How to Prevent the Spread of MDRO’s

Melisa Hobbs RN,

Infection Preventionist

Carilion Clinic

No disclosures.

Hand Washing!!

Hand Hygiene: When• Before and After

• Putting on Gloves• Preparing or eating food• Contact with a resident• Treating a cut or wound

(Ex: changing dressings or bandages)• Donning and Doffing PPE• Handling/administering medication• Insertion of invasive devices• Touching your eyes, nose, or mouth

Before and After

Wash In and Wash Out

WHO (World Health Organization) and CDC (Centers for Disease Control) guidelines:

• “Hand Hygiene Before Room Entry” is to ensure that hands are clean prior to planned or unplanned contact with the patient or the items contained within that environment and/or prevent the introduction of germs to the patient or their environment.

• “Hand Hygiene at Room Exit” is to ensure that hands are

clean upon the exit of one patient care environment to

prevent introduction of germs to the caregiver or common

areas, after body fluid exposure”.

Why not?

• More convenient for HCW’s to not perform hand hygiene.

• The HCW must engage in an inconvenient behavior at a cost to self in the short run in order to benefit others, collectively in the long term.

Hand Hygiene Compliance Monitoring

Teaching residents hand hygiene

• Teach the resident the importance of hand hygiene when exiting and entering their room.

• For cognitively impaired residents, the use of hand sanitizing wipes may be effective for certain pathogens prior to leaving room.

Standard Precautions

• Practicing hand hygiene before and after contact with a resident, objects around a resident and after removing gloves.

• Wearing disposable glove when the HCW may come into contact with blood, feces, urine, or any other body fluid.

• Wearing a gown to prevent contamination of the HCW clothing with blood or body fluids

• Use of a face mask, face shield, and/or goggles if splashing of body fluids occur.

• Cleaning of pt care equipment between residents. • Respiratory hygiene and cough etiquette. • Appropriate Patient placement

PPE Used in Healthcare Settings• Gloves – protect hands• Gowns – protect skin and/or clothing• Surgical Masks – protect mouth/nose • Goggles – protect eyes from splash• Face shields – protect face, mouth, nose, and eyes.• Respirators( N 95 / Duckbill) – protect

respiratory tract from airborne infectious agents

Donning PPE

Wearing of PPE is mandated by the OSHA Bloodborne Pathogens Standard

(Occupational Health and Safety Administration)

Removing PPE

Transmission Based Precautions

• Contact Precautions (Includes Special Contact Precautions.)

• Droplet• Airborne

Contact Precautions

• Are used in addition to standard precautions. • Designed to reduce the risk of transmission of

microorganisms by direct or indirect contact. • Requires wearing of gown and gloves for all

activities that may involve resident contact or potentially contaminated areas in the environment.

• Dedicated use of care equipment (B/P cuffs) to a single resident or disposable equipment.

Contact Isolation

Perform hand hygiene.

Wear gloves.

Wear gown.

Clostridium difficile• Opportunistic, anaerobic (grows in the absence of oxygen) spore-forming

bacillus (rod)• Produces spores (dormant bacteria) that persists in the environment and

make the organism very difficult to eliminate.

Risk Factors: • Underlying GI issues/GI surgery • Proton pump inhibitors (omeprizole)• Gastrointestinal surgery/manipulation • Long length of stay in healthcare settings • A serious underlying illness • Immunocompromising conditions • Advanced age • Antibiotic use

Special Contact Precautions-

(Enteric)

If it is BROWN

Bleach it down!!

Droplet Precautions

• Used for illnesses that can be spread by speaking, sneezing, or coughing.

• These germs may travel through the air for approximately 3-6 feet and can be inhaled into the nose or mouth of another person.

• A surgical mask is used by staff and visitors upon entering the room.

• Hand Hygiene is essential.

Respiratory Etiquette

• Used to decrease the transmission of respiratory illness such as influenza and the common cold by:• Cover your cough or cough in elbow. Hand

Hygiene. • Availability and use of tissues and hand hygiene

products.• Use of mask for person who is coughing. • Spatial separation of the person with the

respiratory illness

http://www.cdc.gov/flu/protect/covercough.htm

http://www.vdh.virginia.gov/epidemiology/surveillance/hai/longterm.htm#Assisted

QUESTIONS

References

• Feming, Jean,. N, MPM, CIC, is clinical director of infection prevention and education at Professional Disposables International Inc. The challenges of hand hygiene in the long-term care setting (http://www.pdipdi.com/) http://www.mcknights.com/the-challenges-of-hand-hygiene-in-the-long-term-care-setting/article/128883/

• Occupational Safety & Health Administration (OSHA) Regulations: Standards – 29 CFR http://www.osha.gov/pls/oshaweb/owasrch.search_form?p_doc_type=STANDARDS&p_toc_level=1&p_keyvalue=1910 Respiratory protection: 29 CFR 1910.134 Personal protective equipment : 29 CFR 1910.132

• Siegel JD, Rhinehart E, Jackson M, et al., and the Healthare Infection Control Practices Advisory Committee (HICPAC). Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, 2007. http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf

• Smith PW, Bennett G, Bradley S, Drinka P, Lautenbach E, Marx J, Mody L, Nicolle L, Stevenson K. SHEA/APIC Guideline: Infection Prevention and Control in the Long-Term Care Facility. Infection Control and Hospital Epidemiology 2008;29:785–814 http://www.apic.org/Content/NavigationMenu/PracticeGuidance/APIC-SHEA_Guideline.pdf

• Smith PW, Rusnak PG. Infection Prevention and Control in the Long-Term-Care Facility. Infection Control and Hospital Epidemiology 1997;18:831-849. http://www.shea-online.org/Assets/files/position_papers/IC-LTCF97.PDF