4%

About __ of patients admitted develop an nosocomial infection (HAIs)

Nosocomial infection

a disease acquired in a hospital or clinical setting

Pneumonia

About 9-27%of mechanically ventilated patients develop __ (VAP), with mortality at 30-50%

Eliminate the sources, create barriers to transmission, monitor the effectiveness of control, take responsibility & follow procedures

Infection Control Procedures Objectives

Source, host, route of transmission

3 elements present to spread infection

Primary source

People (patients,personnel,or visitors)

Sources of pathogens

Contaminated equipment & medications; catheters, tubes, lines, etc

Bacterial, handwashing

Most nosocomial infections are __ in origin and are the result of improper ___.

Host

Those susceptible to infection: immunocompromised (AIDS,chemotherapy, transplantation), diabetics, obesity, COPD/other chronic illness, smokers, the elderly, lines/drains/airways, surgical- incisions

Colonization

The presence of microorganisms in a host

Contact, droplet, airborne

3 Major Routes of Transmission

Common vehicle & vector borne

Minor Routes of Transmission

Direct contact

Body surface to body surface contact, pathogen transferred from person to person, most efficient (touching a patient w your hands, changing a dressing, or any procedure requiring close contact)

Indirect contact

Most frequent, occurs b/w host and an inanimate object (clothings, dressings, instruments, & equipment), contact w infected secretions via fomite (eating utensils, drinking glass, respiratory equipment, toys), inadequately processed equipment

Contact pathogens

HIV, STD/STI, Hepatitis A/B/C, Pseudomonas aeruginosa, C. difficile, Staphylococcus, Polio

C. difficile

Requires soap & water handwashing to remove

Droplet

Large contaminated particles released into the air by coughing, sneezing, or talking or procedures (suctioning,bronchoscopy, sputum/cough induction); travels 3-6 feet; deposited on the host's conjunctivae, nasal mucosa, or mouth

Influenza, H. influenza, Rubella, Adenovirus, & Streptococcal pneumonia, Pertussis, Meningitis, SARS, COVID-19, RSV

Droplet pathogens

12 ft

Droplets can travel up to ____

Airborne

spreading of contaminated dust particles or evaporated water dropletsex: common cold, legionellosis, tuberculosis, fungal infections, measles, chickenpox, influenza, pertussis (whooping cough)

Common vehicle

pathogens transmitted by contaminated food, water, medication

Vector borne

animal or insect transfers the pathogen to the host (ex. mosquito-west nile, tick-lyme disease)

safe culture, healthy workforce, source of pathogens, route of transmission

Infection Prevention Strategies:1. Create a __ __ - a shared commitment a. organization's structure & systems b. individual responsibility- assure caregiver has appropriate time, equipment, training2. Maintain a __ __3. Eliminate the __ _ __4. Interrupt the __ _ __

Immunization and chemoprophylaxis

focus on employee ____ and ___ - healthy workforcevaccines include: influenza, hepatitis, diphtheria, tetanus, pertussispost-exposure chemotherapy: pertussis, mengitis, anthrax, HIV, etc.HCWs are required to be immunized against Hep B

Clean, number of pathogens

General Sanitation Measures:- Help to keep overall environment __ (housekeeping, food processing, and laundry management)- Aim to reduce __ _ __ to safe level

Decontaminate; cleaning, disinfection, sterilization

Specialized equipment processing:- __ equipment capable of spreading infection- Involves __, __, & __

Standard Precautions

used in caring for all patients all of the time

Transmission-based Precautions

patients with known/suspected infections with pathogens that require additional control measures

Hand Hygiene, Personal Protective Equipment

Standard Precautions:- __ __- __ __ __ (gloves, goggles, gowns, masks depend on anticipated exposure)

Hand Hygiene

best defense against the spread of infection, change gloves at appropriate times, short nails, no artificial nails, minimal jewelry

Between, after

remove gloves __ patients and __

Ten minute scrub

From elbows to fingertips- used before surgery or before entering special units burn or NICU))

Three minute scrub

lower forearms to fingers - done when arriving at work and upon leaving facility

Thirty second scrub

Wrists to fingertips- b/w patients, before/after eating, before giving or preparing meds, after contacting dirty equipment, before/after using the bathroom

15 seconds

Minimum time to wash hands during clinic

Absence of visible soil

Alcohol based gels, foams, rubs are acceptable in __ _ __ __, have superior microbicidal activity, are convenient, and require competent hand rubbing (>15 sec and allow to dry)

Gloves

Protect caregivers & patients when used properly, not a substitute for handwashing, vinyl/latex/nitrile, must be correct fit and size, replace when heavily soiled/torn b/w each patient contact, used to avoid "touch contamination

Masks

Protects nose & mouth, fit snugly, decreased effectiveness when moist- discard after use

