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Infection Control and

Prevention of Healthcare-Associated

Infection (HAI)

Recommendations for theControl and Prevention of HAI

Welcome to the Infection Control and Prevention of Healthcare-Associated Infection (HAI) course. This course will help you understand how to control and prevent infections from occurring in the healthcare environment and reduce the risk of healthcare-associated infections for our patients, visitors and staff. The course will cover the primary types of HAIs identified in The Joint Commission’s National Patient Safety Goal number 7- Surgical Site Infections, Central Line-Associated Blood Stream Infections, Multi-Drug Resistant Organisms, and Catheter Associated Urinary Tract Infections.

Course Information

Course Title: Infection Control and Prevention of Healthcare-Associated Infection (HAI)

Regulations/Standards:The Joint Commission National Patient Safety Goal 7: Reduce the risk of

healthcare-associated infections.

Approximate Time to Complete: 25 Minutes

Content Version: Clinical Staff

Intended Audience: Clinical Staff

Technical Specifications:Flash Player 9, Internet Explorer 6, Headphones or speakers are

recommended but not required

Date Revised: February 1, 2013

Contact Information

Please forward any content questions or concerns to

the Subject Matter Expert:

Infection Control and Prevention

484-884-1180

Please call the Help Desk at 610-402-8303 with any technical issues.

The Infection Control and Prevention of HAI course fulfills the training requirements set by The Joint Commission. The course should take approximately 25 minutes to complete. If you have any questions, please contact the appropriate number listed on this screen. Remember, all technical questions should go to the Help Desk at 610-402-8303. To review the navigational features of the course, click on the Navigation tab at the top of the screen.

Objectives

Identify strategies that can reduce the risk of developing a surgical site infection

List the key elements in the Central Line Bundle

Discuss key facts about specific multi-drug resistant organisms in the healthcare settingExplain methodologies that can help decrease the likelihood of developing a Catheter Associated Urinary Tract Infection

Upon completion of this course, you should be able to:

Upon completion of this course, you should be able to: •Identify strategies that can reduce the risk of developing a surgical site infection •List the key elements in the Central Line Bundle •Discuss key facts about specific multi-drug resistant organisms in the healthcare setting •Explain methodologies that can help decrease the likelihood of developing a Catheter Associated Urinary Tract Infection If you feel you have already mastered the content described in the course objectives and would like to demonstrate your knowledge, you may click the “Demonstrate Knowledge” button and move directly to the course test. You must earn a score of at least 80% on the test to successfully pass this course. However, it is recommended that you review the content as it has been updated. To continue onto the course content, please select the next button located at the bottom of the screen.

Healthcare-Associated Infections

Healthcare-Associated Infection (HAI): An infection that a patient develops while receiving treatment for medical or surgical conditions. The infection can not be present or incubating at the time of admission to the hospital.

HAIs must be reported to the Patient Safety Authority, the Pennsylvania Department of Health and the Centers for Medicare and Medicaid Services (CMS).

What is a healthcare-associated infection? A healthcare-associated infection is an infection that a patient develops while receiving treatment for medical or surgical conditions. To be considered a healthcare-associated infection, the infection can not be present or incubating at the time of admission to the hospital. Healthcare-associated infections must be reported to the Patient Safety Authority, the Pennsylvania Department of Health and the Centers for Medicare and Medicaid Services.

Healthcare-Associated Infections

HAIs can be the result of:

Invasive medical devices (central line-associated blood stream infections, catheter associated urinary tract infections, ventilator associated pneumonia)

Surgery (surgical site infections)

Certain microorganisms present in healthcare settings

Multi-Drug Resistant Organisms (Methicillin Resistant Staphylococcus Aureus [MRSA], Vancomycin Resistant Enterococci [VRE] and others)

Clostridium difficile (C. DIF)

Anyone who is a patient in a hospital is at risk for healthcare-associated infection. HAIs occur in all settings of care, including acute care within hospitals, same day surgical centers, home care, ambulatory outpatient care in health clinics, and long term care facilities. HAIs are associated with a variety of causes, including (but not limited to) the use of invasive medical devices such as catheters and ventilators, complications following surgery, and the transmission of microorganisms present in healthcare settings.

