Infection Control and Prevention in Hospitals

What is Infection Control?

• Infection control involves identifying and reducing the risk of infections from developing or spreading

Healthcare-Associated Infections (HAIs)

• According to the WHO, HAIs are also called "nosocomial" infections
• HAIs are defined as infections acquired in a hospital by a patient admitted for a reason other than the infection
• HAIs are infections occurring in a patient in a hospital or healthcare facility, which are not present or incubating at the time of admission

Infection Prevention

• Hospital-associated infections (HAIs) are infections that a patient would not have acquired if not in a hospital setting
• Hospital Associated Infections include: Catheter Associated Urinary Tract Infections (CAUTI), Central Line Associated Blood Stream Infections (CLABSI), Ventilator Associated Pneumonia (VAP), Surgical Site Infections (SSI)
• HAIs affect hospitals through longer patient stays and lack of reimbursement for necessary care

HAI Prevention - Urinary Tract Infections (UTI)

• Catheter-associated UTIs account for about 35% of all HAIs and are the most frequent
• Strategies for prevention include avoiding catheters, assessing the need for Foley catheters, initiating nurse-driven removal protocols, keeping Foley bags off the floor and empty, securing tubing to the leg to prevent tension, and doing perineal care every shift

HAI Prevention - Surgical Site Infections (SSI)

• Surgical infections account for approximately 20% of all HAIs
• Pre-op antibiotics can prevent SSI

HAI Prevention - Bloodstream Infections

• Bloodstream infections associated with intravascular devices account for about 15% of all HAIs
• CLABSI can be prevented by assessing the need for central lines and assessing/changing the site dressing

HAI Prevention - Pneumonia

• Pneumonia associated with ventilators accounts for approximately 15% of all HAIs
• VAP prevention involves positioning patient's head of bed at 30 degrees, providing oral care every 4 hours, and using sedation vacation

Non-Reimbursement for HAIs

• The Centers for Medicare and Medicaid Services (CMS) no longer pay for costs related to 3 common hospital-acquired infections
• The three common hospital-acquired infections include catheter-associated infections, blood infections from central vascular lines, chest incision infections after open-heart surgery

Impacts of HAIs

• HAIs can increase patient suffering, lead to permanent disability or death
• HAIs can prolong hospital stays, increase the need for higher levels of care, and increase costs to patients and hospitals

Chain of Transmission

Breaking the Chain of Infection

• Healthcare workers can break the chain of infection through education and ensuring patients adhere to hygiene measures
• Education involves hand hygiene, gloves, clean rooms, disinfected surfaces, and proper medical device care/maintenance
• Patients should maintain personal hygiene, cover up cuts/wounds, follow isolation when necessary, and avoid unnecessary antibiotics

Reservoir

• Reservoirs are where pathogens live and multiply
• Reservoirs may be living and include humans, animals, and insects
• Reservoirs may be nonliving and include food, floors, equipment, and contaminated water

Portal of Exit/Entry

• These include skin and mucous membranes with seeping wounds
• Respiratory tract like sneezing and coughing
• Urinary tract, gastrointestinal tract like diarrhea, and reproductive tract

Antibiotic-Resistant Microorganisms

• Problem exist due to overuse and inappropriate use resulting in normal flora gone bad.
• Antibiotic-resistant microorganisms are resistant to multiple antibiotics, reducing treatment options
• Requires isolation precautions
• Examples include MRSA, VRE, and MDR TB
• Solutions include more appropriate antibiotic use, better infection control, and more comprehensive prevention

Modes of Transmission

• Contact (direct and indirect)
• Direct: Touching, kissing, sexual contact
• Indirect: Contact with fomite

Usual Bacteria Suspects: Multidrug-Resistant Organisms (MDROs)

• Residents with an indwelling catheter are more likely to have one of these MDRO's

Survival of Select Microbes on Surfaces

• Clostridium difficile (C. diff) spore can survive for over 1 year
• Viruses like Hepatitis B can live for about 1 week.

