Prepared Nurses Protect Patients: Prevention Strategies for Healthcare-Associated Infections - PowerPoint Presentation

Slide1

Prepared Nurses Protect Patients: Prevention Strategies for Healthcare-Associated Infections and Emerging Infectious Diseases Slide2

Objectives

List significant healthcare associated infections

Understand the epidemiology of significant healthcare associated infections

Identify disease transmission Utilizing evidence based literature develop strategies used to prevent the spread of infectionSlide3

Healthcare-associated Infection (HAI)

An infection that

patients acquire during the course of receiving treatment for other conditions within a 

healthcare setting Slide4

Common type of HAIs include:

Catheter-associated

urinary tract

infectionsCentral-line associated bloodstream infectionsSurgical site infectionsMethicillin Resistant Staphylococcus aureus (MRSA)

Clostridium difficileSlide5

Other infections: Old and New

Tuberculosis

Human Immunodeficiency Virus (HIV)

Candida aurisZIKASlide6

HAIs in the U.S.

1 out of

25

hospitalized patientsIncreased morbidity and mortality Increase in length of hospitalization

Attributed

costs: $26-33 billion

annually

Impact the patient and familySlide7

Germs spread

within and across health care

facilitiesSlide8

National Healthcare Safety Network (NHSN)Slide9

HAI Progress ReportsSlide10

HAI Progress ReportsSlide11

Value Based PurchasingSlide12

Type of HAIs and Prevention StrategiesSlide13

Type of HAIs and Prevention Strategies

Catheter associated urinary tract infections

(CA UTIs)

Central line associated bloodstream infections

(CLA-BSI)

Surgical Site infections

(SSIs)

C.difficile

MRSA (blood)Slide14

Catheter associated urinary tract infections (CA UTIs)

Symptomatic UTI (SUTI)

Indwelling urinary catheter in place > 2 days on the date of event

AND

present for any portion of the day on the day of event

OR

removed the day before the event.

Patient has at least one of the following: fever >100.4, suprapubic tenderness, costovertebral angle pain or tenderness, urinary urgency, urinary frequency, dysuria

Patient has a urine culture with no more than 2 species identified, at least one of which is a bacterium of

>

100,000 CFUsSlide15

Catheter associated urinary tract infections

(CA UTIs

)

Prevention

Insert catheter using established indications:

Acute

urinary retention

: 

e.g

., due to medication

, anesthesia

,

paralytics

Acute

bladder outlet obstruction

: e.g., due to severe prostate

enlargement

Need for 

accurate measurements of urinary output in the critically ill

To assist in healing of 

open sacral or perineal wounds in incontinent patients

To improve comfort for end of

life

Patient requires strict prolonged immobilization

 (e.g

.,

multiple traumatic

injuries)

Selected peri-operative

needs

 Slide16

Catheter associated urinary tract infections

(CA UTIs

)

Prevention

Insert under aseptic technique, using staff members

Secure catheter to leg

Drainage bag is below the level of the bladder to prevent backflow

Tubing is not kinked

Label drainage bag with insertion date/time

Assess the need for the catheter q shift

Perform hand hygiene prior to handling the catheter and after

Obtain specimens using sterile technique

Separate emptying container

Educate the patient and family on the prevention of CA UTIsSlide17

Central line associated bloodstream infections

(CLA BSIs)

Lab-Confirmed Bloodstream Infection

Patient has at least one of the following: fever > 100.4F, chills or hypotension

AND

Organism9S0 identify from blood is not related to an infection at another site Slide18

Central line associated bloodstream infections (CLA BSIs)

Prevention Measures:

Insert the catheter under maximal barrier protection using aseptic technique

Gown, gloves, mask, large drape

Use alcohol impregnated caps

Use endcaps when disconnecting the catheter from tubing

Label IV tubing with date/time/ initials

Change IV tubing and dressing per hospital policy

Assess the need for the catheter q shift

Educate the patient and family on the prevention of CLA BSIsSlide19

Surgical Site Infections

(SSIs)

