respiratory infection Diarrhea Nausea and vomiting Other symptoms of communicable disease Sick Call Reporting Line (425) 261-3099 Employee Health staff can advise you regarding the appropriateness of your continuing your usual duties.
Infection Control Resources Welcome to Providence Regional Medical Center! Infection Control staff are available anytime (24/7) via x 84487 Policies & procedures are available in the Lucidoc online system Online tools also include infection-specific care plans & patient teaching tools that are available on the Infection Control webpage on the Intranet Please don t hesitate to contact us if we might be of assistance.
Lightning Overview: Infection Prevention Gary Preston, PhD, CIC, FSHEA Terry Caton, CIC Carla Ward, CIC X 84487 24/7 2012 Healthcare Management Alternatives, Inc.