Presentation on theme: "Bad News – Good News: The Basics of Infection Prevention and Control"— Presentation transcript:
1 Bad News – Good News: The Basics of Infection Prevention and Control July 2012Judith Conway, RN, BS, CICInfection Control CoordinatorCommunicable Disease Control SectionOffice of Health ProtectionIllinois Department of Public HealthTelephone: 217/
2 Session Overview Fundamental information “Germology terminology” “Antibiotic resistance 101”Chain of infection – routes of infectious disease transmissionBrief review of basic infection prevention/control recommendations used to prevent transmissionProblematic pathogensScenarios
3 Fundamental Information It’s a “bug-drug” war“Bug” = bacteria“Drug” = antibioticBad news: Some bacteria have become increasingly resistant to antibioticsGood news: We can help prevent infectious disease transmission by understanding and applying basic infection prevention/control practices
4 Antibiotic Resistant Germs Antibiotic resistance can travel the globe“Resistance anywhere is resistance everywhere”
6 FUNdamental Information: Pre-Assessment Antibiotics are drugs that fight infections caused by:BacteriaVirusesBacteria and virusesFILL IN THE BLANKS: ____________ ___________ is the primary strategy recommended by CDC as the foundation to prevent transmission of infectious agents in all healthcare settings.TRUE or FALSE? MRSA is spread by airborne transmission.
7 FUNdamental Information: Pre-Assessment Antibiotic-resistant pathogens are most frequently spread from one patient to another in healthcare settings by:Airborne spread resulting from patients coughing and sneezingPatients coming in contact with contaminated equipmentThe contaminated hands of healthcare workersSubstandard environmental maintenanceWhat is the IDPH recommendation for the length of time to perform proper hand washing?TRUE of FALSE? Clostridium difficile is readily killed by alcohol-based hand hygiene products.
9 “Germology Terminology” Microorganisms Microorganisms: bacteria, viruses, fungi, protozoa, helminths, rickettsia, prionsBiologic agents capable of causing diseaseAlso known as infectious agents or pathogensCommonly called “germs” or “bugs”NOTE: In today’s session, we will focus exclusively on bacteria
10 “Germology Terminology” Infection versus Colonization Infection: Bad news, bad news, bad newsBad news: You’ve got it (it = bacteria “X”)Bad news: It’s making you sick (invading your tissues and cells)Bad news: It can be spread to othersColonization: Bad news, good news, bad newsGood news: It’s not making you sick
11 Antibiotic Resistance 101 What are antibiotics?Drugs used to fight infections caused by bacteriaIt is important to remember that antibiotics have no effect on virusesHow do antibiotics work?2 main types of actionBacteriostatic: inhibit bacterial growthBactericidal: kill bacteria
12 Antibiotic Resistance 101 What is antibiotic resistance?Ability of bacteria to resist the effects of an antibioticHow does it occur?Occurs when bacteria change in some way that reduces or eliminates the effectiveness of antibioticsBecause the antibiotic isn’t effective, the bacteria survive and continue to multiply and cause harm
13 Antibiotic Resistance 101 How do bacteria become resistant to antibiotics?Bacteria have several mechanismsSome bacteria develop the ability to neutralize the antibioticOther bacteria rapidly pump out the antibioticStill other bacteria change the antibiotic attack site (on the bacterial cell wall) so that the antibiotic can’t do its work of affecting bacterial metabolismAdditionally, some bacteria can transfer pieces of DNA that code for resistance to other bacteria
14 Antibiotic Resistance 101 What happens when bacteria become resistant to antibiotics?Selective pressure: resistant bacteria survive, multiply, and replace all the sensitive (susceptible) bacteria that were killed offJust like antibiotic-susceptible bacteria, resistant bacteria can spread to other people and cause colonization or serious infections
