Hospital Acquired Conditions

1. Hospital Acquired Conditions Education 2013

2. What are Hospital Acquired Infections (HAI’s) Blood Stream Infections Ventilator Associated Pneumonia (VAP) Surgical Site Infections (SSI) Urinary Catheter Associated Infection (CAUTI) Multi-drug Resistant Organism (MRO)

3. Blood Stream Infections (BSI) Blood Stream Infections occur after the insertion of an IV catheter either peripherally or centrally within 48 hours of insertion up to 48 hours after removal. A BSI requires 2 positive blood cultures, with pathogens not related to an other infection. PSMH as adopted the Central Line Insertion Bundle to help prevent Central Line Blood Stream Infections.

4. Central Line Bundle Fill out central line insertion check list Hand Hygiene prior to insertion Use standardized supply cart or kit that is all inclusive for the insertion of central venous catheter Use maximal barrier precautions (Full body drape, wearing of cap, mask, gown and gloves) Clean Skin with Chlorhexidine and allow to air dry Need for continuation of catheter is evaluated on a daily bases Use of central line dressings that include chlorhexidine Central line dressings are changed every 7 days or PRN using sterile techniques Positive pressure caps are used on all central line posts and changed every 7 days

5. Measures to Prevent Peripheral Line Infections Hand Hygiene prior to insertion Use of IV catheter insertion kits Use of Chlorhexidine/alcohol skin prep Use of Tegaderm dressings IV site and tubing to be changed every 96 hours IV site dressing dressings changed every 96 hours or PRN Need for continuation of IV catheter evaluated on a daily bases

6. Ventilator Associated Pneumonia (VAP) Ventilator Associated Pneumonia is defined as a lung infection occurring after a patient is placed on the ventilator. The diagnosis is confirmed by analysis of the infection by the Infection Control Department

7. VAP Bundle Elevation of the head of the bed 30 degrees to prevent aspiration Sedation holiday to check for continued ventilation needs Weaning trials to indicate if the ventilator is still needed daily Medication to prevent Peptic Ulcers DVT Prophylaxis Sub-glottal suctioning to prevent colonization and infection from pooling of secretions must be done every 4 hours Oral care to prevent accumulation of oral bacteria every 4 hours

8. Surgical Site Infections (SSI) Surgical site infections are defined as infections that occur within 30 days of surgery, unless an implant is inserted during the procedure then the time increases to 3 months. All reported SSI’s are analyzed for preventability and reports are provided to the Infection Control Committee, Department of Surgery, Clinical Operations, Quality Board, CMS Core measures, and CDC.

9. Categorized by location SSI’s Superficial – involving the skin and superficial tissue within30 days of procedure. Deep incisional – the infection appears to be related to the operative procedure and involves deep soft tissue (muscle, facial layers) of the incision Organ Space – involves any part of the body, excluding the skin incision fascia or muscle layers that is opened or manipulated during the operative procedure.

10. Process to Prevent SSI’s Patients who are scheduled for implants are screened prior to surgery for MRSA Patients who are positive for MRSA are educated on decolonization for MRSA Patients are educated and provided special soap, for pre-operative bathing the night before surgery and the morning of surgery.

11. Catheter Associated Urinary Tract Infections (CAUTI) Urinary Catheter Associated Infections are defined as an infection occurring 48 hours after insertion of a urinary catheter, signs and symptoms of infection (fever, pain, frequency, urgency, increased white count, etc.) and a positive urine culture of 100,000CFU/ml with no more than 2 species of bacteria.

12. Process to Prevent CAUTI’S Evaluation of catheter need prior to insertion Hand Hygiene should be done immediately before and after any manipulation of the catheter site Closed Catheter System Catheter securement system Urinary collection bag not to be higher than the bladder Urinary collection bag not to rest on the floor The catheter and collecting tube should be free of kinking The collecting bag should be emptied regularly Daily nursing intervention to document physician order for catheter

13. Multidrug Resistant Organism (MRO) Multidrug resistant organisms of concern at PSMH are Methicillin Resistant Staphylococcus Aureus (MRSA), Vancomycin Resistant Entercoccus (VRE) and Clostridium Difficile (C. Dif) MRO’s are bacteria that have become resistant to many of the antibiotics used to treat infections caused by them.

14. MRO’s Continued MRSA has become resistant to methacillin (Oxicillin) and many other antibiotics VRE has become resistant to Vancomycin Clostridium Difficile is treated with several antibiotics it is becoming more resistant and virile. MRO’s are tracked by the Infection Control Department by date, unit, physician. Data is analyzed for outbreaks and nosocomial transmission and reported to the Infection Control Committee, Clinical Operations Committee, and Quality Board.

15. MRSA Patients who have tested positive in the past for MRSA and VRE are placed in Contact Isolation upon admission to the hospital When they meet criteria for discontinuation of isolation they can removed by the Infection Control Department. Patients admitted from Long Term Care, Other Hospitals, admitted with wounds, on dialysis, or admitted to the ICU are screened upon admission for MRSA. Patients with positive MRSA screenings will by placed in Contact Isolation Positive Screenings of MRSA will be reported as critical test value. Educate Patient/Family on reason for Contact Isolation. Provide education tool and document teaching on Intervention screen Communicate results of a positive nasal swab screen results to the physician during physician rounding.

16. Clostridium Difficile Patients admitted with diarrhea or develop diarrhea after admission are placed in Contact Isolation until C. dif is ruled out and Infection Control Department discontinues isolation. Positive C.dif patients are to be in Contact Isolation until discharge Never use Alcohol foam or gel for hand hygiene (Alcohol foam and gels do not kill C. diff spores) Always wash hands with soap and water (use friction when washing hands with soap and water to rinse spores down the drain).

17. Toxic Colon from C Difficile

18. Contact Isolation Contact Isolation requires gowns and gloves to be donned prior to entering the patients room. Equipment used for the patient must be dedicated to that patient (i.e. thermometers, B/P cuffs) – do not use unit based thermometers or data scope. When unable to dedicate equipment, it must be disinfected between each patient use.

19. Hand Hygiene Facts Thousands of people die every day around the world from infections acquired while receiving health care Hands are the main pathways of germ transmission during health care There are approximately 5,000 germs on your hands at any given time A working adult touches 30 objects in one minute Healthcare specialist consider hand washing as the single most effective way to prevent the transmission of disease

20. Hand Hygiene Hand Hygiene refers to cleaning your hands Using soap and water when your hands are visibly soiled (The CDC recommends washing with soap and water for at least 20 seconds) If you sing Happy Birthday to yourself twice that is 20 seconds Using Alcohol rubs/gels when there is no visible soiling. You need to work the gel into your hands until they become dry

21. Perform Hand Hygiene At the start of your shift Entering a patient room Doing a invasive task Dispensing oral or IV medication Taking care of newborns Touching all wound, touching non-contact skin or mucous membranes After going to the restroom Contact with equipment or surfaces that are likely contaminated Removing gloves and other Personal Protective Equipment As you leave the patient’s room At the end of your shift before leaving