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HOW CAN WE PREVENT INFECTIONS?The Clean Environment
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Hospitals in the Past
Hospitals were dirty, smelly, over-crowded places, full of disease
Hospitals were places where poor people went to die.
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Hospitals in the Past
Women and children died from infection because doctors went straight from doing autopsies to delivering their babies without washing their hands.
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Things started to Change
Florence Nightingale devoted her life to improve health by improving the environment.Proved that clean environment, warmth, air quality, sunlight and quiet led to good health.
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Others Followed
Doctors began to learn about how germs are spread.
Doctors like Holmes and Pasteur realized that the simple thing like a doctor washing his hands led to less people getting sick and dying.
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Hospitals Today
Today we expect hospitals to be very clean places of healing.
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Specialized Team
Today we have created a specialized team devoted to making sure the environment is clean enough.
To promote healingTo prevent the spread of disease
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YOUare the
SpecializedTeam
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Tell us what you know…
Handout copy for everyone
We will walk through questions together but please answer on your own
Hand in your copy of your answers when you finish
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Tell us what you know…Question 1
People who live in a long term care setting are not at a greater risk for infections.
TRUE FALSE
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Tell us what you know…Question 2
MRSA bacteria can live on surfaces in a patient’s room or a resident’s room.
TRUE FALSE
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Tell us what you know…Question 3
Cleaning a surface removes germs and kills them.
TRUE FALSE
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Tell us what you know…Question 4
When cleaning a patient’s room or a resident’s room you must clean from the dirtiest area to the cleanest area in the room.
TRUE FALSE
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Tell us what you know…Question 5
Environmental staff play as important a part in preventing the spread of infection as nurses and doctors do.
TRUE FALSE
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Tell us what you know…Question 6
Disinfection on its own will prevent the spread of infection.
TRUE FALSE
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Tell us what you know…Question 7
When cleaning a patient’s room or a resident’s room you must clean from the lowest area to the highest area.
TRUE FALSE
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Tell us what you know…Question 8
Environmental cleaning is an important part of infection control in SCHR.
TRUE FALSE
ALL DONEPLEASE HAND IN YOUR ANSWERS
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The Clean Environment
GERMSFound in places that look dirty and found in places that look clean
Can cause illness, especially in those who are already sick or weak (newborns, elderly, dialysis and cancer patients)
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Cleaner than Your Own Home
The hospital and nursing home must be cleaner than your home.
Our patients and residents are vulnerable and need to be protected from MRSA and other germs that may come into the hospital or long term care facility.
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Cleaner than Your Own Home
Remember germs are there even though we cannot see them
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Host, Agent, Environment
HOST
(Residents & Patients)
ENVIRONMENT
AGENT
(Bug/Germ,
MRSA)
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Chain of Infection
Portal of
Exit
Portal
of Entry
Transmission
Reservoir(HCW, Environment,
Patient) Infectious
Agent(MRSA)
Host
Susceptibility(older,
immunocompromized)
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Outbreak Graph
0
2
4
6
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10
12
6-Fe
b
8-Fe
b
10-F
eb
12-F
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20-F
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22-F
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Mar
3-M
ar
Date of Onset
Nu
mb
er o
f S
ick
Peo
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Staff with Illness Residents with Illness
Infection Control Notified
Facility Closed
Outbreak Declared
Over 20 Days Later
Seven Deaths during outbreak
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Team Work
There are many different tools required to provide the best protection for our residents/patients and employees
Preventing infections:Takes team work Is like putting together the pieces of a
puzzle
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Preventing Infections
Name some important things you do to prevent infections like MRSA….
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Infection Control Puzzle
MasksHandwashing
ENVIRONMENTAL CLEANING
VaccinationGowns
Gloves De-cluttering
Cleaning EquipmentEducation & Training
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High Touched Spots (HTS)
Can you name some high touch spots in the patient or
resident’s room?
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High Touched Spots (HTS)
Bed: Footboard
Window Sill
Bed Rails
Bedside Tables
Bed: Adjustment
Clothing Storage Handle
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High Touched Spots (HTS)
Sink Tap
Toilet Seat
Towel Dispenser Light Switch
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Cleaning HTS
How do we know we have done a good job?
Let’s try it out…..
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Environmental Services are One of Our Most Important lines of Defense in Infection Control
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Lines of Defense
Vaccines
Hand Hygiene
Environmental Cleaning Treatment
Personal Protective Equipment
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How Do We Prevent Infections?
Educate about infection prevention and control
Update cleaning procedures
Focus on High Touched Spots
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How Do We Prevent Infections
Standard Precautions are used with every patient or resident.
