Preventing Infection Ppt

PREVENTING INFECTIONIN THE HOSPITAL

• Staff nurses play an important role in risk reduction by

1.paying careful attention to hand hygiene,

2.by ensuring careful administration of prescribed antibiotics,

3.and by following procedures to reduce the risks associated with patient care devices.

Specific Organisms With Health Care- Associated Infection Potential

• spore-forming bacterium with significant HAI potential.

1. CLOSTRIDIUM DIFFICILE

• Extensive use of antibiotics in the hospital setting

• preceded by antibiotics :

1. that disrupt normal intestinal flora

2.allow the antibiotic-resistant C. difficile spores to proliferate within the intestine.

1. CLOSTRIDIUM DIFFICILE

CLOSTRIDIUM DIFFICILE

• most serious cause of antibiotic-associated diarrhea (AAD)


• can lead to pseudomembranous colitis, a severe infection of the colon, resulting from eradication of the normal gut flora by antibiotics

CLOSTRIDIUM DIFFICILE SPORE

1. resistant to disinfectants

2. can be spread on the hands of health care providers after contact with equipment that has previously been contaminated with C. difficile.

CONTROL• Control is best achieved by

1.intensifying cleaning,

2.using Contact Precautions for infected patients

3.stressing glove use

4.hand hygiene for all care workers.

CDC RECOMMENDATION1. Intensified environmental cleaning

using 1:10 bleach : water solution

2. Equipment cleaned whenever visibly soiled

3. Items close to the patient should be cleaned daily

4. IV poles should be cleaned when the patient is discharged.

PHARMACOLOGICAL TREATMENT

• oral administration of metronidazole or vancomycin is the treatment of choice


2. METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS

• refers to S. aureus organisms that are resistant to methicillin

• 1940- PENICILLIN was discovered

• Soon after penicillin was introduced, S. aureus became all but universally penicillin resistant

2. METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS

• cephalosporins

• synthetic penicillin solutions such as methicillin were introduced

MRSA

• late 1970s- S. aureus showed resistance to methicillin

• Linezolid and vancomycin - alternative treatments for serious MRSA infection

MRSA

• Health care providers often transmit MRSA to patients because S. aureus easily colonizes skin

3. VANCOMYCIN-RESISTANT ENTEROCOCCUS (VRSA)

• April 2002- a patient in Michigan was diagnosed with an S. aureus infection that was fully resistant to vancomycin (ie, vancomycin resistant S. aureus [VRSA])

VANCOMYCIN-RESISTANT ENTEROCOCCUS

• Enterococcus is a gram-positive bacterium that is part of the normal flora of the gastrointestinal tract.

• It can produce significant disease when allowed to infect blood, wounds, or urine.

VANCOMYCIN-RESISTANT ENTEROCOCCUS

• The host carries an abundance of the organism even in a noninfected state;

• the organism is bile resistant and can withstand harsh anatomic sites, such as the intestine;

• sensitive to teicoplanin

Preventing Nosocomial Bloodstream

Infections (Bacteremia and Fungemia)

• Bacteremia - bacteria in the bloodstream.

• Fungemia is a bloodstream infection caused by a fungal organism.

VADAny vascular access device (VAD)

can serve as the source for a bloodstream infection

HOW?

Contamination can occur:1. from the patient’s own flora traversing the

exterior of a catheter or by contamination of internal tubing during manipulation.

2. The intravenous fluid itself can become contaminated and serve as a source of infection

DISINFECTING SKIN1. During the insertion of all VADs, there

must be strict attention to aseptic technique.

2. Those inserting VADs must vigorously wash their hands before insertion.

3. Those inserting central catheters should use surgical technique, including sterile gloves, sterile gowns with long sleeves, masks, and a large drape over the patient.

4. The preferred solution to disinfect the insertion site is chlorhexidine gluconate

5. Alternative solutions are povidone iodine or alcohol.

6. Triple-antibiotic ointment should not be used on the insertion site because it has been shown to lead to increased colonization with Candida species

7. if blood is oozing from the catheter insertion site, a gauze dressing should be used.

8.dressing should be applied using aseptic technique

9. dressing should be sealed along its entire perimeter.

• BIOPATCH ANTI-MICROBIAL- A highly absorbent CHG (chlorhexidine gluconate) impregnated dressing

• -releases disinfectant for up to 7 days

• - reduces the incidence of HAI by 60%

Conditions That Suggest the Presence of

Nosocomial Vascular Access Device-Related

Bacteremia or Fungemia

1. The patient has catheter in place, appears septic, but has no obvious reason to suggest predisposition to sepsis.

2. There is no infection at another body site to indicate probable source of sepsis.

3. The site of vascular line insertion is red, swollen, or draining (especially purulent drainage).

4. The patient has a central vascular line in place at the onset of sepsis.

4. The bloodstream infection is caused by Candida species or by common skin organisms such as coagulase-negative staphylococci, Bacillus species, or Corynebacterium species.