Just the Facts

Number of Healthcare-Associated Infections

Each Year

Do you know the facts?

Click each button on the left to learn the answers.

Number of Patient Deaths Caused by HAI

Each Year

You may be surprised by some of the facts related to healthcare-associated infections. Do you know how many healthcare-associated infections occur in the United States each year? What about the number of patient deaths that are caused by healthcare-associated infections each year? Click each of the buttons to learn the facts.

Just the Facts

1.7 million Healthcare-Associated

Infections occur each year in the

United States!Number of Healthcare-Associated Infections

Each Year


Each Year

How many healthcare-associated infections occur each year in the United States? 1.7 million healthcare-associated infections occur each year in the United States!

Just the Facts

99,000 deaths result from infection that might have started after the

patient was hospitalizedNumber of Healthcare-Associated Infections

Each Year


Each Year

How many patient deaths might be caused by healthcare-associated infections each year? About 99,000 deaths result from infection that might have started after the patient was hospitalized.

Prevention of HAI

Hand Hygiene has long been recognized as the single most effective way to prevent the spread of infection

Information on basic infection control measures and hand hygiene practices are contained in another eLearning module

Prevention of HAI is also possible through the application of certain best practices

In this module, we will address key practices to prevent:

Surgical Site Infections

Central Line-Associated Blood Stream Infections

Multi-Drug Resistant Organisms

Catheter Associated Urinary Tract Infections

Hand Hygiene has long been recognized as the single most effective way to prevent the spread of infection. The prevention of HAI is also possible through the application of certain best practices. In the following sections of this module, we will address the key practices to prevent Surgical Site Infections (SSIs), Central Line-Associated Blood Stream Infections (CLABSIs), Multi-Drug Resistant Organisms (MDROs), and Catheter Associated Urinary Tract Infections (CAUTIs).

Surgical Site Infection Prevention

Surgical Site Infection

Surgical site infections are one of the most frequently occurring types of healthcare-associated infections. Preventative actions can reduce your patient’s risk for developing a surgical site infection. In this brief section, you will learn about the strategies to reduce your patient’s risk for developing a surgical site infection.

Surgical Site Infection (SSI)

Surgical Site Infection (SSI):An infection that occurs after surgery in the part of the body where the surgery took place.

Superficial incisional

Deep incisional

Organ/space

Develop in 1-3 out of every 100 patients who have surgery

500,000 SSIs occur each year

What is a surgical site infection? A surgical site infection is an infection that occurs after surgery in the part of the body where the surgery took place. SSIs are classified as superficial incisional, deep incisional, or organ/space. Superficial incisional surgical site infections only involve the skin or subcutaneous tissue of the incision. Deep incisional surgical site infections involve fascia and/or muscle layers. Organ/space surgical site infections involve any part of the body that is opened or manipulated during the operative procedure. Surgical site infections develop in about 1 to 3 out of every 100 patients who have surgery. Approximately 500,000 SSIs occur each year.

Strategies to Prevent SSIs

Microbiological Characteristics

Patient Characteristics

Surgical Characteristics

Developing a surgical site infection relies on three factors:




Click on each button to learn more

The likelihood of developing a surgical site infection relies on a combination of three factors – microbiological characteristics, patient characteristics, and surgical characteristics. Click on each button to learn more.



Microbiological Characteristics:

Presence of bacteria near the surgical site

The amount of bacteria and other microorganisms that are present depends on the location of the procedure

Fewer microorganisms are encountered during a joint replacement surgery compared to surgeries that involve the gastrointestinal system



Microbiological characteristics involve the presence of bacteria near the surgical site. The amount of bacteria and other microorganisms that are present near the surgical site is dependent upon the location of the procedure. For example, fewer microorganisms are encountered during a joint replacement surgery compared to surgeries that involve the gastrointestinal system.



Patient Characteristics:

Diabetes

Obesity

Smoking

Weakened immune status

Remote skin infections



Patient characteristics include factors such as diabetes, obesity, smoking, weakened immune status and remote skin infections. Patients with any of these characteristics are at a greater risk for developing a surgical site infection.





Surgical Characteristics:

Type of procedure

Duration of the procedure

Amount of damage caused to the tissue

Surgical characteristics include the type of procedure, the duration of the procedure, and the amount of damage caused to the tissue.

