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Hospital Patient Safety Initiatives: Infection Control. Bernard C. McDonnell, DO. Urinary Catheter Tracer. Use of urinary catheters in a manner to minimize infection Hospital maintains guidelines for appropriate use of urinary catheters Hand hygiene Before and after insertion

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urinary catheter tracer
Urinary Catheter Tracer
  • Use of urinary catheters in a manner to minimize infection
    • Hospital maintains guidelines for appropriate use of urinary catheters
    • Hand hygiene
      • Before and after insertion
    • Placement of catheter using aseptic technique
    • Catheter properly secured after insertion
urinary catheter tracer1
Urinary Catheter Tracer
  • Catheter insertion and indication are documented
  • Hand hygiene before and after manipulation of catheter
  • Avoid irrigation
  • Collection bag emptied using aseptic technique
  • Aseptic collection of urine samples
    • Small amounts through needleless port
urinary catheter tracer2
Urinary Catheter Tracer
  • Keep urine collection bag below level of bladder at all times
  • Catheter tubing unobstructed with no kinking
  • Need for catheter reviewed daily
    • Prompt removal when deemed unnecessary
      • No “convenience”
central venous catheter tracer
Central Venous Catheter Tracer
  • Central venous catheters are inserted, assessed and maintained in a manner to minimize infection
    • Hand Hygiene performed before and after insertion
    • Maximal barrier precautions used for insertion
      • Surgical protection including full patient body drape
    • Use of >0.5% chlorhexidine with alcohol used for skin antisepsis prior to insertion
      • Can use tincture of iodine, iodophor or 70% alcohol alternatively
central venous catheter tracer1
Central Venous Catheter Tracer
  • Dressing to cover catheter insertion site
    • Sterile gauze
    • Transparent, semi-permeable dressing
      • Well healed and tunneled catheters may not need to be covered
  • Central line insertion and indication documented
  • Hand hygiene performed before and after manipulating catheter
    • Gloves
    • Soiled dressings are changed promptly
    • All dressings changed using aseptic technique
      • Gloves
central venous catheter tracer2
Central Venous Catheter Tracer
  • Access port is scrubbed with an appropriate antiseptic prior to accessing
    • Chlorhexidine
    • Povidone iodine
    • An iodophor
    • 70% alcohol
  • Catheter accessed with sterile devices
  • Need to central venous catheters reviewed daily with prompt removal when not necessary
ventilator respiratory therapy tracer
Ventilator/Respiratory Therapy Tracer
  • Respiratory procedures are performed in a manner consistent with hospital infection control policies to maximize the prevention of infection and communicable disease
    • Hand hygiene
    • Gloves
    • Sterile water for nebulization
    • Single dose vials for aerosolized medications
      • Using manufacturer’s instructions for handling, storing and dispensing of medications
ventilator respiratory therapy tracer1
Ventilator/Respiratory Therapy Tracer
  • If multi-dose vials for aerosolized medications are used for more than one patient—
    • Restricted to a centralized medication location
    • They do not enter the immediate patient treatment area
ventilator respiratory therapy tracer2
Ventilator/Respiratory Therapy Tracer
  • Ventilators are used in a manner consistent with hospital infection control policies to maximize the prevention of infection and communicable disease
      • Ventilator circuit is changed if visibly soiled or mechanically malfunctioning
      • Sterile water is used to fill bubbling humidifiers
      • Condensate in tubing is periodically drained and discarded
        • Condensate should not drain toward the patient
ventilator respiratory therapy tracer3
Ventilator/Respiratory Therapy Tracer
  • Use of sterile single-use suction catheter
  • Multi-use closed system catheter
    • Only sterile fluid is used to remove secretions
  • Sedation is lightened daily in eligible patients
  • Spontaneous breathing trials are performed daily in eligible patients
    • “Weaning”
spinal injection procedures
Spinal Injection Procedures
  • Spinal injection procedures are performed in a manner to minimize infection and the spread of communicable disease
    • Hand hygiene
    • Spinal injection
      • Aseptic technique
