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Infection Prevention Stephanie Langdon, MSN, CIC Infection Control Practitioner Presbyterian Novant Health Charlotte, NC.

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Presentation on theme: "Infection Prevention Stephanie Langdon, MSN, CIC Infection Control Practitioner Presbyterian Novant Health Charlotte, NC."— Presentation transcript:

1 Infection Prevention Stephanie Langdon, MSN, CIC Infection Control Practitioner Presbyterian Novant Health Charlotte, NC

2 Medical asepsis vs. Surgical asepsis Asepsis the freedom from disease causing microorganisms. Two types Medical and Surgical. Medical asepsis practices intended to confine a specific organisms to a specific area. Can be clean or dirty. Surgical asepsis or sterile technique practices intended to destroy all microorganisms

3 Types of Microorganisms Causing Infections Bacteria (MRSA and VRE) Viruses (Flu and Parvo) Fungi (Aspergillus) Parasites (Intestinal Worms)

4  Germs live everywhere!  Most microbes that live in our environment perform functions essential to our survival, a small percentage of them enter our bodies to cause an infection, and a smaller proportion cause a drug resistant infection.  Because microbes have extremely high replication rates, they can also mutate quickly to enable them to adapt to changing conditions.

5 Bacteria Most common infection causing microorganism Lives on your skin and surfaces Can live and be transported through air, water, food, soil, body tissues and fluids.

6 Staph Aureus to MRSA In the beginning Staph Aureus Emergence of MRSA (1960’s) Emergence of CA-MRSA (1990’s)

7 Terms You Might Hear  Community Acquired MRSA (CA-MRSA)  Methicillin-Resistant Staph Aureus (MRSA)  Hospital Acquired MRSA (HA-MRSA)  Methicillin-Susceptible Staph Aureus (MSSA)  Colonized MRSA  Infected MRSA

8 CA-MRSA Control Measures Also Try to Prevent  Know the difference between Cleaning and Disinfecting  First you clean then you disinfect  Use correct products  Skin  Surfaces

9 Disinfectants that Kill Germs on Skin Alcohol based hand Sanitizers Antibiotics Soaps and wipes made for skin Good old soap and water (Doesn’t have to be antibiotic soap)

10 Disinfectants that Kill Bacteria on Surfaces Sani-wipes (Kill time 10 minutes) Virex (Kill time 3 minutes) Dispatch (Kill time 1 minute) Bleach kills everything (see handout)

11 Ultraviolet Waves Ultraviolet waves are effective in killing bacteria and viruses. Hospitals use equipment that produce these waves to sterilize equipment, water and air in rooms. It is also used to treat acne and psoriasis. These are the same waves used in tanning beds.

12 CA-MRSA Control Measures  Cover all wounds  Train athletes in first aid for wounds and signs of infection  Encourage Good hygiene Practices  Discourage sharing of items  Establish routine cleaning schedules for shared equipment  Encourage players to report skin lesions

13 Investigational Findings  Increase number of Spider Bites reported in the Emergency Rooms cultures revealed MRSA.  CA-MRSA median Age is 23  HA-MRSA median Age is 68 (Naimi, T.S. et al. JAMA 2003, 290: )

14 Hospital vs. Community Acquired Infections  Hospital (Nosocomial) Acquired MRSA : defined by the CDC as MRSA acquired after 48 hours stay in the hospital with no previous documentation of a positive MRSA culture  Community Acquired MRSA: defined by the CDC as MRSA acquired in the community. If we test within 48 hours of admission and patient is positive this is a community acquired MRSA

15 How to Recognize an Inflammatory Response 1 st Stage: Vascular and Cellular Responses 2 nd Stage: Exudate Production 3 rd Stage: Reparative Phase

16 Types of Infections  Colonized: defined as a carrier of the bacteria but you are not sick. Cultures (screening) are from nares or perirectal area.  Infected: defined as someone with a wound (infected area) that has been cultured and is positive for an infection

17 Off the Beaten Path  VRE - Vancomycin Resistance Enterococus  C diff- Clostridium difficile or CTOX  ESBLs - extended-spectrum beta- lactamases (which are resistant to cephalosporin's and monobactam’s)