5. The patient remains septic after appropriate therapy without removal of the vascular access device.

CHANGING INFUSION SETS, CAPS, AND SOLUTIONS

• Infusion sets and stopcock caps- every 3 days

• Infusion sets and tubing for blood, blood products, or lipid emulsions should be changed within 24 hours of initiating the infusion.

• Blood infusions should finish within 4 hours of hanging the blood;

CHANGING INFUSION SETS, CAPS, AND SOLUTIONS

• lipid solutions should be completed within 24 hours of hanging.

• There are no guidelines for the appropriate intervals for the hang time of other solutions.

• Injection ports should be cleaned with 70% alcohol or an iodophor before accessing the system

Isolation Precautions

Need For Protection

Protection From What?•Blood (saliva)-borne

pathogens

• Air-borne pathogens

• Pathogens transmitted by skin contact

Protecting Whom?

• Protecting:

– Ourselves

– Patient

– Other patients

– Other staff

– Our families

Cannot autoclave patients

Universal Precautions• CDC (Centers for Disease Control) in

1987:– All patients be regarded as

potentially infective (HIV & Hepatitis…)

– that all patients are colonized or infected with microorganisms, whether or not there are signs or symptoms

Universal Precautions

•Staff members & patients should be protected from

blood-borne (and all) infections

I. STANDARD PRECAUTIONS• was designed for the care of all

patients in the hospital

• the primary strategy for preventing HAI’s

• “All health care workers should routinely use appropriate barrier precautions to prevent skin and mucous membrane exposure when contact with blood or other body fluids of any patient is anticipated”

Elements of Standard Precautions1. hand hygiene

2. use of gloves and other barriers

(eg, mask, eye protection, face shield, gown),

3. handling of patient care equipment and linen

4. environmental control

5. prevention of injury from sharps devices

6. patient placement.

1. Hand Hygiene• hands should be washed with soap

and water

• antimicrobial agents (eg, chlorhexidine gluconate, iodophors, chloroxylenol, triclosan) may be used.

Hand Hygiene

• Effective hand washing requires at least 20 seconds of vigorous scrubbing with special attention to the area around nail beds and between fingers, where there is high bacterial burden.

Hand Hygiene• alcohol-based, waterless antiseptic agents

1. If hands are not visibly soiled

2.For routine hand decontamination

3.These solutions are superior to soap or antimicrobial handwashing agents in their speed of action and effectiveness against bacteria and viruses

• Normal skin flora usually consist of coagulase-negative staphylococci

• In the health care setting, employees may temporarily carry bacteria (ie, transient flora) such as S. aureus, Pseudomonas aeruginosa, and other organisms with strong pathogenic potential.

• transient flora are superficially attached and are shed with hand hygiene and skin regeneration

Nurses!!• should not wear artificial fingernails or

extenders when providing patient care.

• These items have been epidemiologically linked to several significant outbreaks of infections.

• Natural nails should be kept less than 0.25-inch (0.6-cm) long

Nurses!!

• nail polish should be removed when chipped, because it can support increased bacterial growth

2. Use of Personal Protective Equipment (PPE)

Gloves

Glove Use• Worn when a health care worker has

contact with any patient’s secretions or excretions

• hands must be thoroughly washed with soap after gloves are removed

• Vinyl gloves, powder-free gloves, or “low-protein” latex gloves if allergic to latex

Glove Use• Should be worn when in contact with patients,

specimen, and hospital equipment.

• Changed between patients.

• Changed when they are visibly soiled.

• Changed when visibly damaged and removed when leaving the work area.

Glove Use• For sterile gloves, maintain sterility when

donning until used on the patient.

• Keep sleeves inside the gloves.

• Remove gloves without touching the contaminated part.

• Wash hands after removing the gloves.

• Dispose gloves in biohazard.

Gowns

•Must be fluid resistant with cuffs to protect clothing and skin from exposure to patient’s body samples.

•Completely buttoned and gloves pulled over the cuffs.

• Worn at all times when working with patient’s samples and removed when leaving the work area.

• For sterile gowns, maintain sterility until used on the patient.

• Changed when become visibly soiled.

Gowns

Masks/ Goggles/ Face shields.

Masks/ Goggles/ Face shields.

• Protects mucus membrane.

• Prevents transfer of airborne microorganisms.

• Worn when patient procedures will generate splashes or sprays.

