Infection Prevention & Control Update

Introduction In this module the reader will be introduced to policies that address infection prevention and control practices at Tulare Regional Medical Center (HCCA) which support specific goals: 1. Hand Hygiene recommendations 2. Best aseptic technique practices 3. Cleaning recommendations 4. Proper donning and doffing of PPE

at Tulare Regional Medical Center. Policy 20-8022 Infection Prevention and Control Program Policy 20-8022 The Infection Control Officer has the authority to perform ongoing and/or immediate surveillance, prevention and control measures or studies instituting prevention and control activities such as appropriate isolation, maintenance of a sanitary environment, assurance of proper sterile processing, and other measures that reduce patient, employee, and/or visitor harm related to transmission of disease at Tulare Regional Medical Center.

CDC Hand Hygiene Guidelines Policy 20-8025 Key Points: Tulare Regional Medical Center’s “Are You Gellin?” hand hygiene campaign (use alcohol-based hand sanitizer prior to entering and upon exiting patient rooms). Soap and water is used in place of alcohol-based hand sanitizer when hands are visibly dirty, after use of the bathroom, after caring for a patient with Clostridium difficile or Norovirus and when there is an outbreak of Clostridium difficile or Norovirus in the hospital.

CDC Hand Hygiene Guidelines Policy 20-8025 Key Points cont: Fingernails shall remain less than ¼ inch in length and artificial nails are prohibited for staff providing patient care. Procedural areas (i.e. Operating Room) must use a hand sanitizer with persistence (i.e. Chlorhexidine gluconate) between patients.

CDC Hand Hygiene Guidelines 5 Moments for Hand Hygiene The 5 moments for hand hygiene are: Before patient contact Before aseptic task After body fluid exposure risk After patient contact After contact with patient surroundings Remember to also wash hands after removing gloves and/or before reapplying gloves if moving from a dirty task to a clean task

Cleaning Policy 20-8030 Key Points: Cleaning is the physical removal of organic material or soil from objects. Disinfection is the killing or inactivation of microorganisms. When medical equipment is cleaned/disinfected it is bagged in plastic indicating that it has been cleaned/disinfected. Clean and dirty processes are performed exclusive from one another, and clean items will remain separate from dirty items at all times.

Cleaning Cleaning Key Points: • Wipe frequently touched surfaces (bedrails) prior to patient transport to another area, especially if a procedure caused contamination of surfaces on the bed/gurney (for example, if a colonoscopy was performed). • Wipe down monitor cords or other equipment cords individually (not in a bundle)

Cleaning More Key Points: “Scrub the Hub” is a reminder for nursing staff to thoroughly clean the injection port of an IV when accessing the line to give medications. TRMC also recommends using 3 alcohol wipes (triple wipe) to clean the IV port especially when accessing a central line.

Cleaning More Key Points: In order to appropriately disinfect it is important to use a disinfectant according to the manufacturer’s recommended “contact time” – the length of time the disinfected surface must remain wet to effectively kill microorganisms on that surface. If a product has the “contact time” of 2 minutes it is important to keep the surface wet (with the product) for 2 minutes (it is recommended to actually check the clock to know the time). This applies to cleaning all surfaces and patient care equipment (for example a glucometer or IV pump).

PPE PPE order of application: When donning full PPE 1. Don Mask 2. Don Gown 3. Don Gloves last (make sure there are no gap between the gown sleeve and the glove cuff for potential exposure of the wrist.)

PPE PPE order of removal: When donning full PPE 1. Remove gloves first (take care not to contaminate skin) 2. Remove Gown (untie back, roll down from shoulders, take care not to contaminate clean areas) 3. Remove mask last

Reduction of Healthcare Associated Infections (HAI) Policy 20-8033 Key Points: There are 5 different types of HAI 1. Surgical Site Infection (SSI) 2. Multidrug Resistant Organism (MDRO) 3. Central Line Associated Bloodstream Infection (CLABSI) 4. Catheter Associated Urinary Tract Infection (CAUTI) 5. Ventilator Associated Pneumonia (VAP) Historically these types of HAI account for: - 2 million people infected a year nationwide; - 100,000 deaths related to an HAI annually nationwide; - a financial burden of $28 – 33 billion dollars spent a year nationally to treat patients with an HAI -Hospitals are targeting for zero healthcare associated infections nationwide

