IN REVIEW

HEALTHCARE ACQUIRED INFECTIONS



What is a healthcare associated infection?

"Healthcare-associated infections (HAI) are defined as infections not present and without evidence of incubation at the time of admission to a healthcare setting. As a better reflection of the diverse healthcare settings currently available to patients, the term healthcare-associated infections replaced old ones such as nosocomial, hospital-acquired or hospital-onset infections.” http://emedicine.medscape.com.

Types of HAIs

Central line infections

Catheter-associated urinary infections

Surgical site infections

Ventilator-associated infections

Clostridium difficile infections

Prevention

Over the last several weeks of blogging many topics about prevention have been covered. The prevention technique that is a consistent throughout is PROPER HAND HYGIENE. If healthcare workers followed proper protocol and appropriate technique think how many healthcare associated infections we could eliminate along with pain and suffering of patients.

HOW ARE YOU GOING TO PRACTICE DIFFERENTLY?

 Reference:

http://emedicine.medscape.com.



WHAT IS YOUR STATE DOING TO HELP PREVENT HAIs

Indiana

The Indiana State Department of Health is leading a state improvement initiative to prevent healthcare associated infections. The initiative is a two-year state collaborative effort to promote the prevention of healthcare associated infections.

“Indiana has been active in addressing healthcare associated infections. Most recently, the Indiana State Department of Health utilized a collaborative process to address Methicillin-resistant Staphylococcus aureus (MRSA) exposures and provide Indiana communities with current MRSA information and necessary tools to promote prevention strategies. The Indiana State Department of Health also created a toolkit for Clostridium difficile infections.”

In September 2009, the ISDH was awarded a grant from the CDC to support state healthcare associated infection initiative.

Using the grant money Indiana developed two projects:

1. “The development of a state plan for the prevention of healthcare associated infections
2. A state healthcare associated infection prevention initiative”

The purpose:

Develop an Indiana Plan for the Prevention of Healthcare Associated Infections

(Indiana has NEVER produced a state plan focusing on healthcare associated infections)

Goals

"Improve and identify healthcare associated infections by health care providers

Reduce the number of healthcare associated infections

Increase public and healthcare worker awareness of healthcare associated infections"

Objectives

"Create a State Plan for Healthcare Associated Infections

Develop and implement healthcare associated infections surveillance and reporting system

Develop and implement a healthcare associated infections prevention initiative”

Reference:

www.in.gov.





Economic Consequences of HAI

“Healthcare associated infections in hospitals impose significant economic consequences on the nation’s healthcare system”

Incidence

Approximately 4.5 HAIs for every 100 hospital admissions

Cost

“According to the CDC, each year, U.S hospitals experience 1.7 million health-care acquired infections, causing roughly 99,000 deaths at a cost of 37$ to 45% billion dollars”

Of these infections:

32% of all healthcare –associated infections are urinary tract infections

22% are surgical site infections

15% are pneumonia

14% are bloodstream infections

Cost to the patient

Patients who acquire a infection from surgery on average spend , an additional 6.5 days in the hospital

Five times more likely to be readmitted after discharge

Twice as likely to die

60% more likely to require admission to a hospital’s intensive care
unit

Surgical infections are believed to account for up to 10 million dollars annually

Reference:

www.cdc.gov

http://www.hpoe.org

PREVENTION OF CLOSTRIDIUM DIFFICILE

Prevention of C. Diff

What can hospitals do to help prevent C. diff?

Doctors, Nurses, Healthcare personnel need to do:

Proper hand hygiene before and after caring for patient. This can help prevent C.diff germs from being passed from one patient to another on their hands.

Ensure that environmental services thoroughly clean rooms and medical equipment that have been used for patients with C. diff.

Only give antibiotics as necessary

Use contact isolation precautions, this will help prevent C. diff from spreading to other patients and healthcare workers

Contact Isolation:

• Patients with C. diff should have private rooms if possible
• Healthcare providers must wear gloves and a gown over their clothing while caring for patients with C. diff
• Visitors must wear gown and gloves
• When leaving the room healthcare workers and visitors must remove their gown and gloves and wash their hands appropriately
• Patients are to remain in their room as much as possible, they should not go to common areas, such as, the gift shop or cafeteria

What can patients do to help prevent C. diff?

