1. INFECTION
PREVENTION
Part 1

2. National Patient Safety Goal #7
PREVENTION OF HEALTHCARE ASSOCIATED INFECTIONS
Comply with hand hygiene guidelines by either
Centers for Disease Control and Prevention (CDC) OR
World Health Organization (WHO)
Healthcare facilities must implement evidence based practices for the prevention of
Multi-drug resistant organisms (MDRO)
Central Line Associated Blood Stream Infections (CLABSI)
Surgical Site Infections (SSI)
Catheter Associated Urinary Tract Infections (CAUTI)
HAIs causing death or permanent loss of function are managed as sentinel events

3. HAI Surgical Site Infection (SSI) Ventilator Associated Event (VAE)
Catheter Associated
Urinary Tract Infection (CAUTI)
Central Line Associated
Blood Stream Infection
(CLABSI)

4. Healthcare Associated Infections (HAI)
An infection not present or incubating on admission
Related to a previous hospitalization (within 30 days)
May be associated with a procedure performed at a healthcare facility

5. HAND HYGIENE

7. Before and after contact with a patient or contaminated surfaces:
Hand Hygiene Practice
Before and after contact with a patient or contaminated surfaces:
Antibacterial soap and water when hands are:
Visibly soiled
Had contact with blood or body fluid
If C. dif. is suspected or confirmed
Alcohol gel hand rub on any other occasion
Use friction
Cover all surfaces of hands
SING HAPPY BIRTHDAY!
To ensure you have washed long enough
Don’t forget to keep nails ¼ inch in length to decrease accumulation of bacteria

8. Skin Care An important part of hand hygiene.
Hands that are chapped and dry not only present an exposure risk, but healthcare workers are less likely to wash when skin integrity is impaired.
Maintain good skin health with a hospital grade lotion.
Hospital grade lotions are compatible with alcohol gel.
Other lotion will decrease the efficacy of alcohol based gel.

9. DRUG RESISTANT ORGANISMS
VRE
MRSA
ESBL
KLEBSIELLA
ACINETOBACTER

10. Multi-drug Resistant Organisms (MDRO)
Microorganisms that are resistant to
one or more classes of antimicrobial
agents .
Antibiotics fight off disease when
patient’s immune system cannot.
But what happens when a patient
(who is already in a weakened
state) acquires an organism that is
resistant to antibiotics?

11. 07.03.01 EP# 8&9 Laboratory-Based Alert System for MDRO
Why identify patients who have a history of drug resistance?
Patients with a history of MDRO
pose a risk to the inpatient
population because they may
remain colonized with the
infectious bacteria even after
treatment.
Identification of these patients
on admission allows us to
protect other patients and staff.

12. MDRO History Continued
An alert will appear on the admission assessment for patients with a KNOWN drug
resistant history.

13. Process for Patients with a MDRO History (Includes C.difficile)
The RN will initiate Contact Precautions (RNs may initiate isolation precautions for a period of up to 24 hours pending a physician order).
The RN contacts the physician to report the type of drug resistance and date of occurrence.
A physician order is obtained to maintain or discontinue isolation WITHIN 24 hours, no exceptions.
During SBAR, offgoing RN will ensure that oncoming RN is aware of any nurse initiated isolation precautions
Oncoming RN will follow up to ensure that an isolation order is obtained or discontinued
The single biggest problem with COMMUNICATION
is the illusion that it has taken place.
- George Bernard Shaw

14. Universal Identifier for C.difficile
Clostridium difficile (C.dif) while not technically a drug resistant organism is
considered epidemiologically important due to:
A propensity for transmission within healthcare facilities.
Patients may develop as a result of antibiotic use.
General association with serious disease and increased morbidity /mortality.
Place a black square magnet on the
Patient Census board (white board)
next to the name of any patient who
is suspected or confirmed to have
C.difficile
Purpose: identifies any transmission risk to other patients and staff
1. alerts healthcare personnel to
wash with soap and water
2. alerts EVS that a 2 step terminal
cleaning process is indicated

15. Those aren’t flammin’ hot Cheetos!

16. Use of Proper Technique During Specimen Collection to Avoid…
Wrong Diagnosis
False positive or negative result
Wrong treatment
Antibiotic prescribed when not
needed will delay or
prevent the appropriate
treatment
New process for C.difficile
Poor Outcomes
Antibiotic resistance
C.difficile colitis
Drug allergies
…..AND Public reporting of erroneous rates by the IP

17. HAI Report to the Stakeholders
EP#6 ▬ EP#5 ▬ EP#6
Report of identified acquired infections within the facility
Posted in designated areas for staff to review
Includes a brief analysis with suggested strategies for improvement
Analysis: 1 VRE, 5/27DX Sepsis & Sacral Abscessè 5/28 intra-operative Cultures are negative è
6/9 wound Cultures test + VRE
Risks Factors: multiple co-morbidities, multiple transfers during visit, bowel prep when patient has sacral wound
Action Plan: Opportunities for improvement are use of rectal tube if indicated, wound care consult, limit
transfers.

18. 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

19. 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