• Masks are worn after washing the hands; It is worn for 15- 20 minutes before changing.

• Should be tied securely.

3. Needlestick Prevention• needles, scalpels, and other

sharp objects

• Used needles should not be recapped- placed directly into puncture resistant containers in the vicinity of their use.

• Puncture proof containers are changed when they are ¾ full.

Needles and Sharps• If a situation dictates that a

needle must be recapped, the nurse must use a mechanical device to hold the cap or use a one-handed approach to decrease the likelihood of skin puncture.

• OSHA has required nurses to use needleless devices and other instruments designed to prevent injury from sharps when appropriate

Needles and Sharps• Reusable needles and sharps are

placed in puncture proof container before transporting to reprocessing area.

• If these injuries occur, report the incident promptly according to Hospital protocol

4. Proper Handling of Soiled Linens

• Change linens in between patients.

• Observe aseptic technique when changing soiled linens.

• Fold soiled linens as small as possible. Do not place soiled linens on the floor.

• Clean the bed with antiseptic solution as necessary.

• Contaminated linens, especially those with body fluids should be placed in yellow bags then placed in appropriate laundry container.

5. Care of Hospital Equipment/ Environmental Control

• Clean hospital equipment(including counter tops) every shift.

• Use disinfectant to clean hospital equipment as necessary.

• Clean equipment in between patients.

• Disposable equipment should not be re used.

• Follow hospital procedures for routine care, cleaning and disinfection of environmental surfaces, beds and equipment.

• Used equipment should be identified as infected and handled with gloves before discarding into container, or washing and autoclaving.

6. Correct Patient Placement

• Place patients who contaminates the environment or who cannot assist in maintaining proper hygiene in a private room.

• Avoid transporting the patient out of the room unless necessary

II. TRANSMISSION-BASED PRECAUTIONS

1. Airborne Precautions • are required for patients with

presumed or proven pulmonary TB or chickenpox.

• if, as a victim of bioterrorism, a patient is suspected of having smallpox.

• When hospitalized, patients should be put in rooms with negative air pressure;


Airborne Precautions • the door should remain closed, and

health care providers should wear an N-95 respirator (ie, protective mask) at all times while in the patient’s room.(suspected with Infectious PTB.)

• Limit transport and movement to essential purposes.

• Use surgical mask when transporting patient.

• If resuscitation is necessary, use resuscitative devices.


2. DROPLET Precautions

• for organisms that can be transmitted by close, face-to-face contact, such as influenza or meningococcal meningitis.

• nurse should wear a facemask if within 3 feet of the patient.

• Remove mask when leaving the room.


2. DROPLET Precautions

• the risk of transmission is limited to close contact, the door may remain open.

• The CDC advises that negative-pressure rooms should be used in hospitals if available.


3. CONTACT Precautions • used for organisms that are spread

by skin-to-skin contact, such as antibiotic-resistant organisms or C. difficile.

• Patient is placed in a private room to facilitate hand hygiene and protection of garments from environmental contamination.


3. CONTACT Precautions • Masks are not needed, and doors do

not need to be closed

• Do not touch potentially contaminated surfaces.

• Wear gloves and other PPE when in contact with the patient.

• Remove when before leaving the room.

Proper Segregation and Disposal of Hospital Refuse

a. Black bag

• Used to dispose normal household wastes.

b. Yellow Bag

• Used to dispose any waste arising from direct patient care (soiled dressing, bloody gauze, suction tips etc.)

Proper Reporting and Documentation of Infectious Cases.

• SOP of the hospital regarding reporting of communicable cases

• Filling of Notification Form for Communicable Disease as necessary.

You• Make sure working clothing is clean. Contaminated clothing (e.g. blood-stained) must be changed immediately.

• Hands should be washed thoroughly when entering or leaving clinical areas and before eating or drinking.

You• Soap dispensers and taps should be operated by the elbows or wrists not gloves or hands.

• All specimens for laboratory tests should be placed in appropriate containers and sealed into plastic bags separate from the request form

• Do not eat, drink, comb hair, brush teeth or apply cosmetics in clinical areas

END

Backdrops:

- These are full sized backdrops, just scale them up!

- Can be Copy-Pasted out of Templates for use anywhere!

Title Backdrop Slide Backdrop Transitional Backdrop Print Backdrop

Additional Graphics:

- Scale them up or down!

- .GIF clipart is animated.

- .JPG clipart can be scaled up and take up little file space.

- .PNG clipart can be scaled unusually large without distortion.

www.animationfactory.com

Animated .GIFs

Still Frame .PNGs

http://www.animationfactory.com/

http://www.animationfactory.com/

Documents

Preventing Infection Ppt