Hospital Patient
Safety Initiatives:
Infection Control
Bernard C. McDonnell, DO
Urinary Catheter Tracer
• Use of urinary catheters in a manner to minimize infection
• Hospital maintains guidelines for appropriate use of urinary
catheters
• Hand hygiene
• Before and after insertion
• Placement of catheter using aseptic technique
• Catheter properly secured after insertion
Urinary Catheter Tracer
• Catheter insertion and indication are documented
• Hand hygiene before and after manipulation of catheter
• Avoid irrigation
• Collection bag emptied using aseptic technique
• Aseptic collection of urine samples
• Small amounts through needleless port
Urinary Catheter Tracer
• Keep urine collection bag below level of bladder at all times
• Catheter tubing unobstructed with no kinking
• Need for catheter reviewed daily
• Prompt removal when deemed unnecessary
• No “convenience”
Central Venous Catheter Tracer
• Central venous catheters are inserted, assessed and
maintained in a manner to minimize infection
• Hand Hygiene performed before and after insertion
• Maximal barrier precautions used for insertion
• Surgical protection including full patient body drape
• Use of >0.5% chlorhexidine with alcohol used for skin antisepsis
prior to insertion
• Can use tincture of iodine, iodophor or 70% alcohol alternatively
Central Venous Catheter Tracer
• Dressing to cover catheter insertion site
• Sterile gauze
• Transparent, semi-permeable dressing
• Well healed and tunneled catheters may not need to be covered
• Central line insertion and indication documented
• Hand hygiene performed before and after manipulating catheter
• Gloves
• Soiled dressings are changed promptly
• All dressings changed using aseptic technique
• Gloves
Central Venous Catheter Tracer
• Access port is scrubbed with an appropriate antiseptic prior to
accessing
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Chlorhexidine
Povidone iodine
An iodophor
70% alcohol
• Catheter accessed with sterile devices
• Need to central venous catheters reviewed daily with prompt
removal when not necessary
Ventilator/Respiratory Therapy
Tracer
• Respiratory procedures are performed in a manner consistent
with hospital infection control policies to maximize the
prevention of infection and communicable disease
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Hand hygiene
Gloves
Sterile water for nebulization
Single dose vials for aerosolized medications
• Using manufacturer’s instructions for handling, storing and
dispensing of medications
Ventilator/Respiratory Therapy
Tracer
• If multi-dose vials for aerosolized medications are used for
more than one patient—
• Restricted to a centralized medication location
• They do not enter the immediate patient treatment area
Ventilator/Respiratory Therapy
Tracer
• Ventilators are used in a manner consistent with hospital
infection control policies to maximize the prevention of
infection and communicable disease
• Ventilator circuit is changed if visibly soiled or mechanically
malfunctioning
• Sterile water is used to fill bubbling humidifiers
• Condensate in tubing is periodically drained and discarded
• Condensate should not drain toward the patient
Ventilator/Respiratory Therapy
Tracer
• Use of sterile single-use suction catheter
• Multi-use closed system catheter
• Only sterile fluid is used to remove secretions
• Sedation is lightened daily in eligible patients
• Spontaneous breathing trials are performed daily in eligible
patients
• “Weaning”
Spinal Injection Procedures
• Spinal injection procedures are performed in a manner to
minimize infection and the spread of communicable disease
• Hand hygiene
• Spinal injection
• Aseptic technique
• Surgical masks are used when placing a catheter or injecting
materials into the epidural or subdural space
Point of Care Devices
• Blood Glucose Meter
• INR Monitor
Point of Care Devices
• Hand hygiene
• Gloves
• Used for “finger-stick” procedures
• Removed after the procedure
• Followed by hand hygiene
• Finger stick devices are used for 1 patient
• Lancet
• Lancet holding device
Point of Care Devices
• Point of Care device is cleaned and disinfected after every use
according to manufacturer’s instructions
• Single use only if no manufacturer’s instructions for cleaning and
disinfection
Isolation/Contact Precautions
• Patients requiring contact isolation are identified and
managed in a manner consistent with hospital infection
control policies and procedures to maximize the prevention of
infection and communicable disease
Isolation/Contact Precautions
• Gloves are available and located near point of use
• Signs indicating that the patient is in contact isolation
• Patients in contact isolation are in single rooms
• Can be cohorted based on clinical risk assessment
Isolation/Contact Precautions
• Soap and water must be used when bare hands are visibly
soiled (e.g., blood, body fluids) or after caring for a patient
with known or suspected C. difficile or norovirus during an
outbreak. In all other situations, ABHR is preferred.
Isolation/Contact Precautions
• Gloves and gowns
• Before entering patient care environment
• Removed and discarded; hand hygiene is performed before
leaving the patient care environment
Isolation/Contact Precautions
• Dedicated or disposable noncritical patient- care equipment
(e.g., blood pressure cuffs) is used or if not available, then
equipment is cleaned and disinfected prior to use on another
patient according to manufacturer's instructions.
