An Overview of Infection Control Maria T. Pascual RN MPH. CRRT Conference March PDF

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An Overview of Infection Control Maria T. Pascual RN MPH CRRT Conference March Epidemiology The annual mortality rate among hemodialysis patients is 23% Infections are the second most common cause,
An Overview of Infection Control Maria T. Pascual RN MPH CRRT Conference March Epidemiology The annual mortality rate among hemodialysis patients is 23% Infections are the second most common cause, accounting for 15% of deaths Septicemia (10.9% of all deaths) is the most common infectious cause of mortality. Vascular access infections are caused (in descending order of frequency) by S. aureus, coagulase-negative staphylococci (CNS), gramnegative bacilli, nonstaphylococcal gram-positive cocci (including enterococci), and fungi. 2 The primary risk factor for access infection is access type: 1. catheters having the highest risk for infection 2. grafts intermediate 3. native arteriovenous (AV) fistulas the lowest. 3 Causes of Bacterial Infections Endogenous: Bacterial Flora usually from the nares or stool Colonization is common in patients with frequent exposure to hospitals and other health-care settings. Colonization most often occurs when microorganisms are transmitted from patient to patient from contaminated hands and environmental surfaces (e.g., bed rails, countertops) 4 Causes of Bacterial Infections Exogenous: Source from outside the patient: contaminated dialysis fluids or equipment; inadequate dialyzer reprocessing procedures (e.g., contaminated water or inadequate disinfectant) Contaminated medication vials: Single Use vials are contaminated by repeated puncture to obtain additional doses and by pooling of residual medication into a common vial 5 MultiDrug Resistant Organisms (MDRO) MRSA VISA VRSA Enterococcus Vanco-resistant Linezolid resistant ESBL: Klebsiella, E.coli, Enterobacter, Acinetobacter, Serratia. MTB GC 6 Bacteria with resistant genes Antibiotics kill more than the disease-causing bacteria it is given for. They kill any other susceptible bacteria. Drug-Resistant bacteria remain, mutate and can increase their numbers a millionfold in a day, becoming the predominant microorganism. (Illustration by Bonnie Marshall, from The Antibiotic Paradox, 2nd edition by Stuart B. Levy). 7 Extended Spectrum Beta Lactamase (ESBL) ESBLs are enzymes produced by gram-negative organisms like Klebsiella, E.coli, Enterobacter, Acinetobacter, Serratia. The enzymes render several classes of antibiotics ineffective. Carbapenems (Imipenem, Meropenem), a new class of Beta-Lactams, are the only effective treatment for patients infected with an ESBL organism. Are hardy Environmental organisms; some are slow-growers 8 ESBL Profile 9 Most common sources of MDRO Urine Wounds (ED and outpatient settings) Blood Respiratory Secretions Others: stool 10 The Environment as an Organism Transmitter 11 CONTACT Transmission In the hemodialysis setting, contact transmission plays a major role in the transmission of bloodborne pathogens. Contact transmission can be prevented by hand hygiene, proper PPE use specially when handling hemodialysis and peritoneal dialysis access catheters Contact transmission can also be prevented disinfection of environmental surfaces. Of these, hand hygiene is the most important. 12 Regulatory vs. Guidelines Regulatory: 1. OSHA mandates regulations on workplace health and safety ; OSHA also specifies circumstances for which PPE is indicated 2. FDA regulates use of sterilants or high level disinfectants for equipment 3. EPA regulates types of environmental cleaners CDC, ANNA and APIC (Association of Professionals in Infection Control) offer guidelines 13 Infection Control is Everyone s Responsibility! Standard Precautions are the system of infection control precautions used on all patients whenever needed to prevent POTENTIAL EXPOSURE of the healthcare worker with blood and other potential infectious materials (OPIM). Always use Standard precautions: Infectious and Colonized Individuals. 14 If It Is Wet and Not Yours, Put A Barrier Between You and It! Standard Precautions include: Hand hygiene: preferred Alcohol hand rub; soap and water if hands are visibly soiled. Personal Protective Equipment (PPE) Goggles/Face shield (eyeglasses are not PPE) Apron/Impervious Gown (scrubs are not PPE) Gloves Mask : includes use of fit-tested N95 masks 15 Gloves are NOT a substitute for Hand Hygiene Latex powder-free and nitrile powder-free gloves OSHA: Disposable gloves shall be replaced as soon as practical after they have become contaminated, or as soon as feasible if they are torn, punctured, or their ability to function as a barrier is compromised. Hands must be washed after the removal of gloves used as PPE, whether or not the gloves are visibly contaminated. Hand contamination occurs from holes or defects in the gloves, leakage at the wrist, or contamination of hands during glove removal Hand Lotion should be water based and hospital approved. Petroleum based lotions degrade glove materials. 16 CDC Dialysis Guidelines: Stricter Standard Precautions During the process of hemodialysis, exposure to blood and potentially contaminated items can be routinely anticipated; thus, gloves are required whenever caring for a patient or touching the patient's equipment. 17 CDC Dialysis Guidelines: Stricter Standard Precautions Staff should wear protective gowns at all times while working in the unit and should discard this clothing at the end of the day unless contaminated between patients. 18 Does protective clothing need to be removed before leaving the work area? OSHA requires that personal protective equipment be removed prior to leaving the work area. While work area must be determined on a case-bycase basis, a work area is generally considered to be an area where work involving occupational exposure occurs or where the contamination of surfaces may occur. Major Culprit: Gloves need to be removed before leaving a room. 19 TO EAT OR NOT TO EAT OSHA: No eating, drinking or other similar activities in work areas. Work areas are defined as nurses stations, procedure rooms or any other area where contamination is likely. CDC: Staff members should not eat, drink, or smoke in the dialysis treatment area or in the laboratory. 20 Sharps and Splashes Hepatitis B vaccination for Healthcare workers; Hepatitis status of patients Blood and other specimens should be labeled/handled at the patient s bedside, NOT in med rooms, clean utility rooms, clean storage rooms, or the nursing work stations. Containers with biohazard liquid wastes should not be thrown in regular trash bags or linen bags Sharps and Biohazard containers must be puncture resistant and marked with the BIOHAZARD symbol. Promptly clean spills of body substances. Secure the area; wear appropriate PPE. Disinfect the area with a hospital approved disinfectant. 21 CDC: Separation of Clean and Dirty Infection control practices for hemodialysis units restrict the use of common supplies, instruments, medications, and medication trays and prohibit the use of a common medication cart for preparing or distributing medications. If trays are used to distribute medications, clean them before using for a different patient. If a common supply cart is used to store clean supplies in the patient treatment area, this cart should remain in a designated area. The carts should not be moved between stations to distribute supplies. 22 Acknowledgements: Francesca Torriani MD: UCSD Hospital Epidemiologist Kim Delahanty RN, CIC Ying Yang MS (Analyst) 23 References: CDC MMWR: April 27, 2001 / 50(RR05);1-43: Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients APIC Manual 2005 Occupational Safety and Health Administration 29 CFR Part 1910: Occupational Exposure to Bloodborne Pathogens; Needlestick and Other Sharps Injuries; Final Rule FDA Home Page: FDA-Cleared Sterilants and High Level Disinfectants with General Claims for Processing Reusable Medical and Dental Devices May 13, 2005 EPA Home Page: Disinfectants 24
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