the hot zone: preventing infections in the healthcare settingsofi.ucla.edu/workfiles/documents/the...
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The Hot Zone:
Preventing Infections in the
Healthcare Setting
… Journey towards High Reliability and Zero Harm
UCLA Health Healthcare Quality Week 2019October 23, 2019
Clinical Epidemiology and Infection Prevention (CEIP)
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Healthcare Associated Infections
(HAIs)
Definition of HAIs
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HAIs…
are infections people get while they are receiving health care for another condition
are a significant cause of illness and death
cause financial and medical consequences to both the patient and the healthcare facility
Factors that increase risk of HAIs
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• Catheters (bloodstream, endotracheal, and urinary)
• Surgery
• Injections
• Improperly cleaned and disinfected environment
• Overuse or improper use of antibiotics
• Lack of hand hygiene compliance amongst healthcare
workers
Common HAIs
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Central-line associated
bloodstream infection (CLABSI)
Catheter-associated urinary
tract infection (CAUTI)
Surgical Site Infection (SSI)
Ventilator-associated event
(VAE)
Clostridioidesdifficile (C.diff)
HAI Public Reporting Requirements
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In 2006, CA passed legislation mandating public reporting and
later established the CA Department of Public Health
Healthcare-Associated Infection Program.
Purpose of public reporting requirements:
Public disclosure intended as driver for infection prevention
Encourages healthcare providers to take action
Better informed public = higher quality healthcare
California Mandates
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2006, Senate Bill 739
Requires hospitals to collect HAI data
Requires hospitals to establish
Antibiotic Stewardship programs
Established CDPH Hospital Infections
Program
2008, Senate Bill 1058 & 158
Requires hospitals to publicly report
HAI data
CLABSI
CAUTI
SSI
C.diff, MRSA, VRE
Requires hospitals to offer free
Influenza vaccine to all employees
Requires MRSA screening of “high
risk” patients in hospitals
Tableau HAI Dashboard
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CAUTI Data for RR Medical Center
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Date Range: 4/1/19 – 8/1/19
Key Takeaways
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1
• HAIs can have significant impacts to both the patient and the healthcare facility.
2• Reporting HAIs helps to drive quality improvement.
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• You can use Tableau to identify infections on your unit/facility.
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Hand Hygiene
Clean Hands Saves Lives
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CDC estimates that each year nearly 2 million patients in the US get an
infection in hospitals, and about 90,000 of these patients die as a result of
their infection 1
The most common mode of transmission of pathogens is via hands
Hand hygiene reduces the incidence of healthcare associated infections
1https://www.cdc.gov/handwashing/why-handwashing.html
UCLA Health Policy – Hand Hygiene,
HS IC 001
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Purpose
To state the expectation that HCWs practice
hand hygiene as outlined below, thereby
reducing the risk of HAIs.
When to practice hand hygiene
Indications for hand hygiene
How to practice hand hygiene
Nails standard
Correct of use of gloves
Form #17081 on
Forms Portal
Indications for Hand Hygiene
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Before patient contact; includes before
putting on gloves
Before a clean or aseptic task
After body fluid exposure risk
After patient contact; includes after glove
removal
After contact with patient surroundings,
including medical equipment
If moving from contaminated body site to
a clean body site during patient care
Before eating
https://www.who.int/infection-prevention/campaigns/clean-hands/5moments/en/
Recommended Hand Hygiene
Technique: Soap and water
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Lather your hands for 20 seconds
Avoid using hot water
Use towel to turn off faucet
To be practiced for
• Visibly soiled hands
• After use of restroom
• Caring for a patient with C.diff
https://www.who.int/gpsc/clean_hands_protection/en/
Recommended Hand Hygiene Technique:
Alcohol-based hand rub (ABHR)
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Preferred method for hand hygiene with
the following exceptions:
Not for visibly soiled hands
Not for when caring for patients with
C.diff
Rub hands together, covering all surfaces
of the hands, fingers, and nails until hands
are dry
>60% alcohol in the ABHR
Efficacy of Hand Hygiene
Preparations in Killing Bacteria
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Good
Plain soap
Better
Antimicrobial
soap
Best
Alcohol-based hand
rub
Perceived Barriers to Hand Hygiene
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Agents cause irritation and dryness
Sinks are inconveniently located
Lack of sinks
Busy environment/overcrowding
“I am not going to touch anything”
“Too busy”
“Low risk of acquiring infections from patients”
“I wear gloves instead of practicing HH”
Fingernail Standard
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Staff who work in patient care areas, or who are involved in patient care, shall
have natural nails that are kept clean, neatly trimmed and ¼" long.