Focus:

Colon procedures

Total Abdominal Hysterectomies (TAH)

Total Knee Replacements (TKR)

Coronary Artery Bypass Graphs (CABG)Slide20

Surgical Site Infections

(SSIs)

Prevention

Preoperative:

Smoking and alcohol cessation, dental care, blood sugar control, no remote sites of infection, discontinuation of certain medications

MRSA/MSSA screening

CHG baths

Correct antibiotic

Patient and family educationSlide21

Surgical Site Infections (SSIs) Prevention

Intraoperative:

Timing of antibiotics

Redosing antibiotics

Supplemental oxygen

Normothermia

Type of anesthesia

Changing gloves at certain timesSlide22

Surgical Site Infections (SSIs) Prevention

Postoperative:

Stopping antibiotics

Change dressing per hospital policy

Ambulate

Discontinue indwelling urinary catheter

Discharge home

Educate the patient and family on infection preventionSlide23

Clostridium difficile

Risk Factors:

Age

Previous exposure to health care

Previous roommate’s status

Antibiotics

Proton Pump Inhibitors (PPIs)

Diabetes

Dialysis

ResidenceSlide24

Clostridium difficile

Microbiology –

Clostridium

difficile

 is an anaerobic gram-positive, spore-forming, toxin-producing bacillus

and is the cause for

C.difficile

associated diarrhea.

Epidemiology –

There

has been dramatic change in the epidemiology of Clostridium difficile infection (CDI) since the turn of the 21st

century including an

increase in incidence and

severity

, occurring at a disproportionately higher frequency

in

older patients.Slide25

Clostridium difficile

Reporting definition –

specimen collected > 3 days after admission to the facility

Colonization data -

Prevalence of asymptomatic

C. difficile c

olonization among elderly residents ranged from 0 to 51 %, possibly because CDI is often endemic in units or institutions with elderly patientsSlide26

Clostridium difficile

Symptoms

Diarrhea

Elevated WBC’s

Temperature

Abdominal painSlide27

Clostridium difficile

Prevention

Isolation

Hand Hygiene

Antibiotic Stewardship

Clean environment

Clean patient care equipment

Fecal transplant to prevent recurrenceSlide28

Methicillin Resistant Staphylococcus aureus

(MRSA)

Microbiology

–

gram positive cocci resistant to oxacillin

Epidemiology

–

The

frequency of methicillin-resistant 

Staphylococcus aureus

 (MRSA) infections continues to grow in hospital-associated settings and, more recently, in community settings in the United States and globally.Slide29

Methicillin Resistant Staphylococcus aureus (MRSA)Slide30

Methicillin Resistant Staphylococcus aureus

(MRSA)

Reporting Definition

-

S

pecimen

collected > 3 days after admission to the facility

Colonization data

–

About

one-third of the general population carry staphylococcal microbes.

Estimates

of healthcare workers’ carrier status range from 50% to 90

%.

Slide31

Methicillin Resistant Staphylococcus aureus

(MRSA)

Risk Factors

Diabetes,

Residence prior to admission

Participation in group activities/sports

SymptomsSlide32

Methicillin Resistant Staphylococcus aureus

(MRSA

)

Prevention

Isolation

Hand hygiene

Antibiotic Stewardship – Vancomycin time out

Clean environment

Clean patient care equipment

DecolonizationSlide33

Old and New InfectionsSlide34

Tuberculosis

Epidemiology –

T

he

TB epidemic is larger than previously

estimated

The

number of TB deaths and the TB incidence rate continue to fall

globally.

In

2015, there were an estimated 10.4 million new (incident) TB cases worldwide

, of which

5.9

million (56%) were among men

,

3.5 million (34%) among women

and

1.0 million (10%) among children.

People

living with HIV accounted for 1.2 million (11%) of all new TB cases.

