Isolation Hand Hygiene & Lab ID

1. Isolation Hand Hygiene& Lab ID

2. G.K. Chesterton

3. IsolationPrecautions Transmission Standard • Two Tiered System • Standard Precautions • Transmission Based Precautions

4. Standard Precautions Primary strategy for reducing infection risk in healthcare settings.

5. Standard Precautions • Use for ALL patients, all the time, regardless of presumed infection status. • PPE should be easy to use, easy to find, and convenient.

6. A Universal Rule If it is wet, yucky, gross and not yours…don’t touch it

7. Use of PPE • Gowns, aprons, and other PPE may be required if there is a risk of splatter of blood or body fluids onto clothes or skin. • Gloves should always be worn for Direct Patient Care, regardless of Isolation Status. Masks, goggles and face shields should be worn to protect mucous membranes.

8. Transmission Based Isolation

9. In Addition to Standard Precautions Transmission Based Isolation 2nd Tier- Can transmit disease/organism to unprotected Patient placement: Private room Cohort patients with the same organism Per facility: physician order or nursing protocol

10. Isolation Precautions Equipment Carts Stop Sign on Door Sticker on patient’s chart Alert/Flag patients Educating patients (NPSG)

11. STOP!! Airborne Precautions • Everyone must wear N95 respirator mask • while in room. • Hand Hygiene is required. • The patient will wear a surgical mask when • transported outside the room.

12. Airborne Transmission • Organisms spread by droplet nuclei (small particles) that can remain in the air for long periods of time. Invisible to eye… rides on air currents and do not fall to the ground • Organisms spread by this route: • Mycobacterium tuberculosis (TB) • Rubeola (measles) • Varicella (chickenpox, shingles) add contact also • Smallpox and SARS – add contact also

13. Airborne: Special Needs Negative Pressure Room N-95 NIOSH Approved Mask Annual Fit Testing, for evaluation of changes Keep the Door Closed Document negative pressure

14. STOP!! • Droplet Precautions • Everyone must wear a surgical mask with an • eye shield while in patient's room. • Hand Hygiene is required. • The patient will wear a surgical mask • when transported outside the room.

15. Droplet Transmission • Organisms transmitted by large droplets • These droplets do not remain in the air but drop to horizontal surfaces • Organisms spread by this route: • Mumps • Rubella • Influenza • Bordetella Pertussis (whooping cough) • Neisseria meningitidis

16. Droplet Isolation Used for diseases spread by contact of the conjunctivae, mucous membranes of the nose or mouth with large particle droplets No special ventilation required Door may remain open • Private room • Wear mask with eye shield when entering the room

17. STOP!! • Contact Precautions • Gown and gloves are worn when • entering this room. • Hand Hygiene is required. • The patient will wear clean gown • and sheet when transported • outside the room.

18. Contact Transmission • Most common Isolation Precaution • Transmission: direct contact/ indirect contact with patient or environment

19. Contact Transmission • Organisms spread by this route: • Multidrug-resistant organisms (MRSA, VRE) • Respiratory syncytial virus (RSV), parainfluenza or enteroviral infections in infants & young children • Clostridium difficile • Lice & scabies • Herpes simplex virus (neonatal or mucocutaneous)

20. Contact Isolation • Contact precautions include • Wearing gloves and gown to enter room every time. (2 hr. after patient in room the entire room is colonized) • Organisms stick to you, your clothing, bedside table, IV, bed linens, etc • Dedicate non-critical care items to patient, i.e., thermometer, B/P cuff and stethoscope • Attention to environmental cleaning • Door may remain open

21. Colonized Room Remember green “X”s the next time you go into a patient’s room. You do not have to touch the patient to contaminate your hands.

22. Fighting the Bad BoysMRSA and the Resistant Gang

23. MDRO Flagging • Communication within the system • Identifying the patient with MDRO Identify readmissions Notify IP Facility Specific (ie Standard Precautions ?)

24. MDRO Definition Multi Drug Resistant Organism Organism that has adapted to current antibiotics and are no longer susceptible or vulnerable to the effects of the antibiotics An organism that shows at least 2 different resistances on susceptibility testing

25. MDRO • Methicillin-resistant Staphylococcus (MRSA), Vancomycin-resistant Enterococcus(VRE), certain gram negative bacilli, Clostridium difficile have increased in prevalence in U.S. hospitals over the last three decades • Limited treatment options become concern • Increased length of stay • HICPAC has approved guidelines for the control of MDROs. • The MDRO and CDI modules of the NHSN can provide a tool to assist facilities in meeting some of the criteria outlined in the guidelines.

26. Risks for Resistance Inappropriate prescribing practices Failure to complete prescription Tendency to take antibiotics until feeling better then stop taking them and save what is left for the next time Prescribing practices by groups of physicians (everybody prescribing the same antibiotics) Failure to adjust antibiotics according to susceptibility

27. How to prevent resistance • Antibiotic Stewardship Program • Educate patients and their guardians when appropriate • The need to take entire prescription until it is gone • Proper hand hygiene practices • Proper environmental cleaning practices • Importance of not taking another’s prescription of antibiotics

28. STOP!! • Special • Contact Precautions • Gown and gloves are worn when entering the patient’s room. • Hand Hygiene with Soap and Water only. • The patient will wear clean • gown and sheet when transported outside the room.

