preventing/controlling the...
TRANSCRIPT
POLICY REVIEW
•Infection prevention policies are paramount to the standardization of a program
•Purpose is to protect the patient and healthcare workers in a cost efficient environment
•Use national references such at APIC, SHEA, CDC, HICPAC
•TJC and CMS have standards but not references
PREPAREDNESS FOR
BIOLOGICAL EVENTS
•Assess hazards and vulnerabilities
•Develop plans
•Incorporate syndromic surveillance
•Educate all involved
•Practice the plan
MITIGATION/INFECTION
PREVENTION PROCEDURES
•Follow the principles of an outbreak investigation
•Report unusual infections
•Triage quickly
•Quarantine
•Prophylaxis, vaccination, treatment
•Decontamination
•Post mortem care
POTENTIAL BIOTERRORISM
AGENTS CATEGORY A
•Anthrax
•Botulism
•Plaque
•Smallpox
•Tularemia
•Viral hemorrhagic fevers
Category A severe morbidity and low mortality
High-Priority agents that pose a risk to national security
POTENTIAL BIOTERRORISM
AGENTS CATEGORY B
•Brucellosis
•Clostridium perfringens
•Food safety threats
•Glanders
•Meliodosis
•Psittacosis
•Q fever
•Ricin toxin
•Staphylococcal
enterotoxin B
•Typhus fever
•Viral encephalitis
•Water safety Threats
Category B moderate morbidity and low mortality
HAND HYGIENE
•Assure that the definition of hand hygiene is
standardized
•Look at product standardization, dispenser
location, indication for hand hygiene, and technique
•Surgical hand hygiene requires persistent activity
(CHG and alcohol is best)
•Develop monitoring programs to comply with
JCAHO
CLEANING,
DISINFECTION AND
STERILIZATION
Spaulding classification:
• critical
• semi-critical
• non-critical
• Pre-cleaning is key:
• Ultrasound
• enzymes
• washer sterilizer
• Sterilization:
• Steam
• Chemical:
• ETO
• Glutaraldehyde/OPA
• Gas
• Plasma( hydrogen peroxide)
• liquid peracetic acid
HIGH LEVEL
DISINFECTION
•Glutaraldyde and OPA can also be used as a high level disinfectant
•Assure that the solutions and strips are marked with expiration date
•Assure that the temperature of the solution is monitored for each soaking
•Assure that the QC for the strips and the solution are documented
HIGH LEVEL
DISINFECTANTS CON’T
•OPA is safer to use than gluteraldehyde
due to low fumes
•Do not need to activate product
•Soak products for 12 minutes at 20 degress
•CMS is monitoring this process and
focusing on monitoring of the temperature
of the solution
LOW LEVEL
DISINFECTION
•Quaternary Ammonia products ( quats) (4th generation). Most common in hospitals
•Phenolics: never use in nurseries due to associated neurotoxicity to infants
•Phenolics are frequently used to clean floors in hospitals
•The text calls phenolics an intermediate disinfectant
MONITORING OF
STERILIZATION SYSTEMS
•Mechanical indicators: recording charts
•Chemical indicators: impregnated paper or strips. The
Bowie Dick checks to see if the air has been removed
from the chamber and the efficiency of the vacuum
pump
•Biological indicators: (spore strip) use first load of
every day but at least once a week and with all
implantables
•Have a policy and plan for all sterilization failures
CONTROL OF INFECTIONS IN
SPECIFIC CARE SETTING-
RESPIRATORY THERAPY
•Use sterile water for nebulizers
•Nebulizers should be disposable single patient
use
•Avoid multidose vials
•Incentive spirometers should be single use and
rinsed between each use
•Do not change circuits on vents routinely
•HEPA filters are recommended on vents
RESPIRATORY
THERAPY CON’T
•VAP prevention:
•Head of bed 30-40 degrees elevation
•Antiseptic mouth wash
•Peptic ulcer prophylaxis
•DVT prophylaxis
•Sedation vacations
•Cuff pressure assessment
•Turn patient every 2 hours
SPECIFIC CARE SETTING-
ENDOSCOPY
•Endoscopes are a common source for outbreaks
•Pre-cleaning is essential prior to high level disinfection or sterilization
•Clean, disinfect, rinse, dry store
•New endoscopy guidelines have been published
•Be careful of endoscope washer products
SPECIFIC CARE SETTING- SURGICAL SERVICES
•ORs should be 15 air exchange and positive pressure
•Consider HEPA and Laminar filters and UV light
•Evaluate traffic control and supplies
•Evaluate surgical attire
•Evaluate environmental cleaning
•Assure proper sterilization and disinfection of
instruments
•Assure aseptic technique
SPECIFIC CARE SETTING-
SURGICAL SERVICES
•The surgical skin prep is essential for
infection prevention
•CHG has been proven in Clean and
Clean Contaminated procedures to be
superior
•Iodine preps MUST dry before
incision before drying
SPECIFIC CARE SETTING-
INTENSIVE CARE
•ICU patients are more at risk because of
invasive lines and procedures
•Use standard CDC definitions for surveillance
•Assure use of proper isolation, removal of
lines/tubes and drains as soon as possible
•Assure proper staffing
SPECIFIC CARE SETTING-AMBULATORY CARE
