Control of Transmissible Diseases POD 3205 2024 PDF

Control of Transmissible Diseases Background Surveillance Precautions Control of Outbreak Investigation Transmissible Education Diseases Employee Health POD 3205 Antibiotic...

Control of Transmissible Diseases Background Surveillance Precautions Control of Outbreak Investigation Transmissible Education Diseases Employee Health POD 3205 Antibiotic 2024 Stewardship Policy & Michael Carruthers, Ph.D. Intervention Associate Professor Development Department of Microbiology and Immunology Environmental [email protected] Hygiene  Control of Transmissible Diseases Objectives Background Describe role of surveillance and reporting in Surveillance preventing HAI’s Precautions Explain the chain of infection Outbreak Investigation Describe the interventions that can be used to break the chain of infection (emphasis on handwashing) Education Employee List the reasons why physicians overprescribe Health antibiotics Antibiotic Define & describe elements of antibiotic stewardship Stewardship programs Policy & Intervention Describe the hierarchy of controls Development Environmental Hygiene  Control of Transmissible Diseases Why? Background Each day in the USA _____ develop an HAI Surveillance § 1 in 31 hospitalized patients Precautions § 1 in 43 nursing home residents Outbreak Investigation Education Resources § https://www.cdc.gov/infectioncontrol/ Employee Health § https://www.cdc.gov/nhsn/index.html Antibiotic § https://www.cdc.gov/infection- Stewardship control/media/pdfs/Pocket-Podiatry-Guide- 508.pdf Policy & Intervention § https://www.cdc.gov/infection- Development control/media/pdfs/Podiatry-Guide-508.pdf Environmental Hygiene  Control of Transmissible Diseases Modern Infection Control in the US Background Surveillance 1950’s and control of HAI staph infections Precautions Outbreak Mental Shift on HAIs: Late 1990s - Mid 2000s Investigation § HAI’s are no longer the “cost of doing business” Education and are preventable harm Employee § Shift from infection control to infection prevention Health § Precipitating events Antibiotic Stewardship o 1999 report on errors in health care (included HAI’s) o 2002 Chicago Tribune exposé on HAI’s Policy & Intervention o 2004 & 2006 pubs on reducing HAI via standardizing Development central venous catheter insertion Environmental Hygiene  Control of Transmissible Diseases Podiatry Specific Case #1 Background 2008- Nine new cases of HBV in patients at a Surveillance skilled nursing facility. Precautions § Five received care from a one DPM on a specific Outbreak date. Investigation § Investigation revealed the first resident seen was Education infected with HBV at the time. Employee § Review revealed instruments becoming Health contaminated with blood after first use (nail, cuticle, tissue nippers) and being placed in close proximity of Antibiotic clean instruments for other patients. Stewardship § Viral specimens from first patient and two other Policy & acutely ill patients were the same HBV genotype Intervention with highly similar genome sequence. Development Environmental Hygiene  Control of Transmissible Diseases Podiatry Specific Case #2 Background Surveillance 2011- Two residents of an assisted living facility newly infected with HBV Precautions Outbreak § Comprehensive review of the facility uncovered Investigation a breakdown of infection control in the podiatry Education unit o No separation of clean and dirty counter space Employee o No cleaning or disinfection between patients (callus Health shavings, skin/nail debris left on floor/chair footings Antibiotic between patients) Stewardship o Failure to appropriately clean medical equipment before disinfection or sterilization Policy & Intervention o Failure to rinse and dry equipment after disinfection Development o Cases could not be linked to these practices Environmental Hygiene  Control of Transmissible Diseases Podiatry Case #3 Background 2012- New case of HBV at a skilled nursing facility Surveillance Audit by County/State Health Department audit of all Precautions healthcare facilities used by patient Outbreak Skilled nursing facility Investigation § deficiencies related to blood glucose monitoring & infection safety Education Private podiatric clinic § Reuse of single-use blades for multiple patients Employee § Failure to: Health o clean medical equipment before disinfection or sterilization o monitor disinfection and sterilization processes Antibiotic o Store/prepare medication from muti-dose vials in a dedicated Stewardship clean area § Similar lapses by this podiatrist at two additional care facilities Policy & Intervention Development Letters notifying of potential exposure (HBV, HCV, HIV) were sent to 182 residents (nursing facility) & to all 1,115 patients who received Environmental Hygiene care from this podiatrist.  