Infection Prevention & Control for Physicians Infection Prevention & Control Department (TH 9am-5pm M-F) (HJD 9am-5pm M-F) (off-hours beeper) Employee Health/Needle Stick Hotline

Infection types in acute care settings Apic. Guide to the Elimination of Catheter-Associated Urinary Tract Infections, 2008

Surveillance at NYULMC occurs for the following Hand hygiene (HH) compliance Hospital acquired (HA) multi-drug resistant organisms (MDROs) HA C. difficile Standard and Isolation Precautions Surgical site infections (SSIs)  Hip arthroplasties  CABG  Colon Central line associated bloodstream infections (CLABIs) Catheter associated urinary tract infections (CAUTIs)

Hand Hygiene Indications  Immediately before touching patients  After touching patients  After contact with the patient’s environment (even if you don’t touch the patient)  Immediately before an invasive procedure  After removing gloves Policy location  The Link Departments Infection Prevention and Control Infection Prevention and Control Policies Hand and Skin Antisepsis Hand Hygiene

Multi-drug Resistant Organisms Policy Location  The Link Departments Infection Prevention and Control Infection Prevention and Control Policies Standard and Isolation Precautions, MDROs and other diseases requiring precautions Multi-drug Resistant Organisms

C. difficile Testing  Polymerase chain reaction (PCR) -tests for DNA (99.6% specificity)  Do not order stool samples x3 to rule out infection  Cure of C. difficile is a clinical assessment, do not repeat testing for “clearance” of toxin Antibiotic Stewardship Program available Precautions  Once a PCR is ordered-C. difficile Contact Precautions should be initiated irrespective of C. difficile status.  Discontinue C. difficile Contact Precautions if Test results are negative or Test results are positive and the patient has started on appropriate anti- microbial treatment and remained symptom free for at least 48 hours. Policy  The Link Departments Infection Prevention and Control Infection Prevention and Control C. difficile Patient Care Patient Testing

Standard and Isolation Precautions Policy Location  The Link Departments Infection Prevention and Control Infection Prevention and Control Policies Standard and Isolation Precautions, MDRO and other diseases requiring precautions

Surgical Site Infection Prevention Limit flash sterilization (book cases correctly) Pre-admission testing (PAT) patients at TH and HJD are given 2% impregnated Chlorhexadine Gluconate (CHG) wipes for skin antisepsis if they are to undergo the following:  Cardio-thoracic (requiring sternotomies)  Major joint procedures  Spinal procedures

CLABSI & CAUTI Housewide surveillance  January 1, 2010 Central Line Insertion Bundle  For all patients, not just ICU’s! Central Line Insertion Checklist  For all patients, not just ICU’s!

Bloodborne Pathogen Exposure Information If you have been exposed  Stop what you are doing and wash the site immediately  Go to EHS ( ) (or the ED on weekends or off hours) If you are the ordering physician  Obtain NYS source patient HIV consent form (The Link Hospital Administration Infection Prevention and Control Information for Health Care Workers NYSDOH HIV consent)  Obtain source patient consent for HIV  Order patient testing for HIV, HBV and HCV using the ICIS order set called “Blood/Body Fluid Exposure.”

Bloodborne Pathogen Exposure Information What NOT to do…  Do NOT go to another hospital, such as Beth Israel for post- exposure care.  Do NOT decide what tests the source patient needs on your own. Employee Health Service will help with getting the appropriate tests for the patient. They have created a pathway in ICIS to get you to the correct tests.  Do NOT try to get anonymous (numbered) testing for source patients. NYS no longer has anonymous testing.

Michael Phillips, MD Sandra Hardy, RN Tania Williams, RN Steven Bock, RN Faith Skeete, RN Alex Rowan-Hazelrigg, RN Ranekka Dean, RN Sapna Mehta, MD Delia Valentin The Infection Prevention & Control Department