Epidemiology and Risk of Infection in Home Health and Hospice Settings - PowerPoint Presentation

1. Epidemiology and Risk of Infection in Home Health and Hospice SettingsStatewide Program for Infection Control and Epidemiology (SPICE)UNC School of MedicineModule C

2. ObjectivesDiscuss the infectious process through review of the chain of infection.Review methods for controlling transmission of infection.Describe steps for detecting and controlling outbreaks.Describe the process for surveillance of infections

3. Chain of Infection

4. Infectious Agent or “The Harmful Germ”Bacteria (MRSA, VRE)Viruses (Influenza, Norovirus)Fungi (Candida, Aspergillis)Parasites (Giardia, pinworms)Arthropods (mites)Infestations, not infectionsInfectious Agent

5. Infectious Agent or “The Harmful Germ”Disease Producing Characteristics:VirulenceAbility to grow and multiplyInvasivenessAbility to enter tissuePathogenicity Ability to cause diseaseInfectious Agent

6. Reservoir or “Hiding Places”Where germs live, grow, and increase in numbersA personAn animalEnvironment/FomiteReservoir

7. People as ReservoirsBloodSkinDigestive tractMouth, stomach, intestinesRespiratory tractNose, throat, lungsUrinary tractReservoir

8. People We Know Who Are InfectedPeople as ReservoirsPeople We Don’t Know Who Are Infected

9. Portal of Exit or “The Way Out”

10. MODES of transmissionContact – victim comes in contact with sourceDirect – physical contact between source and victimIndirect – victim contacts contaminated inanimate objectsDroplet – brief passage of infectious agentAirborne – airborne phase in disease disseminationCommon vehicle – contaminated inanimate vehicle serves as the vector for transmission to multiple persons.Vectorborne - Not associated with healthcare transmission

11. Portal of Entry or “The Way In”Nose and MouthGI TractUrinary TractBreaks in skinCut, open sore, needlestick

12. Susceptible PersonAge: very young or olderStressFatiguePoor nutritionChronic illnessesNot properly vaccinatedOpen cuts, skin breakdownImmune suppressive medications

13. Knowledge CheckA disease or condition when harmful germs get into the body and cause pathology:HostInfectionReservoirPortal of exit

14. Knowledge CheckGerms can be spread indirectly through:Shared medical equipmentBloody gauzeNeedlesticksA and B onlyAll of the above

15. Breaking The chain of infectionStandard Precautions and Transmission-Based Precautions As long as the chain of infection remains intact, infection will spread to others.

16. Elements of Standard PrecautionsHand hygieneUse of personal protective equipment (PPE)gowns, gloves, mask, eye protectionSafe injection practicesSafe handling of potentially contaminated equipment or surfacesRespiratory hygiene/cough etiquette

17. What is the Best Way to Stop the Spread of Infection?Hand Hygiene

18. When to Perform Hand Hygiene

19. at thePOINT-OF-CAREWhere Should Hand Hygiene be Performed?

20. Personal Protective Equipment (PPE)Wear gloves for potential contact with blood, body fluids, mucous membranes, non-intact skin or contaminated equipment. Do not wear the same pair of gloves for more than one patient Do not wash gloves for the purpose of reuse Wear a gown to protect skin and clothing during procedures or activities where contact with blood or body fluids is anticipated. Do not wear the same gown for more than one patientWear mask and eye protection during procedures that are likely to generate splashes or sprays of blood or other body fluids. Wear a surgical mask when placing a catheter or injecting material into the spinal canal or subdural space.

21. Respiratory Hygiene/Cough EtiquettePost signs at entrances.Provide tissues and no-touch trash cans for disposal in waiting areas.Provide hand hygiene product in waiting areas.Offer a mask to symptomatic patients.Encourage ill patients to sit away from others.

