2Healthcare Associated Infections (HAIs) in the USA Today HAIs affect 5-10% of patients in US acute care hospitals.HAIs affect nearly 2 million patients per year.HAIs cost an estimated $5-10 Billion per year.More than 70% of bacteria that cause HAIs are resistant to at least one of the drugs most commonly used to treat the infections.
3HAIs – The Human Cost 99,000 people will DIE this year from a HAI. It’s equivalent to a 747 plane crash killing all passengers and crew every other day.It’s one death every 6 minutes.IT IS PREVENTABLE!
4Desired Goals Reduce hospital acquired infections Thereby reducing avoidable morbidity, mortality and cost.Key Factors:Hand hygieneEnvironmental decontaminationIdentification and isolation of colonized patientsEducation
5Contaminated Surfaces tested positive for VRE (+) in patient environment. Hayden M. ICAAC,2001, Chicago, IL
6Hand HygieneHand hygiene is the single most important means of preventing the spread of infection.It is to be performed before and after every patient encounter, and after the removal of gloves.
9Access the CDC Hand Washing Course go to: http://www. cdc
10Personal Stethoscopes Personal stethoscopes should be cleaned before and after each use. An EPA registered hospital disinfectant (disinfecting surface wipes) or alcohol wipes may be used
11Personal Protective Equipment Gowns, gloves, masks, goggles, face shields, PAPRsAvailable on the nursing unitsGloves should be in every patient roomTypes of PPE required for each isolation category are identified on a sign posted on the door to the patient room.
12Key Points About PPEDon before contact with the patient, generally before entering the roomUse carefully – don’t spread contaminationRemove and discard carefully, either at the doorway or immediately outside patient room; remove respirator outside roomImmediately perform hand hygiene
13Sequence* for Donning PPE Gown firstMask or respiratorGoggles or face shieldGloves* Combination of PPE will affect sequence – be practical
14How to Don a Gown Select appropriate type and size Opening is in the backSecure at neck and waistIf gown is too small, use two gownsGown #1 ties in frontGown #2 ties in back
15How to Don a Mask Place over nose, mouth and chin Fit flexible nose piece over nose bridgeSecure on head with ties or elasticAdjust to fit
16How to Don a Particulate Respirator Select a fit tested respiratorPlace over nose, mouth and chinFit flexible nose piece over nose bridgeSecure on head with elasticAdjust to fitPerform a fit check –Inhale – respirator should collapseExhale – check for leakage around face
17How to Don Eye and Face Protection Position goggles over eyes and secure to the head using the ear pieces or headbandPosition face shield over face and secure on brow with headbandAdjust to fit comfortably
18How to Don Gloves Don gloves last Select correct type and size Insert hands into glovesExtend gloves over isolation gown cuffs
19“Contaminated” and “Clean” Areas of PPE Contaminated – outside frontAreas of PPE that have or are likely to have been in contact with body sites, materials, or environmental surfaces where the infectious organism may resideClean – inside, outside back, ties on head and backAreas of PPE that are not likely to have been in contact with the infectious organism
20Sequence for Removing PPE GlovesFace shield or gogglesGownMask or respirator
21Where to Remove PPEAt doorway, before leaving patient room or in anteroomRemove respirator outside room, after door has been closed
22How to Remove Gloves Grasp outside edge near wrist Peel away from hand, turning glove inside-outHold in opposite gloved hand
23How to Remove GlovesSlide ungloved finger under the wrist of the remaining glovePeel off from inside, creating a bag for both glovesDiscard
24Remove Goggles or Face Shield Grasp ear or head pieces with ungloved handsLift away from facePlace in designated receptacle for reprocessing or disposal
25Removing Isolation Gown Unfasten tiesPeel gown away from neck and shoulderTurn contaminated outside toward the insideFold or roll into a bundleDiscard
26Removing a Mask Untie the bottom, then the top Remove from face Discard
27Removing a Particulate Respirator Lift the bottom elastic over your head firstThen lift off the top elasticDiscard
28Hand Hygiene Perform hand hygiene immediately after removing PPE. If hands become visibly contaminated during PPE removal, wash hands before continuing to remove PPEWash hands with soap and water or use an alcohol-based hand rub
29Protect Yourself and Your Patient PPE is available to protect you from exposure to infectious agents in the healthcare workplaceKnow what type of PPE is necessary for the duties you perform and use it correctly
30Donning and Removal of PPE Video Review Click on the link below.
31CDC Guideline for Isolation Precautions There are 4 isolation categories - The name of each reflects how the infectious organism/disease is transmitted.The next few slides will detail the requirements of each category and show examples of the signs posted on patient doors to communicate these requirements to all who enter.
