1. How to Prevent the Spread of MDRO’s Melisa Hobbs RN, Infection Preventionist Carilion Clinic

2. No disclosures.

3. Hand Washing!!

5. Hand Hygiene: When Before and After Putting on Gloves Preparing or eating food Contact with a resident Treating a cut or wound (Ex: changing dressings or bandages) Donning and Doffing PPE Handling/administering medication Insertion of invasive devices Touching your eyes, nose, or mouth

6. Before and After

7. Wash In and Wash Out WHO (World Health Organization) and CDC (Centers for Disease Control) guidelines: “Hand Hygiene Before Room Entry” is to ensure that hands are clean prior to planned or unplanned contact with the patient or the items contained within that environment and/or prevent the introduction of germs to the patient or their environment. “Hand Hygiene at Room Exit” is to ensure that hands are clean upon the exit of one patient care environment to prevent introduction of germs to the caregiver or common areas, after body fluid exposure”.

8. Why not? More convenient for HCW’s to not perform hand hygiene. The HCW must engage in an inconvenient behavior at a cost to self in the short run in order to benefit others, collectively in the long term.

9. Hand Hygiene Compliance Monitoring

10. Teaching residents hand hygiene Teach the resident the importance of hand hygiene when exiting and entering their room. For cognitively impaired residents, the use of hand sanitizing wipes may be effective for certain pathogens prior to leaving room.

11. Standard Precautions Practicing hand hygiene before and after contact with a resident, objects around a resident and after removing gloves. Wearing disposable glove when the HCW may come into contact with blood, feces, urine, or any other body fluid. Wearing a gown to prevent contamination of the HCW clothing with blood or body fluids Use of a face mask, face shield, and/or goggles if splashing of body fluids occur. Cleaning of pt care equipment between residents. Respiratory hygiene and cough etiquette. Appropriate Patient placement

12. PPE Used in Healthcare Settings Gloves – protect hands Gowns – protect skin and/or clothing Surgical Masks – protect mouth/nose Goggles – protect eyes from splash Face shields – protect face, mouth, nose, and eyes. Respirators( N 95 / Duckbill) – protect respiratory tract from airborne infectious agents

13. Donning PPE

14. Wearing of PPE is mandated by the OSHA Bloodborne Pathogens Standard (Occupational Health and Safety Administration )

15. Removing PPE

17. Transmission Based Precautions Contact Precautions (Includes Special Contact Precautions.) Droplet Airborne

18. Contact Precautions Are used in addition to standard precautions. Designed to reduce the risk of transmission of microorganisms by direct or indirect contact. Requires wearing of gown and gloves for all activities that may involve resident contact or potentially contaminated areas in the environment. Dedicated use of care equipment (B/P cuffs) to a single resident or disposable equipm ent.

19. Contact Isolation Perform hand hygiene. Wear gloves. Wear gown.

20. Norovirus NOROVIRUS

21. Norovirus Highly contagious. Residents in close quarters and have frequent contact with one another. Chronic underlying health conditions or weakened immune systems that make it easier for them to become ill. No medication or vaccine available. Provide supportive care only. Symptoms : Frequent or explosive watery stools Vomiting Abdominal pain Nausea Low grade fever.

22. Clostridium difficile Opportunistic, anaerobic (grows in the absence of oxygen) spore-forming bacillus (rod) Produces spores (dormant bacteria) that persists in the environment and make the organism very difficult to eliminate. Risk Factors: Underlying GI issues/GI surgery Proton pump inhibitors (omeprizole) Gastrointestinal surgery/manipulation Long length of stay in healthcare settings A serious underlying illness Immunocompromising conditions Advanced age Antibiotic use

23. Prevent transmission Place suspected pt with GI symptoms immediately in Special Contact Precautions. Wash hands with soap and water for 15 sec. C diff spores can live on surfaces up to 5 months. Must clean with 10% Bleach solution per manufacturer recommended “Contact time” Use disposable or resident- dedicated equipment. Inanimate Environment William Rutalla PhD, MPH- University of North Carolina

24. Special Contact Precautions- (Enteric) If it is BROWN Bleach it down!!

25. Droplet Precautions Used for illnesses that can be spread by speaking, sneezing, or coughing. These germs may travel through the air for approximately 3-6 feet and can be inhaled into the nose or mouth of another person. A surgical mask is used by staff and visitors upon entering the room. Hand Hygiene is essential.

29. Respiratory Etiquette Used to decrease the transmission of respiratory illness such as influenza and the common cold by: Cover your cough or cough in elbow. Hand Hygiene. Availability and use of tissues and hand hygiene products. Use of mask for person who is coughing. Spatial separation of the person with the respiratory illness

30. http://www.cdc.gov/flu/protect/cover cough.htm

31. http://www.vdh.virginia.gov/epidemiology/surveill ance/hai/longterm.htm#Assisted

32. QUESTIONS

33. References Feming, Jean,. N, MPM, CIC, is clinical director of infection prevention and education at Professional Disposables International Inc. The challenges of hand hygiene in the long-term care setting (http://www.pdipdi.com/) http://www.mcknights.com/the-challenges-of-hand-hygiene-in-the-long-term- care-setting/article/128883/http://www.pdipdi.com/http://www.mcknights.com/the-challenges-of-hand-hygiene-in-the-long-term- care-setting/article/128883/ Occupational Safety & Health Administration (OSHA) Regulations: Standards – 29 CFR http://www.osha.gov/pls/oshaweb/owasrch.search_form?p_doc_type=STANDARDS&p_toc_level=1&p _keyvalue=1910 Respiratory protection: 29 CFR 1910.134 Personal protective equipment : 29 CFR 1910.132 http://www.osha.gov/pls/oshaweb/owasrch.search_form?p_doc_type=STANDARDS&p_toc_level=1&p _keyvalue=1910 Siegel JD, Rhinehart E, Jackson M, et al., and the Healthare Infection Control Practices Advisory Committee (HICPAC). Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, 2007. http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf Smith PW, Bennett G, Bradley S, Drinka P, Lautenbach E, Marx J, Mody L, Nicolle L, Stevenson K. SHEA/APIC Guideline: Infection Prevention and Control in the Long-Term Care Facility. Infection Control and Hospital Epidemiology 2008;29:785–814 http://www.apic.org/Content/NavigationMenu/PracticeGuidance/APIC-SHEA_Guideline.pdf Smith PW, Rusnak PG. Infection Prevention and Control in the Long-Term-Care Facility. Infection Control and Hospital Epidemiology 1997;18:831-849. http://www.shea- online.org/Assets/files/position_papers/IC-LTCF97.PDF