ENH505-Lecture 7-2024 PDF

Nosocomial Infections/Health Care- Associated Infections & Respiratory/Enteric Outbreaks ENH505-Infection Control School of Occupational and Public Health Toronto Metropolitan University Final Exam Information Wed Dec 11th - 3pm TRSM 2099 AND 2166 – I will post yo...

Nosocomial Infections/Health Care- Associated Infections & Respiratory/Enteric Outbreaks ENH505-Infection Control School of Occupational and Public Health Toronto Metropolitan University Final Exam Information Wed Dec 11th - 3pm TRSM 2099 AND 2166 – I will post your room assignment on D2L MC and T/F questions Covers post-midterm material only ~45 questions total Remember to book through test center if you have accommodations – there is a school deadline for this! Nosocomial Infections/HIAs Modern healthcare employs many types of invasive devices and procedures to treat patients and to help them recover. Infections can be associated with the devices used in medical procedures, such as catheters or ventilators. Nosocomial Infections/HIAs Healthcare-associated infections (HAIs) include 1. Central line-associated bloodstream infections 2. Catheter-associated urinary tract infections 3. Ventilator-associated pneumonia 4. Surgical site infections Public health and healthcare providers work closely to monitor and prevent these infections because they are an important threat to patient safety. Central Line-associated Bloodstream Infections (CLABSI) A central line is a catheter (tube) that doctors often place in a large vein in the neck, chest, or groin to give medication or fluids or to collect blood for medical tests. A serious infection that occurs when microorganisms (usually bacteria or viruses) enter the bloodstream through the central line. Healthcare providers must follow a strict protocol when inserting the line to make sure the line remains sterile and a CLABSI does not occur. Catheter-associated Urinary Tract Infections (CAUTI) A urinary tract infection (UTI) is an infection involving any part of the urinary system, including urethra, bladder, ureters, and kidney. Among UTIs acquired in the hospital, approximately 75% are associated with a urinary catheter, which is a tube inserted into the bladder through the urethra to drain urine. Between 15-25% of hospitalized patients receive urinary catheters during their hospital stay. The most important risk factor for developing CAUTI is prolonged use of the urinary catheter. Therefore, catheters should only be used for appropriate indications and should be removed as soon as they are no longer needed. Ventilator-associated Pneumonia Ventilator-associated pneumonia is a lung infection that develops in a person who is on a ventilator. A ventilator is a machine that is used to help a patient breathe by giving oxygen through a tube placed in a patient’s mouth or nose, or through a hole in the front of the neck. An infection may occur if germs enter through the tube and get into the patient’s lungs. Surgical Site Infections A surgical site infection is an infection that occurs after surgery in the part of the body where the surgery took place. Surgical site infections can sometimes be superficial infections involving the skin only. Other surgical site infections are more serious and can involve tissues under the skin, organs, or implanted material Legal Authority Health Protection and Promotion Act (HPPA)- HPPA lists “communicable” diseases that are ‘Reportable’- A) For surveillance B) For public health intervention (case and contact management)  Who must report? Physician, nurse, pharmacist, dentist, chiropractor, optometrist Administrator of a hospital (Infection Control Practitioner is considered an administrator) Superintendent of an institution Principal of a school Operator of a laboratory Physician who signs a medical certificate of death Outbreak Reporting Responsibilities of Healthcare Institutions Under the Health Protection and Promotion Act (HPPA), healthcare institutions are required to monitor staff and patients/residents for signs and symptoms of gastroenteric (e.g., nausea, vomiting, diarrhea, fever) and respiratory (e.g., cough, runny nose, sore throat, fever) infections. Healthcare institutions must also actively look for, detect and report suspected and/or confirmed outbreaks to their local public health unit. Public Health's Mandate Public Health is required to respond to reports of suspected and confirmed outbreaks of gastroenteric and respiratory illness. Public Health works with healthcare institutions to prevent and control institutional outbreaks, including the use of best practices in infection prevention and control. What is surveillance? “Surveillance is the systematic, ongoing collection, collation, and analysis of data with timely dissemination of information to those who require this information in order to take action.”  