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…..