15 Antibiotic Resistance 101 Why are bacteria becoming resistant to antibiotics?Antibiotic use promotes development of antibiotic-resistant bacteriaEvery time a person takes antibiotics, sensitive (susceptible) bacteria are killed, but resistant bacteria may be left to grow and multiplyOveruse and misuseAntibiotics are not effective against viral infections
16 Chain of Infection Causative Agent Susceptible Host Reservoir Portal of ExitPortal of EntryMode of Transmission
17 Chain of Infection: Modes of Transmission Microorganisms are spread through 3 primary routes:AIRBORNEDROPLETCONTACTDirect contactIndirect contact
18 Airborne Spread Least common mode of transmission Dissemination of airborne droplet nuclei (small-particle residue [5 microns or smaller in size] of evaporated droplets that contain the infectious pathogen and remain suspended in the air) or dust particles containing the infectious pathogenExamples of diseases spread through airborne transmission:Anthrax spores from contaminated environmentChickenpoxDisseminated herpes zoster (shingles)Measles (rubeola)Novel Strain Influenza: airborne spread may occur, extent unknownSevere Acute Respiratory Syndrome (SARS)SmallpoxTuberculosis
19 Droplet SpreadPathogen is spread in large respiratory droplets that don’t stay suspended in the air; they travel about feet and then drop to the ground/surfacesStudies have shown that the nasal mucosa and conjunctivae (and, less frequently, the mouth) are susceptible portals of entry for respiratory virusesExamples of diseases spread through droplet transmission:Influenza (seasonal influenza)Meningococcal MeningitisMumpsPertussis (Whooping cough)Rubella (German measles)Severe Acute Respiratory Syndrome (SARS)JAC
20 Contact Spread Most common mode of transmission Direct contact: germs (microorganisms) are transferred directly from one person to another person through physical contactIndirect contact: transferred from contact with a contaminated item or contaminated handsShort list of examples of diseases spread through contact transmission:ChickenpoxC. diffLiceMRSA and other multidrug-resistant organisms (MDRO)NorovirusScabiesSmallpox
21 Chain of Infection: Preventing Transmission CDC recommended these isolation precautions in 1996:Standard PrecautionsTransmission-based PrecautionsAirborne PrecautionsDroplet PrecautionsContact Precautions
22 Standard PrecautionsPrimary strategy recommended by CDC as the foundation to prevent transmission of infectious agents in all healthcare settingsBasic level of infection prevention/control practices to be used in the care of all patients at all times and in all healthcare settings, regardless of suspected or confirmed infectionIntended to reduce the risk of transmission of bloodborne and other pathogens from recognized and unrecognized sources of infectionDesigned to both protect the healthcare worker and prevent the healthcare worker from spreading infections among patients
23 Standard Precautions Five components of Standard Precautions: Hand hygiene before and after touching a patientPersonal protective equipment (PPE) (gloves, gowns, face protection [masks, goggles, face shields]) is used as indicated to prevent exposure to blood, body fluids, secretions, and excretions (except sweat), mucous membranes, non-intact skin, or contaminated equipmentSafe injection practices (recommended in 2007)One & Only campaign: ONE needle, ONE syringe, ONLY ONE timeSafe handling of potentially contaminated equipment or surfaces in the patient environmentRespiratory hygiene/cough etiquette (recommended in 2007)Cover Your Cough
25 Alcohol-Based Hand Hygiene Products “Alcohol-based products are more effective for standard handwashing or hand antisepsis by healthcare workers (HCW) than soap or antimicrobial soaps… In studies examining antibiotic-resistant organisms, alcohol-based products reduced the number of multidrug-resistant pathogens recovered from the hands of HCWs more effectively than did hand washing with soap and water.”SOURCE: CDC Hand Hygiene Guideline, 2002; page 11.
27 Who, What, Where, When, & Why WHO: On whom is the Precaution(s) used?WHAT: What type of personal protective equipment is used by healthcare worker(s)?WHERE: Where is the patient placed in the hospital or LTCF?WHEN: When is the Precaution(s) used?WHY: Why is the Precaution(s) used?
