1. Welcome Community Partners Michelle Nelson

2. Infection Prevention Update Darcy Minter RN CCRN, CIC

3. Objectives  Review of Multi Drug Resistant Organisms  Discuss issues regarding care and maintenance of lines in non-acute setting  Recognition of bed bugs, prevention, and treatment

4. Multi-Drug Resistant Organisms  any organism can become resistant  Commonly thought of as MRSA, VRE and Extended Spectrum Beta Lactamase (ESBL)  More recently included… CRE, C. diff, A. baumannii, MTB, and GC

5. MDRO Prevention  Hand Hygiene  Utilization of PPE  Environmental cleaning  Adherence to medication regimens

6. Care and Maintenance of lines

7. Impact of CLABSI 7  250,000 CLABSI’s/year  30,665 deaths/year from CLABSI  $45,814/infection

8. Mechanisms Leading to CLABSI 8

9. Line care and maintenance GUIDELINES:  Hand hygiene compliance  Scrub access port or hub immediately prior to each use with appropriate antiseptic (70% IPA, CHG, provodineiodine)  Access catheters with only sterile devices  Dressing care. Replace wet, soiled or dislodged (using aseptic technique with clean or sterile gloves)  Replacement of administration sets and needleless connectors  Perform daily assessments to determine need for CVL 9

10. Line care and maintenance  Challenges with keeping lines clean:  Pets  Cleanliness of environment  Patient non compliance  Lack of education or experience

11. Protection of lines 11  70% IPA in a cap  To be placed on any swabable, luer- activated device  To disinfect and act as a physical barrier between accesses when not in use

12. Bed Bugs Cimex lectularius 12

13. Bed Bugs 13 Bed bugs, a problem worldwide, are resurging, causing property loss, expense, and inconvenience. The good news is that bed bugs do not transmit disease. The best way to prevent bed bugs is regular inspection for signs of an infestation.

14. 10 Bed Bug facts  Adult bed bugs are around 5-7 mm long and expand up to 3x their size after feeding.  Bed bugs are a parasite and primarily feed on the blood of humans  Ordinarily the bugs are active at night but will adjust to the hosts sleeping pattern  The scientific name for bed bugs is Cimex Lectularius  The saliva of the bed bug contains anesthetic which makes the host unaware they are being bitten. 14

15. 10 Bed Bug facts  The bed bugs are attracted by the carbon dioxide that comes from the breath of the host  Bed bugs can lay between 1 and five eggs per day and over five hundred in their lifetime.  Bed bugs can go over a year without feeding by entering a hibernation state.  The bed bug has six life stages broken up into 5 nymph stages and the adult stage. The parasite gets gradually bigger with each phase.  Bed bugs are not a sign of unhygienic surroundings, they can thrive in both clean and dirty conditions.

16. Bed Bug Bites/Rash

17. Bed Bug Mating 17  All bed bugs mate by traumatic insemination. After feeding the adult male becomes very interested in mating. He literally grabs on to the female and stabs his needle-like reproductive organ thru the abdomen wall into a specialized organ (Organ of Berlese) located on her right side. The sperm then migrates to her ovaries and fertilizes the eggs.

18. Prevention and treatment 18  Look for signs of infestation  the bed bugs’ exoskeletons after molting,  bed bugs in the fold of mattresses and sheets,  rusty–colored blood spots due to their blood-filled fecal material that they excrete on the mattress or nearby furniture, and  a sweet musty odor.  Avoid placing bags on beds or carpeted areas Bites  Avoid scratching  Apply antiseptic lotion or cream  Antihistamines Environment  Professional pest control

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20. Resources  http://www.cdc.gov/hicpac/mdro/mdro_ 4.html http://www.cdc.gov/hicpac/mdro/mdro_ 4.html  The Joint Commission. Preventing Central Line–Associated Bloodstream Infections: A Global Challenge, a Global Perspective.Oak Brook, IL: Joint Commission Resources, May 2012. http://www.PreventingCLABSIs.pdfhttp://www.PreventingCLABSIs.pdf  http://www.cdc.gov/parasites/bedbugs/ http://www.cdc.gov/parasites/bedbugs/