      • Surgical masks are used when placing a catheter or injecting materials into the epidural or subdural space
point of care devices
Point of Care Devices
  • Blood Glucose Meter
  • INR Monitor
point of care devices1
Point of Care Devices
  • Hand hygiene
  • Gloves
    • Used for “finger-stick” procedures
      • Removed after the procedure
        • Followed by hand hygiene
  • Finger stick devices are used for 1 patient
    • Lancet
    • Lancet holding device
point of care devices2
Point of Care Devices
  • Point of Care device is cleaned and disinfected after every use according to manufacturer’s instructions
    • Single use only if no manufacturer’s instructions for cleaning and disinfection
isolation contact precautions
Isolation/Contact Precautions
  • Patients requiring contact isolation are identified and managed in a manner consistent with hospital infection control policies and procedures to maximize the prevention of infection and communicable disease
isolation contact precautions1
Isolation/Contact Precautions
  • Gloves are available and located near point of use
  • Signs indicating that the patient is in contact isolation
  • Patients in contact isolation are in single rooms
    • Can be cohorted based on clinical risk assessment
isolation contact precautions2
Isolation/Contact Precautions
  • Soap and water must be used when bare hands are visibly soiled (e.g., blood, body fluids) or after caring for a patient with known or suspected C. difficile or norovirus during an outbreak. In all other situations, ABHR is preferred.
isolation contact precautions3
Isolation/Contact Precautions
  • Gloves and gowns
    • Before entering patient care environment
    • Removed and discarded; hand hygiene is performed before leaving the patient care environment
isolation contact precautions4
Isolation/Contact Precautions
  • Dedicated or disposable noncritical patient- care equipment (e.g., blood pressure cuffs) is used or if not available, then equipment is cleaned and disinfected prior to use on another patient according to manufacturer's instructions.
isolation contact precautions5
Isolation/Contact Precautions
  • Traffic control
    • Into patient’s room
    • Patient moving out of the room to other parts of the hospital
  • Contact precautions outside the patient’s room
  • Cleaning of objects and patient care areas that are touched in patient’s isolation room
    • When visibly soiled
    • At least once a day
  • Terminal cleaning
    • All surfaces thoroughly cleaned and disinfected and all textiles are replaced with clean textiles
  • Cleaners and disinfectants are labeled and used in accordance with hospital policy and procedure and manufacturer’s instructions
isolation droplet precautions
Isolation: Droplet Precautions
  • Patients requiring Droplet Precautions are identified and managed in a manner consistent with hospital infection control policies and procedures to maximize the prevention of infection and communicable disease including the following:
isolation droplet precautions1
Isolation: Droplet Precautions
  • Masks
    • On entering
    • Discarded when leaving
  • Signs
  • Patient on droplet precautions are housed in a single room or cohorted based on clinical risk assessment
  • Hand hygiene
  • Limited patient movement for droplet isolation patients
    • Medically necessary procedures
    • Patient wears surgical mask when transported
    • Communication of patient’s status
isolation droplet precautions2
Isolation: Droplet Precautions
  • Cleaning
    • Once a day per policy and manufacturer’s instruction while patient is admitted
    • Terminal cleaning after discharge including wiping and disinfection of all hard surfaces
      • Changing all textiles in the isolation room
    • All cleaners are used in accordance with hospital policy and procedure and manufacturer’s instructions
isolation airborne precautions
Isolation: Airborne precautions
  • Patients requiring Airborne Precautions are identified and managed in a manner consistent with hospital infection control policies and procedures to maximize the prevention of infection and communicable disease including the following:
isolation airborne precautions1
Isolation: Airborne precautions
  • Use of N-95 or higher particulate respirators
    • Available and near point of use
    • Signs indicating patient is on airborne precautions
      • Clear and visible
  • Patients on airborne isolation are housed in airborne isolation rooms
  • Hand hygiene before entering
