presentation infectiousdiseases 2013 ictsummit

7/30/2019 PRESENTATION InfectiousDiseases 2013 ICTSummit

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Infectious Disease and Prevention in

the Perioperative Environment

This presentation is property of PREZIO Health and may not be used without expressed written permission


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Program Content:

Infection prevention in the perioperative

environment

Common infectious diseases

The Chain of Infection

Six Factors in Disease Transmission

Standard Precautions


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TRUE STORY1

Lisa Black- 26 year old nurse, accidentally

stuck herself with a contaminated needle

from a patient in the terminal stages of AIDS.

Lisa followed all protocols, including ER

treatment with PEP (post-exposure

prophylaxis)

Lisa confirmed HIV and Hep C infectionsseveral months after incident


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Introduction

We understand as healthcare professionalswe are at risk for potential exposure topathogenic microorganisms while in ourclinical environment.

We also understand our actions can placepatients at risk for potential exposure topathogenic microorganisms.

In this education program, we will examinesome of the common pathogens and reviewmethods to control their spread and protectourselves and patients from exposure


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Overview of Infectious Diseases

Infectious diseases are caused by pathogenicmicroorganisms, such as bacteria, viruses,parasites or fungi; the diseases can be spread,directly or indirectly, from one person to another

Some pathogenic microorganisms included:

MRSA, VRE, CRE

Clostridium Difficile C. Diff.

TB

Hepatitis B and C

HIV


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Standard precaution is an approach toinfection control where all human blood

and body fluids are treated as if known tobe infectious for blood-borne pathogens.12

Standard Precaution


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Chain of Infection

Pathogenic microorganism

Mode of transmission

Susceptible host

Reservoir Portal of entry

Six factors of disease transmission and the Chain of Infection2

Portal of exit


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Chain of Infection

Pathogenic

microorganism


Causative agent:

A microbial organism with the

ability to cause disease, or apathogenic microorganism


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BREAK the Chain- Pathogen2

Prompt Treatment

Decontamination

Rapid Identification


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Chain of Infection

Reservoir


Reservoir:

The place where the causative

agent can survive. A human is a

good example


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BREAK the Chain- Reservoir2

Health/Hygiene

Sanitation

Disinfection/Sterilization


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Chain of Infection

Portal of exit


Portal of exit:

Path by which the pathogen

leaves the reservoir. Hands,

clothes, shoes and skin areexamples


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BREAK the Chain- Portal of Exit2

Proper attire

Hand Hygiene

Proper waste disposal Control of secretions/excretions


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Chain of Infection

Mode of transmission


Mode of transmission:

Method of transfer by which the

organism moves or is carriedfrom one place to another. This

can be direct or indirect contact


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BREAK the Chain- Transmission2

Hand Hygiene

Airflow control

Disinfection/Sterilization

Proper food handling Isolation precautions


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Chain of Infection

Portal of entry


Portal of exit/Portal of entry:

Paths by which the pathogen

leaves the reservoir and enters the

host. The mucous membranes are

an example


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BREAK the Chain- Portal of Entry2

Aseptic technique

Wound care

Hand Hygiene Device care


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Chain of Infection

Susceptible host


Susceptible host:A person who cannot resist a

microorganism invading the body


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BREAK the Chain- Susceptible Host2

Treatment of disease

Recognize high risk patients

Vaccinations


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The host is susceptible to disease because they lackimmunity or physical resistance to overcome this

invasion.

We as healthcare professionals must play an activerole in disrupting the Chain of Infection.


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Infectious Diseases Bacteria

Bacteria live in and on everyone and areessential to basic human life functions asnormal flora

Normal colonization- aids in digestion and helpskeep other microorganisms in check

Pathogenic microorganisms can sometimesovercome host defenses and/or becomeresistant to antibiotics making them moredifficult to treat


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Potentially Pathogenic Bacteria

Types discussed

Staphylococcus Aureus: Found on the skin ofroughly 30% of individuals- usually not

harmful unless injected into a skin wound orlesion

Enterococci: Normally found in humanintestines and the female genital tract

Enterobacteriaceae: Normal part of thehuman gut including Klebsiella and E. coli.


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Common Antibiotics/Antimicrobials

Methicillin Oxacillin, penicillin and amoxicillin

Vancomycin

Frequently given prophylactically to surgicalpatients

Cephalosporins Ceftriaxone, cefotaxime, ceftazidime

Carbapenems Doripenem, meropenem, imipenem


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Infectious Diseases - MRSA

Methicillin Resistant StaphylococcusAureus (MRSA)3

Occur most frequently among persons inhospitals and healthcare facilities who haveweakened immune systems

Can cause potentially life threateningsurgical site infections, bloodstreaminfections or pneumonia (most commonly inhigh risk patients with frequent healthcareexposure)

Can be spread from hand contact,surfaces, or from open wounds. It can alsobe spread by sharing personal items suchas razors or towels

Examples of MRSA infection


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Special Consideration:

MRSA infections that occur in otherwise

healthy people who have not been recently

(within the past year) hospitalized or had a

medical procedure (such as dialysis,

surgery, catheters) are known ascommunity-associated (CA)-MRSA

infections.