Positive VRE Culture Sites

• Vancomycin-resistant Enterococci (VRE) can be detected on surfaces even after discharge cleaning/disinfection

Nursing Process: Nursing Diagnosis for infection

• Risk for Infection
• Impaired Nutritional Status: Deficient Food Intake
• Impaired Oral Mucous Membrane
• Social Isolation
• Impaired Tissue Integrity

Nursing Process: Planning

• Common goals of care for infection prevention include preventing further exposure, controlling the extent of infection, maintaining resistance, and verbalizing understanding of prevention measures
• Priorities should be set for each diagnosis and care goals, which include collaboration with patients and interprofessional teams

Nursing process: Implementation

• Health promotion includes nutrition, hygiene, immunization, and adequate rest/exercise
• Acute care of infection: Eliminate the infectious organism and support the patient's defenses

Hand Washing Guidelines

• Wash for at least 20 seconds in nonsurgical settings or 2-6 minutes in surgical settings
• Remove jewelry and clean beneath fingernails before washing
• Use a bactericidal solution or water if hands are visibly soiled
• Use warm water, apply soap to wet hands, use friction, and rinse with soap
• Dry hands with a towel, and scrub soiled hands with a cleansing brush/sponge

CDC Hand Hygiene Guidelines

• No artificial nails, no chipped nail polish.
• Natural nail no longer than 0.25 inch
• Use antimicrobial soap and water if visibly soiled or after caring for Clostridium difficile patients
• Hand hygiene before and after patient contact, including after glove removal, is necessary, generally by using an alcohol handrub

Standard Precautions

• It should be used for preventing exposure to blood, body fluids, secretions, and excretions (except sweat), broken skin, or mucous membranes
• Based on the concept that body fluids from ANY patient can be infectious
• Use necessary PPE
• CDC guidelines require the use of category-specific isolation (ex – TB isolation) in addition to Standard Precautions when a patient is known or suspected to have an infection
• Use protective barriers for all potential contact with all body fluids (including blood, secretions excluding sweat), mucous membranes, and non-intact skin

When to Wear Gowns

• When expecting contact with clothing or exposed skin with blood or body fluids, secretions or excretions.
• Gowns should be used during procedures where splashes or droplets of blood and body fluids (e.g., catheter insertion, emptying urine collection bags) are likely
• Gowns should also be used when in contact with non-intact skin or when handling fluid containers likely to leak/splash/spill

Gown and Glove Use

• Outside of gloves and gowns are contaminated
• If wearing a gown, extend it to cover the wrist of gloves

How to Remove Gloves

• Grasp the outside of glove with the opposite gloved hand and peel off
• Hold the removed glove in the gloved hand, then slide the fingers of the ungloved hand under the remaining glove at the wrist and remove

How to Remove Gown

• Remove gloves first
• Unfasten the gown at neck, then waist ties
• Remove gown using a peeling motion, turning it inside out, and hold it away from body
• Roll the gown into a bundle and discard into the designated room receptacle

Transmission-Based Precautions

• Add to standard precautions when the spread of infection or organisms is not completely stopped with standard precautions alone Based on how organisms spread- Contact: Touching/oozing, Droplet: Sneezing/dripping, Airborne: Coughing

Contact Precautions

• Contact Precautions prevents the transmission of infectious pathogens through direct or indirect contact with a patient or their environment
• These are indicated when excessive wound drainage, incontinence, or MDRO infections/colonization
• Examples include MRSA, VRE, resistant gram-negative bacilli (ESBLs or CREs), C. difficile and scabies
• Do not share non-critical equipment between patients
• If equipment is shared, clean and disinfect properly
• Place patients on airborne, contact, or droplet precautions in a private room

C. Diff

• Hand sanitizer does not kill Clostridium difficile (C. diff) spores
• Follow contact precautions AND wash hands with soap and water

Droplet Precautions

• Droplet Precautions are intended to prevent transmission of pathogens through close respiratory or mucous membrane contact with respiratory secretions
• Pathogens requiring droplet precautions do not remain infectious over long distances and don't require special ventilation handling
• Examples include: Influenza, Meningococcal meningitis, rubella, mumps, pertussis, Rhinovirus, Diphtheria
• Pathogen is spread via moist droplets
• Coughing and sneezing with contaminated objects
• Precautions include same as those for contact and Addition of mask and eye protection within 3 ft of client

Droplet precautions

• A face mask (non-N95) is needed prior to entering the patient room
• Spacial separation at least 3 feet

Airborne Precautions

• Prevents infectious agents that stay infectious even when suspended in the air over long distances (measles(rubeola), chicken pox(Varicella), TB)
• Patient must be placed in an airborne isolation infection room (AIIR).
• A single room equipped with special air handling and ventilation capacity that complies with regulations: monitored negative pressure relative to the surround, Air exhausted directly to the outside or recirculated through a HEPA filtration system, a closed door
• Staff need to wear N-95 respirator mask or PAPR.
• Visitors entering must wear surgical mask.

