Infection Control and Prevention

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• Infection Control and Prevention
• Presentation by Karin Dentinger RN, BSN, CIC
• Infection Control Manager

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• Infection Control Prevention
• Presentation to include
• Overview of Hand Hygiene
• Hand Hygiene product information
• Hand Hygiene compliance

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The Joint Commission

• National Patient Safety Goal 7a
• Reduce the risk of healthcare acquired
  infections.
• The Center for Disease Control and Prevention
  (CDC) reports that each year nearly 2 million
  patients are infected with healthcare acquired
  infections. Proper hand hygiene is critical to
  the prevention of these infections which
  contribute to the death of nearly 90,000 hospital
  patients per year and 4.5 billion in medical
  expenses.

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Kaiser Sacramento Medical Center
Financial Impact of Healthcare
Acquired Infections for 2006
Setting and Site of Infection Total infections identified Average cost per infection ALOS per infection Total Additional LOS days Total cost
General M/S MRSA/VRE/C.Diff 162 7,044 4 days 648 1,141,128
General Surgical SSI 57 7,044 4 days 228 401,508
General Surgical - Hip Knee SSI - deep/organ space 5 20,854 7.3 days 35.5 104,270
ICU or NICU - BSI 13 19,726 7.4 days 96.2 256,477
NICU - VAP 5 15,729 5.9 days 29.5 78,645
1,982,028
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Soap Water versus Alcohol Degermer
(Fontana Study,2002)
1) Before hand hygiene
2) After contaminated hands were washed with
plain soap
3) After contaminated hands were degermed with
waterless alcohol product
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Why are Alcohol Degermers Preferred for Routine
Hand Decontamination?

• MORE EFFECTIVE An alcohol degermer (gt60 Ethyl
  alcohol) is more effective at killing pathogens
  than soap and water. It reduces bacteria on
  hands by 99 within 15 seconds of
  application.
• TAKES LESS TIME Use of an alcohol degermer
  requires significantly less time than washing
  appropriately, rinsing and drying with paper
  towels. Use of the waterless alcohol degermer
  takes 20 seconds on average, hand-washing takes
  60 seconds on average (if done correctly). An
  average of one hour per nurse per 8 hour shift is
  saved based on an average of 12 opportunities for
  hand hygiene per hour (once every 5 minutes).
• BETTER FOR YOUR HANDS Alcohol degermers are
  waterless, they may contain emollients, and they
  do not require the use of paper towels therefore
  less drying to your hands than washing with soap
  and water.
• MORE ACCESSIBLE THAN SINKS Alcohol degermers
  can be placed almost anywhere, it is more
  convenient to use than soap and water washing.

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• When is it Preferable to Decontaminate Hands with
  an Alcohol Degermer?
• When hands are not visibly soiled.
• Before and after patient contact.
• After removing gloves.
• Between contact with different patients.
• After touching potentially contaminated surfaces
  or equipment between procedures on the same
  patient.

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• When is Hand Washing with Soap and Water
  Required?
• At the beginning and ending of your
• work shift.
• Whenever your hands are visibly soiled.
• Before and after eating or performing personal
  hygiene (i.e. using the restroom, applying
  cosmetics or lip balm, manipulating contact
  lenses).
• After coughing or sneezing.
• After 10-12 uses of an alcohol degermer or if
  hands feel sticky.
• Always wash your hands when patient has suspected
  or confirmed C. difficile.

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Hand Hygiene Product Information

• Use only Kaiser contracted Hand Hygiene
  Products!!!
• Kaisers current national contract is with
  Ecolab Huntington Brand
• If an employee has problems using Kaiser
  contracted hand hygiene products then they must
  first report the problem to their manager and (if
  appropriate) be evaluated by Employee Health
  Services
• Departments should order Hand Hygiene products
  from Materials Management (Not from the Pharmacy)