Six

countries accounted for 60% of the new cases: India, Indonesia, China, Nigeria, Pakistan and South Africa

. Slide35

Tuberculosis

Risk Factors

Age

Foreign born

Immunosuppression

Exposure

Symptoms

Cough

Fever

Chills

Night sweats

HemoptysisSlide36

Tuberculosis - Prevention

Early Identification

Early Isolation

Airborne precautions – negative pressure room

Personnel protective equipmentSlide37

Human Immunodeficiency Virus

(HIV)

Epidemiology

The

epidemiology of

HIV in

the United States has changed significantly from the early 1980s when it began as an epidemic predominantly in young, white, middle-class men who have sex with men (MSM) and who resided principally in a few of the larger West and East Coast cities

.

Today

,

HIV is

a disease of

a greater

demographic diversity, affecting all ages, sexes, races, and income levels; involving multiple transmission risk behaviors; and having a broad geographic distribution in the United States

.

This epidemiologic diversity is important to understand in order to target the interventions needed to diagnose and treat this disease and to potentially slow the transmission of the virus. Slide38

Human Immunodeficiency Virus

(HIV)

Risk Factors

Unprotected sex

IVDU

Other

Symptoms

Weight loss

Fevers

Diarrhea

Rash

STIsSlide39

HIV - Care

No isolation if respiratory symptoms are absent

Continue antiretroviral therapy

Educate patient on transmission of virus

toothbrush, razors

unprotected sex

PRepSlide40

Principles of Disease TransmissionSlide41

Infection vs. Colonization

I

nfection

Occurs when pathogens and other microorganisms

are

present in the body and cause tissue damage and signs and symptoms of illness

(e.g.,

fever, redness, pain).

Colonization

Occurs

w

hen pathogens and other

mi

croorganisms

are present but do not

cause signs and symptoms of illness. Slide42

Incubation Period

People are not immediately infectious after

exposure

The

period

between exposure to an infection and the appearance of the first symptoms

Can vary by individual

, degree

of exposure and type of

microorganismSlide43

Chain of InfectionSlide44

Modes of Transmission

Three main categories:

Contact

Droplet

AirborneSlide45

Modes of Transmission

Contact Transmission

Direct transmission -

microorganisms transferred from one infected person to another person without a contaminated intermediate object or person

Indirect transmission -

transfer of an infectious agent through a contaminated intermediate object or

person

Droplet Transmission-

Transmission of pathogens spread through close respiratory or mucous membrane contact with respiratory

secretions, e.g., group A strep

Airborne Transmission -

Transmission of infectious agents that remain infectious over long distances when suspended in the

air, e.g., tuberculosis, varicellaSlide46

Prevention StrategiesSlide47

Hand Hygiene

Hand

Hygiene:

The single most important strategy in the prevention of infections.

Use

of soap/water or alcohol-based

hand sanitizer

Before direct patient contact

After contact with bodily fluids or excretions, (non-) intact skin

Between body sites on the same patient

After contact with fomites proximal to patient

Before and after

removing glovesSlide48

Hand Hygiene

Access to hand hygiene

stations is essential

Wash hand for 15 seconds

Barriers to effective hand hygieneSlide49

Standard Precautions

Standard Precautions – all patients blood and body fluids are potentially infectious

Recommended care of all patients regardless of suspected or confirmed infection

Application depends on the nature of healthcare personnel – patient interaction and anticipated exposure to blood / body fluids or known infectious agentsSlide50

Standard Precautions

Key Elements

Hand

hygiene

P

ersonal

protective

equipment

Safe

injection

practices

Safe

handling of potentially contaminated

equipment, environmental surfaces, and linen

Respiratory hygiene/cough etiquetteSlide51

Standard PrecautionsPersonal Protective Equipment

Wear

PPE appropriate to anticipated patient

interaction

Gloves, gown, face protection (masks, goggles, face shields), respiratory protection

Prevent

contamination of clothing and skin during

PPE

removal

Remove and discard PPE before leaving patient room/cubicle

Do not reuse disposable

PPE Slide52

Standard PrecautionsRespiratory Hygiene and Cough Etiquette

Prevention strategies include:

