Infection Prevention & Control for Physicians

1. Infection Prevention & Control for Physicians Infection Prevention & Control Department 212-263-5454 (TH 9am-5pm M-F) 212-598-6767 (HJD 9am-5pm M-F) 212-263-4316 (off-hours beeper) Employee Health/Needle Stick Hotline 212-263-5020

2. Infection types in acute care settings Apic. Guide to the Elimination of Catheter-Associated Urinary Tract Infections, 2008

3. Surveillance at NYULMC occurs for the following • Hand hygiene (HH) compliance • Hospital acquired (HA) multi-drug resistant organisms (MDROs) • HA C. difficile • Standard and Isolation Precautions • Surgical site infections (SSIs) • Hip arthroplasties • CABG • Colon • Central line associated bloodstream infections (CLABIs) • Catheter associated urinary tract infections (CAUTIs)

4. Hand Hygiene • Indications • Immediately before touching patients • After touching patients • After contact with the patient’s environment (even if you don’t touch the patient) • Immediately before an invasive procedure • After removing gloves • Policy location • The Link Departments Infection Prevention and Control Infection Prevention and Control Policies Hand and Skin Antisepsis Hand Hygiene

5. Multi-drug Resistant Organisms • Policy Location • The Link Departments Infection Prevention and Control Infection Prevention and Control Policies Standard and Isolation Precautions, MDROs and other diseases requiring precautions Multi-drug Resistant Organisms

6. C. difficile • Testing • Polymerase chain reaction (PCR) -tests for DNA (99.6% specificity) • Do not order stool samples x3 to rule out infection • Cure of C. difficileis a clinical assessment, do not repeat testing for “clearance” of toxin • Antibiotic Stewardship Program available • Precautions • Once a PCR is ordered-C. difficileContact Precautions should be initiated irrespective of C. difficilestatus. • Discontinue C. difficileContact Precautions if • Test results are negative or • Test results are positive and the patient has started on appropriate anti-microbial treatment and remained symptom free for at least 48 hours. • Policy • The Link Departments Infection Prevention and Control Infection Prevention and Control C. difficilePatient Care Patient Testing

7. Standard and Isolation Precautions • Policy Location • The Link Departments Infection Prevention and Control Infection Prevention and Control Policies Standard and Isolation Precautions, MDRO and other diseases requiring precautions

8. Surgical Site Infection Prevention • Limit flash sterilization (book cases correctly) • Pre-admission testing (PAT) patients at TH and HJD are given 2% impregnated Chlorhexadine Gluconate (CHG) wipes for skin antisepsis if they are to undergo the following: • Cardio-thoracic (requiring sternotomies) • Major joint procedures • Spinal procedures

9. CLABSI & CAUTI • Housewide surveillance • January 1, 2010 • Central Line Insertion Bundle • For all patients, not just ICU’s! • Central Line Insertion Checklist • For all patients, not just ICU’s!

10. Bloodborne Pathogen Exposure Information • If you have been exposed • Stop what you are doing and wash the site immediately • Go to EHS (212-263-5020) (or the ED on weekends or off hours) • If you are the ordering physician • Obtain NYS source patient HIV consent form(The Link Hospital Administration Infection Prevention and Control Information for Health Care Workers NYSDOH HIV consent) • Obtain source patient consent for HIV • Order patient testing for HIV, HBV and HCV using the ICIS order set called “Blood/Body Fluid Exposure.”

11. Bloodborne Pathogen Exposure Information • What NOT to do… • Do NOT go to another hospital, such as Beth Israel for post-exposure care. • Do NOT decide what tests the source patient needs on your own. Employee Health Service will help with getting the appropriate tests for the patient. They have created a pathway in ICIS to get you to the correct tests. • Do NOT try to get anonymous (numbered) testing for source patients. NYS no longer has anonymous testing.

12. The Infection Prevention & Control Department • Michael Phillips, MD • Sandra Hardy, RN • Tania Williams, RN • Steven Bock, RN • Faith Skeete, RN • Alex Rowan-Hazelrigg, RN • Ranekka Dean, RN • Sapna Mehta, MD • Delia Valentin