Evidence-Based Strategies to Tackle the Three Most Common Sources of HAIs: Contaminated Hands, Envir...
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Evidence-Based Strategies to Tackle the Three Most Common Sources of HAIs: Contaminated Hands, Environmental Surfaces, and Skin Cindy Winfrey, MSN, RN, CIC Senior Medical Science Liaison PDI Healthcare. Financial Disclosures. PDI Healthcare-Employee. Objectives.

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Evidence-Based Strategies to Tackle the Three Most Common Sources of HAIs: Contaminated Hands, Environmental Surfaces, and SkinCindy Winfrey, MSN, RN, CICSenior Medical Science LiaisonPDI Healthcare


Financial disclosures

Financial Disclosures Sources of HAIs: Contaminated Hands, Environmental Surfaces, and

PDI Healthcare-Employee


Objectives
Objectives Sources of HAIs: Contaminated Hands, Environmental Surfaces, and

  • Discuss the impact of contaminated environmental surfaces, hands (of both patients and healthcare providers), and skin in the transmission of Healthcare Associated Infection

  • Review the current research gaps for pediatric Infection Prevention literature

  • Discuss strategies to meet and exceed Joint Commission NPSG 7

  • Discuss patient and family involvement and empowerment strategies to reduce the incidence of HAIs


Could this be you
Could this be You? Sources of HAIs: Contaminated Hands, Environmental Surfaces, and


What do these have in common
What do these have in Sources of HAIs: Contaminated Hands, Environmental Surfaces, and common?


The importance of a checklist
The Importance of a Checklist Sources of HAIs: Contaminated Hands, Environmental Surfaces, and


Who checklist for safer surgical care
WHO Checklist for Safer Surgical Care Sources of HAIs: Contaminated Hands, Environmental Surfaces, and


Transmission of Infection Sources of HAIs: Contaminated Hands, Environmental Surfaces, and


How does transmission occur
How Does Transmission Occur? Sources of HAIs: Contaminated Hands, Environmental Surfaces, and


Pathogens of Significance Sources of HAIs: Contaminated Hands, Environmental Surfaces, and


Examples of multidrug resistance in Sources of HAIs: Contaminated Hands, Environmental Surfaces, and

HAI pathogens

  • Acinetobacterbaumannii

    • About 75% are multidrug resistant*

      • 10% increase from 2000

  • Pseudomonas aeruginosa

    • About 17% are multidrug resistant*

  • Staphylococcus aureus

    • MRSA causes about 55% of HAIs (Antimicrobial-Resistant Pathogens Associated with Healthcare Associated Infections, Annual Summary of Data Reported to the NHSN at CDC, 2006-2007)

* Percent Acinetobacterbaumanniiand P. aeruginosa in ICUs that are multidrug-resistant, NNIS and NHSN, 2000-2008. Includes ICUs only (MICU, SICU, MSICU) and device-related infections only (CLABSI, CAUTI, VAP).


How do you view mortality
How do you view mortality? Sources of HAIs: Contaminated Hands, Environmental Surfaces, and


Healthcare associated infections hais
Healthcare-Associated Infections (HAIs) Sources of HAIs: Contaminated Hands, Environmental Surfaces, and

  • 1 out of 20 hospitalized patients affected

  • Associated with increased mortality

  • Attributed costs: $26-33 billion annually

  • HAIs occur in all types of facilities, including:

    • Long-term care facilities

    • Dialysis facilities

    • Ambulatory surgical centers

    • Hospitals


Outbreaks vs endemic problems
Outbreaks vs. Endemic Problems Sources of HAIs: Contaminated Hands, Environmental Surfaces, and

  • Endemic problems represent the majority of HAIs

  • Device-associated infections

    • Catheter-associated urinary tract infections (CAUTI)

    • Central line-associated Blood stream infections (CLABSI)

    • Ventilator-associated Pneumonia (VAP)

  • Procedure-associated infections

    • Surgical site infections (SSI)

  • Adherence problems

    • Antimicrobial stewardship

    • Hand hygiene

    • Isolation precautions


Changing landscape of healthcare
Changing Landscape of Healthcare Sources of HAIs: Contaminated Hands, Environmental Surfaces, and

  • Growing populations at risk

    • Immunocompromised individuals

    • Low birthweight, premature neonates

    • Transplant recipients on immunosuppressive therapy

  • Special environments

    • Intensive care and burn units

    • Infusion services


Hhs action plan 5 year goals
HHS Action Plan 5-year Goals Sources of HAIs: Contaminated Hands, Environmental Surfaces, and

NHSN – CDC’s National Healthcare Safety Network EIP – CDC’s Emerging Infections Program

NHDS – CDC’s National Hospital Discharge Survey SCIP – CMS’s Surgical Care Improvement Project

HCUP – AHRQ’s Healthcare Cost and Utilization Project


Sources of evidence
Sources of Evidence Sources of HAIs: Contaminated Hands, Environmental Surfaces, and


Holistic bundled approach
Holistic Bundled Approach Sources of HAIs: Contaminated Hands, Environmental Surfaces, and


Impact of neonatal clabsi
Impact of Neonatal CLABSI Sources of HAIs: Contaminated Hands, Environmental Surfaces, and

Inherent risk with CVCs

Difficult to identify and treat

Prolonged & often frequent exposure to antibiotics

Major contributor of morbidity and mortality

Increased length of stay and hospital costs

Infants are especially vulnerable


Challenges to skin antisepsis evidence based approaches
Challenges to Skin Antisepsis: Sources of HAIs: Contaminated Hands, Environmental Surfaces, and Evidence-Based Approaches

Prepping the skin

  • Chlorhexidine (CHG) vs Alcohol vsPovidone-Iodine

  • CHG shown to be more effective due to residual effect.

