preventing/controlling the...

PREVENTING/CONTROLLING

THE TRANSMISSION OF

INFECTIOUS AGENTS

APIC DFW Professional Advancement

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


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


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


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


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


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)


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


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)

[email protected]

QUESTIONS???

Jerry Kelley

817-705-7822 (Cell)

817-255-1899 (Work)

[email protected]

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