Reducing Patient Related Risks

Encourage patients to:

Control their serum glucose levels

Lose weight

Stop smoking

Identify and treat any infections that the patient may already have before they have elective surgery

Decontaminate skin pre-operatively with chlorhexidine wipes

Decolonize nose pre-operatively with Mupirocin (topical antibiotic) as directed by the surgeon

Patients can reduce their risk for developing a surgical site infection. Encourage your patients to control their serum glucose levels, lose weight if they are obese, and stop smoking. Patients who smoke get more infections than patients who don’t. You should also identify and treat any infections that the patient may already have before they have elective surgery. Decontamination of the skin with chlorhexidine wipes and nasal decolonization with Mupirocin can also help to reduce the risk for developing a surgical site infection.

Reducing Surgical Related Risks

Perform preoperative surgical scrub

incision site

Handle tissue carefully to reduce trauma

Minimize operative time as much as possible

Minimize operating room traffic

Control blood glucose level during and after the procedure

Maintain perioperative normothermia

Procedure related risk factors can also be reduced. Follow these precautions to lower your patients’ risk of developing a surgical site infection: • Perform preoperative surgical scrub with an alcohol-based surgical hand antisepsis

product, • Wash and clean the skin around the patient’s incision site with an appropriate

antiseptic agent, • Handle tissue carefully to reduce trauma, • Minimize operative time as much as possible, • Minimize operating room traffic, • Control blood glucose level during and after the procedure • Maintain perioperative normothermia.


Minimize talking during the procedure

Adhere to dress code policies

emergent needs

Assure all instruments are properly sterilized

Assure all equipment is decontaminated

Assure environmental decontamination is performed

• Minimize talking during the procedure • Adhere to dress code policies • Use “just in time” sterilization only for emergent needs • Assure proper sterilization • Assure all equipment is decontaminated • Assure environmental decontamination is performed

Antibiotic Prophylaxis

Deliver antibiotics within 1 hour before incision

2 hours for vancomycin and fluroquinolones

Use the recommended antibiotic

Discontinue antibiotics within 24 hours after surgery

Discontinue antibiotics within 48 hours for cardiothoracic procedures in adult patients


Antibiotic prophylaxis also have an impact on reducing your patients’ risk for developing a surgical site infection. Deliver antibiotics within one hour before the incision is to be made. Vancomycin and fluroquinolones should be delivered within 2 hours. Only use the recommended antibiotic. Discontinue use of antibiotics within 24 hours after surgery. For adult patients undergoing cardiothoracic procedures, discontinue antibiotics within 48 hours.

Proper Hair Removal

Only remove hair if it will interfere with the operation


Proper hair removal can also reduce your patients’ risk for developing a surgical site infection. Only remove hair if it will interfere with the operation. If hair removal is necessary, use clippers.

Patient Involvement

Patient Safety Tips for the Surgical Patient

How hospitals prevent SSIsHow patients can prevent SSIs

The Joint Commission requires hospitals to provide patients and their families with education related to preventing adverse events in surgery. “Patient Safety Tips for the Surgical Patient” includes information on the prevention of surgical site infections. This document includes information on what hospitals are doing to prevent surgical site infections and what patients can do to prevent surgical site infections. This health sheet is intended for patients who are scheduled for surgery.

Documentation

Use Krames On-Demand

Outpatient Departments:

Intranet

Document in the medical record (Pre-admission database, Ambulatory Surgery/Staging Units Admission database, etc.)

Use Krames On-Demand to document your patient’s understanding of the information provided in the “Patient Safety Tips for the Surgical Patient” health sheet. For Outpatient departments who do not use Krames On-Demand, the “Patient Safety Tips for the Surgical Patient” can be found on the LVHN Intranet. Documentation and evaluation of the patient’s understanding should be done in the medical record.

Central Line-Associated

Blood Stream Infection

Prevention

Central Line-Associated Blood Stream Infection

In this section of the course, you will be introduced to key evidence-based practices to prevent the incidence of central line-associated blood stream infections.

