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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 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 • 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 • Duration on mechanical ventilator • Decreased level of consciousness • Weak immune system • Preexisting lung
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 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 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) 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’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’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 • 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.