Posting signs at

entrancesProviding tissues and no-touch receptacles for disposal

Providing resources for hand hygiene

Offering facemasks to coughing patients and other symptomatic individuals upon entry to the facility

Providing space and encouraging persons with symptoms of respiratory infections to sit as far away from others as possibleSlide53

Standard Precautions

Injection Safety

Unsafe practices that have led to patient harm include:

Failure to use aseptic technique when preparing or administering

medications

Use of the same syringe (with or without the same needle) to administer medication to >1 patient

Reuse of a syringe (with or without the same needle) to access a medication container used for >1 patient

Use of medications labeled as single-dose or single-use for >1 patientSlide54

Standard PrecautionsInjection Safe Practices

Never administer medications from the same syringe to more than on patient, even if the needle has been change

Do not enter a vial with a used syringe or

needleMedications packaged as single-use vials never be used

for more than one

patient

Bags or bottles of intravenous solution not be used as a common source of supply for more than one

patient

Cleanse the access diaphragm of medication vials before inserting a device into the vialSlide55

Standard PrecautionsInjection Safe Practices

Ensure medication containers labeled as single-dose or single-use are used for one patient only

Dedicate

multi-dose vials to a single patient whenever possibleIf multi-dose vials are used for >1 patient, restrict the vials to a centralized medication area and do not bring them into patient treatment areas (e.g., operating room, patient room/cubicle)

Dispose of used sharps at the point of use in a sharps container that is closable, puncture-resistant and leak-proofSlide56

Standard PrecautionsLinen and Laundry

Handle used linen with minimum agitation to avoid contamination of air, surfaces, and persons

Always use Standard Precautions when handling soiled laundrySlide57

Standard PrecautionsEnvironmental Cleaning

Inadequate

environmental cleaning and disinfection practices have led to the transmission of

healthcare-acquired pathogens related to contamination of near-patient surfaces and equipmentFollow

manufacturer’s recommendations for use of cleaners and EPA-registered disinfectants

(know the

contact

time,)Slide58

Standard PrecautionsInstrument Reprocessing

Ensure that reusable medical equipment

(e.g., point-of-care devices, surgical instruments, endoscopes) is cleaned and reprocessed appropriately prior to use on another

patientIf the manufacturer instructions are not provided, the device may not be suitable for multi-patient use

Follow manufacturer’s instructions for proper reprocessing

Assign

responsibilities for reprocessing of medical equipment to healthcare personnel with appropriate trainingSlide59

Transmission-Based Precautions

Used in addition to Standard Precautions

Contact

Airborne

Droplet Slide60

Contact Isolation

For infections spread by direct or indirect contact with patients or patient-care environment (e.g.,

MRSA,

VRE)

Private

room or room shared with patients with the same infection

status

Wear disposable gown and gloves when entering the patient

room

Remove disposable

gown and gloves

and

discarded inside the patient

room

Wash hands immediately after leaving the patient

room

Clean patient room daily using a hospital disinfectant, with attention to frequently touched

surfaces

Use dedicated equipment if possible (e.g., stethoscopesSlide61

Droplet Transmission

For infections spread by

splashes generated

by coughs, sneezes, etc. (e.g.,

meningitis

, pertussis,

seasonal influenza)

Patients

should be placed in single-patient room

PPE: Eye protection and

a

mask (facemask, N-95, etc.), or face shield

are worn to prevent droplets reaching the mucous membranes of the eyes, nose and

mouth upon room entry or within 6 feet of the patient

Patient

should wear a surgical mask when outside of the patient

roomSlide62

Airborne Precautions

For

infections spread by particles that remain

viable and suspended in

the air (TB, measles,

chickenpox,

and

smallpox)

Patient should be placed in negative pressure (

a

irborne isolation) room

PPE: N-95 or higher respirator for personnel inside isolation room

Patient should wear a surgical mask when outside of the patient roomSlide63

PracticeSlide64

Exercise 1: Disease Transmission

A 35 year old patient on hospice develops a cough, fever, and pancytopenia three weeks after admission.