Central Line

A central line is a type of catheter (central venous catheter) that is:

Inserted through the skin

Terminates at or close to the heart or in one of the great vessels

Used for infusion, withdrawal of blood, or hemodynamic monitoring

Examples of Central Lines:Single, double, triple and quad lumen cathetersPeripherally inserted central catheters(PICC)Umbilical catheters in newbornsHickman and Broviac cathetersTesio cathetersPort-A-catheters

A central venous catheter, also known as a central line is a flexible tube that is inserted through the skin and ends at or close to the heart or in one of the great vessels. Central lines can be used to administer infused solutions, withdraw blood and/or for hemodynamic monitoring.

Central Line-Associated Blood Stream Infections (CLABSIs)

A CLABSI is a blood stream infection that is associated with the presence of a central line or an umbilical catheter in newborns

• Approximately 200,000 CLABSIs occur in U.S. hospitals each year

• 14,000 28,000 deaths annually

• Increase mortality 4 to 20%

• Prolong hospital stay by 7 days

• Increase costs $3,700 to $45,000

A central line-associated blood stream infection or (CLABSI) is a blood stream infection that is associated with the presence of a central line or an umbilical catheter in newborns. Central lines disrupt the integrity of the skin, making patients vulnerable to bacterial and fungal infections, that lead to a central line-associated blood stream infection. A blood steam infection can occur when bacteria or other germs travel down the central line and enter the blood. Approximately 200,000 CLABSIs occur in U.S. hospitals each year, resulting in 14,000 to 28,000 deaths annually. CLABSIs are very serious infections, increasing mortality rates 4 to 20% and prolonging a patients hospital stay on average by 7 days. The reported range for patient care cost attributed to CLABSI is $3,700 to $45,000 per episode.

The central line bundle is a group of evidence-based interventions for patients with

central venous catheters that when implemented together, result in substantially better

outcomes than when implemented individually. The implementation of the central line

bundle improves patient outcomes by decreasing the incidence of central line

associated blood stream infections.

The Institute for Healthcare Improvement (IHI) defines the 5 key elements of the central

line bundle as:

1. Hand hygiene

2. Maximal barrier precautions upon insertion

3. Chlorhexidine skin antisepsis

4. Optimal catheter site selection, with avoidance of the femoral vein in adult

patients

5. Daily review of line necessity with prompt removal of unnecessary lines

The science behind the central line bundle is so well established that it should be

considered a standard of care.

Proper implementation of the central line bundle involves all members responsible for

the treatment and care of a patient with a central venous catheter.

In the prevention of all heath care associated infection including CLABSI, proper hand

hygiene has long been recognized as the single most effective way to prevent the

spread of infection. Proper hand hygiene before catheter insertion, (even when wearing

gloves) and during all care and maintenance is essential. Follow the CDC Guidelines for

Hand Hygiene and the World Health Organization 5 Moments for Hand Hygiene.

Observe the appropriate hand hygiene procedures by washing hands with soap and

water or using an alcohol based hand sanitizer.

Maximal sterile barrier precautions during the insertion of a central line substantially

reduces the incidence of CLABSIs. For the Operator and Supervisor placing the central

line and for all those assisting in the procedure, maximal barrier precautions means

strict compliance with hand hygiene and personal protective equipment protocols.

• The Operator and Supervisor must wear full sterile attire including eye protection.

• Assistants and all others in the room must wear hair covers and masks with face

shield or eye protection.

• The patient’s head and body must be covered with a large sterile drape.

The proper preparation of the skin site for insertion of central line should include:

- Prepare skin with 2% chlorhexidine gluconate (CHG) in 70% isopropyl alcohol

solution.

- Apply CHG antiseptic solution, using a back an forth friction scrub for at least 30

seconds. Do not wipe or blot.

- Allow antiseptic solution time to dry completely before puncture of the site.

CHG is used because it provides persistent bacterocidal activity.

In selecting a site for the central line the Physician must weigh the risk-benefit of site

selection for each individual patient.

In general the subclavian site is the preferred site for types of catheters that are used for

short term therapy because of the lower risk for CLABSI then the internal jugular vein.

A central line placed in the femoral site is more at risk for infection, especially in

overweight patients.

Daily review of central line necessity will prevent unnecessary delays in removing lines

that are no longer needed. Include daily review of line necessity in multidisciplinary

rounds.