29. Clostridium difficile • C. difficile infections continue to rise • C. difficile infections linked to about 14,000 deaths each year. • CDC Vital Signs • Emerging Infections Program 2010 • 94% CDI were health care associated • 75% had onset not currently hospitalized • 52% POA but largely health-care related. • Antibiotic use and healthcare exposure greatest risk factors.

30. Infection Control Strategies • Hand hygiene (Soap and water not hand gel) • Contact precautions • Identify cases within hospital (appropriate hand • hygiene and room disinfection) • Environmental disinfection • Appropriate use of antibiotics • Laboratory-based alert system for immediate notification of positive test results • Educate about CDI: HCP, housekeeping, administration, patients, families

31. Supplemental Infection Control Strategies • Extend use of Contact Precautions beyond duration of diarrhea (e.g., 48 hours)* • Presumptive isolation for symptomatic patients pending confirmation of CDI • Evaluate and optimize testing for CDI • Implement soap and water for hand hygiene before exiting room of a patient with CDI • Implement universal glove use on units with high CDI rates* • Use sodium hypochlorite (bleach) – containing agents for environmental cleaning • Implement an antimicrobial stewardship program

32. Transportation of Patients on Isolation Precautions Isolated patients should leave their rooms for essential purposes only Reverse the process when patient comes out of the room Receiving departments should be informed of patient’s status ahead of time Reverse the isolation process when patient goes out of room…. ISOLATE THE SOURCE

33. Identification of Isolation Patient Outside of Room

34. Patient-Care Equipmentin Isolation Rooms • When possible use all disposable items • Disinfect equipment coming out of room as in X-ray machine, or EKG machine, Accucheck. • Daily cleaning and disinfecting by housekeeping • No wait time after room is cleaned • Special cleaning for C. difficile spores (stabilized bleach product) Hand hygiene with soap and water recommended.

35. Environmental Services

36. Linen and Laundry Avoid contact with clothing. Minimize motion. Bag soiled linens at the bedside Transport to linen chute/dirty utility room like other laundry. All linen within patients room considered contaminated. Laundry is processed using Standard Precautions.

37. Food Trays No special precautions needed for dishes or silverware (radiation is the exception) Trays are taken directly from patient’s room to tray cart Hot water and detergents used are sufficient to decontaminate dishes and utensils http://www.cdc.gov/ncidod/dhqp/gl_isolation_ptII.html

38. TRASH Refer to your State Regulations Texas has no restriction for isolation trash. Isolation trash may go to regular land field if no blood.

39. HCW education should focus on • Mode of transmission & risk • Appropriate use of PPE • Cleaning routines for equipment • Role of hand hygiene & gloves • Components of an efficient program Patient, visitor education should be provided OSHA required Annual Blood borne pathogen training Annual Isolation Precautions training, include in Annual Competency Isolation Rounds for compliance-Sample included in packet

40. Hand HygieneThe #1 most important component of your IC program

41. Hand Hygiene Program#7 TJC NPSG • What is your compliance rate? • How assessable is your alcohol gel? • What is the motivation for hand hygiene • Staff must develop the habit: Washing hands as automatic as breathing • Foundation of the Infection Prevention Program • If it is not important to leaders It won’t be important to staff

45. Nail Your Policy Down No Artificial Nails No Overlays Natural Nails ¼ inch Fresh Nail polish OK but no chips Literature showing evidence of nails transmitting disease to patients Determine area of compliance in your hospital Coordinate with local hospitals on policy

46. Lab ID Reporting

47. Lab id core reporting • Option 1: Laboratory-Identified (LabID) Event Reporting 1A: MDRO LabID Event Reporting (MRSA Bloodstream Infection) 1B: Clostridium difficile (C. difficile) LabID Event Reporting • Option 2: Infection Surveillance Reporting 2A: MDRO Infection Surveillance Reporting 2B: C. difficile Infection Surveillance Reporting All reporting depends on your facility objectives and required reporting by state and regulatory agencies. NOTE: LabID Event reporting and Infection Surveillance reporting are two separate and independent reporting options. See Appendix 3: Differentiating Between LabID Event and Infection Surveillance for key differences between the two options.

48. Mrsanhsn definition Includes S. aureus cultured from any specimen that tests oxacillin-resistant, cefoxitin-resistant, or methicillin-resistant by standard susceptibility testing methods, or by a laboratory test that is FDA-approved for MRSA detection from isolated colonies; these methods may also include a positive result by any FDA-approved test for MRSA detection from specific sources.

49. Mrsa bacteremia definition MRSA positive blood specimen for a patient in a location with no prior MRSA positive blood specimen result collected within 14 days for the patient and location. Duplicate MRSA Bacteremia LabID Event Any MRSA blood isolate from the same patient and same location, following a previous positive MRSA blood laboratory result within the past 14 days.

50. Choose at least 1 reporting method