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23. Transmission-based PrecautionsCertain conditions (syndromes) require triage and additional attentionDiarrhea (C. difficile, norovirus)Febrile respiratory illness (influenza)Febrile rash (chickenpox/shingles, measles)Early detection is important

24. Contact PrecautionsPut on gloves before direct contact with patient or immediate environment.Use gown for contact with:Uncontrolled secretionsPressure ulcersDraining woundsLimit amount of non-disposable patient care equipment brought into home.Place contaminated re-usable noncritical patient care equipment in plastic bag for transport.Clean horizontal surfaces and equipment with Environmental Protection Agency (EPA)-registered disinfectantStool IncontinenceOstomy tubes or bags

25. Droplet PrecautionsInstruct patient to follow respiratory hygiene/cough etiquette.HCP should wear surgical mask upon entry to room.Have patient wear a mask when outside the home. Disinfect all horizontal surfaces and equipment using a Environmental Protection Agency (EPA)-registered disinfectant.

26. Have system in place to identify patients with known or suspected airborne spread infections.Instruct patient to follow respiratory hygiene/cough etiquette.If tolerated, patient can wear surgical mask while in the home to prevent dispersion of microorganism. Educate family regarding the contagious nature of the disease.Protect vulnerable household members (immunocompromised, <4 yrs old)For TB, HCP must wear fit-tested N-95 respirator upon entry.For Chickenpox and Measles, susceptible staff should wear a surgical mask.Clean horizontal surfaces and equipment with EPA-registered disinfectant. Airborne Precautions

27. Precautions in the homeCaregivers should wash hands with soap and water after contact with infected or colonized person and before leaving homeUse disposable towels to dry hands Do not share personal care items with infected personDisposable gloves should be worn if contact with body fluids is possible. Wash hands following removalChange linens and wash on a routine basisClean environment routinely and when visibly soiled with body fluids

28. Knowledge CheckWhat is the single most effective way to prevent the spread of infections?Using PPECleaning patient care equipmentHand HygieneCoughing into the crook of elbow or tissue

29. Outbreak* Investigation* Outbreak: occurrence of more cases of disease than normally expected within a specific place or group of people over a given period of time.

30. DefinitionsEndemic: the usual presence of disease within a geographic areaEpidemic (Outbreak): an excess over the usual or expected occurrence of disease within a geographic areaPandemic: epidemics that affected several countries or continents (e.g., AIDS, pandemic influenza, SARS)

31. Outbreaks StepsVerify diagnosisEstablish case definitionReview for cases – case searchCreate a line listingMake an epi-curve*Develop hypothesisTest hypothesisImplement control measuresEvaluate control measuresDisseminate information*a chart showing the number of persons who became ill each day

32. Suspected Outbreak…Know Who to Call for AssistanceFacility Risk ManagerLocal Health Department first OR State Public Health Department (Raleigh 919-733-3419)Infection Control Assistance: Statewide Program for Infection Control and Epidemiology (SPICE), spice@unc.edu, 919-966-3242

33. Knowledge CheckWho should be notified of a suspected or known communicable disease outbreak?Risk ManagementAdministration/DirectorLocal Health DepartmentAll of the above

34. Surveillance of Infections

35. PurposeAssess safety and quality of patient careMonitor infection trendsImprove care and prevent healthcare-acquired infectionsAssist with identifying conditions that may be reportable to public health department

36. Developing a surveillance programAssessment of population served and services providedReview of existing infection data

37. Published Rates of Home Care-Acquired Infection RatesAuthor (Date of pub)Catheter Associated UTIs (per 1000 catheter daysCentral Line Associated Bloodstream infections (per 1000 catheter days)Missouri Home Care Alliance (2004)3.90.82Gorski (2004)--0.77Moureau (2002)--0.19Long (2002)4.4--Leuhm (1999)2.790.54Weber (2009)2.21.24APIC Infection Control in Home Care and Hospice (2nd ed.), 2006Weber DJ, et al. ICHE 2009;30:1022-1024

38. The surveillance PlanDefines the scope of the data gatheringShould focus on frequently occurring infections, high-risk infections, and infections where interventions are likely to result in preventionMust specify minimum data to be collected, the data collectors and methodology

39. Surveillance DefinitionsFebruary 2008, APIC-HICPAC published surveillance definitions for Home Health and Hospice.Definitions should be used consistently http://apic.org/Resource_/TinyMceFileManager/Practice_Guidance/HH-Surv-Def.pdf