Goals of Surveillance An important goal of surveillance is to ensure early identification of a potential outbreak or an outbreak in its early stages. Education for Staff The role of staff in surveillance and its importance Symptoms of gastroenteritis and respiratory illness Criteria for a suspected outbreak Procedures for reporting  What is an Outbreak? An unexpected increase of disease occurring within a specific population at a given time and place. Objectives of an Outbreak Investigation Outbreak Investigation Confirm the existence of a problem and establish a case definition Determine its extent in terms of time, person and place characteristics (use line list) Identify the agent, the source, the method of spread and contributing factors Implement control measures Assessing the situation: Case definition A case definition is the criteria that will be used throughout the outbreak to consider a resident or staff member as outbreak associated case. Residents who meet this case definition will be considered a case regardless of the results of laboratory testing unless another diagnosis is confirmed. Declaring an Outbreak Suspect Respiratory Infection Outbreak 2 cases of acute respiratory illness within 48 hours in a geographic location (floor/unit) OR one laboratory- confirmed case of influenza. Confirmed Respiratory Infection Outbreak 2 cases of acute respiratory infections (ARI) within 48 hours with a common epidemiological link (e.g., floor/unit), at least 1 of which must be laboratory- confirmed OR 3 cases of ARI (laboratory confirmation not necessary) occurring within 48 hours with any common epidemiological link (e.g., floor/unit). Declaring a Gastroenteritis/Enteric Infection Outbreak Defined as occurrence of gastroenteritis/enteric infection beyond what is normally expected based on surveillance data Confirmed Gastroenteritis/Enteric Infection Outbreak Two or more cases meeting the case definition with a common epidemiological link (e.g. specific unit or floor, same caregiver) with initial onset within a 48 hour period. Confirmed Gastroenteritis/Enteric Infection Outbreak- CASE DEFINITON Symptoms must not be attributed to another cause (e.g. medication side effects, laxatives, diet, or prior medical condition) and are not present or incubating upon admission and at least one of the following must be met: Two or more episodes of diarrhea (i.e. loose/watery bowel movements) within a 24-hour period OR Two or more episodes of vomiting within a 24-hour period; OR One or more episodes of diarrhea AND one or more episodes of vomiting within a 24-hour period. Declaring an Outbreak Over  Declaring a Respiratory Infection Outbreak Over The time before which an outbreak can be declared over is dependent on: The causative organism (period of communicability & incubation period) The epidemiology of the outbreak Whether the last case was a resident or staff member Declaring Respiratory Outbreaks Over As a general rule, outbreaks can be declared over if no new cases have occurred in 8 days from the onset of symptoms of the last patient/resident case (Period of communicability (5 days) + 1 period of incubation (3 days) OR 3 days from last day of work of an ill staff, whichever is longer Declaring a Gastroenteritis/Enteric Infection Outbreak Over Norovirus and "unknown agent" outbreaks can be declared over 5 days after onset of symptoms in the last res./pt. case or 1 incubation period (48 hours) has passed since staff last worked in the facility. Health Unit Responsibilities Assign outbreak number Notify Public Health Lab Facilitate specimen testing at the OAHPP lab Report to Ministry of Health within specific timeframes (e.g. 1 day for respiratory outbreaks) Member of outbreak management team Assist in the investigation, confirmation, declaration and management of the outbreak Investigate potential sources (food/water samples) Provide disease specific information Provide specimen kits Communicate to institutions/media Consultation re: declaring the outbreak over Provide final outbreak report to MOHLTC Outbreak Management Team Public Health Unit Infection Prevention and Control Occupational Health Environmental Services Corporate Communications Pharmacy Services Food Services Diagnostic Laboratories Patient Care Managers/ Physicians Senior Management  OMT Meeting Review the line list information Develop a working case definition Review the control measures Appropriate signs and their placement Go through TPH OB Checklist Communication Occurs daily or as needed between Health Unit and facility (provide update & review line list) Between Public Health unit and Public Health Lab if necessary Between Health Unit & other Institutions re: outbreak Between the facility and the Coroner (if any deaths occur during the outbreak Communication The facility should advise: Public Health Unit CCAC of their admission status Other relevant LTCHs and hospitals Compliance advisor from Ministry of Health Resident’s physicians and families Other healthcare providers (e.g., physiotherapist) Staffing agencies Emergency Medical Services, including dispatch Coroner’s office, if there are any deaths (cases and non-cases) Outbreak Control Measures Hand Hygiene Enhanced Environmental Cleaning Use of PPE Patient Control Measures Visitor Control Measures Staff Control Measures  Control Measures Hand Hygiene Enhanced Cleaning and Disinfecting Hand hygiene is the