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HNMC Nurses' Orientation

Infection Prevention and Control
by

Valerie Clark

on 14 February 2014

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Transcript of HNMC Nurses' Orientation

All of this info and more can be found on the Intranet!
Respiratory Screening Tool in Cerner is to be completed for all new patients upon admission


Patient to be automatically placed in Airborne Isolation in negative pressure room if:
PPD is placed/ordered
Any part of diagnosis includes “suspect or rule out TB”


If the patient has had exposure to TB currently has 2 or more symptoms, place a surgical mask, initiate Airborne Precautions, and notify Infection Control immediately. Patient requires a negative pressure room
Patient Assessment for Tuberculosis
Limit patient transport to essential purposes only

Do portable chest x-rays

Patient will wear a SURGICAL mask
ER C11-12; SICU 706, 707; WA 172, 174;

MICU 2042, 2043, 2056, 2056;

North Tower 375, 475, 575, 677

South Tower 5033, 5028, 5029, 6033, 6028, 6029,

Also in Endo, Dialysis, OR Rm 2
Airborne Isolation
Large droplets that are generated when patient talks, coughs, sneezes, or when procedures are performed

Diseases include H. influenza, N. meningitidis, pertussis, adenovirus, flu, mumps, rubella

Minimum PPE to wear – regular surgical mask

Place surgical mask on patient to transport
Droplet Isolation
Discontinuation Criteria
Patients meeting the following high risk criteria will receive an MRSA nares screen:
ICU Admits/transfers

Designated Pre-Op Patients (SCIP procedures)

Previous History of MRSA

Patients admitted/transferred from a Nursing Home or other Healthcare Facility

Dialysis Patients

Patients with a visualized/report of an open/draining wound

Morbidly obese/bariatric patients
MRSA Active Surveillance
copyright 2004 IP&MA
Minimum PPE – Gloves and Gown!! Sometimes a mask.

Use a private room

Check Infection Control Isolation Census daily

Sticker on chart and door
Most commonly used Isolation – Green Sticker
Used for MRSA, VRE, other MDROs, ESBLs, lice, RSV, C.difficile, large draining wounds that cannot be contained in a dressing, diarrhea of unknown etiology
Contact Isolation
1.
Place
appropriate sticker on patient’s chart and door.

2.
Check
PPE boxes for isolation supplies
Don’t forget temp-a-dots and disposable blood pressure cuffs!

3.
Notify
ICP of isolation
Call x2333
Chart in Cerner
Isolation at HNMC
Indications for Isolation
History of MDRO (Check the Medical History & Problems tab on PowerChart)
Current colonization or infection (based on current labs)
Isolation table is in the Infection Control Manual on Intranet

Initiate Isolation
Nurse is responsible for obtaining order for isolation.
If physician is unavailable, nurse can initiate isolation for conditions listed in Isolation Table
Notify physician ASAP to obtain order for isolation
Isolation at HNMC
Solicit assistance from a coworker.

Perform hand hygiene before inserting the catheter.

Maintain aseptic technique.

Use gloves, and apply a sterile drape before insertion.

Clean the perineal area or penis with an antiseptic solution.

Use the smallest catheter possible to minimize urethral trauma.

Insert the catheter using sterile technique, according to your facility's policy.

Properly secure the catheter to prevent movement and urethral traction.

Document the indication for catheter use and the date and time the catheter was inserted.
Insertion of a Urinary Catheter
Other options
Straight Cath
Condom Cath
Bed Pan
Bedside Commode
Absorbent underpads/chucks
UTI Prevention
Acute Urinary Retention/obstruction
Need for accurate measurements in CRITICALLY ILL patients
Recent urological surgery
Assist in healing of open sacral or perineal wounds (stage ¾) in incontinent patients
Patients admitted with a chronic Foley in place
Patients who require prolonged immobilization (unstable spine, multiple traumatic injuries, etc.)
To improve comfort for end of life care
UTI Prevention
Hand Hygiene (always a good answer)

Convenience is NOT okay

Assess the need for catheterization prior to insertion and every 24 hours thereafter
UTI Prevention
80% of UTIs
are attributable to an indwelling urethral catheter.

12%-16%
of hospital inpatients will have a urinary catheter at some time during their hospital stay.

When an indwelling urethral catheter remains in situ, the
daily risk of acquisition is from 3% to 7%

Catheter use is also associated with other
negative
outcomes
Nonbacterial urethral inflammation
Urethral strictures
Mechanical trauma.
UTI Statistics
1. Elevation of the head of the bed to between 30 and 45 degrees

2. Daily “Sedation Vacation” and daily assessment of readiness to extubate

3. Peptic ulcer disease (PUD) prophylaxis

4. Deep vein thrombosis (DVT) prophylaxis (unless contraindicated)

5. Oral Care – Sage products
Ventilator Bundle Elements

In early studies, it was reported that
10%-20%
of patients undergoing ventilation developed
VAP.

Recent publications report rates of VAP that range from
1 to 4 cases per 1,000 ventilator days.

Rates may exceed
10 cases per 1,000
ventilator days in some neonatal and surgical patient populations.

The mortality attributable to VAP may exceed 10%

Patients with VAP require
prolonged
periods of mechanical ventilation,
extended
hospitalizations,
excess use
of antimicrobial medications, and
increased
direct medical costs.
Pneumonia Statistics
+
Hand hygiene – always a good answer!!

Maximal barrier precautions

Chlorhexidine skin antisepsis

Optimal catheter site selection

Date / Initial dressing

Place biopatch
During Insertion
Catheter Related Blood Stream Infections Occurs in 2 ways:
Seeded into the bloodstream during insertion when sterility is compromised and break down in aseptic technique occurs.