Control of Transmissible Diseases Infection Control & Prevention Background Goal: Keep people from getting sick Surveillance Precautions Stakeholders: Outbreak § Everyone (public, patients, support staff, Investigation healthcare providers, etc.) Education Employee Learning About Infection Control Health § Perception that it is a waste of time, just Antibiotic learning a new vocabulary/jargon for common Stewardship sense practices Policy & § Understanding the why’s and how's of Intervention infection control = increased buy-in & better Development adherence Environmental Hygiene  Control of Transmissible Diseases Background Surveillance Precautions Outbreak Investigation Education Employee Health Antibiotic Stewardship Policy & Intervention Development Environmental Hygiene  Control of Transmissible Diseases Breaking the Chain of Infection Background Surveillance Host factors Environmental Reservoirs Immunizations Cleaning, disinfection, Precautions Treatment of disease sterilization Outbreak Health insurance Infection prevention Investigation policies Patient education Pest control Education Portal of Entry and Exit Mode of transmission Employee Health PPE & hand hygiene PPE & hand hygiene Aerosol control Antibiotic Cleaning, disinfection, Stewardship Personal hygiene sterilization Policy & First aid Isolation & quarantine Intervention Development Engineering controls Engineering Controls Environmental Hygiene  Control of Transmissible Diseases Infection Prevention: HoC Approach Background Surveillance Precautions Outbreak Investigation Education Employee Health Antibiotic Stewardship Policy & Intervention Development Environmental Hygiene  Control of Transmissible Diseases Healthcare Infection Prevention Background 1. Surveillance Surveillance Precautions 2. Isolate patients with transmissible diseases Outbreak 3. Outbreak investigation and management Investigation 4. Education Education 5. Employee health Employee Health 6. Monitor antibiotic resistance & prescribing Antibiotic rates Stewardship 7. Development of infection prevention Policy & Intervention policies and interventions Development 8. Environmental hygiene Environmental Hygiene  Control of Transmissible Diseases Sources of Infection in the Background Healthcare Environment Surveillance Direct sources (person to person) § Patients' normal microbiota Precautions § Other humans(staff, patients, visitors, drug/device Outbreak reps) Investigation Indirect sources Education § Surfaces o Floors, countertops, keyboards, walls, remotes, etc. Employee § Patient care devices Health o Thermometers, glucose monitors, etc. Antibiotic § Medical instruments (not cleaned/disinfected) Stewardship o Nippers, endoscopes, etc. Policy & § Water or water systems Intervention § Ventilation systems Development Environmental Hygiene  Control of Transmissible Diseases Surveillance and Reporting Background If you don’t look, then is there a problem? Surveillance § Determine endemic HAI rates o Compare # of patients per hospital unit, device usage days, Precautions and number/type of diagnosed HAI’s Outbreak Investigation Issues/outbreaks can be identified if there is a significant increase from the baseline Education Employee Electronic health records are helping Health § Best data is unit-based/site-based; infection site- specific & risk-adjusted Antibiotic o Allows comparison between hospitals Stewardship o ICU will always have higher rates than other units (ventilators, central lines, urinary catheters, Policy & immunocompromised patients) Intervention Development Data should be shared with staff in each unit Environmental Hygiene  Control of Transmissible Diseases Surveillance and Reporting Background Instruct patients: Surveillance § on signs/symptoms of infection associated with Precautions procedure/care Outbreak § to notify the provider/facility if they develop Investigation signs/symptoms of infection Education Employee Adhere to local, state, and federal laws/rules Health § HAI surveillance, reportable diseases, outbreak Antibiotic reporting, contact tracing, etc Stewardship Policy & Intervention Perform regular audits of adherence to Development infection prevention practices Environmental Hygiene  Control of Transmissible Diseases