  • CHG/alcohol solutions: 0.5% to 3.15% CHG

  • CHG/aqueous solutions: 0.5% to 4%

  • CHG recommended by the CDC Guideline for all but < 2 months

  • But, in <1000 gms, CHG associated with skin irritation

    • Andersen J Hosp Infect 2005 (2% CHG/aqueous)

    • Garland Pediatr Infect Dis J 1996 (2% CHG/alcohol)

  • CHG studies currently being conducted for safety in neonates

  • 61% of US NICU Medical Fellowship Directors reported using CHG

    • Tamma ICHE, 2010

      NICU compromise


  • The debate of chg in neonates
    The Debate of CHG in Neonates Sources of HAIs: Contaminated Hands, Environmental Surfaces, and


    Skin antiseptic agents
    Skin Antiseptic Agents Sources of HAIs: Contaminated Hands, Environmental Surfaces, and

    • Choice varies with age

      • Population based complications

      • < 2 months

        • EGA

        • Post natal age

    • Agents

      • 2 to 3.15% CHG - alcoholic formulation

      • CHG - aqueous formulation

      • Povidoneiodine

    • Removal considerations

      • Normal Saline

      • Sterile Water


    Survey of neonatal chg use
    Survey of Neonatal CHG Use Sources of HAIs: Contaminated Hands, Environmental Surfaces, and

    • Survey of Neonatology Fellowship Directors in the United States

    • 61% reported use of CHG for skin antisepsis for neonates

      • 51% limited use on basis of birth weight, gestational age or chronological age.

      • Skin reactions (erythema, erosions, burns) occurring primarily in those weighing <1500 grams were reported by 51%. 

      • No difference in adverse events between the alcoholic or aqueous CHG preparations

        Tamma, Aucott, & Milstone, 2010




    Do you have these
    Do You Have These? Insertions


    Best practices for disinfection of non critical items
    Best Practices for Disinfection of InsertionsNon-Critical Items

    Examples include surfaces in the environment and medical equipment used in patient care





    State of prevention knowledge and science
    State of prevention knowledge and science Insertions

    • Guidelines developed for each type of infection and based on systematic reviews of medical literature

      • Prevention of central line-associated blood stream infections

      • Prevention of catheter-associated urinary tract infections

      • Prevention of surgical site infections

      • Prevention of healthcare-associated pneumonia

      • Management of multidrug-resistant organisms

    • Recommendations graded according to evidence

    • Guidelines contain many recommendations

    • Current efforts to help prioritize interventions that are most effective


    Adherence to infection control guidelines is incomplete
    Adherence to infection control guidelines is incomplete Insertions

    • Many HAIs are preventable with current recommendations

    • Failure to use proven interventions is unacceptable

    • Only 30%-38% of U.S. hospitals are in full compliance

    • Just 40% of healthcare personnel adhere to hand hygiene

    • Insufficient infection control infrastructure in non-acute care settings has allowed major lapses in safe care


    Local success fuels national prevention Insertions

    National

    Regional

    Facility

    Unit


    National Insertions

    CDC knowledge and data fuels local to national CLABSI prevention

    • Nationalexpansion of CLABSI prevention

    • 60% Reduction in CLABSI between 1999-2009

    • State-based public reporting using NHSN

    • State/regional prevention collaboratives (CUSP, Recovery Act projects)

    • CMS/IPPS – hospitals report CLABSIs for full Medicare payment

    Regional

    • Subsequent projects based upon CDC prevention:

    • Michigan Keystone

    • Institute for Healthcare Improvement

    • Others

    Facility

    Unit

    Outbreak Investigations

    Pittsburgh Regional Healthcare Initiative

    First successful, large-scale CLABSI prevention demonstration project

    NHSN Data

    CDC Guidelines

    Prevention Research (e.g. chlorhexidine bathing)

    Inputs

    Outputs


    The Insertions need for HAI prevention research

    Prevented

    • Need for complete implementation of practices known to prevent HAIs

    Preventable

    Healthcare-associated Infection

    • Need for ongoing research to identify new strategies to prevent the remaining HAIs

    Prevention Approach Unknown


    Prevention
    Prevention Insertions

    Hand hygiene

    No touch technique

    Dressing

    Skin antisepsis

    Injection cap/needleless connector


    Consumers Insertions

    Medical

    Professionals

    Public Health

    Safe Healthcare is Everyone’s Responsibility

    Patients

    Payors

    Government

    Healthcare

    Facilities


    Hypothetical
    Hypothetical ? Insertions

    If you knew……………………….

    That you could do something simple, easy, cost effective, and that was

    Evidence-Based, but took a little extra time…..

    Would you do it?????


    Questions
    Questions Insertions

    • Whose Infection will you prevent when you return to your institution?

    • Contact Information:


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