G.K. Chesterton - tsicp.org · Includes S. aureus cultured from any specimen that tests...

34

Transcript of G.K. Chesterton - tsicp.org · Includes S. aureus cultured from any specimen that tests...

G.K. Chesterton

Primary strategy for reducing

infection risk in healthcare settings.

• Use for ALLpatients, all the time, regardless of presumed infection status.

• PPE should be easy to use, easy to find, and convenient.

If it is wet, yucky, gross and not yours…don’t touch it

• Gloves should always be worn for Direct Patient Care, regardless of Isolation Status.

• Masks, goggles and face shields should be worn to protect mucous membranes.

• Gowns, aprons, and other PPE may be required if there is a risk of splatter of blood or body fluids onto clothes or skin.

Includes S. aureus cultured from any specimen that tests oxacillin-resistant, cefoxitin-resistant, or methicillin-resistant by standard susceptibility testing methods, or by a laboratory test that is FDA-approved for MRSA detection from isolated colonies; these methods may also include a positive result by any FDA-approved test for MRSA detection from specific sources.

MRSA positive blood specimen for a patient in a location with no prior MRSA positive blood specimen result collected within 14 days for the patient and location.

Duplicate MRSA Bacteremia LabID Event

Any MRSA blood isolate from the same patient and same location, following a previous positive MRSA blood laboratory result within the past 14 days.

• Multi Drug Resistant Organism

• Organism that has adapted to current antibiotics and are no longer susceptible or vulnerable to the effects of the antibiotics

• An organism that shows at least 2 different resistances on susceptibility testing

• Methicillin-resistant Staphylococcus (MRSA), Vancomycin-resistant Enterococcus(VRE), certain gram negative bacilli, Clostridium difficile have increased in prevalence in U.S. hospitals over the last three decades

• Limited treatment options become concern

• Increased length of stay

• HICPAC has approved guidelines for the control of MDROs.

• The MDRO and CDI modules of the NHSN can provide a tool to assist facilities in meeting some of the criteria outlined in the guidelines.

• Inappropriate prescribing practices

• Failure to complete prescription

• Tendency to take antibiotics until feeling better then stop taking them and save what is left for the next time

• Prescribing practices by groups of physicians (everybody prescribing the same antibiotics)

• Failure to adjust antibiotics according to susceptibility

• Educate patients and their guardians when appropriate

– The need to take entire prescription until it is gone

– Proper hand hygiene practices

– Proper environmental cleaning practices

– Importance of not taking another’s prescription of antibiotics

• Antibiotic Stewardship Program

• Hand hygiene (Soap and water not hand gel)

• Identify cases within facility (appropriate hand

hygiene and room disinfection)

• Environmental disinfection

• Appropriate use of antibiotics

• Educate about CDI: HCP, EVS, administration, patients, families

Joint Commission• IC.01.05.01 (7) & IC.02.01.01 (7) – Implements its methods to

communicate responsibilities for preventing and controlling infections to LIPS, staff, visitors, patients, and families. Information for visitors, patients, and families includes hand hygiene and respiratory hygiene practice.

• NPSG.07.01.01 – Comply with either the current Centers for Disease Control and Prevention (CDC) hand hygiene guidelines or the current World Health Organization (WHO) hand hygiene guidelines

- Set goals for improving compliance with hand hygiene guidelines

- Improve compliance with hand hygiene guidelines based on established

goals

• What is your compliance rate?• How assessable is your alcohol gel?• What is the motivation for hand hygiene• Staff must develop the habit: Washing

hands as automatic as breathing• Foundation of the Infection Prevention

Program• If it is not important to leaders

it won’t be important to staff

• AAAHC Chapter 7.G – Written policies address the cleaning of patient treatment and care areas

• AAAHC Chapter 7.F – A system exists for the proper identification, management, handling, transport, and disposal of hazardous materials and waste, whether solids, liquid, or gas.

• AAAHC Chapter 10.K – The surgical environment contains safeguards to protect patients and others from cross-infection

Common problems during survey

• Lack of adherence to hand hygiene and/or safe injection practices

• Lack of written policies regarding cleaning of treatment and care areas or lack of adherence to them

TDSHS 135.43(d) Alcohol-Based Hand Rubs (ABHRs) are considered flammable. When used, the ABHRs shall meet the following requirements.1) The dispensers may be installed in a corridor so long as the corridor

width is six (6) feet or greater. The dispensers shall be installed at least four (4) feet apart.

2) The maximum individual dispenser fluid capacity is 1.2 L for dispensers in rooms, corridors, and areas open to corridors, and 2.0 L for dispensers in suites of rooms.

3) The dispensers shall not be installed over or directly adjacent to electrical outlets or switches.

4) Dispensers installed directly over carpeted surfaces shall be permitted only in sprinklered smoke compartments.

5) Each smoke compartment may contain a maximum aggregate of ten (10) gallons of ABHRs solution in dispensers and a maximum of five (5) gallons in storage.

CMS 416.51(b) – The ASC must maintain an ongoing program designed to prevent, control, and investigate infections and communicable diseases. In addition, the infection control and prevention program must include documentation that the ASC has considered, selected, and implemented nationally recognized infection control guidelines.

1) Promotion of hand hygiene among staff and employees, including utilization of alcohol based hand sanitizers

2) Measures specific to the prevention of infections caused by organisms that antibiotic-resistant

Environmental Services

• Refer to your State Regulations

• Texas has no restriction for isolation trash.

• Isolation trash may go to regular land field if no blood.

HCW education should focus on

▪ Mode of transmission & risk

▪ Appropriate use of PPE

▪ Cleaning routines for equipment

▪ Role of hand hygiene & gloves

▪ Components of an efficient program

Patient, visitor education should be provided

OSHA required Annual Blood borne pathogen training

Annual Isolation Precautions training, include in Annual Competency

IndexHospital Infection Control Practices Advisory Committee Membership List

Part I. Evolution of Isolation Practices

Part II. Recommendations for Isolation Precautions in Hospitals

Table I. Synopsis of Types of Precautions and Patients Requiring the

Precautions

Table II. Clinical Syndromes or Conditions Warranting

Additional Empiric Precautions to Prevent Transmission of

Epidemiologically Important

Pathogens Pending Confirmation of Diagnosis

Appendix A. Type and Duration of Precautions Needed for

Selected Infections and Conditions

References

Reviewers

Web-based Excerpts (added 7/2012)

Standard Precautions

Contact Precautions

Droplet Precautions

Airborne Precautions

http://www.cdc.gov/ncidod/dhqp/gl_isolation.html

– www.apic.org (APIC home page) see practice guidelines

– http://www.cdc.gov/ncidod/dhqp/gl_isolation.html. Guideline for Isolation Precautions in Hospitals

– http://www.apic.org/AM/Template.cfm?Section=Search&section=Non_APIC_Education_Infor&template=/CM/ContentDisplay.cfm&ContentFileID=4525

How to toolkit for improving Hand Hygiene

– http://www.cdc.gov/ncidod/hip/ARESIST/mrsa_spotlight.htm (MRSA spotlight)

I alone cannot change the world,

but I can cast a stone across the waters to create

many ripples.Mother Teresa