•Risk of HAI is lower; more in line with
underlying disease
•Assure responsibility is assigned to HCW
•Perform surveillance of outcome and
process
•Complete reportable disease reports
•See new Ambulatory Care guidelines
PREVENTION OF SURGICAL
SITE INFECTIONS
•SSI begin in the OR
•Focus prevention on:
•Procedure risk factors
•HICPAC guidelines
•Pre-operative control ( clipping, skin prep)
•Intra-operative control (technique, barriers, air exchanges,
humidity, traffic)
•Post –op control ( sterile dressing, hand hygiene)
PREVENTION OF CENTRAL LINE
RELATED BLOOD STREAM
INFECTIONS
•Source is either percutaneous tract or hub
•Focus on catheter insertion:
•Aseptic technique
•Site of insertion
•Skin prep
•Sterile dressing
•Maintenance
• removal of device
•Dressing changes
PREVENTION OF CATHETER
ASSOCIATED URINARY
CATHETER INFECTIONS
•Remove catheters ASAP
•Use Aseptic technique
•Maintain closed system
•Assure bag is below the bladder
•Do not routinely change catheters
•Secure catheters when in place
VENTILATOR ASSOCIATED
PNEUMONIA
•New guidelines have just been published
•Perform routine mouth care
•Maintain head of bed
•Discontinue vent when possible
•Avoid routine vent changes
•Drain condensate ( rain) away from patient
•Use disposable or high level disinfected
components
PREVENTION OF INFECTIONS
DURING HEMODIALYSIS
•Maintain proper vascular access
•Assure proper vaccination status of
employees and patients
•Focus attention on hepatitis status of
patients and employees
•Assure proper water treatment and testing
•Follow quality improvement plans
ISOLATION PRECAUTIONS-
STANDARD PRECAUTIONS
•Treat all patients’ blood and body fluids as if
they are infectious material
•Use gowns, gloves, mask, face shield
( eye protection)
•Use safer injection practices
•Comply with respiratory hygiene/cover your
cough
ISOLATION PRECAUTIONS-
CONTACT PRECAUTIONS
•Used for diseases transmitted via contact
with patient or patients environment
•Single room or cohort
•Gloves and gown required for entry
•Limit patient transport
•Consider ways to discontinue contact
isolation
ISOLATION PRECAUTIONS-
DROPLET PRECAUTIONS
•Used for diseases that are caused by large
respiratory droplets
•Use surgical mask, gloves
•Limit patient transport
•Mostly diseases of pediatric population
( Neisseria meningitidis)
ISOLATION PRECAUTIONS-
AIRBORNE TRANSMISSION
•Use for the diseases that are
transmitted by agents that remain
suspended in the air and travel great
distances
•Use negative pressure, 6-12 air
exchanges
•Wear N-95 mask
ISOLATION PRECAUTIONS-
PROTECTIVE ENVIRONMENT
•Recommended for allogenic hematopoietic
stem cell transplant recipients
•Positive pressure and HEPA filtered air
•Keep patient in the special precautions as
much as possible
ENVIRONMENTAL HAZARDS-
LINEN AND LAUNDRY
•Store clean linen in closed carts or
cabinets
•Clean linen taken into a patients room
but not used should be considered
contaminated
•Any garment that is considered PPE
must be laundered by the facility
ENVIRONMENTAL HAZARDS-
TRASH AND BIOHAZARD WASTE
Categories include:
•Sharps
•Microbiology waste
•Animal wastes
•Blood and blood products
•Pathology wastes
PREVENTION OF INFECTION
THROUGH CONSTRUCTION AND
RENOVATION
Develop Infection control risk assessment
•Assessment based on location of construction and type
of patient care area
•Define the role of the IP and the construction personnel
•Set in place monitors ( visual, air samples, rounds,
negative pressure)
•Dust partitions should extend to the deck and
encompass the entire project
PREVENTION OF TRANSMISSION
OF TUBERCULOSIS
•Complete your annual TB risk assessment
•Screen in high risk areas if necessary
•Comply with TB skin testing program
•Use negative pressure and N-95 masks for
patient care
•Educate patients and staff about risk of
transmission
•Communicate with the local health department
PREVENTION OF TRANSMISSION OF
BLOOD BORNE PATHOGENS IN
DIALYSIS UNITS
•Follow standard precautions
•Vaccinate patients and staff
•Only HBsAb positive staff may care for patients with
unknown Hepatitis B status
•Follow CDC hepatitis testing strategy
•Gown and glove and goggle for each initiation and
discontinuation of dialysis
•Gloves for each contact with the dialysis machine
PREVENTION OF TRANSMISSION
OF CLOSTRIDIUM DIFFICILE
•Use contact precautions
•Do not allow use of alcohol rub for hand
hygiene
•Clean room using EPA approved germicide
for disinfection
•Allow for appropriate dwell time for
disinfectants
PREVENTION OF MULTIDRUG
RESISTANT ORGANISMS
High level of suspicion for MDRO
•Use contact isolation
•Adopt antibiotic stewardship
•Identify methods for MDRO surveillance
•Asses environmental cleaning and disinfection
processes
Cheryl Sharp
817-965-1561 (Cell)
817-848-4068 (Work)
QUESTIONS???
Jerry Kelley
817-705-7822 (Cell)
817-255-1899 (Work)