    • And leaving
  • N-95 or higher particulate respirator to be worn when entering patient room for confirmed or suspected TB
isolation airborne precautions2
Isolation: Airborne precautions
  • Facility limits movement of patients on airborne isolation to medically necessary purposes
    • Patient wears surgical mask per hospital policy
    • Hospital has means to communicate patient’s status
surgical procedure tracer
Surgical procedure tracer
  • Surgical procedures are performed in a manner consistent with hospital infection control policies and procedures to maximize the prevention of infection and communicable disease including the following:
surgical procedure tracer1
Surgical procedure tracer
  • Surgical scrub before donning of sterile gloves for a surgical procedure in the OR
    • Use of either
      • Antimicrobial surgical scrub
      • FDA-approved alcohol-based antiseptic surgical hand rub
    • Visibly soiled hands should be washed with soap and water prior to the above procedures
    • After surgical scrub hands and arms are dried with a sterile towel and sterile surgical gown and gloves are donned in the OR
surgical procedure tracer2
Surgical procedure tracer
  • Surgical attire
    • Scrubs
    • Surgical caps/hoods covering all head and facial hair
      • Worn by all personnel in semi restricted and restricted areas
  • Restricted areas include
    • OR
    • Procedure rooms
    • Clean core
  • Semi restricted areas include
    • Peripheral support areas of the surgical suite
surgical procedure tracer3
Surgical procedure tracer
  • Masks
    • Properly tied and fully covering mouth and nose are worn by all personnel in restricted areas where open sterile supplies or scrubbed persons are located
  • Sterile drapes are used to establish the sterile field
  • Sterile field
    • Items in sterile field are sterile
    • Items introduced to the sterile field are opened, dispensed and transferred in a manner to maintain sterility
    • Established in a location where it will be used and as close as possible to the time of use
    • Movement around the sterile field is done in a manner to maintain sterility
surgical procedure tracer4
Surgical procedure tracer
  • Traffic in and out of the OR is kept to a minimum and is limited to essential staff
    • Traffic Control Policies and Procedures
  • Surgical masks are removed when leaving the sterile areas and are not reused when returning
surgical procedure tracer5
Surgical procedure tracer
  • Cleaners and disinfectants
    • Used according to hospital policy and procedure and manufacturer’s instructions
surgical procedure tracer6
Surgical procedure tracer
  • Cleaning—start of the day
    • Horizontal surfaces
      • Damp dusted with a lint-free cloth and EPA-registered hospital detergent/disinfectant
  • High touch surfaces cleaned and disinfected between patients
  • Anesthesia equipment is cleaned and disinfected between patients
  • Reusable noncritical items (BP cuffs, etc.) are cleaned and disinfected between patients
surgical procedure tracer7
Surgical procedure tracer
  • Terminal cleaning of Operating Rooms
    • After the last procedure of the day
      • Including weekends!
      • Includes
        • Wet-vacuuming or moping the floor with an EPA-registered disinfectant
      • All surfaces
      • Internal components of anesthesia machine breathing circuit are cleaned according to manufacturer’s instructions
surgical procedure tracer8
Surgical procedure tracer
  • Ventilation requirements
    • Positive pressure, 15 air exchanges per hour—at least 3 of which are fresh air
    • 90% filtration
      • HEPA optional
      • Air filters are checked regularly and replaced according to hospital policies and procedures
      • Temperature and relative humidity are maintained at required levels
      • Doors are self-closing
      • Air vents and grill work are clean and dry
a protective environment e g bone marrow patients
A Protective Environment (e.g. Bone Marrow patients)
  • Positive pressure—air flow out to the corridor from the room
  • 12 air exchanges per hour
  • Supply air is HEPA filtered
  • Well sealed rooms so that there are no penetration spaces in the walls, ceilings or windows
  • Self closing door that fully closes on all room exits
  • Failures are addressed and documented
  • Ventilation requirements are monitored using visual methods
    • “Kleenex test”; flutter strips, etc.
questions
QUESTIONS?

Please submit questions to:

info@hfap.org