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HAI source – hands of health care workers
Discovered in 1961 with 1 clone
5 clones identified in 2002
Divided into HAIs and CAIs
CAIs initially found in drug addicts, but now
in healthy people
Found in almost every HAI because of biofilm
Examples: MRSA, VRSA, C-diff, Legionnaires’
Disease, UTI, pneumonia
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MRSA – infectious pathogen, resistant to Blactams antibiotics
Nosocomial Infection – infection received in
hospital as a result of being treated for a
separate condition (HAIs).
Staphylococcus aureus (s. Aureus) – common
cause of MRSA
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Non-compliance to hand washing guidelines
by medical personnel
Cost per patient = $8,832.00
85% of invasive MRSA related to health care
33% developed during hospital stay
Community Acquired Infections (CAIs) in
gyms, prison and day care
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Many pathogens are now resistant to
antibiotics
Hand washing is most effective way to
prevent infections
Staff are reluctant to wash hands
Reduce water loss
Protection from germs and abrasions
Barrier from unfriendly environmental
influences
Everybody sheds skin cells – use caution
around patient’s environment (clothing, linen,
furniture, etc).
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Taking vital signs
Transferring a patient
Touching linens or equipment that comes in
contact with the patient
Touching body secretions, excretions
Touching skin – whether intact or not intact,
wounds
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When handling food
After sneezing or using bathroom
After handling animals
After handling any type of waste
When your hands are dirty
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Hands are visibly dirty (blood and body fluids)
Before eating
Before and after using the bathroom
Patient has diarrhea - more efficient at
destroying C-Difficile
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Use warm, running water and soap
Lather all areas of hands away from running
water
Rub all areas of hands – fingers, underneath
fingernails, back of hands, palms
Soap and running water removes germs
Rub for at least 15 - 20 seconds – use
friction!
Rinse
Dry with paper towel or one-time cloth
Use paper towel to turn off spigots
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Available in gels, foam or rinse
More effective at killing germs than soap and
water
Does not irritate skin
Easier to locate at point of care
Requires less time to use than soap and water
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Between patients if hands are not visibly dirty.
Before having direct contact with the patient
Before using sterile gloves to insert invasive devices
such as central intravascular catheter, indwelling
urinary catheters, peripheral vascular catheters
After having direct contact with mucous membranes,
wound or wound dressings, body fluids, broken skin
After touching equipment or furniture that the patient
uses
After taking off your gloves
When moving from contaminated site on body to
clean site on body
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Use 1 ½ to 3 ml of gel – about the size of a
quarter
Apply to palm of hand
Rub hands together and include fingers,
fingernails, palms, back of hands
Rub until completely dry – 15-25 seconds
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Protects patient and HCW
Can become contaminated during patient care
Should be changed when moving from an
infected site to a clean site (along with hand-gel)
Should be changed between patients
Can develop tiny holes during use
Does not replace hand hygiene
Wash hands when you take off the gloves
Use when coming in contact with blood or
infectious body fluids, excretions, secretions,
mucous membranes and non-intact skin
Do not need gloves for touching patients’ sweat
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Intensive Care Unit
Diabetics, dialysis patients and chronic dermatitis
may have intact skin that is colonized with S.
aureus (staphalacoccus aureus).
Excess antibiotics, long hospitalizations, history
of MRSA, exposure to MRSA patients
Touch, ingestion, contaminated medical
equipment
New colonized patients – no symptoms but carry
germ
Infected/draining wounds or intact skin with
colonized areas.
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Skin to skin contact, activities that damage
skin, contaminated towels and sports
equipment
Often will affect healthy people
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Compliance rates estimated to be below 50%
Lack of supplies, irritation to skin, insufficient
evidence, heavy workload
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Each year there are over 2M HAIs
30,000 resulted in death
70,000 = contributed to death
Colonized patients have a 10-30% chance of
infection.
80% of tested stethoscope ear tips
contaminated
Cost $20B a year
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Laws require hospitals to do more
HAI screening
Monitor and report HAI’s
Public disclosure laws leading to
compliance
MRSA Surveillance swabbing
Copper – pathogens can not grow on copper
Wash your hands!!
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You should clean your hands before entering a patients
room
The patient may not have any visible signs of infection
Germs can live over 2 hours on surfaces such as tables,
door knobs, desks
Coughing and sneezing sends droplets throughout the air
as far as 3 feet. You can pick these germs up on your
hands
When warm water is not available, you can use rubbing
alcohol
You should never share a towel
You should not touch surfaces that other people are
constantly touching – door knobs, computer keyboards,
faucets, toilet handles, etc.
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The U.S. Public Health Service recommended
washing hands for 1 – 2 minutes before and
after patient care
Some germs can last for several minutes on
HCW’s hands.
Improper hygiene fails to kill the germs – do
it right!!
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Bacteria cut by up to 95% in copper trial. Health Estate
Journal. 58-59
Bonnuel, N., Byers, P., Gray-Beckness, T. (2009).
Methicillin
resistant staphylococcus aureus
(MRSA) prevention through facility-wide culture
change.
Critical Care Nursing Quarterly, 144-149
Boyce, J. S. (2009). Epidemiology of methicilin-resistant
staphylococcus aureus infections in
adults. UptoDate Online Data Base. Retrieved on
September 3, 2009 from
www.utdol.com/online/index.do
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Camins, B., & Fraser, V. (2005). Reducing the risk of
health care- associated infections
by complying with CDC hand hygiene guidelines.
Journal on Quality and
Patient Safety, 331 (3), 173-179.
Klevins, R., Morrison, M., Nadle, J., Petit, S.,
Gershman, K., Ray, S., et al. (2007). Invasive
Methicillin-resistant staphylococcus aureus
infections in the United States. Journal of
American Medical Association. 1763-1771
Leapfrog Group (2008) retrieved from internet on
7/18/10 from:
www.leapfroggroup.org
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Sprague, I. (2009). Health care-associated infections: Is there an end in
sight? Issue
Brief/National Health/Policy Forum
Weber, S., Huang, S., Oriola, S., Huskins, W., Noskin, G., Harriman, K., et
al.
(2007). Legislative mandates for use of active surveillance cultures to
screen
for methicillin-resistant staphylococcus aureus and vancomycinresistant
enterococci: Position statement from the joint SHEA and APIC task
force.
35 (2), 73-85.
Wolfe, A. (2009). Infection correction: Hospital-acquired infections can
be reduced significantly
Or even eliminated with sound prevention procedures. States
Legislatures.