28 Standard Precautions WHO: All patients in all healthcare settings WHAT: Hand hygiene and PPE: healthcare workers have clean hands and use of appropriate personal protective equipment (gloves, gown, face protection) as indicated by the nature of the interaction and the extent of anticipated blood, body fluid etc. exposureWHERE: No special room placement is requiredWHEN: During all healthcare encountersWHY: Prevent transmission of bloodborne and other pathogens from recognized and unrecognized sources of infection
29 Airborne PrecautionsWHO: Patient with known or suspected infection with airborne infectious agentWHAT: Respirator and AIIR: healthcare workers will wear respiratory protection (respirator) upon entry into patient’s Airborne Infection Isolation Room (AIIR)WHERE: Airborne Infection Isolation Room (AIIR): patient is placed in a room with special air handling and ventilation capacity (negative air pressure)WHEN: During hospitalization or LTCF stay while patient is known/suspected to be contagiousWHY: Prevent transmission of airborne infectious agents
30 Droplet PrecautionsWHO: Patient with known or suspected infection with droplet-spread infectious agentWHAT: Mask: healthcare workers will wear mask upon room entry / when working within 6 feet of patientWHERE: Private room: patient is placed in a private room, if available. Special air handling and ventilation capacity are NOT required or indicated.WHEN: During hospitalization or LTCF stay while patient is known/suspected to be contagiousWHY: Prevent transmission of infectious agents spread through close respiratory or mucous membrane contact with infectious respiratory secretions
31 Contact PrecautionsWHO: Patient with known or suspected infection with contact-spread infectious agentWHAT: Gown and gloves: healthcare workers will wear gown and gloves for all interactions that involve contact with patientWHERE: Private room: patient is placed in a private room, if available. Special air handling and ventilation capacity are NOT required or indicated.WHEN: During hospitalization or LTCF stay while patient is known/suspected to be contagiousWHY: Prevent transmission of infectious agents spread through direct or indirect contact
32 How to Safely Don & Remove PPE The addddddition of a mask for certain spinal procedures grew from recent evidence of an associated risk for developing meningitis caused by respiratroy floraThe use of a mask when performing certain high-risk, prolonged procedures involving spinal canal punctures (e.g., myelography, epidural anesthesia)
34 Clostridium difficile a.k.a. C. diff Bacteria: spore-forming bacteriaToxin-producer: produces exotoxins (toxin A and toxin B) that are pathogenic to humansExotoxins: toxin A and toxin BIllness: diarrhea (known as Clostridium difficile infection – CDI)Can also cause serious intestinal conditions, sepsisCDC estimates that 14,000 deaths occur annually due to CDI
35 Main Symptoms of CDI Watery diarrhea Fever Loss of appetite Nausea Abdominal pain/tendernessPublic Health definition of diarrhea: 3 or more loose stools within a 24-hour period
36 Risk Factors for CDI Antibiotic exposure Proton pump inhibitors Gastrointestinal surgery/manipulationLong length of stay in healthcare settingsSerious underlying illnessImmunocompromising conditionsAdvanced age
37 CDI: New Difficulties With an Old Pathogen Nationwide, increased rates of CDI, with more severe disease and increased mortalityPossible reasons include the emergence of a new strain of C. diff with increase virulence and/or antibiotic resistanceNew strain has increased production of toxins A and B, and can produce an additional toxin known as binary toxin
38 CDI: Healthcare Facility Infection Control Contact Precautions for patients with known or suspected CDISoap & water hand hygiene; alcohol doesn’t kill sporesContinue Contact Precautions until diarrhea ceases and patient has been diarrhea-free for 3 daysEnsure adequate cleaning and disinfection of environmental surfaces, especially items likely to be contaminated with fecesDuring outbreaks, use a bleach-based disinfectant or an EPA-registered disinfectant with a sporicidal claim
39 Multidrug-Resistant Organisms Multidrug-resistant organisms (MDRO) are microorganisms, predominantly bacteria, that are resistant to 1 or more classes of antibioticsIn some cases, the microorganisms have become so resistant that no available antibiotics are effective against them