Isolation/Contact Precautions
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Traffic control
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Into patient’s room
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Patient moving out of the room to other parts of the hospital
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Contact precautions outside the patient’s room
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Cleaning of objects and patient care areas that are touched in patient’s isolation room
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When visibly soiled
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At least once a day
Terminal cleaning
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All surfaces thoroughly cleaned and disinfected and all textiles are replaced with clean
textiles
Cleaners and disinfectants are labeled and used in accordance with hospital policy and
procedure and manufacturer’s instructions
Isolation: Droplet Precautions
• Patients requiring Droplet Precautions are identified and
managed in a manner consistent with hospital infection
control policies and procedures to maximize the prevention of
infection and communicable disease including the following:
Isolation: Droplet Precautions
• Masks
• On entering
• Discarded when leaving
• Signs
• Patient on droplet precautions are housed in a single room or
cohorted based on clinical risk assessment
• Hand hygiene
• Limited patient movement for droplet isolation patients
• Medically necessary procedures
• Patient wears surgical mask when transported
• Communication of patient’s status
Isolation: Droplet Precautions
• Cleaning
• Once a day per policy and manufacturer’s instruction while
patient is admitted
• Terminal cleaning after discharge including wiping and
disinfection of all hard surfaces
• Changing all textiles in the isolation room
• All cleaners are used in accordance with hospital policy and
procedure and manufacturer’s instructions
Isolation: Airborne precautions
• Patients requiring Airborne Precautions are identified and
managed in a manner consistent with hospital infection
control policies and procedures to maximize the prevention of
infection and communicable disease including the following:
Isolation: Airborne precautions
• Use of N-95 or higher particulate respirators
• Available and near point of use
• Signs indicating patient is on airborne precautions
• Clear and visible
• Patients on airborne isolation are housed in airborne isolation rooms
• Hand hygiene before entering
• And leaving
• N-95 or higher particulate respirator to be worn when entering patient
room for confirmed or suspected TB
Isolation: Airborne precautions
• Facility limits movement of patients on airborne isolation to
medically necessary purposes
• Patient wears surgical mask per hospital policy
• Hospital has means to communicate patient’s status
Surgical procedure tracer
• Surgical procedures are performed in a manner consistent
with hospital infection control policies and procedures to
maximize the prevention of infection and communicable
disease including the following:
Surgical procedure tracer
• Surgical scrub before donning of sterile gloves for a surgical
procedure in the OR
• Use of either
• Antimicrobial surgical scrub
• FDA-approved alcohol-based antiseptic surgical hand rub
• Visibly soiled hands should be washed with soap and water prior to the
above procedures
• After surgical scrub hands and arms are dried with a sterile towel and
sterile surgical gown and gloves are donned in the OR
Surgical procedure tracer
• Surgical attire
• Scrubs
• Surgical caps/hoods covering all head and facial hair
• Worn by all personnel in semi restricted and restricted areas
• Restricted areas include
• OR
• Procedure rooms
• Clean core
• Semi restricted areas include
• Peripheral support areas of the surgical suite
Surgical procedure tracer
• Masks
• Properly tied and fully covering mouth and nose are worn by all personnel in
restricted areas where open sterile supplies or scrubbed persons are located
• Sterile drapes are used to establish the sterile field
• Sterile field
• Items in sterile field are sterile
• Items introduced to the sterile field are opened, dispensed and transferred in a
manner to maintain sterility
• Established in a location where it will be used and as close as possible to the
time of use
• Movement around the sterile field is done in a manner to maintain sterility
Surgical procedure tracer
• Traffic in and out of the OR is kept to a minimum and is limited
to essential staff
• Traffic Control Policies and Procedures
• Surgical masks are removed when leaving the sterile areas and
are not reused when returning
Surgical procedure tracer
• Cleaners and disinfectants
• Used according to hospital policy and procedure and
manufacturer’s instructions
Surgical procedure tracer
• Cleaning—start of the day
• Horizontal surfaces
• Damp dusted with a lint-free cloth and EPA-registered
hospital detergent/disinfectant
• High touch surfaces cleaned and disinfected between patients
• Anesthesia equipment is cleaned and disinfected between
patients
• Reusable noncritical items (BP cuffs, etc.) are cleaned and
disinfected between patients
Surgical procedure tracer
• Terminal cleaning of Operating Rooms
• After the last procedure of the day
• Including weekends!
• Includes
• Wet-vacuuming or moping the floor with an EPA-registered disinfectant
• All surfaces
• Internal components of anesthesia machine breathing circuit are
cleaned according to manufacturer’s instructions
Surgical procedure tracer
• Ventilation requirements
• Positive pressure, 15 air exchanges per hour—at least 3 of which
are fresh air
• 90% filtration
• HEPA optional
• Air filters are checked regularly and replaced according to hospital
policies and procedures
• Temperature and relative humidity are maintained at required levels
• Doors are self-closing
• Air vents and grill work are clean and dry
A Protective Environment (e.g. Bone Marrow
patients)
• Positive pressure—air flow out to the corridor from the room
• 12 air exchanges per hour
• Supply air is HEPA filtered
• Well sealed rooms so that there are no penetration spaces in the walls,
ceilings or windows
• Self closing door that fully closes on all room exits
• Failures are addressed and documented
• Ventilation requirements are monitored using visual methods
• “Kleenex test”; flutter strips, etc.
QUESTIONS?
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