C

ultures reveal Aspergillus.

Who is the host?

What is the agent?

What are possible environments sources/reservoirs?Slide65

Exercise 1: Disease Transmission

35 year old patient on hospice develops a cough, fever, and pancytopenia three weeks after admission.

C

ultures reveal Aspergillus.

Host: Immunocompromised patient

Agent: Aspergillus

Potential environmental sources:

Construction

, ventilation systemSlide66

Exercise 2: Reservoirs

Your patient is a 84 year old woman admitted to your telemetry unit for a wound infection caused by group A streptococcus (GAS). She lives in a nursing home and receives only enteral feedings.

She has chronic hepatitis B,

C. difficile, diabetes, is incontinent and has dementia.

What potential environmental sources/reservoirs of infection exist in this situation?Slide67

Exercise 2: Reservoirs

Your patient is a 84 year old woman admitted to your telemetry unit for a wound infection caused by group A streptococcus (GAS). She lives in a nursing home and receives only enteral feedings. She has chronic hepatitis B,

C. difficile

, diabetes, is incontinent and has dementia.

Potential Reservoirs

Hepatitis B-patient’s blood and other body fluids, used lancet, insulin syringe and vial, dried blood on glucometer, contaminated gloves

Group A Streptococcus-

Intact

skin, sheets, bed rails, HCW hands

C. diff- surfaces

; spores on counter tops and not

killed, HCW hands, diapers, telemetry equipmentSlide68

Exercise 3: PPE

You are the primary nurse for a 45 year male that suffered a spinal cord injury. He is

quadriplegic

and now has multiple decubiti. Upon your assessment, you note that he has a large, unstageable sacral decubitus that has foul-smelling, copious drainage. As you prepare for his wound

care

(at a minimum

)

what PPE should you anticipate using?

Gown

Gloves

G

loves

only

A

&

B

No

PPE requiredSlide69

Exercise 3: PPE

You are the primary nurse for a 45 year male that suffered a spinal cord injury. He is

quadriplegic

and now has multiple decubiti. Upon your assessment, you note that he has a large, unstageable sacral decubitus that has foul-smelling, copious drainage. As you prepare for his wound

care

(at a minimum

)

what PPE should you anticipate using?

Gown

Gloves

G

loves

only

A

&

B

No

PPE requiredSlide70

Emerging DiseasesSlide71

Candida auris

Fungus resistant to common antifungals

Causes severe infections and invasive disease

33 cases in four states identified since 2013; all but one case was identified between 2015-201760% mortality rate

Infections identified in blood, wound, ear; isolated in respiratory tract and urineSlide72

Candida auris

Risk factors include recent surgery, diabetes, antifungals

,

broad-spectrum antibiotic and central venous cathetersDifficult to identify with standard laboratory methodsLikely spread by contact with contaminated surfaces, equipment and person to person

Treatable with a

class of antifungal drugs called

echinocandins

Standard and Contact Precautions are recommended

Enhanced environmental cleaning using an EPA-registered disinfectant with fungal claimSlide73

Zika

Zika is spread mostly by the bite of an infected 

Aedes

 species. These mosquitoes bite during the day and night.Zika can be passed from a pregnant woman to her fetus. Infection during pregnancy can cause certain birth defects.There is no vaccine or medicine for Zika.

Local mosquito-borne Zika virus transmission has been reported in the continental United States. Slide74

Zika

Many people infected with Zika virus won’t have symptoms or will only have mild symptoms. The most common symptoms of Zika are

Fever

RashHeadacheJoint painConjunctivitis (red eyes)Muscle painSlide75

Summary

Preventing the transmission of infection is everyone’s responsibility and nurses have an impactful role in promoting and modeling best infection control

practices.

Disease transmission can be prevented by 

consistently

using infection control

strategies.

New disease threats require increased vigilance by everyone

involved

in caring for

patients

.