Infection Control and PatientStaff Safety - PowerPoint PPT Presentation

1 / 35
About This Presentation

Infection Control and PatientStaff Safety


List measures for preventing/reducing hospital infections ... than 5 microns (such as mycoplasma pneumonia, pertussis, mumps, and influenza) ... – PowerPoint PPT presentation

Number of Views:649
Avg rating:3.0/5.0
Slides: 36
Provided by: webs85


Transcript and Presenter's Notes

Title: Infection Control and PatientStaff Safety

Infection Control and Patient/Staff Safety
  • Infection Control
  • Jan 2009
  • Estimated completion time 15 minutes

  • At the conclusion of the lesson you will be able
  • Describe the importance of infection control in
  • List measures for preventing/reducing hospital
  • List the categories of infection control
    precautions that healthcare workers use to
    prevent/reduce inrections

What is a healthcare-associated infection?
  • A healthcare associated infection (HAI) is one
    which was not present or incubating when the
    patient was admitted to the hospital, but is
    acquired after admission.
  • Urinary tract infections are the most common HAI,
    followed by surgical wound infections, lower
    respiratory tract infections (pneumonia) and skin
  • Other infections include gastrointestinal
    infections (Clostridium difficile) and
    bloodstream infections.

Healthcare-associated infections are serious and
affect patient and staff safety
  • Over 98,000 people die each year from
    complications of healthcare-associated infections
  • HAIs also cause suffering, disability and
    increased healthcare costs, which may not be
  • About 5 of patients develop a HAI.
  • Hand hygiene (handwashing or use of an alcohol
    hand rub) can prevent nearly half of preventable
    infections and helps to protect staff from
  • Other additional infection control measures
    significantly reduce infection risks
  • Our goal is to have zero infections!

Risk Factors for HAIs
  • Invasive devices, such as ventilators, foley
    catheters and central lines predispose patients
    to infection.
  • Immune system suppression predisposes patients to
    infections with atypical germs (like fungus) that
    usually do not make others sick.
  • Antibiotic use predisposes patients to infections
    with antibiotic-resistant germs, fungus, and
    gastrointestinal infections.
  • Numbers of at risk patients are increasing
    because of advances in medical therapies,
    antibiotic use, and diagnostic techniques.

Organisms that cause HAIs
  • Any organism which can cause disease is called a
  • Pathogens which cause HAIs include
  • Staphylococcus
  • Pseudomonas, E. coli and other gram negatives
  • Clostridium difficile
  • Candida
  • Some viral agents such as RSV (respiratory
    syncytial virus), and influenza
  • Multidrug resistant organisms (MDROs), such as
    MRSA, VRE and ESBLs
  • Patients, who are colonized (carriers) of MDROs,
    are a source for spread within the hospital and
    are at risk of developing deadly infections.

MUSCs Active Surveillance Program
  • MUSC has an active surveillance (culturing)
    program to identify patients with MRSA and VRE
    and control the transmission of these pathogens
  • Patients colonized or infected with these
    organisms are placed on Contact Precautions and
    are flagged in Oacis
  • Rates of MUSC acquisition are tracked and
    analyzed. Please see the next two slides.
  • Each one of us can impact our rates and need to
    do all we can to reduce these rates.

MUSC MRSA Acquisition Rates
MUSC VRE Acquisition Rates
How are infections transmitted?
  • Infections do not occur simply because a pathogen
    exists in the environment.
  • Example MRSA
  • The pathogen must have a reservoir in which it
    grows and lives (e.g., humans serve as a
    reservoir as well as the environment)...
  • The portal of exit would be contact with the
    colonized/infected patient or contaminated
  • The mode of transmission would be direct or
    indirect contact, example via hands of healthcare
  • The portal of entry would be via contact with
    another patients non intact skin, mucous
    membranes, contamination of invasive devices,
    such as IV lines, etc
  • - A susceptible host is anyone at risk
    for colonization or
  • infection with MRSA, i.e. patients with
    invasive devices, non
  • intact skin, acutely ill, etc.

