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85 Cards in this Set
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Hospital Acquired Infections |
Nosocomial Infection: infectious disease that is acquired or develops during a hospital stay ◦ Typically presents 48-72 hours post-admission ◦ 1/3 HAIs are preventable |
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Hospital Acquired Infections |
Iatrogenic Infection: infection due to the activity of a physician or therapy ◦ Also termed a physician-acquired disease improper hand washing, improperly preparing skin for procedure |
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Hospital Acquired Infections |
Cross Infection: infection transmitted from: ◦ patient to patient ◦ patient to medical personnel ◦ medical personnel to patient |
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Nosocomial Infections |
Transmission Requires: ◦ microorganisms in hospital environment ◦ compromised host ◦ chain of transmission |
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Nosocomial Infections Chain of Transmission |
1. infectious agent 2. reservoir 3. portal of exit 4. mode of transmission 5. portal of entry 6. new (susceptible) host |
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Compromising Conditions |
2 principle conditions that compromise a ◦ broken skin or mucous membrane ◦ suppressed immune system |
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Common Nosocomial Infections |
◦ Urinary tract infections (34%)
◦ Surgical site infections (17%)
◦ ** Lower respiratory tract infections (13%) |
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Common Nosocomial Infections |
◦ Bacteremia (14%)
◦ Others (22%)
◦ benchmarking - best practice guidelines ◦ ex: pts should get meds 20mins prior to incision reduce chance of infection during sx |
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Common Nosocomial Agents |
Frequently transmitted in respiratory equipment (we get blamed because bypass upper resp. tract where filtering of air happens so stays moist which attracts growth of bugs/bacteria) - rod shaped - gram negative |
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Common Nosocomial Agents |
◦ Staphylococcus aureus |
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Preventing Nosocomial Infections |
Infection control practices include: |
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Universal Precautions |
◦ Center for Disease Control (CDC) guidelines for health care workers regarding the prevention of disease transmission when handling patients and body substances
◦ Based on assumption that all patient specimens could harbor infectious agents** |
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Universal Precautions |
◦ Attempt to ensure that carriers of bloodborne treated in a way which will prevent hospital-acquired infections in other patients and in personnel
◦ developed in response to HIV |
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Elements of Routine Practices |
◦ Environmental controls ◦ Administrative controls ◦ Risk assessment ◦ Hand hygiene ◦ Personal protective equipment (PPE) |
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Elements of Routine Practices Environmental Controls |
- patient placement - environmental and equipment cleaning - ventilation and air flow - sharps and waste management |
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Elements of Routine Practices Administrative Controls |
- policies and procedures |
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Elements of Routine Practices Risk Assessment |
Performing a risk assessment will aid HCPs and other staff in choosing strategies for interaction, such as hand hygiene, use of PPE and specialized accommodation, which will reduce the risk of transmission of microorganisms to and from the client/patient/resident during the planned interaction |
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Elements of Routine Practices Risk Assessment |
- Will I be exposed to body fluids (e.g., blood, excretions, secretions) ?
If yes, PUT ON PPE AS INDICATED, OR maintain a spatial separation of at least two metres |
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Elements of Routine Practices Risk Assessment |
- Will my hands be exposed to blood, excretions, secretions or contaminated items?
If yes, WEAR GLOVES & PERFORM HAND |
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Elements of Routine Practices Risk Assessment |
- Will my face be exposed to a splash, spray, cough or sneeze?
If yes, WEAR FACIAL PROTECTION, OR maintain a spatial separation of at least two metres |
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Elements of Routine Practices Risk Assessment |
- Will my clothing or skin be exposed to splashes/sprays or items contaminated with blood, excretions or secretions?
