physician education - infection prevention
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Physician Education
Infection Prevention
Clean Hands Isolation At CHOMP Central Line Associated Bloodstream
Infection (CLABSI) Multiple Drug-Resistant Organism Infection
(MDRO)
Surgical Site Infection (SSI)
Catheter-Associated Urinary Tract Infection(CAUTI)
Content Overview
From the Centers for Disease Control and Prevention:Hand hygiene is the most simple, effective, and proven way to prevent the spread of infection.
The Experiment In 1847, Dr. Ignaz Semmelweis practiced obstetrics at Vienna GeneralHospital where mortality from childbed fever was as high as high as 35%. He implemented chlorinated lime solution hand rinse for use before patient exams. Mortality rates from childbed fever fell dramatically.Mortality on the unit where it was not practiced remained three times greater.
Alcohol Hand Rub Recommended by CDC over soap and waterContains emollients to keep skin intact and smooth
Soap and WaterUse soap and water for 15 seconds or more when hands are visibly dirty, or if the patient has C. difficile.
Clean Hands
Clean hands Gloves for potential contact with blood/body
fluids, contaminated equipment Gown if splashing of uniform/clothing is likely Protective eyewear if splashing to face is likely Surgical mask if coughing & unable to cover
cough
Standard PrecautionsUsed for all patients all the time
Contact PrecautionsGloves, blue plastic isolation gown
Droplet PrecautionsSurgical mask
Airborne PrecautionsN95 respirator (mask), negative airflow room with
door closed
Isolation
CLABSICentral Line AssociatedBloodstream infection
What Is “CLABSI”?Central Line Associated Bloodstream Infection
After a central line is inserted, patient has a pathogen from one or more blood cultures, unrelated to an infection at another site
The bloodstream infection was not present on hospital admission
Examples of bloodstream pathogens: (CDC definitions)
◦ Enterococcus ◦ Pseudomonas◦ Klebsiella◦ Staph. aureus
Increased length of stay - 6.5 days
Increased cost of care - $50,000
Increased risk of mortality - 50%
Central Line Associated Bloodstream InfectionThe Impact
Site infection at central line
Clean hands Hair cover, mask, sterile gloves & gown Maximum sterile barrier drape Site selection – highest risk of infection is femoral site Use chlorhexidine to cleanse skin - allow to dry
Remove the device as soon as possible – evaluate the need daily
Insertion of Central LinesEvidenced-Based Practices To Prevent Infection
Multiple Drug Resistant Organisms
MDROs
Judicious antibiotic use Prevents development of resistant organisms
Contact Precautions for resistant organisms in clinical infections: (MRSA, VRE, C. difficile, ESBLs, and MDROs) Clean hands with alcohol before and after
patient contact (use soap/water if C. difficile) Wear gloves, gown to enter room If respiratory infection, add surgical mask
Resistant OrganismsPrevention
Staphylococcus aureus is spread on hands. MRSA = Methicillin-resistant Staphylococcus
aureus Control spread by clean hands, and Contact Precautions If respiratory infection with MRSA, Contact PLUS Droplet
Precautions
MRSA in nares Standard Precautions (used for all patients) About 10% of admissions to CHOMP have nasal MRSA
MDROs: Staphylococcus
VREVancomycin-resistant Enterococcus faecium/faecalis Group DOccurs infrequently at CHOMP InfectionsUrinary tract, biliary tree, bloodstream, and surgical site infections TransmissionContaminated equipment, or unwashed hands can carry VRE and other resistant organisms from room to room; from patient to patient Prevent SpreadClean hands, Contact precautions
MDROsEnterococcus
MDROsEnterococcus
Risk FactorsProton pump inhibitors, antibiotics (especially broad spectrum
cephalosporins and quinolones) chemotherapy, GI surgery, and among those with previous C. difficile infection
Infection: Diarrhea with abdominal symptoms; can mimic other abdominal
syndromes Pseudonym: “Antibiotic Associated Colitis” Pseudomembranous colitis seen on CT Complications:
Toxic megacolon, perforation, shock, death Prevention Clean hands with soap and water Contact Precautions Judicious antibiotic use
MDROsClostridium difficile
Two types: Produce extended spectrum beta-lactamases (ESBL)
Sensitive to carbapenems (ertapenem, doripenem, imipenem) Laboratory will provide a message alert when an ESBL is identified Contact Precautions Most common among Escherichia coli and Klebsiella pneumoniae
Gram negative bacteria that are resistant to 3 or more classes of antimicrobial drugs Select a drug to which the bacterium demonstrates sensitivity
Clean hands, Contact Precautions for both
MDROsOther Gram negative Bacteria
Surgical Site Infection Prevention
o Prophylactic Antibiotic◦ Pre-op: within1 hr. (2 hr. for vancomycin) before cut time◦ Pre-op order sets have been developed to assist you to easily
work within recommendations◦ Duration of prophylaxis less than 24 hrs (48 hrs. for cardiac
surgery) to meet national standards
◦ Limit hair removal (use clippers, not razors)
◦ Maintain perioperative warmth
◦ Prevent hyperglycemia ◦ Chlorhexidine bath pre-op on day of surgery and P.O. day 1
Surgical Site Infections (SSI)Best Practices To Reduce Risk
No immediate use sterilization (“flash” sterilization) unless critical need
All appliances / instruments from outside vendors must be on site for appropriate sterilization the day prior
Chlorhexidine (CHG) skin prep is recommended. Both betadine and CHG skin antiseptics have a kill rate of 99%+.
CHG has antimicrobial persistance for up to a week (betadine does not).
Additional measuresSSI Prevention
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