NOSOCOMIAL INFECTIons (HOSPITAL ACQUIRED INFECTIONS) by lovella d NOSOCOMIAL INFECTIons (HOSPITAL ACQUIRED INFECTIONS) by lovella d. kanu, m.d

Objectives: Define hospital acquired infections identify the 5 major types of hospital acquired infections To discuss and apply the top CDC Recommendations to prevent hospital acquired infections To emphasize the importance of adequate hand hygiene

Definition: Infection in a hospitalized patient Not present or incubating on admission Hospital acquired infection

Why does this matter?

Hospital-acquired infections cost $10 billion a year: study Five most common health care-associated infections strike 440,000 U.S. Patients each year sept. 3, 2013, at 12:00 p.M.

CDC SURVEY 1 In 25 Hospital Patients Has At Least One Healthcare-associated Infection. 722,000 HAIs In U.S Acute Care Hospitals In 2011. About 75,000 Hospital Patients With HAIs Died During Their Hospitalizations. More Than Half Of All HAIS Occurred Outside Of The Intensive Care Unit.

EPIDEMIOLOGIC INTERACTION

SOURCES OF INFECTION

TYPES OF HOSPITAL ACQUIRED INFECTIONS Central Line Associated Blood Stream Infections (CLABSIs) Surgical Site Infections (SSSIs) Catheter Associated Urinary Tract Infections (CAUTI) MRSA Bacteremia Clostridium Difficile Infections

Illinois Vs The National Baseline Cook County Vs University Of Chicago Vs Loyola

How do we get rid of the extra staph???

Top CDC Recommendations to Prevent HAIs To Prevent Catheter-Associated Urinary Tract Infections (CAUTIs): Use of Catheter Only when indicated Insert and Maintain by properly trained persons aseptic technique maintain unobstructed urine flow hand hygiene recommendations and standard precautions

To prevent surgical site infections (SSIS) Before surgery antimicrobial prophylaxis treat remote infections-before elective operations avoid hair removal at the operative site unless it will interfere with the operation; do not use razors antiseptic agent and technique for skin preparation

DURING SURGERY keep or doors closed during surgery except as needed for passage of equipment, personnel, and the patient After Surgery maintain immediate postoperative normothermia sterile dressing control blood glucose level discontinue antibiotics

To Prevent Central Line-Associated Bloodstream Infections (CLABSIs) Outside ICUs • Remove unnecessary central lines • follow proper insertion practices • comply with hand hygiene recommendations • Use adequate skin antisepsis • provide education on central line maintenance and insertion

To Prevent Clostridium difficile Infections (CDI) Contact precautions • hand hygiene • cleaning and disinfection of equipment and environment • laboratory‐based alert system • educate about CDI

To Prevent MRSA Infections hand hygiene Contact Isolation rapidly report MRSA lab results Provide MRSA education for healthcare providers

common finding!!!!

SO WHY DON’T STAFF WASH THEIR HANDS? (COMPLAINCE ESTIMATED AT LESS THAN 50%)

References Gould CV, umscheid CA, agarwal RK, et al. Guideline for the prevention of catheter-associated urinary tract infections 2008. Centers for disease control and prevention. Meddings j, saint s, fowler ke, et al. The ann arbor criteria for appropriate urinary catheter use in hospitalized medical patients www.uptodate.com http://www.cdc.gov/hai/scott_costpaper-author-R.Douglas Scott II www.medicare.gov/hospitalcompare

Please break into your assigned small groups THANK YOU

POST TEST REVIEW: 1. What are the 5 major types of hospital acquired infections (HAIs)? - Central line associated blood stream infections (CLABSI) - Surgical site infections (SSIs) - Catheter associated urinary tract infections (CAUTI) - MRSA bacteremia - Clostridium difficile infections 2. What is the simplest most effective measure of preventing HAIs - Hand hygiene

3. For how long should one’s hands be rubbed together for effective hand washing? A. 1 minute B. 45 seconds C. 30 seconds D. 15 seconds 4. Based off CDC recommendations, post-op blood glucose should be maintained at atleast 200 mg/dl without complications

5. When do you discontinue prophylactic antibiotics after surgery? Within 24 hrs, and 48hrs if cardiac   6. Do antibiotic impregnated central lines decrease CLABSI? Yes, antibiotic impregnated lines have been shown to reduce CLABSI

7. When can the central line be used for blood draws or meds? When needed B. Only once a day Rarely if at all and then only after a sterile alcohol scrub of the hub for 15 seconds.  8. A patient admitted for diarrhea secondary to c-difficile and MRSA should be place under what type of precautions? A. Droplet B. Contact C. Airborne D. A & b e. All of the above

Thank you