1. Infection Control: it’s everybody’s business

2. Objectives Hand Hygiene Isolation Practices Environment of Care
Respiratory Virus Prevention Campaign

3. Hand Hygiene: Not a New Concept
Semmelweis’ Hand Hygiene Intervention
After Semmelweis insisted that students and physicians clean their hands with a chlorine solution between each patient, the maternal mortality rate in the First Clinic dropped.
Maternal mortality rate in the First Clinic dropped dramatically and remained low for years.
This is the first evidence indicating that cleansing heavily contaminated hands with an antiseptic agent between patient contacts may reduce healthcare-associated transmission of contagious diseases more effectively than handwashing with plain soap and water.
~ Hand antisepsis reduces the frequency of patient infections ~
Adapted from: Hosp Epidemiol Infect Control, 2nd Edition, 1999

4. Could this be your hand?
Culture plate showing growth of bacteria 24 hours after a healthcare provider placed their hand on the plate

5. Germs Are Everywhere-- Healthcare workers pick up germs on their hands by:
pulling patients up in bed
taking blood pressure or pulse
touching a patient’s hand
rolling patients over in bed
touching patient’s gown or linens
touching equipment such as bedside rails, over-bed tables or IV pumps
Touching computer keyboard in nursing stations

6. X represents VRE culture positive sites
The Inanimate Environment Can Facilitate Transmission
X represents VRE culture positive sites
In one study, hands of 131 healthcare workers (HCWs) were cultured before, and hands and gloves after, routine care.
A mean of 56% of body sites and 17% of environmental sites were VRE positive.
After touching the patient and environment, 75% of ungloved HCWs hands and 9% of gloved HCWs hands were contaminated with VRE.
After touching only the environment, 21% of ungloved and 0 gloved HCWs hands were contaminated.
The inanimate environment plays a role in facilitating transmission of organisms.
~ Contaminated surfaces increase cross-transmission ~

7. HAND HYGIENE When to wash with soap & water: ALWAYS:
If hands have had contact with any body fluid
Blood, mucous, wound drainages, stool, urine, etc.
Patients’ …..or…..
YOURS!!!
If hands are visibly soiled
Before eating/drinking
After using restroom

8. HAND HYGIENE --using alcohol-based hand gel (Or soap and water).
When—
Hands not visibly soiled or
contaminated w/ blood/body fluid
ALWAYS Before:
Every patient contact
Donning gloves
Moving from contaminated to clean body-site

9. HAND HYGIENE -using alcohol-based hand gel (or soap and water)
ALWAYS After:
Touching a patient
Removing gloves and other PPE
Touching equipment or anything else in patient’s environment!!!!!

10. HAND HYGIENE: Using Soap & Water
How
Soap and water
15-30 second duration
Scrub palms, backs, webs, nails
Always use if visible soil on hands
Use Friction!!!

11. Hand hygiene: Alcohol-Based Handrubs.
Hand hygiene: Alcohol-Based Handrubs
How:
Cover all surfaces of your hands
Don’t forget backs of hands, under and around fingernails
Continue to rub into hands until dry (should take at least 15 seconds)
Don’t rinse with water!
Don’t use towel to dry hands!
Use Friction!!!

12. Round 1 -- Feb 2005 Round 2 -- March 2005 Round 3 -- May 2005
2005 Hand Hygiene Compliance Direct Observations Summary Rounds 1, 2 and 3
Round Feb 2005
76.6% Compliance (N= 316)
Round March 2005
90.5% Compliance (N= 275)
Round May 2005
92% Compliance (N= 319)

13. 418 observations done & scored
Hand Hygiene Compliance Direct Observations Summary Patient Safety Week March 2006
418 observations done & scored
90% demonstrated Good Practice (N=378)
10% violated HH Guidelines (N=40)
69% (65 of 95) patient care sites monitored
72% (88 of 123) observers reported

