INFECTION CONTROL SHOWCASE

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INFECTION CONTROL SHOWCASE

• PRESENTED BY
• MAURO GARCIA
• RN, BSN, CIC,
• INFECTION PREVENTIONIST
• MARK TWAIN ST. JOSEPHS HOSPITAL

Streptococcus
Staphylococcus
Influenza
Giardia
Pseudomonas
H. Pylori
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OBJECTIVES

• INFECTION CONTROL PRACTICES
• INFECTION 101
• HAND HYGIENE
• ISOLATION PRECAUTIONS
• PERSONAL PROTECTIVE EQUIPMENT (PPE)
• RESISTANT ORGANISMS
• MRSA, VRE, ESBL
• OTHER BUGS TO LOOK OUT FOR!
• CLEANING AND DISINFECTION
• LEVELS OF CLEANING, DISINFECTANTS.
• GUIDELINES
• INTERACTIVE SESSION (QUESTIONS AND ANSWERS)

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INFECTION 101

• Colonization is the presence of a microorganism
  in the absence of symptoms or tissue invasion
• Infection is the presence of an organism from a
  normally sterile body site or production of
  inflammatory response

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INFECTION 101

• Pathogen vs host
• Pathogen
• Evaluating risk of pathogen
• Adequate of pathogenic organisms (DOSE)
• Virulence of pathogen
• Access to mode of entry

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INFECTION 101

• Pathogen vs host
• Host
• Evaluating risk of host
• Susceptible host (Immuno-compromised)
• Device associated risk (catheters)
• Procedural associated risk
• (surgery, contact with HCWs)
• Environmental risk

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INFECTION 101

• Mode of transmission

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What is wrong with this picture?
It does not take an IC person to catch this stuff
Boxes on floor
Floor dirty
Dirty mop
Towels on floor
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INFECTION 101

• Who has the upper hand???
• Does the pathogen have a secret weapon???
• What can HCWs do???

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HAND HYGIENE

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Hand Hygiene

• Time
• More than 15 seconds
• Quality
• Both sides and fingernails
• Type
• Alcohol or soap and water

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Question???

• Does Alcohol foam / gel
• work on all pathogens???

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Isolation Precautions
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Isolation Precautions

• Contact Isolation
• Droplet Isolation
• Airborne Isolation
• Universal or Standard Precautions.

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Contact Isolation

• Personal Protective equipment required
• Gown, Gloves. (Mask is optional)
• Mode of transmission
• Direct or indirect contact with skin.
• Duration of Isolation
• Reusable patient equipment
• Visitors and patient privileges

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Examples of Contact Isolation Bugs

• MRSA (Methicillin Resistant Staphylococcus
  Aureus)
• VRE (Vancomycin Resistant Enterococcus)
• ESBL (Extended Spectrum Beta Lactamase)
• ROTAVIRUS
• ADENOVIRUS
• ANTHRAX
• C-DIFF (Clostridium Difficile)
• SHINGLES (Herpes Zoster) LOCALIZED
• RSV (Respiratory Syncytial Virus)
• SCABIES

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Droplet Isolation

• Personal Protective equipment required
• Mask, Gloves.
• Mode of transmission
• Mucous membrane to mucous membrane.
• Duration of Isolation
• Reusable patient equipment
• Visitors and patient privileges

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Examples of droplet isolation bugs
INFLUENZA MENINGITITIS PERTUSSIS
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Airborne Isolation

• Personal Protective equipment required
• N-95 Mask, Gloves.
• Mode of transmission
• Airborne droplets into lungs.
• Duration of Isolation
• Reusable patient equipment
• Visitors and patient privileges

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Examples of airborne isolation bugs

• Chicken Pox
• Measles
• Tuberculosis
• SARS (and contact)
• Avian Flu (and contact)
• Small Pox (and contact)

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PPE for Airborne Isolation

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Actual Airborne Isolation (PPE)

Powered Air Purified Respirator (PAPR Hood)
N- 95 Mask
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WHEN BUGS FIGHT BACK!

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ANTIBIOTIC RESISTANT ORGANISMS

• MRSA (Methicillin Resistant Staphylococcus
  Aureus)
• VRE (Vancomycin Resistant Enterococcus)
• ESBL (Extended Spectrum Beta Lactamase)

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MRSA

• MRSA (methicillin resistant staphylococcus
  aureus). Cause pneumonia (PNA), meningitis,
  boils, arthritis, and osteomyelitis. Secretes
  leukocidin, a toxin which destroys WBCs and
  leads to pus or acne.
• Nosocomial MRSA is most commonly caused from poor
  technique or improper hand hygiene.
• There are multiple strains of MRSA that vary in
  severity of mortality.

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VRE

• Enteric normal flora. Cause UTIs, bacteremias,
  intra-abdominal, pelvic wounds.
• Requires contact isolation, commonly cultured in
  urine, and wounds.
• When paired with MRSA there is a chance that MRSA
  can become resistant to Vancomycin (VRSA)

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ESBL

• Escherichia coli
• Most common cause of UTIs. Found in
  contaminated water and food causing diarrhea.
• Has developed some resistance to beta-lactamase
  group of abx.(ESBL) extended spectrum beta
  lactamase. When resistant use contact precaution.
  other enterics can become (ESBL)
• OTHER ESBL INCLUDE KLEBSIELLA

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Other Bugs to look out for!
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CLOSTRIDIUM FAMILY

• CLOSTRIDIUM
• BOTULINUM
• Cause of botulism. Contains spores that
  secrete toxins Used in biological warfare
• DIFFICILE
• Cause pseudo membranous colitis, spore
  forming. Fecal-oral transmission use contact
  precautions.
• Alcohol foam hand cleaners do not work with
  spore formers.
• TETANI
• Cause of tetanus.

