Hospital Acquired Conditions (HACs)

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Hospital Acquired Conditions(HACs)
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Hospital Acquired Infections (HAIs)

• Blood Stream Infections
• Ventilator Associated Pneumonia (VAP)
• Surgical Site Infections (SSI)
• Urinary Catheter Associated Infection (CAUTI)
• Multi-drug Resistant Organism (MDRO)

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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 another infection.
• PSMH as adopted the Central Line Insertion Bundle
  to help prevent Central Line Blood Stream
  Infections.

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Central Line Bundle(Measures to prevent central
line infections)

• Complete central line insertion check list
• Hand Hygiene prior to insertion
• Utilization of all inclusive kits for central
  line insertions
• Use maximal barrier precautions (Full body drape,
  wearing of cap, mask, gown and gloves)
• Clean Skin with Chlorhexidine and allow to air
  dry
• Evaluate need for catheter on daily basis
• CHG (chlorhexadine) central line dressings
  changed every 7 days
• Use of neutral pressure caps changed every 7 days

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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
• Protocol for IV tubing changes dependent on IV
  fluid
• IV sites rotated and dressings changed every 96
  hours or PRN
• Need for continuation of IV catheter evaluated on
  a daily basis

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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

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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
• Oral care to prevent accumulation of oral
  bacteria every 4 hours

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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 SSIs 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.

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Categorized by location SSIs

• 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.

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Process to Prevent SSIs

• 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.

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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.

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Process to Prevent CAUTIS

• Evaluation of catheter need prior to insertion
  and ongoing daily
• Nurse driven protocol for catheter removal
• Closed Catheter System
• Catheter securement device
• Urinary collection bag below 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

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Multidrug Resistant Organism (MDRO)

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

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MROs 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.
• MDROs are tracked by the Infection Control
  Department by date, unit, and physician.
• Data is analyzed for outbreaks and nosocomial
  transmission and reported to the Infection
  Control Committee, Clinical Operations Committee,
  and Quality Board.

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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.

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Clostridium Difficile

• Patients admitted with diarrhea or develop
  diarrhea after admission are placed in Contact
  Isolation until C. diff is ruled out and
  Infection Control Department discontinues
  isolation.
• Positive C.diff 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).

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Toxic Colon from C Difficile
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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 with bleach
  with a 4 minute wet time, allow to air dry.

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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

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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

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Perform Hand Hygiene

• At the start of your shift
• Entering a patient room
• Doing an invasive task
• Dispensing oral or IV medication
• Taking care of newborns
• Touching all wound, touching non-intact 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 patients room
• At the end of your shift before leaving