Hand Hygiene Hand Hygiene and Isolation and Isolation PrecautionsPrecautions

Anthony StullAnthony StullEME 6053EME 6053

Hand HygieneHand Hygiene1.7 million hospital-acquired infections 1.7 million hospital-acquired infections annuallyannually

99,000 deaths annually99,000 deaths annually6 billion dollars annually6 billion dollars annually

Northwestern Memorial HospitalNorthwestern Memorial HospitalVRE and MRSA survive 24 hours on keyboardVRE and MRSA survive 24 hours on keyboardContact resulted in hand transfer of MRSA Contact resulted in hand transfer of MRSA 92% of he time92% of he time

Lab coats contaminated with MRSA 65% of Lab coats contaminated with MRSA 65% of the time when leaning over infected the time when leaning over infected patientpatient

Hand HygieneHand HygienePlain soapPlain soap

Detergent removes, soil, and organic Detergent removes, soil, and organic substancessubstances

Some transient bacteriaSome transient bacteria

AlcoholAlcohol60-95% alcohol to denature proteins rapidly60-95% alcohol to denature proteins rapidly

Potent against many different organismsPotent against many different organisms

Not appropriate when hands visibly Not appropriate when hands visibly contaminatedcontaminated

May dry skinMay dry skin

Hand HygieneHand HygieneChlorhexidine (CHG)Chlorhexidine (CHG)

Used in anti-microbial soapsUsed in anti-microbial soaps

Sustained residual activitySustained residual activity

Microbial resistance can developMicrobial resistance can develop

Other Other Quaternary ammoniaQuaternary ammonia

TriclosanTriclosan

IodaphorsIodaphors

Hand HygieneHand HygieneWhen to perform:When to perform:

Before patient contactBefore patient contact

After contact with blood, body fluids, or After contact with blood, body fluids, or contaminated surfacescontaminated surfaces

Before invasive proceduresBefore invasive procedures

After removing glovesAfter removing gloves

Standard Standard PrecautionsPrecautions

Assume that blood and body fluids from Assume that blood and body fluids from all patients contains infectious all patients contains infectious organismsorganisms

Treat all patients the sameTreat all patients the same

Anticipate potential exposures before Anticipate potential exposures before they happenthey happen

Personal Personal Protective Protective

Equipment (PPE)Equipment (PPE)GlovesGloves

Gowns Gowns

MasksMasks

Goggles/Eye shieldGoggles/Eye shield

GlovesGlovesUse:Use:

Utilize when skin could potentially come Utilize when skin could potentially come in contact with blood or other potentially in contact with blood or other potentially infectious body fluids (OPIM)infectious body fluids (OPIM)

Applying pressure to bleeding sitesApplying pressure to bleeding sites

SuctioningSuctioning

Handling contaminated objectsHandling contaminated objects

Dressing changesDressing changes

Performing proceduresPerforming procedures

GlovesGlovesChange when soiled or tornChange when soiled or torn

Single useSingle use

Change after patient contactChange after patient contact

Hand hygieneHand hygiene

GownsGownsUtilize when splashes, sprays, or Utilize when splashes, sprays, or droplets from body fluids are droplets from body fluids are anticipatedanticipated

Wound irrigationWound irrigation

Cleaning instrumentsCleaning instruments

Cleaning major blood spillCleaning major blood spill

Mask/Eye ShieldMask/Eye ShieldUtilize when splashes, sprays, or Utilize when splashes, sprays, or droplets from body fluids are droplets from body fluids are anticipatedanticipated

SuctioningSuctioning

IntubationIntubation

Removing drains/devicesRemoving drains/devices

Eye glasses are not considered Eye glasses are not considered appropriate eye protectionappropriate eye protection

Isolation Isolation PrecautionsPrecautions

Devised to prevent spread of certain Devised to prevent spread of certain infectious organismsinfectious organisms

Certain PPE required with any patient Certain PPE required with any patient contactcontact

Signs indicate isolation and appropriate Signs indicate isolation and appropriate PPEPPE

Special ContactSpecial ContactMRSA, VRE, other MDROMRSA, VRE, other MDRO

Daily cleaningDaily cleaning

Patient specific equipmentPatient specific equipment

Gown and gloves required for all Gown and gloves required for all contactcontact

Patient transportPatient transportPatient wears gown, mask, and gloves Patient wears gown, mask, and gloves (no gloves if on stretcher)(no gloves if on stretcher)

Staff wears gown and glovesStaff wears gown and gloves

ContactContactC-diff, Scabies, LiceC-diff, Scabies, Lice

Daily cleaningDaily cleaning

Gown and gloves required for all contactGown and gloves required for all contact

Patient transportPatient transportPatient wears gown and gloves (no gloves Patient wears gown and gloves (no gloves if on stretcher)if on stretcher)Staff wears gown and glovesStaff wears gown and gloves

Alcohol hand rubs not effective, must Alcohol hand rubs not effective, must wash handswash hands

All equipment cleaned with bleach All equipment cleaned with bleach solutionsolution

DropletBacterial meningitis, mumps, certain pneumonias, influenza

Daily cleaningDaily cleaning

Patient specific equipmentPatient specific equipment

Mask and gloves required for all contactMask and gloves required for all contact

Patient transportPatient transport

Patient wears mask and gloves (no gloves if Patient wears mask and gloves (no gloves if on stretcher)on stretcher)

Staff wears mask and glovesStaff wears mask and gloves

High Risk High Risk PrecautionsPrecautions

Immunosuppressed Immunosuppressed

Daily cleaningDaily cleaning

Gloves and mask required for all Gloves and mask required for all contactcontact

Patient transportPatient transportPatient wears mask whenever leaving Patient wears mask whenever leaving roomroom

Hand hygiene extremely importantHand hygiene extremely important

PPE RemovalPPE RemovalGownGown

GlovesGloves

Mask/Eye protectionMask/Eye protection

Hand hygieneHand hygiene

ReferencesReferencesCenters for Disease Control and Prevention. (2002). Centers for Disease Control and Prevention. (2002). Guideline for hand hygiene in health-care settings: Guideline for hand hygiene in health-care settings: Recommendations of the healthcare infection control Recommendations of the healthcare infection control practices advisory committee and the practices advisory committee and the HICPAC/SHEA/APIC/IDSA hand hygiene task force. HICPAC/SHEA/APIC/IDSA hand hygiene task force. Morbidity Morbidity and Mortality Weekly Reportand Mortality Weekly Report, 51(, 51(1616).).

Tampa General Hospital Bloodborne Pathogen Exposure Tampa General Hospital Bloodborne Pathogen Exposure Control PlanControl Plan

Tampa General Hospital Standard Precautions and Tampa General Hospital Standard Precautions and Transmission-Based Isolation Precautions, IC11Transmission-Based Isolation Precautions, IC11