1. Physicians: Infection Prevention is in YOUR Hands
YOUR responsibility to: Protect YOUR Patients
Protect YOURSELF

2. X Chain of Infection HANDS Natural body openings YOU
Man-made body openings
YOU
Contact X
Droplet
PATIENT
MRSA
Airborne
Percutanous TB
Sputum
Flu
Catheter
HANDS
Stool
Incision
Wounds
Environment
Mouth
Nose

3. Health Care-Associated Infection (HAI) in the USA
An estimated 722,000 HAIs in U.S. acute care hospitals during 2011
On any given day, ~1 in 25 hospital patients had an HAI
~ 75,000 HAI associated deaths
1 out of 10 patients with an HAI died due to the infection

4. MULTI-DRUG RESISTANT ORGANISMS (MDRO)
CARBAPENEM RESISTANT
Acinetobacter
MRSA
VRE
Klebsiella (KPC)
CRE
ESBL
Resistant Pseudomonas
C. difficile

5. PREVENTION of MDROs and HAIs
And remember the “iceberg effect”
Hand Hygiene
Standard and Transmission-Based Precautions
Communication (and READ the signs!)
Clean environment
Antibiotic Stewardship
Organizational goals for device associated infections

6. The Iceberg Effect
This iceberg graphically represents colonization versus infection. Those patients that are infected with an organism represent just the “tip of the iceberg” of patients that are colonized or infected.
Just because a patient is not infected, or showing signs of infection, does not mean that they do not carry organisms that could be transferred to another patient if proper hand hygiene and other infection control precautions are not taken. 6

7. Your 5 Moments of Hand Hygiene
Before touching a patient because you bring your own bugs with you.
Before a clean or asceptic procedure… at which exact moment? Not before you root around in drawers to find supplies, but immediately before the procedure.
After exposure to potentially infectious materials to protect yourself and others.
After touching the patient, because we must assume they all have bugs.
After touching the patient’s environment because the bugs don’t just sit nicely on the patient... remember the VRE patient?
The WHO calls this the 5 moments of HH, but there is no need to know the numbers… just look for opportunties to interrupt transmission.
Your 5 Moments of Hand Hygiene

9. Standard and Transmission-Based Precautions
Barrier precautions or Personal Protective Equipment (PPE) for ALL patients when you anticipate contact with
body substances or fluids
non-intact skin
mucous membranes
Taking precautions protects YOU against patients with
Known diagnosed or suspected infections and diseases
Unknown incubating diseases or colonized with infectious organisms

10. Direct and Indirect Contact

11. Droplets, Splashes

12. Airborne N95 Respirator: requires fit testing
PAPR: Powered Air Purifying Respirator

13. What’s wrong with these pictures?? (note, staged scenarios)
Beware of fomite
contamination..

14. University of Utah HAI Prevention Goals
Catheter associated urinary tract infections
AKA “CAUTI”
Central line associated bloodstream infections
AKA “CLABSI”
YOU are a critical team member in assessing the need for invasive devices
Be aware if a device is in place
Understand the indications for invasive devices
Communicate daily with the nurses and your attending

15. Indications for a Urinary Catheter

16. Indications for a Central Venous Catheter
Resuscitation
Hemodynamic monitoring
Vasopressors
Chemotherapy, TPN, or other caustic meds
includes some antibiotics
Transvenous pacing
Plasmapheresis, apheresis, hemodialysis, continuous renal replacement therapy (CRRT)
All peripheral access exhausted

17. Bloodborne Pathogen Exposure Risks
HBV
30% from a needle stick (10% chronic infection)
Effective vaccine
Effective post exposure treatment
HCV
3% from a needle stick (85% chronic infection)
No vaccine
No good post exposure (treat if become infected)
HIV
0.3% from a needle stick (100% chronic infection)
Effective post exposure treatment (get ASAP!)

18. Exposure to Blood or Body Fluids
PREVENTION!
BSP, Hand Hygiene, PPE, Vaccination
Go ASAP to the Work Wellness Center (WWC) during open hours, or
ED if WWC closed, then follow up with WWC!
Source patient testing by WWC or Nursing Supervisor
Exposures in Community Clinics/other facilities
most handled onsite, ask your Supervisor
Complete Worker’s Comp form w/ your Supervisor & send to HR
WWC confidentially evaluates & provides free follow-up or Rx based on CDC guidelines

19. EXTREME Care with all Sharps
The person who uses the sharp
puts it into the sharps container
NEVER recap, break or bend needles
BE AWARE OF YOUR ENVIRONMENT

20. Link has policies, protocols, etc..

21. Questions? Call the Infection Prevention and Control Office at 581-2706