Prevention and Control of HAIs
  • The goal of Infection Control is to reduce
    transmission of pathogens from patient to
    patient, from staff to patient, and from patient
    to staff.
  • Good infection control practices break the chain
    of infection. Examples
  • Hand hygiene and changing gloves between patient
    contacts prevents transmission.
  • Removing a foley catheter makes a patient less
    susceptible to HAIs by removing an entry point
    for pathogens.
  • Vaccinations (e.g., vaccinations for Hepatitis B,
    influenza, chickenpox, etc.) reduce the number of
    susceptible individuals.

Hand hygiene is the single most important way to
prevent HAIs
  • Hands should be washed with antiseptic soap and
    water or decontaminated with alcohol hand rubs
  • right before and after caring for a patient
  • during patient care if hands become contaminated
  • after contact with objects and surfaces in the
    patients immediate vicinity
  • after removing gloves
  • before handling food or food trays
  • before and after eating, after using the toilet

Aseptic Technique
  • Practice of ensuring that bacteria are excluded
    from open sites during surgery, wound dressing,
    blood sampling, and other medical procedures.
    Aseptic technique is a first line of defense
    against infection.
  • Use of sterile instruments and supplies and the
    application of principles of asepsis while
    performing invasive procedures are important
    aspects of infection control.
  • Examples of aseptic technique include
  • - Disinfecting IV ports/valves and capping
    open lines
  • - Checking the integrity of sterile
    packages and
  • ensuring a color change on the chemical
  • - Use of a sheathed catheter for closed
    suctioning of ventilated
  • patients.

Standard Precautions
  • The first tier of the CDC isolation guidelines
    is Standard Precautions. Since patient
    examination and medical history cannot reliably
    identify every patient with blood borne pathogens
    and other diseases, Standard Precautions apply to
    all patients and all body substances. The risk of
    infection can be minimized if Standard
    Precautions are followed for ALL PATIENTS.

  • Standard Precautions guidelines
  • Perform hand hygiene before and after patient
    care, regardless of whether gloves are worn.
    Perform hand hygiene immediately after the gloves
    are removed and between patient contacts.
  • Wear gloves when touching blood or any other body
    substance, secretion, or excretion except sweat,
    or when touching contaminated items. Put on clean
    gloves just before touching mucous membranes or
    non-intact skin.
  • Take care to prevent needle sticks and other
    injuries when using needles, scalpels, or other
    sharp instruments. Also be careful when handling
    sharps after procedures and when cleaning them.
    Dispose of used needles properly.

  • Use a mouthpiece, resuscitation bag, or other
    ventilation device as an alternative to
    mouth-to-mouth resuscitation. These devices
    should be available for use in areas where the
    need for mouth-to-mouth resuscitation is
  • Wear a gown to protect your skin and to prevent
    soiling of your clothing during any patient care
    activity that is likely to generate splashes or
    sprays of blood or body fluids.
  • Wear a mask and eye protection or a face shield
    to protect the mucous membranes of your eyes,
    nose, and mouth during any patient care activity
    that is likely to generate splashes or sprays of
    blood or body fluids, including respiratory
    secretions. You should thoroughly wash your hands
    or other skin surfaces immediately after
    accidental exposure to blood or body substances.
    Wear mask and eye protection when working closely
    with a coughing patient.

  • Transmission-Based Precautions
  • The second tier of the CDC guidelines is
    transmission-based precautions. There are three
    simple sets of precautions based on likely routes
    of transmission.
  • The precautions are designed to prevent airborne,
    droplet, and contact transmission of pathogens.
  • These precautions are to be followed when a
    patient is suspected or known to have infection
    or colonization by epidemiologically important
    pathogens (MRSA, VRE, TB, Influenza, etc).
  • They are employed on an empiric basis when an
    adult or pediatric patient presents with a
    specific syndrome strongly suggesting that the
    pathogen/disease is present.
  • Please refer to Infection Control policies 2-002,
    2-003 and 2-004 for additional information and

Airborne Precautions
  • Airborne precautions are designed to protect
    against the transmission of airborne droplet
    nuclei for illnesses such as measles, chickenpox,
    and tuberculosis. Airborne droplet nuclei are
    smaller than 5 microns in diameter and can remain
    suspended in the air and dispersed widely by air
  • Airborne precautions include
  • Isolation of the patient in a private room with
    monitored negative air pressure. The door to
    the room must remain closed and the patient must
    remain in the room.
  • Always wear appropriate respiratory protection
    when you enter the room. For tuberculosis, you
    should wear a respirator mask fit tested to
    your face size. Contact Infection Control if you
    are not sure what type of protection to wear.
  • Limit the movement and transport of the patient
    from the room for essential purposes only. If at
    all possible, have the patient wear a surgical or
    procedure mask during transport.

