preventing healthcare associated infections
DESCRIPTION
Preventing Healthcare Associated Infections. W. Charles Huskins, MD, MSc Associate Professor, Pediatrics Mayo Clinic. Small things, done well together, can make a big difference. Objectives. Identify risk factors for central line infections - PowerPoint PPT PresentationTRANSCRIPT
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Preventing Healthcare Associated Infections
W. Charles Huskins, MD, MSc
Associate Professor, Pediatrics
Mayo Clinic
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Small things, done well together, can make a big difference
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Objectives
• Identify risk factors for central line infections
• Describe practice strategies for line infection prevention
• Review hand washing technique
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Central Line Associated Bloodstream Infections (CLABSI)
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Minnesota Health Care Quality Measures – Statewide Quality Report - 2010 Report
http://www.health.state.mn.us/healthreform/measurement/report/index.html
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Garland JS, et al. Infect Control Hosp Epidemiol 2008; 29:243-9
Intra-luminal
67%
Extra-luminal
20%
Indeter-minate
13%Extraluminal
Intraluminal
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Preventative Intervention: Scrub the Hub
• Scrub all injection caps for 15 seconds prior to accessing
• Peripheral and central lines (adult/pediatric/neonate)
• Use alcohol wipe• Allow to dry• Before blood draws,
infusions, flushes…anytime the catheter is accessed
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PICU Interventions
• Improve facilities for hand hygiene
• Use 2% chlorhexidine for line insertions for all patients >1kg or >14 days old
• Reduce central line entries• Advance enteral feedings more quickly
• Reduce unnecessary laboratory tests
• Convert IV to po medications
• Switch from bolus to continuous sedation if appropriate
• Reprogram pumps to administer prn doses of medications
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Children’s Hospital-Wide Intervention
• Continue to emphasize• Insertion bundle• Standard maintenance practices – dressing
change, hub change, administration set change• Daily assessment of need for line, promptly
remove unneeded lines
• Additional efforts to prevent contamination during line entry
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Central Line Entry Bundle
• Emphasize that line entry is a invasive procedure
• Combine several interventions that can work together to reduce risk
• Improve disinfection of hub• Reduce likelihood of contamination of hub• Reduce unnecessary line entry
• Integrate into/redesign line entry workflow to reinforce adherence
• Pilot test new devices to disinfect and protect hub from contamination
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Standard Precautions andStrict Isolation to Prevent Spread of
Clostridium difficile and Antimicrobial Resistant Bacteria
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MB3B Hand Hygiene Initiative
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Coming to a Bed Near You (at the Point of Care)…
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Environmental Cleaning with Bleach
• Bleach wipes used daily
• Clean all surfaces:• Crib hand rails & bars and bassinets surfaces• Door handles • Light switches• Tray tables• Bathroom sink handles
• Additional forgotten surfaces:• Computer keyboards• Telephones
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Interventions to Prevent Healthcare Associated Infections
Small things, done well together, can make a big difference
• CLABSI• Reduce line entries• Scrub the hub• Protect the hub• Remove line when
it is no longer needed or convert to a lower risk line
• Standard & Isolation Precautions• Wash hands upon entry
in the ICU• Place and use hand rub
at the point of care• Give direct feedback
on compliance• Use bleach wipes for
environmental cleaning
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Nosocomial Urinary Tract Infections
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DefinitionsCatheter-associated urinary tract
infection
• Symptomatic infection
• Asymptomatic bacteriuria
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Maki DG & Tambyah PA. Engineering out the risk with urinary catheters. Emerg Infect Dis 2001;7:342.
Pathophysiology
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Maki DG & Tambyah PA. Engineering out the risk with urinary catheters. Emerg Infect Dis 2001;7:342.
Bacteriuria and Urinary Catheters
Days
Lo
g c
olo
ny
form
ing
un
its
/ m
l
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Duration of Catheterization
0
10
20
30
40
50
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Days
% o
f p
atie
nts
wit
h
bac
teri
uri
a
Daily Prevalence of Bacteriuria
Garibaldi et al. Factors predisposing to bacteriuria during indwelling uretheral catheterization. N Engl J Med 1974;291:215.
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Alternatives to Indwelling Urinary Catheters
• Intermittent catheterization
• Diapers
• External bag collectors (infants & children)
• Condom catheters
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Catheter Insertion
• Catheters should be inserted by trained personnel
• Wash hands before insertion, preferably with an agent with antimicrobial activity
• Clean the periurethral area and apply an antiseptic
• Use a sterile catheter and drainage system
• Use aseptic technique
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Closed Sterile Drainage
• 26% of catheters disconnected at some time
• Risk of infection the day after disconnection was 2 times the risk if there was no disconnection
Platt et al. Reduction of mortality associated with nosocomial urinary tract infection. Lancet 1983;I:893.
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Closed Sterile Drainage
00.10.20.30.40.50.60.70.80.9
1 2 3 4 5 6 7 >7
Days
Cu
mu
lati
ve I
nfe
cti
on
Rate
Unsealed connection
Sealed connection
Platt et al. Reduction of mortality associated with nosocomial urinary tract infection. Lancet 1983;I:893.
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Care of Indwelling Urinary Catheters
• Maintain a closed sterile drainage system
• Monitor for obstruction of urinary flow
• Inspect for encrustations
• Maintain the drainage reservoir below the level of the bladder
• Use individual containers to empty drainage reservoirs
• Wash hands before and after touching the catheter or the drainage system
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Questions?