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Clostridium Difficile (C-diff)

• Notice the spores at the ends of the bacilli!

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Norovirus

• Noroviruses are a group of viruses that cause the
  stomach flu, or gastroenteritis in people.
• Symptoms of norovirus illness usually begin about
  24 to 48 hours after ingestion of the virus, but
  they can appear as early as 12 hours after
  exposure.
• Noroviruses are very contagious and can spread
  easily from person to person.
• Both stool and vomit are infectious.
• Particular care should be taken with young
  children in diapers who may have diarrhea.

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Prevention of Norovirus

• You can decrease your chance of coming in contact
  with noroviruses by following these preventive
  steps
• Frequently wash your hands, especially after
  toilet visits and changing diapers and before
  eating or preparing food. Do not use alcohol foam
• Carefully wash fruits and vegetables, and steam
  oysters before eating them.
• Thoroughly clean and disinfect contaminated
  surfaces immediately after an episode of illness
  by using a bleach-based household cleaner. (CDC
  Category II)
• Immediately remove and wash clothing or linens
  that may be contaminated with virus after an
  episode of illness (use hot water and soap).
• Flush or discard any vomitus and/or stool in the
  toilet and make sure that the surrounding area is
  kept clean.

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Blood Born Pathogens

• HIV
• Hepatitis B
• Hepatitis C

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HIV (HUMAN IMMUNODIFICIENCY VIRUS)

• HIV is transmitted by sexual contact, exposure to
  blood and/or blood products. Presently one of the
  fastest growing transmission is from pregnant
  women to their unborn babies during the birthing
  process.
• Body fluids consist of blood, blood products,
  saliva, tears, urine, semen, vaginal secretions,
  and perspiration.
• Most people develop detectable antibodies within
  1-3 months after infection.

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HEPATITIS B

• How You Get It
• Blood contact, sexual intercourse, contaminated
  needles and mother to fetus.
• Symptoms
• No symptoms for half the infected. Flu-like
  symptoms for the rest.

• Important Facts
• 1.2 million Americans are infected. Ten percent
  of adults and 90 percent of infants become
  carriers.
• Death Rate
• One percent of those infected die immediately.
  Thirty-three percent of carriers eventually die
  from cirrhosis or liver cancer, accounting for
  5,000 deaths annually.

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HEPATITIS C

• How You Get It
• Sexual intercourse and blood contact. Sharing
  items such as syringes and razors. No
  identifiable source of infection for many people.
• Symptoms
• No symptoms for 70 percent of hepatitis C
  patients. The remainder have mild to severe
  symptoms similar to hepatitis A. About 80
  percent of people with hepatitis C become
  carriers.

• Important Facts
• About 30 percent of patients with hepatitis C
  will get cirrhosis, and about five percent will
  get liver cancer
• Death Rate
• 10,000 Americans die each year from hepatitis C
  complications, making it the ninth leading cause
  of death in the country.

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HEPATITIS A

• Important Facts
• Especially at risk are daycare children/staff and
  travelers in countries with poor sanitary
  conditions.
• Death Rate
• Rarely fatal, but may cause weeks of disabling
  illness. Most people recover fully and develop
  immunity.

• How You Get It
• Food or water contaminated by human excrement.
  Poor personal hygiene.
• Symptoms
• Weakness, headache, fever, stomach cramps, loss
  of appetite, diarrhea, darkened urine, yellowing
  of the skin and eyes.

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CLEANING AND DISINFECTION

• Rule 1
• You must first clean then disinfect
• Rule 2
• Make sure you do Rule 1

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Cleaning and Disinfection

• Classifications for cleaning devices
• Body Contact Disinfection Req.
  FDA Device Class
• Intact skin low level
  non-critical
• Mucous membrane high level
  semi-critical
• Sterile body cavity sterilization
  critical

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Level of disinfection vs pathogen

www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a2.htm
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Selection and use of disinfectants

• Low level disinfectants
• Phenolics
• Quaternary Ammonium
• Intermediate level disinfectants
• Alcohols
• Hypochlorites
• Iodine and Iodophor

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Selection and use of disinfectants

• High level Disinfectants / sterilants
• Hydrogen Peroxide
• Gluteraldehyde
• Formaldehyde
• Ortho-phthalaldehyde (OPA)
• Peracetic Acid

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Summary

• If your sick then stay out of the hospital
• Wash your hands.both sides
• If you see a giant praying mantis..run!!
• Dont eat your strawberries on the ride home!!!
  Wash them first
• Resistant bugs do not play fair
• Disinfectants are confusing
• Everyone is responsible for patient safety!!

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QUESTIONS?

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DO YOUR PART TO FIGHT INFECTIONS.
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THE END

Go Green
For an electronic copy of this PPT please email
me Mauro.Garcia_at_CHW.edu