Droplet Precautions
  • Droplet precautions are designed to protect
    against the transmission of infectious droplets
    larger than 5 microns (such as mycoplasma
    pneumonia, pertussis, mumps, and influenza).
    Patients with these illnesses tend to generate
    infectious droplets while sneezing, coughing, or
  • Droplet precautions include
  • Keeping the patient in a private room. The door
    may remain open.
  • You should wear a mask when you enter the room.
  • You should also wear a mask when examining or
    transporting a patient who is suspected to have
    an illness requiring droplet precautions.
  • Limit the movement and transport of the patient
    from the room for essential purposes only. If at
    all possible, have the patient wear a surgical or
    procedure mask during transport.

  • Contact Precautions are designed to halt the
    transmission of pathogens which may be spread by
    direct contact with the patient, contaminated
    equipment, or the patients environment. Contact
    Precautions are designed for different types of
    infections which may survive for extended periods
    in the environment (e.g., C diff, MRSA, VRE,).

  • The patient is placed into a private room
    whenever possible. Cohorting patients with the
    same organism may be done if needed and under the
    guidance of Infection Control.
    that are delivering trays are required to wear
    gloves, not gowns.
  • When providing care, change gloves after contact
    with any infective material such as wound
  • Remove the gown and gloves and perform hand
    hygiene before leaving the room (take care not to
    touch any potentially infectious items or
    surfaces on the way out).
  • Dedicate the use of non-critical patient-care
    equipment to a single patient. If use of common
    equipment is unavoidable, adequately clean and
    disinfect it before use with other patients.
  • The door may be left open and in most cases,
    patients can go for tests and/or therapy off the
    unit. For patient transport, wear gown and
    gloves to enter the room and prepare patient for
    transport. Use only clean linen, dont pull linen
    from patients bed. Remove gown/gloves , wash
    hands and don clean gown and gloves.

  • Place patients into the precautions indicated as
    described in the Infection Control Manual
    (policies 2-002, 2-003 and 2-004)or call
    Infection Control.
  • Isolated patients must have a blank Precautions
    sticker on the outside of their chart. A second
    Precautions sticker goes on the inside of the
    chart so other departments will know the correct
    precautions to follow. Place chart into a plastic
    bag for transport.
  • To facilitate proper control and management of
    patients notify other departments of precautions
    by phone or request whenever possible.
  • Report exposure to infectious illness to employee
    health. Post exposure testing and prophylaxis may
    be necessary to prevent infection.

Prevention of Specific Infections
  • Bundles are groupings of best practices with
    respect to a disease process that individually
    improve care, but when applied together result in
    substantially greater improvement.
  • When all measures in a bundle are practiced
    consistently by all staff, infection rates are
    significantly reduced
  • CLABSI and VAP are serious infections and have
    attributable mortality rates of 4-20 and up to
    50 respectively.
  • Bundles for VAP (ventilator associated pneumonia)
    and CLABSI (central line assoc bloodstream
    infection) have been implemented.
  • All staff, nursing, physicians, radiology,
    respiratory therapy, etc., must practice
    excellent ventilator and IV line care.

Central Line Bundle
  • Hand Hygiene for Insertion/All Line Care
  • Maximal Barrier Precautions Upon
    Insertion-Sterile gown/gloves, also cap/mask
  • Chlorhexidine Skin Antisepsis
  • Optimal Catheter Site Selection, Subclavian Vein
    Preferred Site for Non-Tunneled Catheters in
  • Daily Review of Line Necessity with Prompt
    Removal of Unnecessary Lines
  • Monitor compliance, call Break Scrub
  • Insertion must be recorded on CVL Procedure

Think Outside the Bundle
  • For All IV Lines
  • IV Line Assessment
  • Each shift, assess for patency, site condition
    and dressing patency
  • If the IV line was placed in a true clinical
    emergency, the line is to be changed after 24
  • IV Line Care
  • - Hand Hygiene
  • Change transparent dressings every 7 days, those
    you cannot visualize the site i.e. gauze
    dressing, change every 24 hours
  • Change tubing and caps/valves every 72 hours
  • Cleanse caps prior to tubing change, IVP
    medication or flushing with alcohol or
    CHG/alcohol swab. Use friction and allow to dry
    for 30 seconds!

