2. REDUCING/PREVENTING HOSPITAL-ACQUIRED INFECTIONS— IT’S EVERYONE’S JOB Infection Control

3. Objectives Describe Standard and Isolation Precautions Describe transmission and control of MDROs Identify important infection control processes Identify risk factors for Hospital-Acquired Infections (HAI)

4. Infection Control Web Page The Infection Control Web Page can be reached by going to:  Kaleidascope  Departments and Services  Patient Care / Clinical  Infection Control Take your questions to the Experts!

5. Infection Control is Everyone’s Business Family/Visitors Administrators CNA/PCA/CMA Child Life Nutritionists

6. Healthcare Associated Infections—Some sobering statistics: 7-10% patients develop HAI (This increases to 30% of critically ill patients) 1.7 million HAI Occur annually across the nation More than 99,000 deaths are attributed in part to hospital acquired infections

7. Prevention and Control Methods— Quick, Easy and Simple Use of Standard Precautions Practicing good hand hygiene Use of Personal Protective Equipment, including gloves Attention to Environmental Controls Knowing when and how to use Transmission- Based Precautions

8. Transmission-Based Precautions: CONTACT Precautions Transmission Based precautions: Contact Precautions used for patients with diagnosis of: Precautions include Private room Gloves Hand hygiene Gowns ESBL MRSA, VRE, C.. Difficile

9. Transmission-Based Precautions: DROPLET Precautions Communicable diseases are passed on by droplet dispersion. These include:  Upper respiratory infections (cold and flu)  Neisseria meningitis  Pertussis or whooping cough  Adenovirus Precautions to prevent spread of droplet-borne diseases include: Private room Hand hygiene Use of surgical mask if within 6 feet of the patient.

10. Airborne Isolation is a means of protecting against the spread of some diseases: These diseases include: Varicella Virus (Chicken pox, Disseminated Shingles)  Surgical Mask M. tuberculosis  N-95 respirator Mask Pandemic Flu

11. Airborne Isolation Place in negative pressure room Wear respirator for TB, Pan flu Facilities Management (daily smoke test) Keep doors closed Mask patient for transport Communicate with other departments Instruct visitors: N-95 respirator use OSHA Reg’s-Fit testing Annually!

12. Transporting Patients Transporting Patients on Special Precautions  Droplet/Airborne: mask patient  Contact: cover open areas  Minimize travel off unit  Off-unit procedures: last case of the day

13. Hand Hygiene Culture plate showing growth of bacteria 24 hours after a nurse placed her hand on the plate

14. When to Wash Your Hands Upon arrivingEntering patient roomLeaving patient roomBetween patients in same roomAfter handling patient equipmentBefore/after handling specimens Before serving foodAfter toiletingBefore donning glovesAfter glove removalBefore leaving work

15. Are alcohol-based hand rubs really effective? More than 20 published studies have shown that alcohol-based hand rubs are more effective than either plain soap or antibacterial soaps in reducing the number of live bacteria on the hands.

16. Advantages of cleaning hands with alcohol- based hand rubs When compared to traditional soap and water hand washing, alcohol hand rubs have the following advantages:  take less time to use  can be made more accessible than sinks  cause less skin irritation and dryness  are more effective in reducing the number of bacteria on hands Kaleida Health makes alcohol-based hand rubs readily available to personnel  has led to improved hand hygiene practices

17. A 24-year-old man who had quadriplegia due to a traumatic spinal cord injury was found on routine surveillance cultures to have methicillin-resistant Staphylococcus aureus (MRSA) colonization of his anterior nares. He had no history of MRSA infection or colonization. To assess the potential implications of the patient's MRSA carriage for infection control, an imprint of a health care worker's ungloved hand was obtained for culture after the worker had performed an abdominal examination of the patient. The MRSA colonies grown from this handprint on the plate (CHROMagar Staph aureus). After the worker's hand had been cleaned with alcohol foam, another hand imprint was obtained, and the resulting culture was negative for MRSA (Panel B). These images illustrate the critical importance of hand hygiene in caring for patients, including those not known to carry antibiotic-resistant pathogens. This is the image………………………… January 15, 2009

18. Image of before (A) and after (B) using Alcohol based hand foam…… A. Before using hand foamB. After using hand foam

19. When should you wash your hands with soap and water? Wash your hands with plain soap and water, or with antimicrobial soap and water if:  your hands are visibly soiled (dirty)  hands are visibly contaminated with blood or body fluids  before eating  after using the restroom  after caring for patients with C diff

20. Multi-Drug Resistant Organisms and Clostridium Difficile VRE MRSAMRSA C-DIFFC-DIFF

21. So What’s The Fuss All About ? Drug resistant Pathogens are a growing threat 2 Million patients acquire a HAI 90,000 patients die as result of a HAI 50% -70% of S.aureus isolates are MRSA > 70% of bacteria that cause HAI’s are resistant to at least one antibiotic used for treatment Source: CDC

22. Financial Impact of MRSA Annual cost to treat MRSA patients in the U.S. between $ 3.2 billion and $ 4.2 billion Extra cost associated: a blood stream infection $ 17,422 (MSSA $ 9,661) a surgical site infection $ 36,133 (MSSA $ 4,989) Source: Abramson,ICHE1999;20:408 Abramson,ICHE1999;20:408 Engelman et al. 2001;ICAAC Engelman et al. 2001;ICAAC Cosgrove et al Clin Inf Dis 2003;36:53-59 Cosgrove et al Clin Inf Dis 2003;36:53-59 Cosgrove et al. ICAAC 2001 Cosgrove et al. ICAAC 2001 Kaye et al. ICAAC 2002 Kaye et al. ICAAC 2002 International Society of Pharmacoeconomics Outcome Research, 5/05 Cheng, J Hosp. Inf. 1988; 12:91-101 Cheng, J Hosp. Inf. 1988; 12:91-101 Wakefield, AJIC 1988; 16: 185-192

23. The inanimate environment is a reservoir of pathogens ~ Contaminated surfaces increase cross-transmission ~ Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+) Patient Environment. Hayden M, ICAAC, 2001, Chicago, IL.

24. Eating and Drinking  The previous slide displayed why it is so important not to eat or drink around the patients.  OSHA Regulation Food and drink should not be consumed in patient care areas or areas where contamination with blood or other potentially infectious material could occur.

25. Environmental Surfaces Toys and playroom surfaces should be disinfected as often as possible, but at least daily. Is someone designated to clean toys and surfaces on each floor???

26. Personnel Health Guideline The following are guidelines for personnel who have various diseases Disease Entity 1. Strep Throat 2. Zoster a) Localized b) General 3. Viral Upper respiratory infection Staff restrictions 1. Restrict working until 24 hours after start of antibiotics 2. Zoster a) Cover lesions; restrict from caring for high risk patients b) Restrict from patient contact until lesions are dry/crusted 3. Consider exclusion from care of high risk patients

27. Personnel Health Guideline con’t Disease Entity 4. Conjunctivitis 5. HSV-1 a) Hand b) Oro-facial Staff Restrictions 4. Restrict from patient care until discharge ceases 5. HSV-1 a) Restrict until lesion(s) healed b) Evaluate worker for need to be restricted from care of certain patients

28. Questions If you have any questions regarding how to prevent Hospital Acquired Infections, please contact the Infection Control Specialist at your own site. Preventing infection is – everyone’s job!