The goal is to reduce the number of line days to reduce the risk of acquiring a CLABSI.

A central line that is no longer needed should be promptly removed.

Multidisciplinary Insertion Procedure Checklist

Utilize Central Line Checklist to document compliance with the insertion criteria at the time of insertion

This creates a culture of safety and prevention

Empowers nurses to stop line placement if improper techniques are used

Increases awareness of key components of proper insertion

Improves accountability and compliance with standard of care

Assures essential documentation is met

Shares responsibility

Physician/MLP (primary operator)

Nurse/MLP/Resident (recorder/observer)

During a procedure involving insertion of a central line a multidisciplinary insertion procedure checklist is used. Utilize the Central Line Checklist to document compliance with the insertion criteria at the time of insertion. Using the Central Line Checklist during the procedure creates a culture of collaboration, patient safety, and prevention. The checklist increases awareness of the key components of proper insertion and improves accountability and compliance with standard of care. Completion of the procedural checklist is a shared responsibility between the provider inserting the central line and the nurse or other professional recording and observing the procedure.

Line Care and Maintenance

Transparent, semi-permeable dressing is preferred

Change transparent dressing every 7 days and whenever dressing is soiled or non-adherent

Avoid antibiotic ointment at the catheter insertion site

Utilize antimicrobial disc

Disinfect catheter hubs and injection ports

Minimize manipulation of the catheter

Proper care and maintenance of the central line is essential to prevent CLABSIs. When caring for a patient with a central line the preferred dressing is transparent and semi-permeable. The benefits of a transparent, semi-permeable dressing include the ability to evaluate the insertion site while the dressing is in place, the wicking of moisture away from the skin, and less frequent dressing changes compared with standard gauze and tape dressings. The transparent dressing should be changed every 7 days and whenever the dressing is soiled or non-adherent. Avoid using antibiotic ointment at the catheter insertion site as it promotes fungal infections and antibiotic resistance (except when using dialysis catheters). Instead, utilize antimicrobial discs. When caring for a patient with a central line always, clean your hands and wear gloves when changing the bandage that covers the area where the catheter enters the skin. Disinfect the catheter hub openings with an antiseptic solution before accessing the port. In general, minimize the manipulation of the catheter.

Additional Prevention Measures

Educate and train providers who insert linesUse a standardized supply cart or kitRoutine replacement of central lines is not necessaryReplace central lines within 24 hours when adherence to aseptic technique was not followed during insertion

For More Information:

• LVHN Patient Care Services Clinical Practice Guideline

• LVHN Infection Control and Prevention policy

Control in Intravenous

Additional measures to prevent CLABSIs include: •Educate and train providers who insert lines •Use a standardized supply cart or kit •Routine replacement of central lines is not necessary •Replace central lines within 24 hours when adherence to aseptic technique was not followed during insertion For more information please refer to the LVHN Patient Care Services Clinical Practice Guideline “Central Catheter: Venous or Arterial” and the LVHN Infection Control and Prevention policy “Requirements for Infection Control in Intravenous Therapy.” Both policies can be found on the LVHN Intranet. On the LVHN Intranet home page select the Resources menu and click on LVHN Policy & Procedure Manuals. On the LVHN Policy and Procedure Manual page, select the Patient Care Manual or the Infection Control and Prevention links.


(MDRO)Recommendations

for the

Control and Prevention of MDRO


In this section of the course, you will be introduced to the primary types of multi-drug resistant organisms and learn infection control precautions to prevent the transmission of MDROs in the healthcare environment.

Multi-Drug Resistant Organisms are microorganisms, mostly bacteria, that are resistant to one or more classes of antimicrobial agents, or antibiotics. Types of resistant organisms include: •Clostridium difficile - (C. Diff) •Methicillin-resistant Staphylococcus aureus - MRSA •Vancomycin-resistant enterococci - VRE •MDR Acinetobacter baumannii •Carbapenem-resistant Enterobacteriaceae (Carbapenemase-producing Enterobacteriaceae) - CRE •Extended spectrum beta-lactamase producers - (ESBL)

Key Concepts in Transmission

Patients with severe disease

Underlying medical conditions, recent surgery, indwelling medical devices such as urinary catheters or endotracheal tubes or IVs

Hospitalized patients

Who Is At Risk?

