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HOSPITAL ACQUIRED INFECTIONS. VENTILATOR ASSOCIATED PNEUMONIA & MRSA Leyla Chiepodeu & Ernest Oppong. BACKGROUND. HAIs are a major public health problem 1.7 million HAI in 2012 99,000 deaths occurred from HAI in 2012. PURPOSE.

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Hospital acquired infections

HOSPITAL ACQUIRED INFECTIONS

VENTILATOR ASSOCIATED PNEUMONIA & MRSA

Leyla Chiepodeu & Ernest Oppong


Background
BACKGROUND

  • HAIs are a major public health problem

  • 1.7 million HAI in 2012

  • 99,000 deaths occurred from HAI in 2012


Purpose
PURPOSE

  • Discuss risks factors associated with Ventilator Associated Pneumonia (VAP) and Methicillin Resistant Staphylococcus Aureus ( MRSA)

  • Explore methods that will help reduce or eliminate them


Risk factors associated with vap
RISK FACTORS ASSOCIATED WITH VAP

  • Duration on mechanical ventilator

  • Decreased level of consciousness

  • Weak immune system

  • Preexisting lung


Methods of prevention
METHODS OF PREVENTION

  • Standard precaution

  • Mouth care with chlorhexidine

  • Head of the bed higher than 30 degree

  • Oral endotracheal

  • “Sedation vacation”

  • Conversion of tracheostomy tube when MV no longer needed


Methicillin resistant staphylococcus aureus
Methicillin Resistant Staphylococcus Aureus

BACKGROUND

  • First described in 1960’s

  • Hospital acquired MRSA infection costs about $35,367 compared with $13,973 for other HAI’s.

  • In 2005, Virginia passed a bill requiring acute care hospitals in the Commonwealth to report healthcare-associated infections to the Centers for Disease Control and Prevention (CDC). The law went into effect July 1, 2008.


Plan

  • 1. Developing/Enhancing HAI Program Infrastructure;

  • 2. Surveillance, Detection, Reporting, and Response;

  • 3. Prevention and control

  • 4.Evaluation, Oversight, and Communication.


Prevention and control
Prevention and control

Hand Hygiene

  • Most important method in preventing spread of infections is HAND HYGIENE.

    • Hand sanitizer, hand washing

    • Noncompliance may be due to poor knowledge of guidelines,

      inadequate facilities, time pressures, skin dryness.

      Adherence to antibiotic regimen

    • Prescribers need to use narrow-spectrum antibiotics when appropriate

      and reduce the duration of therapy when appropriate.

    • Teach patients to take antibiotics as prescribed and to finish the whole course of medication therapy.


Prevention and control cont d
Prevention and control (cont’d)

Isolation precautions

  • Use universal standard precautions for handling body fluids

  • Wear gown/gloves

  • Follow hospital/clinic isolation protocol

  • Remove and dispose PPE in patients room and wash your hands prior to leaving the patients room.

  • Make sure visitors are aware of isolation status and recommend them to don PPE prior to entering patients room.

  • If appropriate leave equipment in patients room.


Prevention and control cont d1
Prevention and control (cont’d)

Room environment/Equipment

  • Follow strict room decontamination procedures after patient discharge and make sure all equipment are wiped down.

  • All surfaces in the room are presumed contaminated and should be cleaned.


Prevention and control cont d2
Prevention and control (cont’d)

Surveillance

  • Screen most patients on admission and ideally upon discharge (critical care)

    • May be cost effective in the long run

    • Early detection

  • Surveillance of health care providers to increase compliance

    • Video surveillance – Cost, HIPAA

    • Self Reporting – Honesty issues

    • Measuring equipment use – Cost effective, not very reliable

      Education

    • Patient education

    • Nurse education


References
References

  • Blot, S., Serra, M., Koulenti, D., Lisboa, T., Deja, M.,Myrianthefs, P., Manno,E., Diaz, E.,Topeli, A., Martin-Loeches, I., Rello, J., (2011). Patient to nurse ratio and risk of ventilator-associated pneumonia in critically ill patients. 20:1-9

  • Cason, C., Tyner, T.,Saunders,S., Broome, L., (2007). Nurses’s implementation of guidelines for ventilator-associated pneumonia from the centers for disease control and prevention, 16(1), 28-37.

  • McNicoll, L., &Marsella, M. (2010). The Growing Problem of Methicillin-resistant Staphylococcus aureus: Will Hospitals Prevail?. Medicine & Health Rhode Island, 93(9), 267-270.

  • TorpyJM, Lynm C, Glass RM. Ventilator-Associated Pneumonia. JAMA. 2007;297(14):1616. doi:10.1001/jama.297.14.1616.


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