Nail polish in good repair (i.e., not cracked) is permitted.
Artificial nails, gel overlay (e.g., OPI Axxium Gel, CalGel, CND Shellac,
Harmony Gelish), nail art (e.g., glitters, piercings, 3D art, and adding accessories
like studs, rhinestones, beads, aluminum foil), tips and/or fillers are not allowed in
direct patient care areas, including where food is prepared.
Correct Use of Gloves
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Wear gloves that fit appropriately
Do not wear the same pair of gloves for the
care of more than one patient
Do not wash gloves for the purpose of reuse
Change gloves when they have been in
contact with mucous membranes, blood or
potentially infectious material
Carefully remove gloves to prevent hand
contamination
Key Takeaways
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1
• Many potentially deadly germs are spread from patient to patient on the hands of healthcare workers.
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• Your actions can put you, your colleagues, and your patients at risk of infection.
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• Practice appropriate hand hygiene to protect yourself and others.
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Transmission Based Precautions
Chain of Infection – Break the Chain!
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• Infectious agent: pathogens to cause infection
• Reservoir: microbes live and where the
microorganisms can survive, thrive and reproduce
• Portal of exit: pathogens to leave reservoir (sneezing,
coughing, body excretions)
• Mode of Transmission: The way the organism moves
or is carried from one place to another (touching/poor
hand hygiene)
• Portal of entry: an entry or opening allowing the
pathogen to enter host
• Susceptible host: persons carrying the pathogen
UCLA Health Policy – Standard and
Transmission Based Precautions, HS IC 002
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Purpose
To provide guidance on when and how to use Standard
and Transmission Based Precautions.
Standard Precautions
Hand Hygiene
Use of PPE
Respiratory hygiene/cough etiquette
Safe injection practices
Transmission Based Precautions
Used in addition to Standard Precautions
Targeted specifically at how organisms are
transmitted
For questions, contact CEIP at ([email protected]) or 310-794-0187
Contact/ Spore Precautions: C. auris
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• Candida auris (C. auris): an emerging multi-drug
resistant fungus that is difficult to treat, difficult to
identify, and difficult to clean from the patient care
environment
• Early detection of C. auris and rigorous adherence to
infection control measures is essential for containing
its spread in healthcare facilities
• Process is in place for screening high risk patients for
C. auris
• There is no isolation clearance process for C. auris
For questions, contact CEIP at ([email protected]) or 310-794-0187
How to Prevent C. auris Transmission
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What YOU can continue to do to help prevent the spread of C. auris:
Practice proper hand hygiene
Appropriately wear personal protective equipment (gown and
gloves)
Use hospital approved bleach wipes to clean and disinfect
equipment and surfaces
Dedicate the use of equipment (e.g., stethoscope, blood
pressure cuff) to a single patient
Use single-patient disposable items whenever possible
Disinfect reusable patient care equipment using dilute bleach
wipes before use on another patient
Minimize patient transport
Ensure that patients with C. auris or a history of C. auris
remain on contact/spore isolation indefinitely
Page IP on call (9-4040) upon discharge of a patient with C.
auris or a history of C. auris
Clorox bleach germicidal wipes
Wet contact time: 3 minutes
For questions, contact CEIP at
([email protected]) or 310-794-0187
Key Takeaways
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1
• Isolation based precautions help prevent the spread of infection.
