Infection Control and the BugsInfection Control and the Bugs

Blanche Lenard RN, CICBlanche Lenard RN, CIC

Education Session Education Session

Infection Control in Healthcare Infection Control in Healthcare

Environmental CleaningEnvironmental Cleaning Routes of TransmissionRoutes of Transmission Prevention StrategiesPrevention Strategies BiofilmsBiofilms

Environmental CleaningEnvironmental Cleaning Questions an IP may ask someone presenting a new cleaning product or Questions an IP may ask someone presenting a new cleaning product or

programprogram Q&A Q&A

Hydrogen Peroxide TechnologyHydrogen Peroxide Technology

Personal ExperiencePersonal Experience

Routes of TransmissionRoutes of Transmission

ContactContact

Direct – unwashed hands Direct – unwashed hands

Routes of TransmissionRoutes of Transmission

Respiratory Large Droplets – 3 to 6 feetRespiratory Large Droplets – 3 to 6 feet

Examples of infectious agents:Examples of infectious agents:

Influenza virusesInfluenza viruses

Childhood viral diseasesChildhood viral diseases

Routes of TransmissionRoutes of Transmission

Airborne Droplet Nuclei Airborne Droplet Nuclei

Tb stays suspendedTb stays suspended Air currents can disperse organismAir currents can disperse organism

CDC and OSHA jointly direct Prevention andCDC and OSHA jointly direct Prevention and

Control of Tuberculosis Control of Tuberculosis

Routes of Transmission Routes of Transmission

Blood or Body FluidsBlood or Body Fluids

Occupational sharps injuries – HIV, Hepatitis B Occupational sharps injuries – HIV, Hepatitis B and Hepatitis C virusesand Hepatitis C viruses

OSHA – Blood Borne Pathogen Standard OSHA – Blood Borne Pathogen Standard prevention and Occupational exposure follow up prevention and Occupational exposure follow up

Colonized or Infected: Colonized or Infected: What is the Difference?What is the Difference?

People carry bacteria without evidence of People carry bacteria without evidence of

infection (fever, increased white blood cell count)infection (fever, increased white blood cell count)

= colonization = colonization

Invasion of tissue by bacteria with symptoms Invasion of tissue by bacteria with symptoms

= = infectioninfection

The Iceberg Effect

Infected

Colonized

Fomites, the Inanimate Environment Fomites, the Inanimate Environment

Types of Organisms Recovered: Staph aureus/ MRSA, Enterococcus /VRE, Gram negative bacteria and Clostridium difficile spores

Hand HygieneHand HygieneDefinition – Performing handwashing, antiseptic Definition – Performing handwashing, antiseptic handwashing, alcohol-based hand rub, surgical hand handwashing, alcohol-based hand rub, surgical hand hygiene/antisepsishygiene/antisepsis

CDC/SHEA hand antiseptic the agents of choiceCDC/SHEA hand antiseptic the agents of choice•Recommended by CDC based on strong experimental, Recommended by CDC based on strong experimental,

clinical, epidemiologic and microbiologic data clinical, epidemiologic and microbiologic data •Antimicrobial superiorityAntimicrobial superiority

Greater microbicidal effectGreater microbicidal effect Prolonged residual effectProlonged residual effect

•Ease of use and applicationEase of use and application

Most common mode of transmission of bacteria is via hands!

Healthcare Associated Infections – HAI

Spread of antibiotic resistant organisms

So Why All the Fuss About Hand So Why All the Fuss About Hand Hygiene?Hygiene?

Preventing & Reducing Transmission Preventing & Reducing Transmission Hand HygieneHand Hygiene

Required for standard and transmission based Required for standard and transmission based precautionsprecautions

Wash hands with soap and water or use alcohol-Wash hands with soap and water or use alcohol-based hand rubbased hand rub

Perform…Perform…

• Immediately after removing PPEImmediately after removing PPE

• Between resident contactsBetween resident contacts

Environmental Cleaning Environmental Cleaning ““If TheyIf They’’re Not There They Canre Not There They Can’’t Get Movet Get Move

dd””

Product Types used in healthcare:Product Types used in healthcare:

CleanersCleaners SanitizersSanitizers DisinfectantDisinfectant Sterilants Sterilants

Sanitizers Disinfectants & SterilantsSanitizers Disinfectants & Sterilants

Sanitizer – Reduces organisms to safe levels, 99% Sanitizer – Reduces organisms to safe levels, 99% of all bacteriaof all bacteria

Disinfectant – Kill 99.999% of organismsDisinfectant – Kill 99.999% of organisms

not sporesnot spores

Sterilants – Kill 100% of organisms and sporesSterilants – Kill 100% of organisms and spores

Bacteria & BiofilmsBacteria & Biofilms

Benefits of Biofilm formation to Bacteria Benefits of Biofilm formation to Bacteria

Stationary growth in a hospitable environmentStationary growth in a hospitable environment

Resistance to antibiotics, anti-fouling agents etc. Resistance to antibiotics, anti-fouling agents etc. (limited toxin penetration) (limited toxin penetration)

Synergism between species and metabolismsSynergism between species and metabolisms

Domination of immediate environment Domination of immediate environment

Anatomy of a Healthcare Environment

Critical Areas Critical Areas – Operating Room, Laboratory, – Operating Room, Laboratory, Emergency & Isolation RoomsEmergency & Isolation Rooms

Semi-critical Areas Semi-critical Areas – Patient Rooms – Patient Rooms

Non-critical AreasNon-critical Areas

• Patient room general cleaning and floorsPatient room general cleaning and floors

• Visitor bathroomsVisitor bathrooms

• Common areasCommon areas

Semi & Non Critical SurfacesSemi & Non Critical Surfaces

Semi-Critical:Semi-Critical: Clean and Disinfect Clean and Disinfect Patient room surfaces i.e. everything from the Patient room surfaces i.e. everything from the

waist upwaist up

Non-Critical:Non-Critical: Clean, remove bio-films and Clean, remove bio-films and residues without replacing themresidues without replacing them FloorsFloors Hard non-porous surfaces Hard non-porous surfaces

Multi-faceted ApproachMulti-faceted Approach

Hand HygieneHand Hygiene Personal Protective Equipment Personal Protective Equipment Proper Environmental Cleaning Product and Proper Environmental Cleaning Product and

Protocol Protocol

A healthcare facility must do all three and do all A healthcare facility must do all three and do all three right to reduce HAIs. three right to reduce HAIs.

Top Questions an IP Might Ask Top Questions an IP Might Ask

1.1. How is the product classified by the EPA? How is the product classified by the EPA?

2.2. What does it kill? What does it kill?

3.3. What is the contact time for the product? What is the contact time for the product?

4.4. What PPE are required for application?What PPE are required for application?

5.5. How much staff training is required?How much staff training is required?

6.6. How will this product help reduce HAI?How will this product help reduce HAI?

7.7. Cost/Cost savings?Cost/Cost savings?

The EndThe End

Questions?Questions?