HAI Continued Surgical Site Infection Prevention Bundle Control blood glucose levels Smoking cessation Pre-operative antiseptic shower using Chlorhexidine gluconate (CHG) Pre-operative hair removal using clippers (NOT shaving) Patient skin preparation using Chlorhexidine gluconate (CHG) or Betadine Pre-operative antibiotics administered 1 hour prior to surgical incision Proper draping of the patient prior to incision Proper surgical attire and aseptic & sterile technique used throughout the surgical procedure Maintenance of near baseline body temperature throughout procedure

HAI Continued Multidrug Resistant Organisms Prevention Bundle •Right drug for the Right bug (appropriate antibiotic use), Vancomycin shouldn’t be the first drug choice when the pathogen is unknown •Clean the patient’s environment with appropriate disinfectants regularly to prevent the spread of multidrug resistant organisms

HAI Continued Central Line Associated Bloodstream Infection Bundle Complete the Central Line Insertion Procedure (CLIP) note when inserting a central line (requires that all evidence-based prevention criteria are adhered to during each step of the insertion procedure). After completion forward the CLIP to the Infection Prevention office. The IP office monitors all Central Line Insertions and makes recommendations as appropriate.

HAI Continued Central Line Associated Bloodstream Infection Bundle Prevention of CLABSI infections includes: Always triple-swipe the access port to IV lines & Central Line ports prior to accessing – Known as “Scrub-the-Hub!” Single use alcohol prep pads with any cleaning (swipe one port or one vial per pad) Keep sterile items separate from dirty items (don’t uses the same surface for clean and used items, it is difficult if not impossible to prevent cross contamination when sharing the same surface) Change gloves in between removing an old dressing and before applying a new dressing

Aseptic Technique HAI Continued Basic principles: All items used within a sterile field must be sterile. A sterile barrier that has bee torn or punctured must be considered contaminated. Once a sterile package is opened, a 2.5cm (1 inch) border around the edges is considered unsterile. Tables draped as part of a sterile field are considered sterile only at table level. Movement around and in the sterile field must not compromise or contaminate the sterile field. A sterile object or field out of range of vision or an object held below a person’s waist is contaminated. Sterile persons must keep their hands in view, above waist level and below neckline, to avoid contamination. Once a sterile gown is in place, it is considered sterile from the front chest and shoulders to table level and on the selves to 2 inches (5cm) above the elbow.

Aseptic Technique HAI Continued Medication administration via the IV or central line must be accomplished aseptically to prevent potiential HAI. Clean the port “Scrub the Hub” with new alcohol wipes (3) each time (single use). Properly label syringes Keep the syringe capped (for sterility) until ready to use.

HAI Continued Catheter Associated Urinary Tract Infection Bundle •Always use the Order for Foley Catheter Physician Order Set to insert a Foley Catheter (PHYORD 631) •Assure the urinary catheter remains inserted for an approved medical indication •Maintain a sterile closed drainage system •Maintain good hygiene at catheter urethral interface •Maintain an unobstructed urine flow into urinary catheter bag •Drainage bag should remain below the level of the patient’s bladder at all times

HAI Continued Ventilator Associated Pneumonia Prevention Bundle •Head of bed up 30 to 45 degrees if not medically prohibited •Frequent oral care and every 12 hours use Chlorhexidine gluconate solution wash •Ensure Endotracheal tube cuff is appropriately inflated to prevent tube becoming a conduit for bacterial/viral migration from the upper airway to the lower airways that could result in pneumonia •Check residuals for patient receiving tube-feedings to prevent gastric over distension and risk of aspiration •Assure that ventilator tubing remains below the level of the patient’s head to allow water condensation to drain away from the patient’s airway

The Power Is Yours! You have the power to make a difference everyday Everyone, including you has the power to prevent Healthcare Associated Infections and keep patients safe. If you observe an unsafe or unsanitary practice taking place that is against TRMC Infection Prevention Policies, show your power and speak up! Tell your colleagues or the Infection Preventionist. It may be intimidating at the time, but holding yourself and your colleagues accountable upholds the basic mission of all hospitals: To focus on wellness and improving the health status of the community (not make them sick)

Infection Prevention & Control Conclusion: To perform infection prevention and control effectively it takes participation from all stakeholders within the organization. You are a part of the infection prevention and control team. Familiarize yourself with policies that address infection prevention and control practices, and if you have questions please contact the Infection Prevention and Control Program. With your help, we can protect our patients, ourselves, our co-workers, and community from infection.