33STANDARD PRECAUTIONSAssume that every person is potentially infected or colonized with an organism that could be transmitted in the healthcare setting.Wear PPE according to the level of anticipated contamination, when handling patient-care equipment and instruments/devices that are visibly soiled or may have been in contact with blood or body fluids.
34Protects from diseases spread by contact. CONTACT ISOLATIONProtects from diseases spread by contact.Including:Clostridium difficile (C-Diff)Scabies, lice, impetigoPatients with multiple drug resistant organisms (MDRO) like MRSA, VRE, and MDRO gram negative organisms (i.e.Pseudomonas, Acinetobacter).Private room requiredGown requiredGloves required
36Patient: Patient wears clean gown. Cover any open wounds. Contact Isolation:Patient transport:Patient: Patient wears clean gown.Cover any open wounds.Cover patient with clean sheet prior to transport.HCW: Wear Personal protective equipment (PPE) when touching patient.(Healthcare Remove and dispose of PPE and perform hand hygiene prior toWorker) transporting patient.Don clean PPE to handle patient at transport destination.Visitors: Visitors who are not providing direct care to patients in contact precautions will not need to wear gown and gloves. This does not apply to students, residents or other healthcare providers.Equipment: Clean glucometers, thermometers or any other equipmentused for or on a patient. Dedicate stethoscope, B/P cuff to each patient.
37For patients with spore-forming organisms, such as Clostridium difficile (C. diff), you must wash hands with soap and water. Alcohol-based hand cleaners are less effective.
39AIRBORNE PRECAUTIONS Primarily used for suspected or diagnosed TB. Protects from disease spread by air/respiratory tract.Primarily used for suspected or diagnosed TB.A special ventilation room (negative airflow) is required. Door is kept closed.A Powered Air-purifying Respirator (PAPR) is required to enter the room.Some areas (surgery, MRI) wear a N-95 mask. An annual fit-test is required for N-95 users.
41Airborne Isolation: Patient transport: Patient: Patient wears surgical mask when out of room.Follow respiratory hygiene/cough etiquette.If skin lesions are present—cover lesions with clean sheetHCW: Wear PAPR when entering room and handling patient(Healthcare May remove PAPR once out of the room and patient is wearing worker) maskHand hygiene prior to transportHCW does not need to wear PAPR during transportEquipment: Clean stretchers/wheelchairs after useClean glucometers, thermometers, or any other equipment used for patient
42AIRBORNE/CONTACT PRECAUTIONS Used for other occasions when a special ventilation room (negative airflow) is needed, i.e. varicella (chickenpox), measles, shingles (varicella) in an immunocompromised patient, or disseminated shingles.These conditions are also spread by contact so Contact precautions are required also.A PAPR, gown and gloves are required to enter the room.
43A surgical type mask is required to enter the room. DROPLET PRECAUTIONSProtects against diseases spread by respiratory droplets.Including suspected or known:Neisseria meningitidis (meningococcemia),Meningitis of unknown origin (bacterial vs. viral)InfluenzaPertussis (whooping cough).A surgical type mask is required to enter the room.
45Patient: Patient wears surgical mask when out of room. Droplet Isolation:Patient Transport:Patient: Patient wears surgical mask when out of room.Follow respiratory hygiene/cough etiquetteHCW: Wear mask when entering room(Healthcare May remove mask once patient is wearing a maskWorker) HCW does not need to wear mask during transportEquipment: Clean stretchers/wheelchairs after useClean glucometers, thermometers or any otherequipment used for patient
46SUMMARYStandard: Wear PPE according to the level of anticipated contamination, when handling pt-care equipment and instruments/devices that are visibly soiled or may have been in contact with blood or body fluids.Contact: A gown and gloves are required to enter the room.Airborne: A PAPR is required when entering the room.Droplet: A surgical type mask is required to enter the room.Airborne/Contact: A PAPR, gown and gloves are required to enter the room.
47Equipment Decontamination If extra equipment is taken into an isolation room and used such as a reflex hammer, tuning fork, ophthalmoscope etc., be sure to decontaminate the equipment afterward with the PDI Surface Wipes located in a canister on the infection control cart or plastic wall hanger outside the patient room. Wash your hands after decontaminating the items.
48Note Taking in an Isolation Room For droplet or airborne isolation do not take notes in the room.For contact isolation, if you must, follow these steps.don all appropriate PPEtake paper and a pen into the roomtake and record the history information without touching any equipment or the patient.place the paper and pen in the anteroom or outside the door. Take care to cover the information with a blank paper or turn the forms upside down so the information is not visible to those in the hall.perform the physical exam, remove the PPE, wash hands and record this information after leaving the room..