18 Chain of Infection (Six Links) Etiologic Agent (Microorganism) Reservoir Portal of Exit from the Reservoir Method of Transmission Portal of Entry to the Susceptible Host Susceptible Host

19 Isolation Types Airborne Droplet Contact Contact Enteric

20 Isolation Precautions Airborne to prevent the transmission of highly contagious or virulent infections spread by small airborne droplets (smaller than 5 microns) examples know or suspected TB, chicken pox. Droplet to prevent the transmission of diseases spread by large droplets (larger than 5 microns) Examples are meningococcal meningitis, pertussis, mumps


22 Airborne Precautions Disease requiring Airborne Precautions:  Mycobacterium Tuberculosis (MTB)  Measles  Other significant diseases (i.e. Pandemic Influenza) For a complete list of diseases/conditions requiring Airborne Precautions see Appendix A 1 (Linked to CDC). N 95 respirators or PARA are required for all employees upon entry to an Airborne Precautions room. We do this for Every Patient, Every Time! Monitored Negative pressure is Required

23 Signs and Symptoms of TB Night sweats Coughing up blood Weight loss Why is a positive PPD not always a sign of TB. What does the chest x-ray look like? Are the sputum's that are collected every morning for three consecutive mornings positive for Acid Fast Bacilli?

24 TB  Mycobacterium tuberculosis (MTB) All other Mycobacterium’s can be called MOTT (mycobacterium other than tuberculosis)  Other Pulmonary Mycobacterium’s Mycobacterium avium complex MAC, M. kansasii, M. absessus, M. xenopi  Skin Mycobacterium’s M. marinum  Wound infections M. fortuitum, m. chelonea and m. absessus

25 Genus Species Genus Mycobacterium (ALL Fords) Species M. Tuberculosis (Lincoln Continental) M. Avium (Mustang) M. kansasii (Taurus) M. absessus (Fusion) M. xenopi (Fiesta) They ALL test positive for Acid Fast Bacilli


27 Special Airborne/Contact Precautions This category is for diseases that can be transmitted to others through both the airborne and contact route. Examples include:  Varicella Zoster Virus (VZV): Chickenpox and disseminated zoster/shingles  SARS-CoV

28 Shingle Questions Who is considered immune? Immunity comes from having the chicken pox or having the VZIG. How do you know if the patient has zoster pneumonia? Positive sputum’s would be needed to verify the present of the herpes virus and CXR positive for pneumonia. If the patient is positive for zoster pneumonia and has visible lesion on more than one dermatome is this considered disseminated zoster shingles or is it only localized? Consider disseminated zoster shingles.


30 Droplet Precautions  Most frequent diseases we see:  Pertussis (Whooping Cough)  Neiserria Meningitis  Parvo (5 th disease)  Flu  Our current practice for Flu patients is for staff to wear surgical mask. This may change pending further recommendations by the CDC. Everyone else must also don a surgical mask upon entry to room.

31 Bacterium Meningitis B for Bad Neiserria meningitidis (Treat intimate exposures as well as patient) Only treat Patient Hemoplus influenzae Streptococcus pneumonia Streptococcus group B L. monocytogenes

32 Isolation Precautions Contact to prevent the transmission of potential diseases that are spread by close, direct, or indirect contact. Examples are MRSA, VRE and ESBL. Contact Enteric same as contact but to remove bacteria have to wash hands with soap and water. Examples C diff.


34 How it is Spread Contact The primary method of MRSA transmission is by Contact, usually from people's hands. The organism has been recovered from people's hands after they have touched contaminated material and before they have washed their hands. The MRSA organism also is found among health care workers who carry the organism either in their nose or on their skin. If a person carries MRSA in his or her nares, it can be transferred to patients by hand contact.

35 C. difficile: Do NOT Use Purell Hand Sanitizer

36 When to use PPE (Personal Protective Equipment)  When it is warm  Wet  Not yours

37 Hand Hygiene Initiative Which is More Dangerous? Great White Shark (Carcharodon carcharias) MRSA (Methicillin Resistant Staphylococcus aureus)

38 We Know What To Do!

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