40 Facts About MDRO Transmission Transmitted by the same routes as antibiotic susceptible infectious agentsPatient-to-patient MDRO transmission in healthcare settings is usually via contaminated hands of healthcare workersContact Precautions are recommended to prevent MDRO transmission in healthcare settings
42 What is Staphylococcus aureus? Bacteria often referred to as “Staph”Carried on the skin or in the nose of healthy peopleApproximately 30% of the population carry it on the skin or in the noseApproximately 2% carry a type known as MRSA
43 What Is MRSA?MRSA stands for Methicillin-Resistant Staphylococcus aureusIt is a type of Staph bacteria that is resistant to certain antibiotics including penicillin, methicillin, and amoxicillinHA-MRSA stands for healthcare-associated MRSACA-MRSA stands for community-associated MRSA
44 MRSA InfectionIn the community, most MRSA infections are skin infectionsIn healthcare settings, more severe or potentially life-threatening infections may occur among patients e.g., bloodstream infection, pneumonia, surgical site infection, urinary tract infectionMRSA is spread by contact transmission
45 ESBL-Producing Bacteria ESBL = Extended-Spectrum Beta-LactamaseBeta-lactams are a class of antibioticsBeta-lactamase is an enzyme that deactivates the antibioticsESBLs are enzymes that confer resistance to a broad (extended) spectrum of beta-lactam antibiotics & third and fourth generation cephalasporinsESBL-producing bacteria have been identified in E. coli, and also in Klebsiella, Proteus, Pseudomonas, Salmonella, and Serratia speciesESBL-producing bacteria are spread through contact transmission
46 Carbapenem Resistance and Carbapenemase-Producing Bacteria Carbapenems: a class of beta-lactam antibiotics (imipenem, meropenem, ertapenem, doripenem)Carbapenems have been used as a last line of defense in treating infections caused by ESBL-producing bacteriaSome bacteria have developed the ability to produce carbapenemase which is an enzyme that deactivates carbapenem antibioticsKPC refers to Klebsiella pneumoniae carbapenemaseCRE refers to carbapenem-resistant EnterobacteriaceaeKPC / CRE are spread through contact transmission
47 Bad NewsAntibiotic resistance is one of the world’s most pressing public health threatsAntibiotic overuse increases the development of drug-resistant germsIt will be many years before new antibiotics are available to treat some resistant infectionsKlebsiella pneumoniae carbapenemase (KPC) infection -- a type of antibiotic resistant bacteria also known as CRE -- is found in 37 statesResistance anywhere is resistance everywhereAntibiotic resistance can travel the globe(Information source: CDC Web site “Get Smart for Healthcare”)
48 CDC: 2011 Location of CRE Caused by KPC Enzyme; CRE Caused by Other Enzymes Noted
49 Good NewsMany healthcare facilities are making infection prevention a patient safety priorityImplementation and correct adherence to Standard Precautions, and Contact Precautions when indicated, are “low-tech” practices that help prevent MDRO transmissionCDC has launched educational programs and campaigns to promote the proper use of antimicrobial agents
50 FUNdamental Information: Knowledge Assessment Antibiotics are drugs that fight infections caused byBacteriaVirusesBacteria and virusesBACTERIA.FILL IN THE BLANKS: ________ _________ is the primary strategy recommended by CDC as the foundation to prevent transmission of infectious agents in all healthcare settings.Standard PrecautionsTRUE or FALSE? MRSA is spread by airborne transmission.FALSE: MRSA is spread by contact transmission.
51 FUNdamental Information: Knowledge Assessment Antibiotic-resistant pathogens are most frequently spread from one patient to another in healthcare settings byAirborne spread resulting from patients coughing and sneezingPatients coming in contact with contaminated equipmentThe contaminated hands of healthcare workersSubstandard environmental maintenanceThe contaminated hands of healthcare workers5) What is the IDPH recommendation for the length of time to perform proper hand washing? 20 seconds of scrubbing6) TRUE of FALSE? Clostridium difficile is readily killed by alcohol-based hand hygiene products. FALSE: alcohol doesn’t kill spores
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