These infections are usually skin

infections, such as abscesses, boils, andother pus-filled lesions


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Infectious Diseases MRSA

Methicillin Resistant Staphylococcus Aureus (MRSA) Prevention3 Keep your hands clean by washing thoroughly with soap and water or using an

alcohol-based hand sanitizer.

Keep cuts and scrapes clean and covered with a bandage until healed

Avoid contact with other people's wounds or bandages

Avoid sharing personal items such as uniforms and personal protectiveequipment

Follow standard precautions and use PPE when cleaning and decontaminatinginstrumentation and patient care equipment

Avoid direct patient contact without PPE


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Infectious Diseases VRE4

Vancomycin-resistant enterococci

Colonization with VRE can occur with nosymptoms

No treatment needed Symptomatic VRE infections can usually be

treated with antibiotics other thanVancomycin

Most commonly spread by contaminatedhands of caregivers


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Infectious Diseases VRE

What factors put people at risk of infection4? Hospitalization

Treatment with Vancomycin or other antibioticsfor an extended time period

Weakened immune system (AIDS,Chemotherapy, age)

People who undergo surgical procedures

Presence of long term medical devices (urinary

catheters, central IV, etc.) Known colonization of VRE


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Infectious Diseases- CRE5

Carbapenem-resistant Enterobacteriaceae

Also resistant to ALL cephalosporins

Difficult to treat- resistant to most antibiotictreatments

Infections are potentially deadly

Fatal in up to 50% of individuals who acquireinvasive blood stream infection6


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Infectious Diseases- CRE

Healthy individuals usually do not get CRE

Risk factors:

Recent travel to areas with endemic CRE

Long term devices (ventilators, catheters, IV)

Long courses of certain antibiotics

CRE is a serious threat to public health

Identification and tracking efforts are currentlyunderway by the CDC


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Infectious Diseases- C. diff

Clostridium Difficile (C. Diff.) Infection Control7

Observe enteric and standard precautions and proper hand-washingtechniques to avoid spreading C. Diff.

Ensure adequate cleaning and disinfection of environmental surfacesand reusable devices, especially items likely to be contaminated withfeces and surfaces that are touched frequently

Use an Environmental Protection Agency (EPA)-registered disinfectant

for environmental surface disinfection with a C. diff kill claim Follow the manufacturers instructions for disinfection of endoscopes

and other devices

Perform hand hygiene

Alcohol-based hand sanitizers are not effective against C. diff and shouldnot be used when caring for a patient on enteric precautions.

Soap and water is effective when vigorous friction is applied to physicallyremove spores from skin surface


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Special Consideration:

Latent TB Infection

In most people who breathe in TB bacteria and

become infected, the body is able to fight the bacteria

to stop them from growing.

People with latent TB infection:Show a positive reaction to the TB skin or blood test

Do not feel sick and do not have any symptoms

Are not infectious and cannot spread TB bacteria to others

However, if TB bacteria become active in the body and

multiply, the person will get sick with TB disease


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Infectious Diseases - TB

Tuberculosis Infection Control8 ALWAYS follow all hospital protocols when handling/cleaning

equipment known to be contaminated with TB

As with any instrument following patient use, ensure it is properlycontained while in transit to decontamination area

All personnel should wear appropriate PPE, following standard

precautions, when handling instruments used on patients Initial and ongoing monitored and documented TB training should beadministered

Annual TB testing should be performed on all facility staff on a regularbasis

If working DIRECTLY with a patient who has known TB infection, allpersonnel must wear a N-95 TB mask, which must be annually fit-tested to each individual wearer.

TB face mask is not necessary for cleaning contaminated equipment.


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Viral Infections


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Infectious Diseases- Hepatitis


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Infectious Diseases - Hepatitis

Hepatitis means inflammation of the liver

Most common viral strains are A, B and C

Just because they share a name, strains A

B and C are nothing alike other than thefact that they attack the patients liver


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Infectious Disease Hepatitis A 9

Fecal-Oral transmission Food poisoning usually from contaminated

seafood

Sexual transmission

Blood borne/saliva transmission isuncommon

Does not cause chronic disease- acute liver

failure is rare Vaccine exists- Encouraged for high riskindividuals


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Infectious Disease- Hepatitis B 9

Incubation period = 6 weeks 6 months

Highest concentration found in blood Pathogen can be transmitted through blood or other bodily

fluids

Leading risk factors include: IV drug use

unprotected sex with multiple partners

birth to an infected mother

Can lead to chronic liver infection

Vaccination series available and recommended for allhealthcare workers


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Infectious Disease Hepatitis C 9

