1. INFECTION
PREVENTION
Part 2

3. Biofilm Fast Facts The best way to prevent biofilm…remove the device.
Biofilm is bacteria that adheres to implanted/indwelling devices
( i.e.; Endotracheal Tubes, Central Lines, Urinary Catheters, Implants)
or damaged tissue forming a slimy layer resulting in infection.
Form on living and non-living surfaces; where is there is moisture in
support of bacterial growth
Bacteria in biofilm are highly resistant to antibiotics
(1,000 X more resistant than the same bacteria not growing in a biofilm).
Indwelling devices when inserted, may readily acquire biofilms on the
inner or outer surfaces.
The organisms commonly associated with indwelling devices and biofilms
are Staph epidermidis, Enterococcus faecalis, E. coli, Proteus mirabilis,
Pseudomonas aeruginosa, Klebsiella pneumoniae, and other gram-
negative organisms.
The best way to prevent biofilm…remove the device.
Take a proactive approach  Query the physician  Get the device out!

4. Pathogenic consequences of Biofilm in indwelling devices
Early formation of biofilm
Antibiotic resistant biofilm forms a sticky matrix that cannot be penetrated by antibiotics.
A well established pseudomonas biofilm has grown thick over time and calcified (white areas) rendering aveolus inactive.

5. VAE
VENTILATOR ASSOCIATED EVENTS

6. Ventilator Associated Events (VAE)
Previously known as Ventilator Associated Pneumonia (VAP)
Definitions for VAE
“VAC” Ventilator Associated Condition
“IVAC” Infection Related Ventilator Associated Condition
possible” VAP definition
2 “probable” VAP definitions
Applies to patients≥ 18 years of age who are on mechanical ventilation for ≥3 calendar days.

7. VAE Prevention Strategies
HOB 30 degrees prevents the pooling of secretions
Oral care every 2 hours reduces oral / subglottic bacteria
Sedation Vacations in preparation for weaning from the vent
Deep Vein Thrombosis prophylaxis to prevent venous stasis
Peptic ulcer prophylaxis to decrease risk of stress ulcers

8. CLABSI
CENTRAL LINE ASSOCIATED BLOOD STREAM INFECTION

9. What is Considered a Central Line?
For the purposes of mandated reporting, the following are considered central lines:
Hemodialysis Catheters
Portacaths
PICC Lines
Umbilical Catheters
Central Venous Catheters

10. CLABSI Prevention Strategies
Aseptic technique when changing the dressing
Appropriate disinfection of hubs and ports
Adherence to all elements of the Central Line Insertion Practices(CLIP).

11. Central Line Insertion Practices (CLIP)
Standardizing best practice for insertion techniques ensures better patient outcomes
Insertion Practices
Proper Hand Hygiene
Full barrier precautions including
Gown
Gloves
Mask
Eyeshield
Cap
Full Drape
Avoid use of the femoral vein
Chlorhexidine-based Antiseptic Prep (betadine is permitted on neonates)

12. Standard Disinfection of Hubs and Injection Ports 07.04.01 EP#12
Use of alcohol port protectors (CUROS caps) on ALL ports, ALL the time
Green cap must be in place for 3
minutes in order to be effective
“If the cap is green, the port is clean.”
Excludes pediatric population a (risk of foreign body ingestion)
Scrubbing the hub for 10 seconds
between each infused medication is
REQUIRED when delivering multiple
IVP medications
Demonstrate time frame for scrubbing the hub
Reusable Equipment:
Discard any left over strands of CUROS
prior to disinfection of IV poles and replace
with new strands of caps to prevent cross
Contamination between patients.

13. Use of Catheter Checklist
EP# 6
Use of Catheter Checklist
Prior to Insertion of central line
Provide patient printed education on Central Line Infections.
Obtain “Central Line Packet” (with patient name &MR# ) from forms fast.
Complete all asterisked sections of the central line checklist during procedure.
After Insertion
Fax Central Line Checklist to Infection Control at 1334.
Place checklist in medical record.