Antibiotic use

Presence of larger number of colonized (organism is present but not causing infection) patients

Contamination of healthcare workers hands and environmental surfaces

Other Risk Factors:

Patients with severe disease and hospitalized patients are most at risk for contracting an infection with an MDRO. This includes patients with underlying medical conditions, patients who have recently had surgery, and patients with indwelling medical devices such as urinary catheters or endotracheal tubes or IVs. Other factors that increase the risk for getting an infection with an MDRO include: •Antibiotic use, •A large number of colonized patients, and •The contamination of healthcare worker’s hands and environmental surfaces. The treatment of MDROs is extremely challenging because there are few antibiotics that can be used to eradicate these severely resistant organisms. Severe cases of C. Diff and MDROs can result in death. Therefore, early implementation of prevention efforts is key in preventing the spread of Multi-drug resistant organisms. MDROs are spread by contaminated hands of healthcare providers, contaminated medical equipment and other environmental surfaces in the patient’s surroundings.

Special Precautions for C. Diff

Special Precautions for C. Diff:Practice strict hand hygiene

Gel upon entry, wash upon exit

Wash with antibacterial soap after patient contact and contact

Use Contact Isolation sign with red dot

Click the Attachments tab above to download the Hand Hygiene and Contact Isolation signs

To prevent the spread of MDRO infections, there are certain precautions that should be followed. There are a few special precautions that you should keep in mind when caring for a patient with Clostridium difficile (C. Diff) or Vancomycin-resistant enterococci (VRE). When caring for a patient with C. Diff, it is important to follow strict hand hygiene practices. Wash your hands with antibacterial soap after patient contact. Remember to gel upon entry and wash upon exit of all rooms with C. DIFF patients. Washing with soap and water is preferred when caring for a patient with C. Diff. Use an alcohol-based waterless hand sanitizer in addition to soap and water. Use contact Isolation sign with red dot to indicate the patient has C. Diff. You should also clean medical equipment and the patient room with a hospital approved bleach solution. Clean C. Diff patient’s bathrooms more frequently.

Special Precautions for VRE

Special Precautions for VREIsolation precautions only required if patient has an open draining wound, diarrhea, or are incontinent of urine or stool.

When caring for patients with VRE, isolation precautions are not required unless the patient has an open draining wound, diarrhea, or are incontinent of stool or urine.

MDRO Precautions

Following precautions can help prevent the spread of infections.

Click on each of the numbered buttons above to learn more

about the precautions that you should take when caring for a

patient with a MDRO infection.

1 2 3 4 5 6 7

Now that you have learned the special precautions for C. Diff and VRE, let’s learn more about the precautions that apply to all of the MDROs. Following these precautions can help to prevent the spread of infection to yourself and to others. Click on each of the numbered buttons to learn more about the precautions that you should take when caring for a patient with an MDRO infection.

MDRO Precautions

Utilize Standard Precautions

plus Contact Precautions for

known or suspected cases.

1 2 3 4 5 6 7

Utilize Standard Precautions plus Contact Precautions for known or suspected cases.

MDRO Precautions

Private room or partnered

with another patient who is

infected with the same

resistant organism.

1 2 3 4 5 6 7

Patients with VRE only require isolation precautions in the presence of an open draining wound, diarrhea, or are incontinent of urine or stool.

Patients with MDROs should be assigned a private room, or partnered with another patient who is infected with the same resistant organism.

MDRO Precautions

Hand hygiene before and

after patient contact

Alcohol-based waterless hand sanitizer is preferred*

Use antibacterial soap and water when hands are visibly dirty

1 2 3 4 5 6 7

* EXCEPT for patients with C. Diff, washing with soap and water is

preferred

Perform proper hand hygiene practices before and after all patient contact. It is preferred that you use an alcohol-based waterless hand sanitizer to disinfect your hands. The use of antibacterial soap and water is recommended if your hands are visibly dirty. Remember, for patients with C. Diff, washing with soap and water is preferred.

MDRO Precautions

Use dedicated medical equipment or single use items if

possible.

Disinfect items before using them with another patient.