14. 10 Steps to Protect Patients and Yourself
with Recommended Hand Hygiene
 When to wash hands with soap and water:
1. If your hands have come in contact with any body fluid from the patient or you (blood, urine, mucous, etc.)
2. Before eating
3. and After using a restroom
When to use alcohol-based hand gel or soap and water wash:
For routine hand washing when hands are not visibly soiled with body fluids
AND Immediately BEFORE:
4. Having direct patient contact
5. Donning sterile gloves for inserting any type of catheter
6. Donning sterile gloves for performing any invasive procedure
7. Moving from a contaminated-body site to a clean-body site during patient care
AND Immediately AFTER:
8. Removing gloves
9. Touching a patient
10. Touching equipment or anything else in a patient care room
AND Finally… When in doubt WASH IT OUT
Based on CDC Guideline for Hand Hygiene in the Health-Care Setting 2002

15. Hand Hygiene Monitoring Tool – Monthly Self-assessment

16. Clean Hands Prevent Infection.
Patient Safety
Clean Hands Prevent Infection
in Patients and You

17. Standard Precautions - the forgotten process?
Treat all blood and body fluid as infectious
Assess your risk before caring for patient
Use Standard Precautions for ALL patients
Choose PPE based on
potential risk for exposure
Gloves, gown, mask,
and/or goggles

18. Transmission-Based Precautions:
Breaking the Chain
Source
Transmission
Susceptible Host
Used for important organisms based on mode of transmission
Appropriate PPE must be worn each time patient room is entered
During transport, patient dons PPE, NOT HCW

19. Transmission Precautions: Types of Isolation--
Strict:
germs can invade through many routes
Chicken pox, Disseminated zoster
Negative Pressure Room
Gown, gloves, mask
Respiratory A (Airborne):
must breathe in organisms, can stay afloat for long time
Tuberculosis
Negative Pressure Room
N95 Respirator

20. Transmission Precautions: Types of Isolation-
Contact:
Germs spread by direct or indirect contact
VRE, MRSA, other multidrug resistant organisms, Resp viruses
Gown and Gloves (w/mask if resp)
Keep door closed
Respiratory D (Droplet):
Breathe in organisms within 3 feet of source
Mumps
Pertussis
N. meningitidis
Mask

21. How are We Doing?

22. Linen Storage Clean ….. Soiled
Clean Linen:
In a supply room- Always keep door closed
On a cart in open area –
Always covered
Soiled Linen:
Removing from patient room –
Bagged in yellow linen bag
≤ 2/3 full
Transport to Soiled Linen Room –
In yellow linen bag
Placement in Dirty linen cart-
In yellow linen bag ONLY!!!

23. Patient Supply Storage and EXTERNAL Shipping Cartons
Patient supplies: 8 – 10 inches off floor
Remove pt supplies from external shipping cartons before storing in supply room
NO patient supplies may be stored under sinks
Sharps (needles, scalpels, etc), syringes must be locked up (inaccessible by patients)

24. Refrigerators Patient Food,Temp Logs, Corrective Action
Patient Refrigerators
Temperature:
MUST check and log temps DAILY*
* If center is closed on weekends, document on temp log
Is temp out of range??
Document corrective action and initial (i.e. called facilities, out of service, etc)
Food:
Only patient food permitted (no staff lunch, drinks, etc)
Is patient food labeled with name, MR#, date placed in frig?
Food coming from Isolation Patient rooms may not be stored in patient nutrition refrigerators

25. Disinfection and Sterilization Logs, QC, processes
Sterilizers-
Documentation (log) of runs – successful & unsuccessful
High level disinfection
Post the procedure
Label containers with Reagent name, date of 1st use, expiration date
Log of each run – date & time (if > 1/day)
Include serial numbers of items disinfected
QC reagent and log with each batch (reagent strips)*
* if fresh reagent used each run, document in log book with date

26. Environment of Care - Monthly Self-assessment

27. YOU are Infection Control!!
Patient Safety …..
….. IS in your hands!!!

28. RESOURCES Infection Control Manual inside.mdanderson.org
On MDACC Intranet
inside.mdanderson.org
On Lotus Notes
Call Infection Control x2-3655
Page Infection Control (24/7)