Isolation Background Prevent transmission of microorganisms Surveillance § from infected or colonized patients Precautions § to other patients, hospital visitors, and healthcare workers, who may subsequently transmit them Outbreak Investigation § to other patients or become infected or colonized themselves Education Employee Balance between waste and risk Health § Isolation is costly, time-intensive, uncomfortable, Antibiotic and generates a lot of trash Stewardship § Not isolating could be more costly via increased Policy & length of stay, cost of investigation, lawsuits, loss Intervention of productivity (patient) Development Environmental Hygiene  Control of Transmissible Diseases Precautions Background Standard Precautions Surveillance § Followed with all patients in all situations o Hand Hygiene Precautions o Personal Protective Equipment (PPE) o Safe Injection Practices Outbreak o Environmental Hygiene Investigation o Respiratory Hygiene o Aseptic Technique Education Employee Transmission-based precautions Health § Added precautions depending on the nature of the infectious agent Antibiotic o Contact Stewardship o Droplet o Airborne Policy & Intervention Development Isolation and Quarantine Environmental Hygiene  Control of Transmissible Diseases Precautions Background STANDARD TRANSMISSION-BASED PRECAUTIONS Surveillance ELEMENTS PRECAUTIONS Contact Droplet Airborne Negative pressure, single- Single-patient room preferred patient room required, air Precautions Room exhausted through HEPA filters Door may remain open Door must be closed disposable or dedicate Outbreak Equipment - to a one patient - Investigation Eye For activities likely to generate a splash, spray, or Eye protection required Protection aerosol Education Surgical mask to enter; N95 or PAPR to enter; surgical Respiratory For activities likely to generate a splash, spray, or surgical mask on patient mask on patient for transport Protection aerosol for transport out of room out of room Employee For activities likely to Health Gowns generate a splash, spray, On room entry or aerosol For contact with any body Antibiotic Gloves fluid, mucous membrane, On room entry or nonintact skin Stewardship Hand Before & after patient contact; before any aseptic task; after contact with body fluids, mucous membranes, or Hygiene nonintact skin; after contact with inanimate objects near the patient; after glove removal Policy & Intervention Development Adapted from: Edmond MB, Wenzel RP. Infection Prevention in the Health Care Setting. Mandell, Douglas, and Bennett's Principles Environmental and Practice of Infectious Diseases. 2015:3286–3293.e1. doi: 10.1016/B978-1-4557-4801-3.00300-3. Epub 2014 Oct 31. PMCID: PMC7151977. Hygiene  Control of Transmissible Diseases Hand Hygiene Definitions Background Hand hygiene Surveillance § Performing/using handwashing, antiseptic hand wash, alcohol-based hand rub, surgical hand Precautions hygiene/antisepsis Outbreak Handwashing Investigation § Washing hands with plain soap and water Education Antiseptic hand wash § Washing hands with water and a soap or other Employee detergent that contains an antiseptic agent Health Alcohol-based hand rub Antibiotic § Rubbing hands with an alcohol-containing preparation Stewardship Surgical hand hygiene/antisepsis Policy & § Hand hygiene that follows a prescribed protocol before Intervention conducting a procedure Development Environmental Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; Hygiene vol. 51, no. RR-16.  Control of Transmissible Diseases Hand Hygiene Background Surveillance Why? Precautions § Substantial evidence that hand hygiene reduces the incidence of infections Outbreak Investigation § Historical study: Ignaz Semmelweis Education § More recent studies: infection rates lower Employee when antiseptic handwashing was Health performed Antibiotic Stewardship Policy & Intervention Development Environmental Hygiene  Control of Transmissible Diseases Indications for Hand Hygiene Background Visibly dirty, contaminated, or soiled, = soap and Surveillance water § Also known/suspected cases of Cryptosporidium, Precautions Norovirus, Clostridium difficile Outbreak Investigation Not visibly soiled, use an alcohol-based hand rub Education Immediately before: Employee § Touching a patient Health § Performing an invasive procedure or manipulating an invasive device Antibiotic Immediately after: Stewardship § Touching a patient, invasive devices Policy & § Removing gloves Intervention § Touching any item or surface in the patient care Development environment Environmental Hygiene Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.  