VAP Bundle
- Hand Hygiene - Head of Bed Elevation 30
- 45 degrees, 15 30 degrees for
neonates - Oral Care Q4hrs (Q 6hrs for
neonates), teeth brushed Q12 - Deep
Vein Thrombosis Prophylaxis (as
appropriate for pediatrics.) - Stress Ulcer
Prophylaxis (as appropriate for
pediatrics) - Sedation Management Daily
Wake Up (not for pediatric pts.) -
Spontaneous Breathing Trial (as appropriate
for pediatrics)
VAP/Pneumonia-Additional Measures
  • Provide oral suctioning and deep suctioning. Use
    separate tubing and device set-ups for
    endotracheal suctioning and oral suctioning
  • Encourage coughing and deep breathing for non
    ventilated patients
  • Ambulate and turn patients as possible

Surgical Site Infection (SSI) Prevention
  • 2 to 5 of surgical patients will develop SSI
  • SSI increases length of stay by7.5 days on
    average and adds costs of 2600 to 27,000 per
  • Measures to Reduce SSI Include
  • - Preoperative antiseptic bathing. This is
    hospital policy,
  • C-139.
  • - Identifying and treating infections prior
    to surgery,
  • such as UTI. Notify MD when infection
  • - Appropriate antibiotic selection and
  • Antibiotics should be given within an hour
    of incision.
  • Discontinue antibiotics after surgery
    within 24 hours of
  • surgery.

Measures to Reduce SSI (contd)
  • - Appropriate hair removal. Dont remove hair
    at all or
  • use clippers, no shaving
  • - Maintain appropriate peri and postoperative
  • levels and normal body temperature during
  • - Perform appropriate surgical scrub, no
    artificial nails
  • and natural nails should be no more than ΒΌ
    in. long
  • - Perform a thorough prep of the operative
  • - Avoid flash sterilization of surgical
  • - Limit traffic in and out of ORs, keep doors
  • during procedures
  • - Keep scrubs clean, if leaving the hospital
    or traveling
  • to a dirty area of the hospital, put on
    clean scrubs on return to OR

UTI Prevention
  • Most healthcare acquired UTIs are related to
    foley catheters-avoid catheter placement if at
    all possible-remove catheters as soon as possible
  • Use strict aseptic technique for foley
    insertion-sterile field, prep with pick ups,
    dont contaminate catheter
  • Bag below level of patient
  • Proper technique for specimen collection
  • Foley Care twice a day and with incontinent care

C Diff
  • All patients with diarrhea/testing for C diff are
    placed on Contact Prec
  • Use Dispatch for environmental/equipment cleaning
  • Soap and water hand hygiene followed by alcohol
  • Three negatives before d/c of precautions
  • If pt is positive, two months of prec from last
  • Pts are flagged, consult with IC upon readmission

  • Keep clean separate from dirty
  • Follow appropriate cleaning and disinfecting
  • Stethoscopes (no fabric covers)
  • Multi-use patient equipment
  • Multi-use diagnostic equipment
  • Toys and other distraction devices
  • Lab coats and jackets must be kept clean but are
    NOT sterile!


  • Infection Control is crucial for patient safety.
  • Infection control in the hospital is the
    responsibility of every person working in
    healthcare. Consistent and conscientious
    practice of infection control principles can
    prevent unnecessary suffering. Effective
    communication about the presence of infectious
    diseases and following hospital policies are
    essential to the hospital's effort to protect
    patients, staff, and others in the acute-care
  • All employees are urged to report poor practices
    which might harm patients or staff. Report to
    manager or to Infection Control Dept.
  • The safety of our patients and staff depends on
    all of us.

  • You have completed the lesson. Please complete
    test now.
Write a Comment
User Comments (0)