Hospital Acquired Conditions
Education 2013
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What are Hospital Acquired Infections (HAI’s)
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Blood Stream Infections
Ventilator Associated Pneumonia (VAP)
Surgical Site Infections (SSI)
Urinary Catheter Associated Infection (CAUTI)
Multi-drug Resistant Organism (MRO)
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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 an other infection.
• PSMH as adopted the Central Line Insertion Bundle
to help prevent Central Line Blood Stream Infections.
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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
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Measures to Prevent Peripheral Line
Infections
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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
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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 must be done every 4 hours
• 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 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.
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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.
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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.
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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 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
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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.
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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.
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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. Provide education
tool and document teaching on Intervention screen
 Communicate results of a positive nasal swab screen results to the
physician during physician rounding.
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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).
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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.
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Hand Hygiene Facts
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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
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