Control of Transmissible Diseases Hand Hygiene Compliance Background Surveillance Precautions Outbreak Investigation Education Employee Health Antibiotic Stewardship Policy & Intervention Development Chassin, Mayer, Nether. 2015 Improving Hand Hygiene at 8 Hospitals in the United States by Targeting Specific Causes of Environmental Noncompliance. Journal on Quality and Patient Safety v41 n1 Hygiene  Control of Transmissible Diseases Hand Hygiene Compliance Background Surveillance Precautions Outbreak Investigation Education Employee Health Antibiotic Stewardship Policy & Intervention Development Environmental Hygiene Chassin, Mayer, Nether. 2015 Improving Hand Hygiene at Eight Hospitals in the United States by Targeting Specific Causes of Noncompliance. Journal on Quality and Patient Safety v41 n1  Control of Transmissible Diseases Self-Reported Factors for Poor Background Adherence with Hand Hygiene Surveillance Irritation & dryness Precautions Sinks inconveniently located/lack of sinks Outbreak Investigation Lack of soap & paper towels Education Too busy/insufficient time Employee Health Understaffing/overcrowding Antibiotic Patient needs take priority Stewardship Low risk of acquiring infection from Policy & Intervention patients Development Environmental Adapted from: CDC and Pittet D, Infect Control Hosp Epidemiol 2000; Hygiene 21:381-386.  Control of Transmissible Diseases Selection of Hand Hygiene Agents Background Surveillance Efficacy of antiseptic agent Precautions Acceptance of product by healthcare Outbreak personnel Investigation § Characteristics of product Education § Skin irritation and dryness Employee Health Accessibility of product Antibiotic Stewardship Dispenser systems Policy & Intervention Development Environmental Guideline for Hand Hygiene in Health-care Settings. MMWR Hygiene 2002; vol. 51, no. RR-16.  Control of Transmissible Diseases Hand Hygiene Efficacy Background Surveillance Precautions Outbreak Investigation Education Employee Health Alcohol-based hand rubs are generally Antibiotic considered the most effective & easiest-to-use Stewardship to use hand hygiene agents Policy & Intervention Development Exceptions to this: Cryptosporidium, Norovirus, Clostridium difficile spores Environmental Hygiene (oocysts, unenveloped viruses, bacterial spores)  Control of Transmissible Diseases Hand Hygiene Agent Effectiveness Background Surveillance Precautions Outbreak Investigation Education Employee Health Antibiotic Stewardship Policy & Intervention Development Environmental Hygiene  Control of Transmissible Diseases PPE Background Sufficient & appropriate PPE should available & readily accessible Surveillance to HCPs Precautions Educate all HCPs on proper selection and use of PPE § PPE should be removed & discarded prior to leaving the patient’s room or care area Outbreak § Hand hygiene should be performed immediately after removal of PPE Investigation Education Wear gloves for potential contact with blood, body fluids, mucous membranes, non-intact skin or contaminated equipment. § Do not wear the same pair of gloves for the care of more than one patient Employee § Do not wash gloves for the purpose of reuse Health Antibiotic Wear gown to protect skin & clothing during procedures or Stewardship activities where contact with blood or body fluids is anticipated (a new gown for every patient) Policy & Intervention Wear mouth, nose & eye protection during procedures that are Development likely to generate splashes or sprays of blood or other body fluids Environmental Hygiene  Control of Transmissible Diseases Injection Safety Background Surveillance HCP’s must: Precautions § Receive training on safe injection practices § Demonstrate competency with safe injection practices following training Outbreak Investigation The facility must: § Routinely audit adherence to safe injection practices (monitor & document) Education § Provide feedback to HCP’s from audits Employee Health Antibiotic Stewardship Policy & Intervention Development Environmental Hygiene  Control of Transmissible Diseases Medical Device Management Background Reusable medical devices (e.g., point-of-care Surveillance devices, surgical instruments, endoscopes) must be: Precautions § Cleaned Outbreak § Reprocessed (disinfection or sterilization) Investigation § Maintained according to manufacturer’s instructions Education Individuals reprocessing medical devices must be Employee appropriately trained Health § Hands-on