1 2 3 4 5 6 7

Use dedicated medical equipment or single use items if possible. It is important to disinfect items before using them with another patient.

MDRO Precautions

Wear gloves:

For all patient contact

When you will contact

room

Remove your gloves and

perform hand hygiene when

1 2 3 4 5 6 7

Gloves should be worn for all patient contact. Gloves should also be worn if you will come into contact with environmental surfaces in the patient’s room, such as medical equipment, bed rails, or doorknobs. Remove your gloves and perform hand hygiene when you exit the patient’s room.

MDRO Precautions

Wear a gown when:

There is a chance your clothing will become contaminated through contact with the patient

You will come in contact with a

drainage containing a MDRO

1 2 3 4 5 6 7

Wear a gown whenever there is a chance that your clothing will become contaminated through contact with the patient or the patient’s environment. You should also wear a gown if you will come into contact with a patient’s wound or other drainage containing a MDRO.

MDRO Precautions

Carefully

with a hospital approved disinfectant solution*.

Frequently touched surfaces should be cleaned more often.

1 2 3 4 5 6 7

• For patients with C. Diff, clean medical equipment and the patient room with hospital approved bleach solution.

• When possible, use ultraviolet light disinfection machine -

Careful cleaning of the patient’s room and other medical equipment with a hospital approved disinfectant solution will also help to prevent the spread of infections. Frequently touched surfaces such as bed rails, over bed table, bedside commode, surfaces in the patient’s bathroom, and doorknobs should be cleaned more often. For patients with C. Diff you should also clean medical equipment and the patient room with a hospital approved bleach solution. Clean C. Diff patients’ bathrooms more frequently. When possible, use ultraviolet (UVC) disinfection machine“Tru-D” after terminal cleaning of C. Diff patient rooms on discharge.

Prevent Catheter Associated Urinary Tract Infections (CAUTI)

Key elements of CAUTI Prevention

Use urinary catheters only when necessary

Appropriate indications only

Alternatives to urinary catheterization

Aseptic technique during catheter insertion

Daily care of the urinary catheter

Remove when no longer needed

Measure and monitor CAUTI

Utilize nurse managed urinary catheter removal protocol

Insert catheters only for appropriate indications. Alternatives to catheterization include using the bladder ultrasound to avoid catheterization, considering external catheters and applying adult briefs. Personnel should be trained on the correct technique of aseptic catheter insertion. Use Standard Precautions during any manipulation of the catheter or the collecting system. This includes performing hand hygiene and using gloves for daily care. A securement device should be used to prevent catheter movement. Maintain unobstructed urine flow by keeping the tube free from kinking, the collecting bag below the level of the bladder at all times and emptying the collecting bag regularly. Remove the catheter as soon as it is no longer needed. Surveillance is conducted on all patients with urinary catheters and CAUTI infection rates are available in HBI. Obtain order for foley insertion that includes nursing protocol to remove foley catheter when no longer needed.

Patient Education

Patients and visitors should be educated on ways to prevent the spread of infection. Educational materials on hand hygiene practices, respiratory practices, and contact precautions can be found through Krames On-Demand. This is an example of the handwashing tips for patients, family and friends. This is an example of the education for preventing the spread of infection.

Test Your Knowledge

You should be able to:

Identify strategies that can reduce the risk of developing a surgical site infection

List the key elements in the Central Line Bundle

Discuss key facts about specific multi-drug resistant organisms in the healthcare setting

Explain methodologies that can help decrease the likelihood of developing a Catheter Associated Urinary Tract Infection

To successfully complete this course, you must earn a score of at least 80% on the final test.

Click the Test button to start the final test.

Thank you for participating in the Infection Control and Prevention of Healthcare-Associated Infection course. You should be able to: •Identify strategies that can reduce the risk of developing a surgical site infection •List the key elements in the Central Line Bundle •Discuss key facts about specific multi-drug resistant organisms in the healthcare setting •Explain methodologies that can help decrease the likelihood of developing a Catheter Associated Urinary Tract Infection Click the Test button to continue on to the final test. In order to pass this course, you must earn at least 80% on the test. You can go back and review any section of this course by selecting the Outline tab, then selecting any of the topics listed. If you do not pass the test on the first try, you can go back and try again. Good luck.

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