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• Refer to the back of the isolation signs for further detailed information.
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• If you have questions, contact CEIP at ([email protected]) or 310-794-0187.
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Environment of Care
Environment of Care (EOC)
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• The goal of Environment of Care is to provide a safe environment for our
patients, visitors and staff based on regulatory requirements and guidelines
(e.g., Occupational Safety and Health Administration (OSHA))
Infection Prevention
Environmental Health & Safety
Facilities
Environmental Services
Construction/Renovation Projects
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Holes
through
barrier
Open
barrier
Open
barrier
Environmental Surfaces
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• Environmental cleaning is an
important principle of infection
prevention in the healthcare
setting
• Contaminated surfaces play a
significant role in the
transmission of dangerous
pathogens that can be easily
spread
• Improperly cleaned or
disinfected items can lead to
infections amongst patients,
visitors, and staff
Disinfection Strategies
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• Approved disinfectants
• Best selection for type of pathogen and environment
• Proper solution mix, application & dwell time
• “No-touch” disinfection enhancements systems
• Ultraviolet (UV) light
3 min dwell time 1 min dwell time
3 min dwell time
(Only for equipment
that requires
disinfection with a
alcohol free product)
High Touch Wipe Down (HTWD)
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• High touch surfaces include, but are not limited to:
• Medical equipment knobs or handles (e.g.,
knobs or handles on x-ray machines, cardiac
monitors)
• Blood pressure cuffs
• Bedrails
• Handheld television controls
• Nurse call lights
• Doorknobs
• Light switches
• Telephones
• Computer keyboards/iPads
Instruction for use (IFU) cleaning protocols
must be followed, otherwise may damage
equipment
Environment of Care (EOC) Rounds
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• CEIP conducts monthly EOC rounds on each inpatient unit
• 8 areas of focus during rounds:
IP Knowledge Questions
(6 Questions)
Front Desk/Main Nurses Station
(3 Opportunities)
IP Practices
(28 Opportunities)
Clean Utility Rooms
(8 Opportunities)
Dirty Utility Rooms
(6 Opportunities)
Kitchen
(12 Opportunities)
Isolation Rooms (8 Opportunities)
Linen Rooms/Carts
(6 Opportunities)
IP Practices: Expectation vs. Observation
• Staff food is not
found in patient
care areas
• The lids of
disinfectant wipes
are closed
• Items are not stored
in inappropriate or
unsafe locations
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IP Practices Continued
• High/low level dusting
has been done
throughout the unit
• Staff belongings,
including personal hand
lotions are not stored in
PCA
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Clean Utility Rooms: Expectation vs. Observation
• All clean and sterile
supplies are
appropriately packaged
• No outdated items in
clean area
• No doors propped
open. i.e. doors leading
to corridors or nurses
station
Observed in
September
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Dirty Utility Rooms: Expectation vs. Observation
• Soiled linen is collected
and transported to a
designated dirty utility
area in a covered leak
proof container
• Trash barrels are clean,
covered and not
overfilled
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Linen Room/Cart: Expectation vs. Observation
• No linen on the floor
• Linen is covered and
impermeable and is
stored in carts and
always covered. No
items stored on top
of carts
• Clean pillows are
stored in bags
Report Notification for EOC Rounds
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• All findings are formally put into a report, which includes pictures
(if any are taken)
• Emailed out to the unit leadership, including unit directors
• Ancillary areas are also copied, when necessary for follow-up
• EVS
• ECMO
• Materials management
Key Takeaways
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1
• Infection Prevention is more than just cleaning/disinfection.
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• Just because you can’t see it doesn’t mean it isn’t there.
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• Infection Prevention conducts rounds with real time feedback – ask questions when you see us on the unit!