Most common chronic blood borne infectionin the US

Chronic disease develops in 70-85% of

infected individuals (very high) Most common mode of transmission is

through blood exposure (IV drug use, needle-sticks, donor blood)

Can also be transmitted sexually, although muchless common


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Infectious Disease Hepatitis

No cures exist for any Hepatitis infection

Prevention is the key

Avoidance of high-risk behavior Standard Precautions

Proper handling of all potentially

contaminated waste


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Infectious Disease- HIV 10

HIV (human immunodeficiency virus) causes

flu-like symptoms upon initial infection, but

cannot be cleared out of your body by your

immune system like most other viruses

Virus attacks immune cells and destroys

them, preventing the patients immunesystem from fighting infection


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Infectious Disease- HIV 10

HIV cannot replicate outside of the body

Blood to blood transmission is the most

common mode

Infected needles

High risk sexual activity

Cannot be transmitted through saliva, skin or

air contact


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Infectious Disease- HIV to AIDS

AIDS (acquired immuno deficiencysyndrome) 10

Final stage of HIV infection

Characterized and diagnosed by low immunecell blood counts, certain cancers and/orpresence of opportunistic infection (OI)

AIDS prevents immune system from fighting

off disease OI or Cancer kills the patient- not AIDS itself.


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Infectious Disease- HIV/AIDS

Prevention is extremely important Standard Precautions

Avoidance of high risk behavior

Infected individuals can be treated withmedications that can significantly prolongonset of AIDS from HIV10

Potentially infected people can seek Post

Exposure Prophalyxis (PEP) within 24 hoursof exposure Most effective within 2 hours of exposure


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Influenza

Influenza (the flu) is a contagious respiratory illness caused by influenza viruses

It can cause mild to severe illness, and at times can lead to death.

The best way to prevent the flu is by getting a flu vaccination each year.

Every year in the United States, on average 5% to 20% of the population gets

the flu

More than 200,000 people are hospitalized from flu complications, and about

36,000 people die from flu-related causes each year

Some people, such as older people, young children, and people with certain

health conditions are at high risk for serious flu complications11


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Influenza Infection Control11

Routine cleaning and disinfection strategies are used during influenza

season Management of laundry, utensils and medical waste should also be

performed in accordance with procedures followed for seasonalinfluenza

Clean surfaces that have been contaminated with body substances;perform low- to intermediate-level disinfection on cleaned surfaces with

an EPA-registered disinfectant in accordance with the manufacturer'sinstructions

Wear PPE appropriate for a surface decontamination and cleaning taskand dispose of using routine procedures

Decontaminate reusable PPE as appropriate

In direct patient care environments, employees should take droplet

precautions through the use of a simple surgical mask (always refer tohospital policy)


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Summary

Remember:You, the healthcare professional, have a direct impact in the health and well

being of the patient.

Your diligence throughout the healthcare environment will help to ensure patient

safety and prevent the spread of infectious diseases.


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References

1. American Nurses Association. (2002). Needlestick Prevention Guide. Retrieved fromhttp://www.who.int/occupational_health/activities/2needguid.pdf .

2. IAHCSMM. (2007). CRCST Training Manual(7th edition). 59-76.

3. Methicillin-resistant Staphylopcoccus Aureus (MRSA) Infections. (2011). Retrieved February 22, 2013,from http://www.cdc.gov/mrsa/#

4. Vancomycin-resistant Enterococci (CRE) in Healthcare Settings. (2011). Retrieved March 12, 2013,from http://www.cdc.gov/HAI/organisms/vre/vre.html

5. Carbapenem-resistant Enterobacteriaceae (CRE). (2013). Retrieved March 12, 2013, from

http://www.cdc.gov/HAI/organisms/cre/ 6. Making Health Care Safer- Stop Infections from Lethal CRE Germs Now. (2013). Retrieved March 12,

2013, from http://www.cdc.gov/vitalsigns/HAI/CRE/index.html

7. Clostridium difficile Infection. (2013). Retrieved February 22, 2013, fromhttp://www.cdc.gov/HAI/organisms/cdiff/Cdiff_infect.html

8. Tuberculosis (TB). (2013). Retrieved February 22, 2013, from http://www.cdc.gov/tb/

9. Viral Hepatitis. (2013). Retrieved February 22, 2013, from http://www.cdc.gov/hepatitis/

10. HIV/AIDS. (2013). Retrieved February 22, 2013 from http://www.cdc.gov/hiv/

11. Seasonal Flu (Influenza). Retrieved February 22, 2013 from http://www.cdc.gov/flu/

12. Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in HealthcareSettings. (2007). Retrieved March 11, 2012 fromhttp://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html
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Thank You

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