training upon hire, annually, or changes in device/policy/procedure Antibiotic o Proper selection & use of PPE Stewardship o Detailed analysis of re-processing of devices Policy & o Should be required to demonstrate competency with reprocessing procedures (i.e., correct technique is observed Intervention by trainer) following each training Development Environmental Hygiene  Control of Transmissible Diseases Aerosol Management Background Everywhere in a facility § During aerosol-generating procedures Surveillance § Respiratory hygiene (covering coughs/sneezes) § Masking of patients with respiratory infections Precautions Before Entry: Outbreak § Screening questions to identify patients with respiratory infections Investigation § Educating patients that they report symptoms of respiratory illness before entering the facility (signs on doors, reminders/notifications during appointment scheduling, etc) Education § Allow patients with respiratory symptoms to call while in the parking lot to check in and wait Employee § Possibly postponing non-urgent care until resolution of respiratory infections Health After entry: Antibiotic § Encourage respiratory hygiene and hand hygiene o Provide tissues and no-touch receptacles for disposal Stewardship o Provide resources for performing hand hygiene in or near waiting areas o Notices/signs/infographics on these subjects Policy & o Offer masks to symptomatic persons Intervention § Two waiting areas: sick vs. healthy Development Environmental Hygiene  Control of Transmissible Diseases Isolation vs. Quarantine Background Isolation – separates sick people from people Surveillance who are not sick Precautions Quarantine – separate or restricts movement Outbreak Investigation of people who were exposed to an infectious agent to see if they become sick Education Employee Modern Quarantine Health § Used when: o A person or well-defined group of people has been Antibiotic exposed to a highly dangerous and contagious disease Stewardship o Resources are available to implement and maintain the quarantine, such as: Policy & q Active monitoring Intervention Development q Delivering essential services Environmental Hygiene  Control of Transmissible Diseases Modern Quarantine Background Surveillance What does it look like? § Small group of people Precautions o Short-term (days), voluntary restriction to your Outbreak home Investigation § Larger group of people Education o Restrictions on assembly Employee q Close schools, churches, and public buildings Health q Cancel public events q Ban public gatherings Antibiotic Stewardship o Restrictions on movement q Closure of mass transit systems Policy & Intervention q Institution of mandatory curfew Development q Restriction of passage into and out of an area Environmental Hygiene  Control of Transmissible Diseases Isolation vs. Quarantine Background Federal Isolation & Federal law covers Quarantine authorized for: Surveillance entry/exit from the § Cholera Precautions country or interstate § Diphtheria travel (CDC is the functional body) § Plague Outbreak https://www.cdc.gov/port-health/legal- § Smallpox Investigation authorities/isolation-quarantine.html § Yellow fever § Viral hemorrhagic fevers Education (Lassa, Ebola, Marburg, etc) State law covers people § SARS Employee § Influenza (with pandemic potential) Health within a state https://www.legis.iowa.gov/docs/code/139A. Overseen by the HHS Secretary, authorized/amended by Executive pdf Order of the President Antibiotic Stewardship Policy & Local/Tribal law covers Intervention people within a locality https://www.polkcountyiowa.gov/media/onf Development p52mc/5-ordinance.pdf Environmental Hygiene  Control of Transmissible Diseases Outbreak Investigation & Background Management Surveillance Proper surveillance allows for outbreak detection § Monthly rate exceeds 95% confidence interval for that month last year Precautions § When prompted by HCW, microbiology lab Outbreak Clonal vs. polyclonal origin Investigation § Use of rapid molecular typing § Clonal = point source Education § Polyclonal = multiple sources Employee Investigative team Health § Hospital epidemiologist, director of employee health, infection preventionists, and director of microbiology laboratory (sometimes Antibiotic external consultants) Stewardship Contract Tracing Policy & § Determine who was potentially exposed, inform them, and follow up Intervention Development Environmental Hygiene  Control of Transmissible Diseases Educate and Train Everyone Background Provide job- or task-specific