Goggles

protect eyes, eyeglasses are not a substitute

Face shield

Protects eyes, nose, mouth; covers forehead, extends below chin, wraps around side of face; used when task is likely to generate splash of body fluids

N95 mask

Recommended by NIOSH, excludes particles <5 microns, require medical evaluation + fit testing + training + fit checking

Gowns

Sterile vs. non sterile, universal fit, material variance: barrier protection levels 1-4 (minimal risk -> trauma setting), worn only once then discarded

Transmission Based Precautions

used with documented or suspected contagious disease, used in addition to standard precautions

Contact precautions

handwashing & gloves & gowns; spatial separation

Droplet precautions

handwashing & mask & goggles

Airborn precautions

handwashing & N95 masks; negative pressure room, single patient room only

Reverse Isolation

protected environment: highly immunocompromised patient (neutropenia, stem cell transplant, burn patient, chemotherapy, organ transplant); HEPA air filtration, positive pressure room, prohibition of flowers and plants, reduce dust, prevent infiltration of outside air

Cohorting

grouping patients with the same infection

Limit trips, barrier protection, receiving department, expiratory

Patient Transport:- ___ ___- Patients wears appropriate ___ ___- Notify ___ ___- Manual resuscitator with filter on ___ side

Prevention bundles

use of multiple different evidence-based practices shown to reduce HAIs

Central line

directly into SVC, hand hygiene before line insertion, use of maximal sterile barrier precautions during line placement, chlorhexidine-based skin antisepsis at insertion site, daily review of line necessity

Ventilator-associated pneumonia

elevate the head of the bed, daily sedation vacation, assess daily for readiness to wean, peptic ulcer prophylaxis, deep venous thrombosis prophylaxis, daily oral care with chlorhexidine

Spaulding approach

critical: device introduced into the bloodstream, surgical devices, autoclave sterilizationsemi-critical: devices that directly or indirectly contact mucous membranes, bronchoscope or transesophageal probe, glutaraldehyde/ high level disinfectionnoncritical: devices that touch only intact skin, blood pressure cuff & pulse oximeter, low level disinfection

Equipment processsing

GOAL: to decontaminate equipment that may spread disease (bronchoscopes, transesophageal transducers)1st step: cleaning, Followed by: disinfection or sterilization

Cleaning

most important step, performed in "dirty" area, removal dirt/organic material, disassemble, detergents/enzymatic cleaners/brushes

Disinfection

destroys the vegetative form of pathogenic organisms, not spores3 levels: low, intermediate, high; 2 types: physical (ex. pasteurization), chemical

Pasteurization

moist heat at temperatures below boiling to kill bacteria and viruses, won't kill spores, efficient & cost-effective for RT equipment, clean equipment is immersed in water at 70 C/ 158 F for 30 min, special dryers w filters use laminar flow to aseptically dry equipment

Chemical disinfection

washed and rinsed equipment is immersed in a chemical for a period of time ("contact time"), labels must be read carefully and instructions properly followed during use, equipment rinse & aseptically dried & reassembled in "clean" area

Low

___ level chemical disinfection:- 5% acetic acid in a 1:3 solution, used at home to disinfect equipment- Kills most bacteria and viruses but not resistant bugs or spores- Spray, wipes (contact time!)

Intermediate

___ level chemical disinfection:- Kill all bacteria and fungi but have variable effects on spore and some viruses- 70% ethyl and 90% isopropyl alcohol spray for electrical equipment, stethoscopes, and skin preps- Iodophers (Providone or Betadyne) skin prep prior to blood draw or IV insertion

High

___ Level Disinfection:- Can destroy all microorganisms except spores- Most common- glutaraldehyde - cold chemical disinfectant lasts for 14-30 days - test strips confirm strength of solution - irritation of eyes and hands (use gloves & goggles) - won't damage equipment - soak equipment for 20 min, rinse well, aseptic dry- Household bleach (10% solution for blood spills)

Physical sterilization

removal of all organisms including spores1. Steam (autoclave)- combines heat, steam, and pressure2. Dry heat- 1-2 hours @ 160 to 180 C hot air oven3. Boiling- 30 min @ 100 C

Chemical sterilization

ethylene oxide gas- colorless, toxic gas good for objects that are not heat resistant (items aerated before use), hazardous2% glutaraldehyde solution- at least 10 hrs

Patient's room

all used disposable equipment is tossed in the __ __

Infectious waste

___ ___ is placed in a "red bag" and then may be double bagged when taken from the room

Gloved

Place all lab specimens in a leak-proof (impervious) bag, label it and carry it with a ___ hand

False

T/F: you can re-cap a needle

Surveillance

a systematic process to review & analyze HAI data on patients; on going investigation, prevention control, reporting; infection prevention committee; communicate outcome measurements to caregivers; oversight of hand hygiene practice, precaution adherence, HAI bundles; provide current info on frug resistant pathogens