Improper maintenance of central line causes bacteria to enter the catheter during use.
The non–inflation adjusted attributable cost of CLABSIs has been found to vary from
$3,700 to $29,000 per episode.

Increases length of stay by 6.5 days
Importance of CLABSI prevention

Focus on device related infections
UTI, BSI, VAP, MRSA, VRE

Reported monthly to corporate

Shared at unit staff meetings
Balanced Scorecard
Elements of Standard Precautions
Hand Hygiene
Hand Hygiene at HNMC

Balanced Score Card

IHI / NPSG Bundle
Catheter related BSI
Catheter related UTI
Ventilator associated pneumonia

Isolation at HNMC
Outline
NURSE’S ORIENTATION
INFECTION CONTROL

HOUSTON NORTHWEST MEDICAL CENTER
Patients on isolation precautions should be discouraged from leaving their room.

Patient Rules for Isolation can be found in the Infection Control Manual for printing.

Airborne and Droplet Precautions
Patients should wear a surgical mask and wash hands before leaving room.
Notify receiving department of isolation status.

Contact Precautions
Patients should be instructed to wash hands before leaving room.
Wounds should be covered by a dressing.
Notify receiving department of isolation status.
Ambulation of Patients on Isolation
Things to Remember about Isolation
Best Practices
Receive the appropriate antibiotic within 1 hour prior to incision
Use Chloraprep for skin antisepsis
Glucose control
Maintain a glucose level < 200
Temperature control
Maintain temperature ≥ 96.8ºF
Follow all hospital and manufacturer recommendations for dressing changes

Other considerations
Pre-op skin cleansing with CHG
Waterless scrub
Preventing Surgical Site Infections
Central Line Maintenance
If hands are not visibly soiled, HCWs can use an alcohol-based hand rub for decontamination
No artificial nails allowed for health-care workers with direct patient care
Gloves do not replace need for hand hygiene
Wash hands directly before care
No plants or flowers in ICU patient rooms
Do not eat or drink in patient care areas or where medication or sterile supplies are stored
Maintain refrigerator logs
Store medication, food and laboratory specimens/ biologicals separately
Warren DK, Quadir WW, Hollenbeak CS, et al. Attributable cost of catheter associated bloodstream infection among intensive care patients in a nonteaching hospital. Crit Care Med 2006; 34:2084 2089.
Do not share equipment-all equipment that is not disposable MUST be disinfected before leaving the room

Use temp-a-dot thermometers, disposable BP cuffs

Disinfect beds, call buttons, bed tables, regularly with Cavi-Wipes as you go (3 minute contact time)

Consider everything in room as contaminated

Patient must be off antibiotics for 24 hours

MRSA screening culture of nares and original site of infections-both must be negative
For MRSA:
For VRE:
Patient is off antibiotics for 7 days

3 cultures-72 hours apart- of rectal and original site of infection
For other MDRO:
Patient had full dose of 10 days of antibiotics

No diarrhea

Negative screens not required
Patient is off antibiotics for 24 hours

Negative culture from the original site of infection
For C.diff:
Negative Pressure Rooms:
Process for Respiratory Screen:
Reasons for Insertion
Avoid unnecessary catheterization
Where to Document...
Document under 'Adult Admission History'
For more information, please review the Lippincott Manual on Etenet
Contact time:
the minimum amount of time the disinfectant must be in contact with the surface or instrument to be effective

3 MINUTES

Look on the back of the container
Patient Care Equipment
copyright 2011 IP&MA

Items that would release blood or other potentially infectious materials in a liquid or semi-liquid state
Items that are caked with dried blood or other potentially infectious materials
Contaminated sharps
Pathological and microbiological wastes

*Dispose of in RED Biohazardous container
Regulated Biohazardous Waste
copyright 2011 IP&MA
Surgical Site Statistics
SSI increased length of stay by
9.7
days
Increased cost by
$20,842
per admission
1. de Lissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control 2009;37:387-97.
SURVEY ?
In which of the following situations should hand hygiene be performed?

A. Before having direct contact with a patient?

B. Before inserting an invasive device

C. When moving from a contaminated body site to a clean body site

D. After direct contact with a patient or items in the patient's room

E. After removing gloves
SURVEY ?
How are antibiotic-resistant pathogens most frequently spread from one patient to another in health care settings?

A. Airborne spread resulting from patients coughing or sneezing

B. Patients coming in contact with contaminated equipment

C. From one patient to another via the contaminated hands of clinical staff

D. Poor environmental maintenance
SURVEY ?
Which of the following infections can be potentially transmitted from patients to clinical staff if appropriate glove use and hand hygiene are not performed?

A. Herpes simplex virus infection
B. Colonization of infection with methicillin-resistant Staphylococcus aureus (MRSA)
C. Respiratory syncytial virus (RSV)
D. Hepatitis B virus infection
E. All of the above
www.health.gov/hai/trainings/partneringtoheal.html
CHG Bathing
ICU ONLY:
Patients will receive a DAILY bath with Hibiclens
Med/Surg:
In-patients going to surgery will receive a bath the night before and the morning of a scheduled surgery
Foley Maintenance Bundle
Appropriate indication is determined daily (reassessment necessary EVERY day)

Tubing not looped/kinked

Foley anchored with StatLock

Bag not on floor

Bag below bladder

Bag not full

System is sealed/closed
http://www.cfmc.org/files/jerris_story.html
Full transcript