infection Surveillance prevention education and training to Precautions everyone Outbreak Investigation Training should focus on principles of safety Education for both the employees and patients Employee Health Training provided upon hire, repeated Antibiotic Stewardship annually, or when policies/procedures change Policy & Intervention Competencies should be documented Development following each training Environmental Hygiene  Control of Transmissible Diseases Employee Health Background Management of exposure to blood-borne Surveillance pathogens Precautions Outbreak Ensure HCWs are fit for duty and free from Investigation communicable diseases Education § Physical Employee § Tuberculin skin test Health § Immunization history (rubella, measles, Antibiotic mumps, pertussis, tetanus, hepatitis B, Stewardship varicella, Hib, etc) Policy & § Annual flu vaccine Intervention § Paid time off for illness Development Environmental Hygiene  Control of Transmissible Diseases Antibiotic Stewardship Background Rationale Surveillance § ~60% of hospitalized patients receive antibiotics Precautions § >80% of patient days are associated with antibiotic administration Outbreak Investigation § Antibiotic resistance is a BIG PROBLEM § Antibiotic overprescription is a BIG PROBLEM Education Employee Health In the USA: § 28% of all antibiotic prescriptions are unnecessary Antibiotic (47 million prescriptions) Stewardship § Only 52% of those treated with antibiotics Policy & received the recommended antibiotic based upon Intervention current prescribing guidelines Development Environmental Hygiene  Control of Transmissible Diseases Antibiotic Stewardship Background Surveillance Precautions Outbreak Investigation Education Employee Health Antibiotic Stewardship Policy & Intervention Development Environmental Hygiene  Control of Transmissible Diseases Antibiotic Stewardship Barriers Background Physician Peer Pressure and Relationships Surveillance § Prescribing etiquette- strong norm of Precautions noninterference § Pecking order/hierarchy- junior physicians defer to Outbreak Investigation attendings § Opinions of senior colleagues, peers, and what is Education the norm are more influential than guidelines Employee Health Risk, Fear, Anxiety, and Emotion Antibiotic § Perception of undertreating > individual risk from Stewardship receiving antibiotics unnecessarily (“Antibiotics are the best treatment of physician fears”) Policy & Intervention § Emotional desire to provide all immediate Development therapeutic options Environmental Hygiene  Control of Transmissible Diseases Antibiotic Stewardship Barriers Background Surveillance Misperception of the Problem § Common mentality that antibiotic Precautions overprescribing is a “general problem”, not a Outbreak local one Investigation § Exceptionalism Education o Guidelines don’t apply to me or my patients Employee o Past experience supersedes guidelines Health o Guidelines are ”academic” and not practical Antibiotic o Disbelief that one overprescribes Stewardship (even when shown evidence) Policy & Intervention Development Environmental Hygiene  Control of Transmissible Diseases Antibiotic Stewardship Barriers Background continued Surveillance Contextual and Environmental Factors § Time pressures Precautions o Continual pressure to discharge as quickly as possible, Outbreak no time to watch and wait Investigation § Time of day (decision fatigue) Education o More likely to not follow guidelines and/or give in to Employee demands to prescribe later in the workday Health § Competing priorities Antibiotic o In a lot of healthcare, patient satisfaction scores are Stewardship used to drive promotion, salary recommendations, etc… Policy & Intervention Development Environmental Hygiene  Control of Transmissible Diseases Antibiotic Stewardship: Steps Background Educate everyone Surveillance Implement antibiotic stewardship programs Precautions § Codifies best practice into policy § Disincentives for overprescribing Outbreak § Provides everyone with the “bad guy” Investigation § Types of programs o Active: Formulary restrictions / preauthorization, order sets Education based on diagnosis o Passive: Treatment guidelines, education & feedback of Employee antibiotic usage data (compared to peers) Health § Include the microbiology lab and analyze data o Regular monitoring of antimicrobial susceptibility profiles Antibiotic o Compare to antibiotic usage rates within institution Stewardship (distinguish between potential and known HAI’s vs community acquired isolates) Policy & o Identify trends Intervention o Make informed decisions regarding antibiotic use and infection Development control Environmental Hygiene  Control of Transmissible Diseases Dedicate Administrative Resources Background Develop and maintain infection prevention Surveillance and employee health programs Precautions Outbreak Assure availability of supplies for adherence to Investigation standard precautions Education At least 1 person with training to manage Employee Health infection prevention program Antibiotic Stewardship Written policies and procedures on infection Policy & prevention Intervention Development Infection control committee Environmental Hygiene  Control of Transmissible Diseases Risk Recognition & Assessments Background Surveillance Risk Recognition § Real-time awareness of things that can Precautions transmit infectious agents Outbreak o Is there a risk associated with the task I am about Investigation to perform? Education o If yes, what can I do to mitigate the risks? Employee Health Institutional risk assessments Antibiotic § Infection Prevention Checklist for Outpatient Stewardship Settings (Appendix A) of CDC Guide to Policy & Infection Prevention for Outpatient Settings Intervention Development Environmental Hygiene  Control of Transmissible Diseases Persistence of Bacteria on Surfaces Background Surveillance Precautions Pathogen Persistence on Inanimate Surfaces Outbreak Acinetobacter spp. 3 days – 5 months Investigation C. difficile 5 months (spores) Education Klebsiella spp. - MRSA 4 weeks - 7 months Employee Health Pseudomonas spp. 6 h - 16 months Rotavirus 6 – 60 days Antibiotic Stewardship VRE 4 week - 7 months Policy & Intervention Development Environmental Hygiene  The Inanimate Environment Can Facilitate Transmission X represents VRE culture positive sites ~ Contaminated surfaces increase cross-transmission ~ Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+) Patient Environment. Hayden M, ICAAC, 2001, Chicago, IL.  Control of Transmissible Diseases Environmental Hygiene Background All items in a patients room or a procedure room Surveillance need to be cleaned and disinfected regularly Precautions Everyone has a responsibility in this Outbreak Investigation Don’t be a passive participant Education Know who is responsible for: Employee § Setting policy Health § Carrying out the process Antibiotic § Monitoring Stewardship Policy & Know your role Intervention § Ranging from noticing/reporting issues to performing Development disinfection Environmental Hygiene  Control of Transmissible Diseases Environmental Hygiene Background Cleaning protocols Surveillance § Clean from cleanest to dirtiest areas Precautions Selection of Disinfectants Outbreak § EPA registration Investigation § Multiple types are used per facility depending on: o Risk assessment (type/level of contamination & procedures, etc) Education § Preparation o Follow the manufacturer’s instructions; expiration dates matter Employee o Concentrates should always be mixed via a dispensing system Health (remove human error) § Contact time Antibiotic o Time required to kill while a surface is wetted with disinfectant Stewardship o Ranges from 1-10 minutes or more Policy & o Affected by temperature, humidity, etc Intervention o Multiple applications may be needed Development Environmental Hygiene  Control of Transmissible Diseases Environmental Hygiene Background Newer Methods to sterilize or disinfect Surveillance § Vaporized hydrogen peroxide Precautions § UV light irradiation Outbreak Investigation Performance monitoring Education § A variety of tools to mark places in a room Employee after use but prior to cleaning Health o Fluorescent marking (black light visible) o ATP marking (ATP meter) Antibiotic Stewardship Policy & Establish goals, monitor, educate Intervention everyone, re-monitor (wash, rinse, repeat) Development Environmental Hygiene  Control of Transmissible Diseases Key Takeaways Background If you touch it, own it Surveillance Don’t be a passive participant in the system Precautions Understand what you are doing & why you are Outbreak doing it Investigation § E.g., Hand hygiene - Alcohol-based hand rubs vs Education hand washing o Differences in mechanism of action, what types of Employee situations each is used, how to properly use/perform Health each, etc. Antibiotic Stewardship Be accountable and engaged § Don’t fall victim to the bystander effect Policy & o More bystanders = decrease in chance of Intervention reporting/helping/acting Development Environmental Hygiene