If yes, WEAR A If yes, WEAR A GOWN, OR GOWN, OR maintain a spatial separation of at least two metres |
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Elements of Routine Practices Risk Assessment Medical Asepsis |
◦ Sepsis = presence of microorganisms
◦ Asepsis = absence of microorganisms
◦ Practiced by all hospital personnel
◦ Any measures used to prevent transfer of |
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Elements of Routine Practices Risk Assessment Medical Asepsis |
◦ Techniques that reduce the # of microbes in the environment
◦ Physical and chemical methods |
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Elements of Routine Practices Risk Assessment Surgical Asepsis |
◦ Exclusion of all microbes in a specific area
◦ Performed prior to and during surgery and ◦ Disinfection of surgical space
◦ Sterilization of equipment |
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Elements of Routine Practices Risk Assessment Surgical Asepsis |
◦ Preparation of patient’s skin prior to the first incision surgical “scrub”
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Elements of Routine Practices Risk Assessment Surgical Asepsis |
**introduction of a surgical pause - everybody stopping and talking about patient withoutdoing anything; - happens 3 times - first when patient is awake(surgical resident); turn over to anaestesia then nursing to discuss any concerns - patient gets to hear all of this (can confirm) |
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Elements of Routine Practices Risk Assessment Surgical Asepsis |
- #2 happens before first incision; patient is asleep and is positioned;has had surgical scrub; pause and make sure on same page; - #3 is before closing - count to make sure nothing is left inside body cavity; review what happened in sx, a lot can change from original plan- stolen from aircraft industries (pilots) |
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Elements of Routine Practices Hand Hygiene |
◦ Most significant means of reducing transmission rates***
◦ ~ 70% of preventable nosocomial infections ◦ Also important in preventing cross infections |
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Elements of Routine Practices Hand Hygiene |
Rationale for hand hygiene: ◦ maintaining good skin integrity (don't want hands to become portal of entry) 2 methods of hand hygiene: |
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Elements of Routine Practices Hand Hygiene |
Alcohol-based hand rub: ◦ preferred method for cleaning hands ◦ better than washing hands (even with antibacterial soap) when hands are not visibly soiled. |
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Elements of Routine Practices Hand Hygiene |
Handwashing with soap and running water: ◦ must be done when hands are visibly soiled ◦ if running water is not available, use moistened towelettes to remove the visible soil, followed |
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Elements of Routine Practices Hand Hygiene Alcohol-Based Hand Rub |
◦ Preferred decontamination method when hands are NOT visibly soiled
◦ Rapid kill or removal of most transient bacteria
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Elements of Routine Practices Hand Hygiene Alcohol-Based Hand Rub |
◦ Contain emollients to prevent drying
◦ Quicker and more convenient |
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Elements of Routine Practices Hand Hygiene Regular Vs. Antibacterial Soap |
Regular soap |
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Elements of Routine Practices Hand Hygiene Regular Vs. Antibacterial Soap |
Antibacterial Soap |
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Elements of Routine Practices Hand Hygiene 4 Moments of Hand Hygiene |
1. before initial patient/patient environment contact 2. before aseptic procedures 3. after body fluid exposure risk 4. after patient/patient environment contact |
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Elements of Routine Practices Hand Hygiene Health Care Environment |
Environment beyond the patient’s immediate area. In a single room this is outside the room. In a multiple room this is everything outside of |
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Elements of Routine Practices Hand Hygiene Patient Environment |
This is the patient’s area. In a single room this is |
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Elements of Routine Practices Hand Hygiene When to Perform |
Before… |
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Elements of Routine Practices Hand Hygiene When to Perform |
After… |
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Elements of Routine Practices Hand Hygiene Hand Washing |
Attention must be paid to: ◦ webs between fingers ◦ palms ◦ knuckles ◦ tips of fingers ◦ back of hands ◦ under fingernails |
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Elements of Routine Practices Hand Hygiene Hand Washing Techniques |
1. Turn on taps. |
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Elements of Routine Practices Hand Hygiene Moisturizing |
◦ Important to maintain good skin integrity
◦ Recommended to moisturize frequently (6-10 times/shift) with hospital provided product - wont break down gloves - oil/scent free - cross contamination if bringing from home |
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Elements of Routine Practices PPE |
◦ PPE does not replace the need for hand hygiene
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Elements of Routine Practices PPE |
PPE used to: |
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Elements of Routine Practices PPE |
Includes: ◦ gloves ◦ gowns ◦ face protection ◦ goggles ◦ masks ◦ shields ◦ HEPA filter |
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Elements of Routine Practices PPE Gloves |
◦ Worn to provide an additional barrier between
◦ Reduce transmission between: - infected patients to HCWs - patient to patient via HCW's hands |
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Elements of Routine Practices PPE Gloves |
Should be removed and hands washed… |
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Elements of Routine Practices PPE Glove Selection |
The barrier integrity of gloves varies based on: |
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Elements of Routine Practices PPE Glove Selection |
Glove selection is task specific: ◦ Vinyl
◦ Nitrile |
