Upload
brianna-walker
View
215
Download
2
Embed Size (px)
Citation preview
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
• Describe practice strategies for line infection prevention
• Review hand washing technique
Central Line Associated Bloodstream Infections (CLABSI)
Minnesota Health Care Quality Measures – Statewide Quality Report - 2010 Report
http://www.health.state.mn.us/healthreform/measurement/report/index.html
Garland JS, et al. Infect Control Hosp Epidemiol 2008; 29:243-9
Intra-luminal
67%
Extra-luminal
20%
Indeter-minate
13%Extraluminal
Intraluminal
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
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
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
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
Standard Precautions andStrict Isolation to Prevent Spread of
Clostridium difficile and Antimicrobial Resistant Bacteria
MB3B Hand Hygiene Initiative
Coming to a Bed Near You (at the Point of Care)…
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
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
Nosocomial Urinary Tract Infections
DefinitionsCatheter-associated urinary tract
infection
• Symptomatic infection
• Asymptomatic bacteriuria
Maki DG & Tambyah PA. Engineering out the risk with urinary catheters. Emerg Infect Dis 2001;7:342.
Pathophysiology
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
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.
Alternatives to Indwelling Urinary Catheters
• Intermittent catheterization
• Diapers
• External bag collectors (infants & children)
• Condom catheters
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
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.
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.
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
Questions?