Infection Control

Connie Cavenaugh

UAMS’ Infection Control Practitioner

Standard Precautions

Standard precautions are to be used with all patient contact. Treat all blood and body fluids as infectious. Use gloves if touching non-intact skin, use gowns if soiling is likely, & use a mask if the potential for splashing may occur. Standard precautions are designed to protect you and the patient.

Equipment used from patient to patient (wheelchairs, stretchers, blood pressure machines, etc) should be disinfected in between patient use by using hospital approved disinfectant wipes.

What are Isolation Precautions?

These precautions are determined by the mode of transmission of the suspected or known disease.

- Airborne Precautions Tuberculosis, Measles, Chickenpox, SARS

-Droplet PrecautionsMeningitis, Influenza

-Contact PrecautionsMRSA, VRE, C. difficile, RSV

Isolation

Airborne Precautions Tuberculosis Chicken Pox* Measles SARS

*Requires both airborne and contact precautions

TuberculosisTB is spread through the air from one person to another.

The bacteria are put into the air when a person with TB disease of the lungs or throat coughs or sneezes. People nearby may breathe in these bacteria and become infected. Symptoms of TB depend on where in the body the TB bacteria are growing. TB bacteria usually grow in the lungs. TB in the lungs may cause

* a bad cough that lasts longer than 2 weeks* pain in the chest * coughing up blood or

sputum * weakness or fatigue * weight loss * no appetite * chills * fever * sweating at night Suspect or known TB patients must be housed in a negative

pressure room. Staff dedicated to take care of these patients must be fit tested for N95 respirators through OH&S

Isolation

Droplet Precautions

Meningitis Influenza

Meningitis Meningitis is an inflammation of the meninges, the

membranes that cover the brain and spinal cord. The inflammation is usually caused by bacteria or viruses (viral meningitis is also called aseptic meningitis).

Many of the bacteria or viruses that can cause meningitis are fairly common and are more often associated with other everyday illnesses. Sometimes, however, they spread to the meninges from an infection in another part of the body. The infection can start anywhere, including in the skin, gastrointestinal tract, or urinary system, but the most common source is the respiratory tract. From there the microorganisms can enter the bloodstream, travel through the body, and enter the central nervous system. In some cases of bacterial meningitis, the bacteria spread directly to the meninges from a severe nearby infection, such as a serious ear infection (otitis media) or nasal sinus infection (sinusitis). Bacteria may also enter the central nervous system after severe head trauma or head surgery.

Bacterial Meningitis

Bacterial meningitis is less common than viral meningitis but is usually much more serious and can be life-threatening if not treated promptly. Many different types of bacteria can cause meningitis: Group B Streptococcus, Escherichia coli, and Listeria monocytogenes are the most common causes of meningitis in newborns. Streptococcus pneumoniae (pneumococcus) and Neisseria meningitidis (meningococcus) are more frequent in children older than 2 months of age. Before the 1990s, Haemophilus influenzae type b (Hib) was the leading cause of meningitis in children in the United States. But the widespread use of the Hib vaccine as a routine childhood immunization has dramatically decreased the frequency of meningitis caused by Hib.

Viral Meningitis Viral meningitis is relatively common and far

less serious than bacterial meningitis. It often remains undiagnosed because its symptoms are similar to those of the common flu. The frequency of viral meningitis increases slightly in the summer and fall months because people are more often exposed to common viral agents during those seasons. Most cases of viral meningitis are associated with enteroviruses - viruses that typically cause stomach "flu."

Prophylaxis

After a diagnosis of “meningitis” has been made, it is very common for healthcare workers to want “prophylaxis” to prevent transmission. It is very important to understand that the only prophylaxis given is for meningococcal meningitis (Neisseria meningitidis).

Isolation

MRSA VRE C. difficile RSV

MRSAMRSA is Staphylococcus aureus that has developed resistance to all the penicillin drugs normally used to treat this type of infection. Wearing gloves with all patient contact, using gowns with significant patient contact, and being vigilant about hand hygiene & equipment disinfection will protect you and your patients. MRSA is most often spread via the hands of healthcare workers.

CA-MRSA (Community-associated) is becoming more and more prevalent. These infections most often present as skin and skin structure infections mimicking “spider bites”. They are NOT spider bites!

VRE

VRE is an Enterococcus that has developed resistance to Vancomycin. Enterococcus lives normally in the GI tract and can also be a normal flora in the groin and perineal area. Enterococcus can live for weeks on inanimate objects like bedrails, bedside commodes, & tables. Strict Contact Precautions are necessary to prevent the spread of VRE. Gowns & Gloves must be worn BEFORE entering the patient room. Strict adherence to hand hygiene is very important to prevent transmission.

Clostridium difficileC. diff is a spore-forming bacteria that can produce toxins and cause severe diarrhea. Spores can live in the environment for weeks and C. diff is not killed easily by routine disinfectants. C. diff infection is on the rise and new novel strains have been detected over the last several years. STRICT Contact Precautions are necessary to prevent the transmission. Gowns & Gloves must be worn BEFORE entering the patient room. Alcohol gel is not as effective against C diff as a good handwash.

Multi-drug resistant organisms:Acinetobacter baumanii (MDR-Ac), Pseudomonas