Infection Control: it’s everybody’s business

Objectives Hand Hygiene Isolation Practices Environment of Care Respiratory Virus Prevention Campaign

Hand Hygiene: Not a New Concept Semmelweis’ Hand Hygiene Intervention After Semmelweis insisted that students and physicians clean their hands with a chlorine solution between each patient, the maternal mortality rate in the First Clinic dropped. Maternal mortality rate in the First Clinic dropped dramatically and remained low for years. This is the first evidence indicating that cleansing heavily contaminated hands with an antiseptic agent between patient contacts may reduce healthcare-associated transmission of contagious diseases more effectively than handwashing with plain soap and water. ~ Hand antisepsis reduces the frequency of patient infections ~ Adapted from: Hosp Epidemiol Infect Control, 2nd Edition, 1999

Could this be your hand? Culture plate showing growth of bacteria 24 hours after a healthcare provider placed their hand on the plate

Germs Are Everywhere-- Healthcare workers pick up germs on their hands by: pulling patients up in bed taking blood pressure or pulse touching a patient’s hand rolling patients over in bed touching patient’s gown or linens touching equipment such as bedside rails, over-bed tables or IV pumps Touching computer keyboard in nursing stations

X represents VRE culture positive sites The Inanimate Environment Can Facilitate Transmission X represents VRE culture positive sites In one study, hands of 131 healthcare workers (HCWs) were cultured before, and hands and gloves after, routine care. A mean of 56% of body sites and 17% of environmental sites were VRE positive. After touching the patient and environment, 75% of ungloved HCWs hands and 9% of gloved HCWs hands were contaminated with VRE. After touching only the environment, 21% of ungloved and 0 gloved HCWs hands were contaminated. The inanimate environment plays a role in facilitating transmission of organisms. ~ Contaminated surfaces increase cross-transmission ~

HAND HYGIENE When to wash with soap & water: ALWAYS: If hands have had contact with any body fluid Blood, mucous, wound drainages, stool, urine, etc. Patients’ …..or….. YOURS!!! If hands are visibly soiled Before eating/drinking After using restroom

HAND HYGIENE --using alcohol-based hand gel (Or soap and water) . When— Hands not visibly soiled or contaminated w/ blood/body fluid ALWAYS Before: Every patient contact Donning gloves Moving from contaminated to clean body-site

HAND HYGIENE -using alcohol-based hand gel (or soap and water) ALWAYS After: Touching a patient Removing gloves and other PPE Touching equipment or anything else in patient’s environment!!!!!

HAND HYGIENE: Using Soap & Water How Soap and water 15-30 second duration Scrub palms, backs, webs, nails Always use if visible soil on hands Use Friction!!!

Hand hygiene: Alcohol-Based Handrubs . Hand hygiene: Alcohol-Based Handrubs How: Cover all surfaces of your hands Don’t forget backs of hands, under and around fingernails Continue to rub into hands until dry (should take at least 15 seconds) Don’t rinse with water! Don’t use towel to dry hands! Use Friction!!!

Round 1 -- Feb 2005 Round 2 -- March 2005 Round 3 -- May 2005 2005 Hand Hygiene Compliance Direct Observations Summary Rounds 1, 2 and 3 Round 1 -- Feb 2005 76.6% Compliance (N= 316) Round 2 -- March 2005 90.5% Compliance (N= 275) Round 3 -- May 2005 92% Compliance (N= 319)

418 observations done & scored Hand Hygiene Compliance Direct Observations Summary Patient Safety Week March 2006 418 observations done & scored 90% demonstrated Good Practice (N=378) 10% violated HH Guidelines (N=40) 69% (65 of 95) patient care sites monitored 72% (88 of 123) observers reported

10 Steps to Protect Patients and Yourself with Recommended Hand Hygiene    When to wash hands with soap and water: 1. If your hands have come in contact with any body fluid from the patient or you (blood, urine, mucous, etc.) 2. Before eating 3. and After using a restroom When to use alcohol-based hand gel or soap and water wash: For routine hand washing when hands are not visibly soiled with body fluids AND Immediately BEFORE: 4. Having direct patient contact 5. Donning sterile gloves for inserting any type of catheter 6. Donning sterile gloves for performing any invasive procedure 7. Moving from a contaminated-body site to a clean-body site during patient care AND Immediately AFTER: 8. Removing gloves 9. Touching a patient 10. Touching equipment or anything else in a patient care room AND Finally…. When in doubt - - - WASH IT OUT Based on CDC Guideline for Hand Hygiene in the Health-Care Setting 2002

Hand Hygiene Monitoring Tool – Monthly Self-assessment

Clean Hands Prevent Infection . Patient Safety Clean Hands Prevent Infection in Patients and You

Standard Precautions - the forgotten process? Treat all blood and body fluid as infectious Assess your risk before caring for patient Use Standard Precautions for ALL patients Choose PPE based on potential risk for exposure Gloves, gown, mask, and/or goggles

Transmission-Based Precautions: Breaking the Chain Source Transmission Susceptible Host Used for important organisms based on mode of transmission Appropriate PPE must be worn each time patient room is entered During transport, patient dons PPE, NOT HCW

Transmission Precautions: Types of Isolation-- Strict: germs can invade through many routes Chicken pox, Disseminated zoster Negative Pressure Room Gown, gloves, mask Respiratory A (Airborne): must breathe in organisms, can stay afloat for long time Tuberculosis Negative Pressure Room N95 Respirator

Transmission Precautions: Types of Isolation- Contact: Germs spread by direct or indirect contact VRE, MRSA, other multidrug resistant organisms, Resp viruses Gown and Gloves (w/mask if resp) Keep door closed Respiratory D (Droplet): Breathe in organisms within 3 feet of source Mumps Pertussis N. meningitidis Mask

How are We Doing?

Linen Storage Clean ….. Soiled Clean Linen: In a supply room- Always keep door closed On a cart in open area – Always covered Soiled Linen: Removing from patient room – Bagged in yellow linen bag ≤ 2/3 full Transport to Soiled Linen Room – In yellow linen bag Placement in Dirty linen cart- In yellow linen bag ONLY!!!

Patient Supply Storage and EXTERNAL Shipping Cartons Patient supplies: 8 – 10 inches off floor Remove pt supplies from external shipping cartons before storing in supply room NO patient supplies may be stored under sinks Sharps (needles, scalpels, etc), syringes must be locked up (inaccessible by patients)

Refrigerators Patient Food,Temp Logs, Corrective Action Patient Refrigerators Temperature: MUST check and log temps DAILY* * If center is closed on weekends, document on temp log Is temp out of range?? Document corrective action and initial (i.e. called facilities, out of service, etc) Food: Only patient food permitted (no staff lunch, drinks, etc) Is patient food labeled with name, MR#, date placed in frig? Food coming from Isolation Patient rooms may not be stored in patient nutrition refrigerators

Disinfection and Sterilization Logs, QC, processes Sterilizers- Documentation (log) of runs – successful & unsuccessful High level disinfection Post the procedure Label containers with Reagent name, date of 1st use, expiration date Log of each run – date & time (if > 1/day) Include serial numbers of items disinfected QC reagent and log with each batch (reagent strips)* * if fresh reagent used each run, document in log book with date

Environment of Care - Monthly Self-assessment

YOU are Infection Control!! Patient Safety ….. ….. IS in your hands!!!

RESOURCES Infection Control Manual inside.mdanderson.org On MDACC Intranet inside.mdanderson.org On Lotus Notes Call Infection Control x2-3655 Page Infection Control (24/7) 713-404-2808