14. Routine Evaluation of Central Lines for Removal
EP#13
Routine Evaluation of Central Lines for Removal
Daily evaluation of indwelling devices (i.e., endotracheal tube, central line, urinary catheter) is documented on the progress note by the
Physician.
Unchecked progress notes for patients with indwelling devices are considered incomplete documentation and should be flagged for completion.
Applies to inpatient areas or outpatient units if patients are held ≥ 24 hours

15. CAUTI
CATHETER ASSOCIATED URINARY TRACT INFECTIONS

16. Indications for Urinary Catheters
Urinary Retention
Urinary Obstruction
Strict I & O
Surgeries involving the genitourinary tract
Surgical Patients (Discontinue by post-op day 2)
Acute genitalia wounds
End of life comfort care
Stage 3 or 4 pressure ulcers (skin cannot be kept dry otherwise)

17. That’s no banana smoothie

18. CAUTI Prevention Strategies
Use indwelling catheters only when medically necessary
Use aseptic technique during insertion of the catheter
Use of stabilization device (statlock) to the patient’s body to prevent urethral tension
Peri Care  Peri Care  Peri Care
Maintain sterile closed drainage system that hangs below the bladder
Maintain unobstructed flow with catheter tubing free of dependent loops
Aseptic technique during specimen collection
Document the time of insertion AND discontinuation
Request a physician order to remove catheters
when no longer needed

19. Document indication for urinary catheters
Documentation
Document indication for urinary catheters

20. SSI
SURGICAL SITE INFECTIONS

21. O.R. Excellence Surgical Care Improvement Project (SCIP)
Sponsored by the Centers for Medicare & Medicaid Services (CMS) in
collaboration with:
American Hospital Association (AHA)
Centers for Disease Prevention and Control (CDC)
Institute for Healthcare Improvement (IHI)
The Joint Commission (TJC)
Goal: Reduce the incidence of surgical complications by following a
specific set of evidence-based practices aimed at reducing SSIs.

22. Prevention Strategies of SCIP
Preoperative
Bath with Chlorhexidine (CHG)
removes surface bacteria from skin
Hair removal with clippers
decreases the risk of impairing the skin integrity
Antibiotics are given within 60 minutes of incision
The antibiotic is more effective, resulting in better outcomes for the patient
Postoperative
Normo-thermia
promotes the healing process
Antibiotics discontinued within 24 hours post op
reduces risk of developing a drug resistance 
Remove urinary catheters hours post op
reduces risk of Catheter Associated Urinary Tract Infection (CAUTI)

23. Patient / Family Education
BEFORE a procedure or the insertion of any device, provide
the patient with printed education from KRAMES:
CLABSI – NPSG>Central line associated infections
print “Central Line Infections”
VAE-NPSG
print “Healthcare Associated Pneumonia”
SSI - print “Preventing Surgical Site Infections”
CAUTI – Search CAUTI
DOCUMENT ANY EDUCATION IN MEDITECH

24. References
Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, Jane D. Siegel, MD; Emily Rhinehart, RN MPH CIC; Marguerite Jackson, PhD; Linda Chiarello, RN MS; the Healthcare Infection Control Practices Advisory Committee. Chiarello L, Jackson M, Rhinehart E, Siegel JD, and the Healthcare Infection Control Practices Advisory Committee (HICPAC) (2006). Management of Multidrug-Resistant Organisms In Healthcare Settings. William A. Rutala, Ph.D., M.P.H., David J. Weber, M.D., M.P.H., and the Healthcare Infection Control Practices Advisory Committee (HICPAC) (2008) Guideline for Disinfection and Sterilization in Healthcare Facilities, Centers for Disease Control and Prevention. Lynne Sehulster, Ph.D., Raymond Y.W. Chinn, M.D., Center for Disease Control and Prevention / Healthcare Infection Control Practices Advisory Committee (HICPAC) (2003), Guidelines for Environmental Infection Control in Health-Care Facilities

25. References
Carolyn V. Gould, MD, MSCR; Craig A. Umscheid, MD, MSCE; Rajender K. Agarwal, MD, MPH; Gretchen Kuntz, MSW, MSLIS; David A. Pegues, MD and the Healthcare Infection Control Practices Advisory Committee (HICPAC) (2009), Guideline for Prevention of Catheter Associated Urinary Tract Infections. Atlanta GA. Association for Professionals in Infection Control and Epidemiology (2009), Guideline to the Elimination of Ventilator Associated Pneumonia, APIC Washington DC. Society for Healthcare Epidemiology of America (SHEA) / Infectious Diseases Society America (IDSA) (2008), Strategies to prevent Ventilator-Associated Pneumonia in Acute Care Hospitals, Infection Control and Hospital Epidemiology, vol. 29.supplement 1. Centers for Disease Control and prevention /Healthcare Infection Control Practices Advisory Committee (2003), Guideline for Prevention of Healthcare Associated Pneumonia. Retrieved from: Guidelines for the Prevention of Intravascular Catheter-Related Infections, Centers for Disease Control and Prevention