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Elements of Routine Practices PPE Glove Selection |
Glove selection is task specific: ◦ Latex/neoprene |
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Elements of Routine Practices PPE Gowns |
◦ Protective barrier from blood and bodily fluids
◦ Protect skin and soiling of clothing
◦ Removed immediately when wet or soiled |
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Elements of Routine Practices PPE Gowns |
◦ Never reused, even on the same patient ◦ Can be disposed of with dirty linen or biohazardous waste |
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Elements of Routine Practices PPE Gowns |
Selection is again task dependent:
◦ Blue poly-coated gown |
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Elements of Routine Practices PPE Gowns |
Selection is again task dependent: ◦ Goretex gown |
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Elements of Routine Practices PPE Face Protection |
◦ Barrier protection during procedures likely to
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Elements of Routine Practices PPE Face Protection |
◦ Removed immediately if it becomes moist
◦ Remove upon exiting patient environment
◦ Can be disposed of in garbage or with |
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Elements of Routine Practices PPE Donning (Putting On) |
1. Hand hygiene |
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Elements of Routine Practices PPE Doffing (Taking Off) |
1. Gloves 2. Gown 3. Hand hygiene 4. Mask/eye protection 5. Hand hygiene |
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Elements of Routine Practices PPE HEPA Filter |
High Efficiency Particulate Air Filter
◦ Filters 97% of particulate matter from the
◦ Used in operating rooms, isolation units, |
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Isolation Techniques |
Forward Isolation
◦ Protect HCW, visitors from becoming infected
◦ PPE worn when entering room
◦ PPE disposed of in receptacle when leaving |
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Isolation Techniques |
Forward Isolation ◦ Equipment disinfected or placed in closed
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Isolation Techniques |
Reverse Isolation
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Isolation Techniques |
Reverse Isolation ◦ Positive air pressure
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Contact Precautions |
◦ Patients suspected of being infected with |
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Contact Precautions |
◦ Gowns, gloves, private room or cohort with like
◦ Dedicated equipment (or wiped between |
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Contact Precautions |
Antibiotic Resistant Organisms - MRSA - VRE - C-Diff - uncontained drainage,diarrhea - impetigo - scabies |
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Antibiotic Resistant Organisms MRSA Impact |
◦ Greater morbidity and mortality
◦ Increased hospitalization and supportive care |
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Antibiotic Resistant Organisms MRSA Impact |
Increased use of resources: |
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Antibiotic Resistant Organisms MRSA Canada |
◦ 50% increase in MRSA from 2004 to 2007
◦ Just because acquire MRSA doesn't mean will contract |
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Antibiotic Resistant Organisms MRSA Canada |
◦ 72% reported as hospital acquired |
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Antibiotic Resistant Organisms MRSA Cost |
◦ MRSA costs in Canada estimated at $129 ◦ $12,216 per patient with MRSA infection |
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Antibiotic Resistant Organisms C-Diff |
◦ Superinfection ◦ Resident flora of intestinal tract
◦ Very resistant to antibiotics, can multiply while other microbes are destroyed |
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Antibiotic Resistant Organisms C-Diff |
◦ Causes severe form of diarrhea, colitis
◦ Potentially fatal |
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Contact Precautions |
◦ Gloves required for direct care
◦ Long-sleeved gown required for direct care when skin or clothing may become contaminated
◦ Use dedicated equipment or disinfect before use with another patient |
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Airborne Precautions |
◦ Patients known or suspected to be infected with pathogens transmitted by airborne droplet nuclei (<5 um) ◦ Small particles remain suspended in air for long periods of time; disperse in air currents |
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Airborne Precautions |
◦ Infectious agents:
◦ Staff must be fit tested for a N95 respirator |
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Airborne Precautions |
◦ Pt wears procedure mask outside room
◦ Negative pressure inside pt room - CSA standard 12 room air exchanges per hour |
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Droplet Precautions |
◦ Patients suspected of being infected with microbes transmitted by droplets (>5um)
◦ Larger droplets fall to environmental surfaces
◦ Infectious agents: |
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Droplet Precautions |
◦ Surgical masks and eye protection if within 2m of patient
◦ Gloves for direct patient contact
◦ Private room or cohort
◦ Pt wears procedure mask outside room |
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Droplet and Contact Precautions |
◦ Microbes can exhibit more than one mode of transmission
◦ Incorporates both droplet and contact |
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Droplet and Contact Precautions |
Common indications:
• Meningitis: |
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Droplet and Contact Precautions |
• Group A Streptococcus (GAS):
• Pneumonia etiology unknown
• Necrotizing fasciitis |
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Droplet and Contact Precautions |
◦ Procedure/surgical mask and protective eyewear required within 2m
◦ Gloves required for all patient/patient environment contact
◦Lon-sleeved gown required in skin or clothing will contact patient/patient environment |
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Droplet and Contact Precaution |
◦ Patient to wear a procedure/surgical mask for transport
◦ Use dedicated equipment or disinfect before use with another patient |