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KPs Approved Hand Hygiene Products
Name of Product Size TIMS
Endure 300 (Antiseptic Cida Rinse Gel) 540 ml 81517
Endure 300 (Antiseptic Cida Rinse Gel) 1000 ml 00509
Endure 320 4 oz J2289
Endure 320 540 ml K3175
Quickcare Foam 7 oz J1685
Bactifoam Antimicrobial Soap 500 ml E0805
Bactifoam Antimicrobial Soap 750 ml E0806
Bacti-Stat Antimicrobial Soap (For use in Home Health) 4 oz 00588
Germacare Lotion Soap 540 ml 76871
Germacare Lotion Soap 1000 ml 00115
Endure Gentle Foaming Soap (replaces NATURMILD hypoallergenic soap) 750 ml TIMS Pending
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KPs Approved Hand Hygiene Products
Accent Plus Hand Lotion 4 oz 00463
Accent Plus Hand Lotion 540 ml J0333
Accent Plus Hand Lotion Unscented 540 ml J1492
Endure Revitalizing Skin Lotion (New) 4 oz TIMS Pending
Endure Revitalizing Skin Lotion (New) 540 ml TIMS Pending
Endure Revitalizing FF Skin Lotion (New) 4 oz TIMS Pending
Endure Revitalizing FF Skin Lotion (New) 540 ml TIMS Pending
Endure Revitalizing Skin Crème 4 oz TIMS Pending
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• Introducing
• The New Endure Revitalizing Lotion
• This new lotion is designed to replace the
• currently used Accent Plus Lotion
• Formulation/chemistry between these lotion
• products is completely different.
• Endure Revitalizing Lotion is formulated
• with Sym Repair plus 16 other moisturizers
• and skin conditioners.
• These advance moisturizers and conditioners
• offer a higher level of skin protection and
  prevent
• skin irritation - restores skin health!

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When Should Lotion be Used in Healthcare Settings?

• At the start of the workday
• Shortly after washing hands
• Before going on breaks
• Before you leave work

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Do Not use Consumer Lotions in Healthcare
Settings

• Most lotions purchased at the consumer level
  contain oil or petroleum.
• These types of lotions can effect the barrier
  properties of the gloves and may reduce the
  effectiveness of the antimicrobial hand soap or
  hand rinse which may increase the risk of
  infections.

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Unapproved Products that should NOT be used!
Steris Alcare Purell Vaseline
McKesson Pure Cleanse Lubriderm
Sween Isagel Bac-Down Colopast
Any commercial products brought from home should not be used unless prescribed by Employee Health Services Any commercial products brought from home should not be used unless prescribed by Employee Health Services Any commercial products brought from home should not be used unless prescribed by Employee Health Services
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• 2006 Inpatient Hand Hygiene Data
• 3691 hand hygiene observations were conducted
  during 2006 in the ICU, Camellia, E Station,
• 5 East/West, 4 East/West nursing units, the
  PACU.
• 3172 conducted appropriate hand hygiene.
• 519 missed the opportunity.
• Total compliance for the year via these
  observations
• is measured at 86.
• 11 individuals were reported with artificial or
  long natural nails.

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2006 Inpatient Hand Hygiene Dataper Discipline
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Definition of Handwashing/Degerming

• After patient contact, the Health Care Worker
• will use water, soap, and friction on both
• hands for 10-15 seconds or will use alcohol
  degermer and friction on both hands for
• approx. 10-15 seconds or until dry.
• For removal of visible soil
• (blood, body fluids, dirt), use soap and
• water instead of alcohol degermer.

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Kaiser Permanente Program Wide Policy

• Artificial nails and nail tips are
  prohibited for all health care workers and
  providers who provide direct, hands-on patient
  care, across the continuum of care, including but
  not limited to inpatient, ambulatory and home
  care, invasive or diagnostic procedures or
  therapies, Perioperative services, Sterile
  Processing, intensive care (adult, pediatric
  newborn), Perinatal services( labor and delivery,
  post partum, nursery), etc.

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• How can we perform
• HANDWASHING/DEGERMING AUDITS and MONITOR for
  ARTIFICIAL NAILS
• in the outpatient care setting?
• Who should (or will) be performing these audits?

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What would be most helpful in the Outpatient
setting?

• IDEAS???
• Quality Forum RNs or NPs to provide Infection
  Control Prevention education at monthly staff
  meetings.
• Seek opportunities to streamline the audit
  process and still keep the data meaningful.
• Obtain information/feedback from the frontline
  staff to determine how we can most effectively
  communicate Infection Prevention Education and
  measure Hand Hygiene compliance.
• Hand Hygiene Compliance contests???
• Any Out of the Box ideas?

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• Questions?
• Suggestions?
• Comments?
• Thank You!