-Hand washing/Hand antiseptics-Gloves-Gowns-Masks/Eye protection-Care of equipment
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Tell Me About MRSA
Staphylococcus aureus is a bacteria/germ Up to 30% of us carry it on our body Can cause infections such as boils, impetigo and
blood infections
Methicillin Resistant Staphylococcus aureus (MRSA) is same Staph. aureus bacteria/germ that has become resistant to some of the most common antibiotics we use to treat Staph infections.
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Tell Me About MRSA
MRSA can survive in the environment (door knobs, bed rails, bathroom faucets, etc… high touch).
There is evidence MRSA could survive more than 38 weeks on sterile goods.
(Infection Control and Hospital Epidemiology May 2003 SHEA Guideline for Preventing Nosocomial Transmission of Multidrug-Resistant Strains of Staphylococcus aureus
and Enterococcus – see page 368)
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Definition of CleaningCleaning is defined as the physical removal of foreign material For example - dust, soil such as blood, secretions,
excretions and microorganisms
Cleaning physically removes microorganisms/germs. It does not kill germs. Cleaning is accomplished with water, detergents
and mechanical action.
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Definition of Disinfection
Disinfection is stopping/killing germs that cause disease.
We use special products for disinfection.
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Clean and Disinfect
We must clean first and then disinfect to prevent the spread of infection and stop germs in their tracks.
Disinfectants are not effective when used on items or areas that are soiled with organic material including microorganisms.
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Operation Clean Sweep
Where do you start??
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Director and Chief ofOperation Clean Sweep
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Cleaning Principles
Cleaning goes from clean
to dirty
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Cleaning Principles
Clean from top
to bottom
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De-Cluttering
Assess your environment
Minimize supplies in room
Reduce clutter and remove unnecessary equipment in the room
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How to Measure Cleanliness
Past practice has been to measure cleanliness by what we can see (e.g. dust, litter, dirt)….
…but it is important that the measurement of cleanliness be extended to what we can not see with the naked eye.
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Approaches that Have Proven Successful
How do we know we have done a good job? By assessing the effectiveness of cleaning with an
environmental tracer (e.g. Glitterbug Lotion) that can highlight surfaces that were skipped or not completely done during the cleaning process.
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Approaches that Have Proven Successful
Use improved cleaning protocols.Use checklists to document that all areas were cleaned as per schedule, especially high touch areas.Educate about cleaning High Touched Spots (HTS)Develop tools to measure if policies/procedures are being followed
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Hand Hygiene Activity
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Cleaning Protocols
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Let’s Try Them Out
Let’s go back up to the patient/resident’s room….
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Outbreak Graph
0
2
4
6
8
10
12
6-Fe
b
8-Fe
b
10-F
eb
12-F
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14-F
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18-F
eb
20-F
eb
22-F
eb
24-F
eb
26-F
eb
28-F
eb1-
Mar
3-M
ar
Date of Onset
Nu
mb
er o
f S
ick
Peo
ple
Staff with Illness Residents with Illness
Infection Control Notified
Facility Closed
Outbreak Declared
Over 20 Days Later
Seven Deaths during outbreak
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How Are We Doing Now
Baseline Environmental Cleaning at the 4 SCHR Facilities
0%
14%
5%
15%
25%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Facility 1 Facility 2 Facility 3 Facility 4 Average
Per
cen
t o
f H
TS
Cle
aned
21% = Goal for April 1, 2009 (Improve by 50%)
Nov/Dec 2008
Goal for July 2, 2009 (Improve to 95%)
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How Are We Doing Now
Baseline Cleaning of High Touch Spots
40%
10%
20%
0%
10%
30%
10%
0%
20%
0%
14%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bed R
ails
Bedsi
de Tab
les
Was
hroom
: Sin
k Tap
Was
hroom
: Towel
Dis
pense
r
Was
hroom
: Toile
t Sea
t
Light S
witches
Bed: F
ootboar
d
Bed: A
djust
men
t
Cloth
ing S
tora
ge Han
dle
Win
dow Sill
Overa
ll
Pe
rce
nt
Cle
an
ed
Goal for July 2, 2009 (Improve to 95%)
Nov/Dec 2008
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Wrap Up
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Tell us what you learned …
Please answer questions on your own and hand in your answers when you are finished
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You can make a difference
Handwashing
Follow protocols
Right cleaning product
Gloves
Elbow grease
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Team Work
As a health care team we must work together to make our health care facilities a safe place to stay.
It is everyone’s responsibility to learn the best way to prevent the spread of germs and follow those procedures.
Handwashing
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Team Work Prevents Infections
Hand Hygiene
Effective RoutineCleaning
=
Daily Cleaning of
High Touch Areas
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You are important.......
Each one of you is very important in preventing the spread of germs that may make someone very sick.
You must each do your very best to prevent the spread of germs.
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Tell us what we can do to improve …
Please complete the evaluation form and hand it in before you leave.
Thanks for your feedback today.