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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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