single most Thorough and frequent cleaning of important procedure for preventing equipment and environmental infections. surfaces should be reinforced during an outbreak. Areas of Hand hygiene is the responsibility of concern are, but not limited to, all all individuals involved in health care. washrooms, handrails, tables, During an outbreak, handwashing doorknobs, elevator buttons, call frequency amongst staff and visitors bells, telephones, bed rails, light must be increased. switches, toilet handles and Implement use of ABHR in areas commodes. where hand sinks are not readily available. If equipment is shared with other residents, ensure that the equipment is cleaned and disinfected before and after each use. Ensure that the chemical concentration of the disinfectant is appropriate and the cleaning solutions containing the chemical disinfectant is changed frequently. Control Measures Use of Personal Protective Equipment (gloves, masks, eye protection and gowns) PPE has to be put on before entering an ill resident’s room. Masks (surgical) and eye protection to be used when within 2 meters of an ill resident. Gloves are recommended if contact with blood, body fluid, secretions, excretions or touching the resident’s environment is likely to occur. Gowns are recommended to protect uncovered skin and clothing, if splashing is probable. Gloves, masks and gowns must be changed between residents and/or when contaminated. Staff must have completed patient care and be at least 2 meter distance from resident before any PPE is removed. Hand hygiene performed after PPE is removed. Staff Control Measures Note: Staff includes Staff with respiratory symptoms should not enter the facility. all people who carry on activities in the Ill staff should report to facility including infection control and/ or occupational health. employees, volunteers, nurses, Ill staff should be excluded from students, physicians, work for 5 days from the date of onset of symptoms or until contract workers and symptoms have resolved sitters. (whichever is shorter). For enteric outbreaks staff should remain off work until they are 48 hrs symptom free. Staff Control Measures Staff Working at Other Healthcare Facilities: Staff with respiratory symptoms should not work in any healthcare facility. Well staff should be discouraged from working in any other healthcare setting until the outbreak has been declared over. Cohort Staff: Designate some staff to look after only ill residents and other staff to look after only well residents, if feasible. Minimize the movement of staff within facility, especially if only some areas of the facility are in an outbreak mode. Under What Conditions Can I Work During a Influenza Outbreak? Must be well Vaccinated for 2 weeks or more Vaccinated for less than 2 weeks - must take antivirals Unvaccinated - must take antivirals Resident Control Measures A) New admissions B) Re-admission of cases to a healthcare facility from a hospital C) Resident discharge from an outbreak facility to a private home https://encrypted-tbn3.gstatic.com/images?q=tbn:ANd9GcQtCmOTT-4lOC74rgbW1eTAijkiCIzdYs9xXTHMueO7SwHjwCMW Resident Control Measures Resident appointments: Reschedule non-urgent appointments until the outbreak has been declared over. Urgent appointments for residents during outbreaks may continue with precautions (i.e PPE, advising the physician). Communal activities: Discontinue communal activities that mix residents from different units/areas. Activities on individual units may continue if units are not is outbreak. Visits by outside groups: Visits by outside groups (e.g., entertainers, community groups) are generally not permitted during an outbreak. Exceptions to be discussed with Public Health. Resident Control Measures Restriction of cases to their rooms: Restrict cases to their room until 5 days after the onset of acute illness or until symptoms have resolved (whichever is shorter). For GI outbreaks restrict cases to their room until 48 hrs symptom free. No room restrictions required for asymptomatic roommates of cases, but roommates should be confined to affected areas of the facility. Restriction of residents to their unit: If cases are confined to one unit of the facility, all residents (well and ill) from that unit should avoid contact with residents from the rest of the facility Visitor Control Measures Advise visitors of the outbreak: Post outbreak notification (stop) signs at all entrances. Post appropriate droplet/contact/airborne notices on the room doors of ill residents Visitors should only visit one resident and exit the facility immediately after the visit. Advise about visiting a well resident: Visitors visiting well residents with an ill roommate are not required to wear PPE provided they stay at least 2 metres Advise about visiting an ill resident: Ill residents should be visited in their room only, by one visitor at a time, if possible. Visitors providing direct care (within 2 metres) to an ill resident must wear PPE. After visiting a resident, the visitor should leave the facility immediately. Dirty Hospitals https://www.youtube.com/watch?v=UIOHKrfzJzI