Airborne isolation

• Basic components include negative air pressure isolation room, closed door, fit-tested N95 respirator, and hand washing

Standard Precautions Discussion

• It's important to apply to all patients receiving care in hospitals, regardless of their diagnosis or presumed infection status.
• Designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infections.
• Under standard precautions, blood and body fluids of all patients are treated as potentially infectious

Reverse isolation

• Design to protect a patient from infectious organisms that might be carried by staff, other patients, visitors, or equipment.
• For leukemia patients, after receiving immunosuppressive medication, bone marrow transplant, neutropenia

Reverse/Protective Isolation

• Strict hand-washing, mask, No live plants or fresh flowers ,No fresh fruit ,Private room

Do’s and Don’ts of Glove Use

• Work from “clean to dirty”, limiting opportunities for touch contamination
• Avoid touching your face or adjusting PPE with contaminated gloves and environmental surfaces except as necessary during patient care
• Change gloves if heavily soiled or even during use on the same patient
• After use on each patient discard in appropriate receptacle and never wash/reuse disposable gloves

Face Protection

• Masks protect the nose and mouth
• It should fully cover the nose and mouth while preventing fluid penetration
• Goggles are used to protect the eyes and should fit snuggly over and around the eyes; personal glasses aren't a substitute
• Face shields protect the face, nose, mouth, and eyes, it should cover the forehead and extend below chin and wrap around side of face

PPE Areas

• Contaminated: Outside front
• Clean: Inside, outside back, ties on head and back

Where to remove PPE

• At doorway, before leaving patient room or in anteroom
• Remove respirator outside from room, after door closes

Respiratory Etiquette

• Cover Your Cough/Sneeze, Clean Your Hands, Contain Your Germs & Wear a Mask

Sharps Safety

• Prepare to use device the moment sharp is first opened.
• Use sharps, cleanup and disposal with care

Be prepared

• Wash hands and wear gloves
• Organize equipment and use needleless systems
• Apply lighting
• Sharps pointed away from user.
• Have sharps nearby and check how patient is to see if co-operation

Be aware

• Keep sharps visible and avoid distractions
• Hand off is never allowed and leaving needles and sharps not allowed

Activate

• Always remember to active devices with injury prevention

While disposing of sharps

• Inspect container with hands behind sharps at all times
• Never put hands or fingers into sharps container
• Tubing, use caution for device reaction from movement

After Disposing Sharps

• Visually inspect sharps container for overfilling.
• Replace containers when no more than ¾ full

Sharps Safety

• Do not recap needles or disassemble sharps by hand
• Use safety syringes, needle-less systems when possible
• Immediately dispose of sharps in sharps container

In case of exposure

• Wash that area, notify supervisor in 1-2 hours
• There are certain forms for such occurence

Why infectious Waste Is Regulated

• To minimize the potential for the spread of disease from a medical setting to the general public.
• Infectious Medical Waste is any waste capable of producing the disease.
• The organism is is significant quantity and virulence to transmit disease, is not routinely available in the environment, and/or contaminated by an organism that is able to cause pathogenicity healthy humans.

Waste

• What has been considered from blood/fluids, sharps,isolation are, lab/unfixed tissue

Other Potentially Infectious Material

• Any body fluid with visible blood
• Amniotic fluid
• Cerebrospinal fluid
• Pericardial fluid
• Peritoneal fluid
• Pleural fluid
• Saliva In dental procedure
• Semen/vaginal Secretions,Synovial fluids

Waste IS NOT

• Products used for personal hygiene, gauze/bandages with little blood. medical tubing with no possible waste

Exposure Incident Reaction

• Washing the contacte area, follow facilites plans and reports to supervisor to minimize damage Wash, and check in with Supervisor

Infectious Medical Waste management

• Wastes including suction canisters
• Biohazard storage, sewer disposable for most
• Chemicals for solidification to dispose into solids