By MaryAnn Custer MS, FNP

S. PneumoniaeS. Pneumoniae60,000 cases / year in 2000, 37,000 in 200260,000 cases / year in 2000, 37,000 in 2002 Death in 14% of Hospitalized Adults Death in 14% of Hospitalized Adults *Pneumococcal Vaccine *Pneumococcal Vaccine Up to 25 days (dust), Glass 1-11 days , Up to 25 days (dust), Glass 1-11 days , 7 days in Sputum7 days in Sputum

InfluenzaInfluenza55thth Leading Cause of Death in the Elderly Leading Cause of Death in the ElderlyPrevention – ImmunizationPrevention – Immunization

ListeriaListeriaOpportunistic PathogenOpportunistic PathogenUsually assoicated with foodUsually assoicated with foodSurvives well in Soil, Water, Food, FecesSurvives well in Soil, Water, Food, Feces

C – DifficileC – DifficileSpore Forming OrganismSpore Forming OrganismOpportunistic Pathogen Opportunistic Pathogen Fecal-oral TransmissionFecal-oral TransmissionMay survive for extended periods outside HostMay survive for extended periods outside Host

TBTBCauses more Deaths Worldwide than Any Other Infectious DiseaseCauses more Deaths Worldwide than Any Other Infectious DiseaseSpread Person to Person - Aerosolized DropletsSpread Person to Person - Aerosolized DropletsUp to 70 days in Carpet, Clothes 45 days, Sputum 6-8 monthsUp to 70 days in Carpet, Clothes 45 days, Sputum 6-8 months

CAPCAP3-4 Million Cases / Year in the US3-4 Million Cases / Year in the US66thth Leading Cause of Overall Death Leading Cause of Overall DeathHighest in Children < 5, and ElderlyHighest in Children < 5, and Elderly

MRSAMRSAMethicillin Resistent Staphylococcus AureusMethicillin Resistent Staphylococcus AureusHA MRSA – Hospital Associated ~ 1961 - 50-70%HA MRSA – Hospital Associated ~ 1961 - 50-70%

Estimated Cost to Treat Between $3.2 – $4.2 billion/yearEstimated Cost to Treat Between $3.2 – $4.2 billion/year Joint Commission National Patient Safety Goals and Institute Joint Commission National Patient Safety Goals and Institute

for Healthcare Improvement 5 Million Lives Campaignfor Healthcare Improvement 5 Million Lives Campaign Respiratory, Urine, Wound InfectionsRespiratory, Urine, Wound Infections

CA MRSA – Community Associated – mid to late ‘90sCA MRSA – Community Associated – mid to late ‘90s Skin and Soft TissueSkin and Soft Tissue

Direct and Indirect TransmissionDirect and Indirect TransmissionSurvival in Hospital Environment 1 – 56 daysSurvival in Hospital Environment 1 – 56 days

NorovirusNorovirus Cruise Ships – 2002 Previously Known as Norwalk – like Viruses. Changed in 2002 1968 – 1972 Outbreak of “Winter Vomiting Disease” in Norwalk, OH Acute gastroenteritis – “stomach flu” or “24 hour bug” Explosive vomiting, watery (non bloody) diarrhea, abd cramps, HA,

body aches, low-grade fever. 24-60 hours #1 Cause of Foodborne Illness in US, causing about 2/3 of all

foodborne illness – 23 million infections, 50,000 hospitalizations, 300 deaths / year.

Transmission fecal-oral (food and water) – Direct & Indirect, also airborne (inhale and swallow droplets)

Highly transmissible – as few as 10 viral particles may cause infection. Only the “Common Cold” is reported more frequently.

Virus is stable on environmental surfaces – Non enveloped virus. Quats work by disrupting the viral envelope and are ineffective on non enveloped viruses.

““Getting Back to the Basics”Getting Back to the Basics”

Cleaners and DisinfectantsCleaners and Disinfectants Precision Blend SystemPrecision Blend System

Gloves, Masks, GownsGloves, Masks, Gowns

Mops, Buckets, & Cleaning ClothsMops, Buckets, & Cleaning Cloths

Waste, and Biohazard ContainersWaste, and Biohazard Containers

Hand Hygiene ProductsHand Hygiene Products

Epidemiologic TriangleEpidemiologic Triangle

CausalCausal AgentAgent

EnvironmentEnvironment

Susceptible HostSusceptible Host

HAND HYGIENEHAND HYGIENE

Observe Standard Precautions

Combination of Universal Precautions and Body Substance Isolation.

Wear personal protective equipment in accordance with OSHA’s standards, and facility recommendations:

Gloves, Goggles, Mask, Fluid Resistant Gown.

NOTE: GLOVES ARE A MINIMUM DURING

CLEANING AND DISINFECTION

DefinitionsDefinitions

A "disinfectant" is a substance that destroys or eliminates a specific species of infectious or other public health microorganism, but not necessarily bacterial spores, in the inanimate environment. *

A "sanitizer" is a substance that significantly reduces the bacterial population in the inanimate environment, but does not destroy or eliminate all bacteria or other microorganisms. *

(* EPA March 2002)

Two Levels of Disinfection for Two Levels of Disinfection for Environmental ServicesEnvironmental Services

Intermediate Disinfection (ILD) – Inactivate Mycobacterium Tuberculosis var. Bovis in addition to all other organisms below it.

ex. 3% Hydrogen Peroxide, 70% Isopropyl, Phenolics, Iodophors, and the other ready to use tuberculocidal solutions

Low-Level Disinfection (LLD) – Inactivate most forms of bacteria, some fungi, some viruses.

ex. Quaternary Ammonium Solutions

DESCENDING ORDER OF RESISTANCE TO GERMICIDAL CHEMICALSDESCENDING ORDER OF RESISTANCE TO GERMICIDAL CHEMICALSSterilization

BACTERIAL SPORES Bacillus Subtilis

Clostridium Sporogenes HLD High Level Disinfection

MYCOBACTERIA Mycobacterium Tuberculosis Var. Bovis ILD Intermediate Level ‘TB’

NONLIPID OR SMALL VIRUSES Poliovirus Coxsackie Virus Hepatitis A Virus

Rhinovirus ‘Common Cold’

FUNGI LLD Low Level Trichophyton Spp. ‘Nail Fungus’

Cryptococcus Spp.Candida Spp. ‘Yeast’

VEGETATIVE BACTERIA Pseudomonas Aeruginosa Staphylococcus Aureus ‘Staph’ Salmonella Choleraesuis ‘Gastroenteritis’

LIPID OR MEDIUM-SIZED VIRUSES Herpes Simplex Virus ‘Cold Sores’ Cytomegalovirus ‘CMV’ Respiratory Syncytial Virus ‘RSV’ Hepatitis B Virus ‘HBV’ Human Immunodeficiency Virus ‘HIV’

(Adapted From Bond & Favaro, 1991)