Patients and family members can make sure that ALL healthcare personnel clean their hands with soap and water or antibacterial rub before and after caring for patients

Only take antibiotics as prescribed by your physician

Be sure to wash your hands after going to the bathroom and before meals

What do patients to do when they go home from the hospital (after dx of C.diff)

• Patients may return to normal routine
• The diarrhea will resolve over time
• Take prescribed medication as ordered
• Wash hands often
• If patient develops more diarrhea once they return home, please call MD immediately

Reference:

http://www.cdc.gov/

"C. DIFF"

CLOSTRIDIUM DIFFICILE INFECTION

What is Clostridium difficile infection?

Germ that causes diarrhea

C. diff spores can live outside the human body for a very long time and can be found on things, such as bed linens, bed rails, bathroom fixtures, and medical equipment

Can spread person-to-person on contaminated equipment and on the hands of MDs, nurses, healthcare personnel, and visitors

Most often occurs in patients taking antibiotics

Signs and Symptoms

• Watery diarrhea
• Fever
• Loss of appetite
• Nausea
• Abdominal pain
• Abdominal tenderness

Risk Factors

Anyone who has taken antibiotic, risk increases if you take broad spectrum antibiotics to treat a wide range of bacteria, use several antibiotics, or take antibiotics for extended period of time.

Any person over 65 of age, the risk of infection is 10 times greater for people 65 and older when compared to younger people

Anyone who is hospitalized or have been recently, especially for a long period of time

Anyone who lives in a nursing home or ECF

Anyone with a weakened immune system or serious medical condition

Anyone who has had abdominal surgery or gastrointestinal procedure

Anyone is has a colon disease such as colorectal cancer

Anyone who has had C. diff infection before

antibiotics-without-prescription.com

Treatment

Antibiotics

In severe cases a person may have to have surgery to remove the infected portion of the intestines

Reference:

www.cdc.gov

http://www.mayoclinic.com/

PREVENTION OF CATHETER-ASSOCIATED BLOODSTREAM INFECTIONS

Prevention

What can hospital do to help prevent catheter-associated bloodstream infections?

Doctors/Nurses will need to do the following:

Choose a vein where the catheter can be safely inserted and where the risk of infection is low

Proper hand hygiene before placing the catheter

Wear a mask, cap, sterile gown, and sterile gloves when putting in the catheter to keep it sterile. Also cover the patient with sterile sheet

365healthcare.com

Clean the patient’s skin with an antiseptic cleanser prior to catheter placement

Proper hand hygiene, gloves, and clean the catheter opening with an antiseptic solution before using the catheter to draw blood or give medications

Proper hand hygiene and sterile technique when changing the catheter dressing


Assess everyday if the patient still needs to have the catheter, remove as soon as possible

Patients who have catheter need to do the following:

Ask doctors and nurses to explain why they need the catheter and how long they should expect to have it

Ask healthcare personnel if they are using proper prevention techniques when handling the catheter

healblog.net

Make sure ALL healthcare personnel clean their hands before caring for you

If the bandage comes off notify your healthcare team immediately

Inform healthcare team if you notice pain or redness at catheter site

Make sure visitors also follow proper hand hygiene before visiting you

Some patients may be sent home with catheter from the hospitals if so you need to do the following:

Make sure you understand how to care for the catheter, always ask your healthcare team questions, for example, how will I bath when I get home?

Make sure you have contact information of your healthcare team in case you have questions or problems after discharge

ALWAYS watch for s/s of infection, soreness or redness at the catheter site, fever, chills, if you notice any of these signs  call your healthcare team IMMEDIATELY

Reference:

www.cdc.gov

CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS

CENTRAL LINES

Central line associated infections cause thousands of deaths each year, yet these infections are preventable.

What is a central line?

A central line (central venous catheter) is a tube that is placed in a large vein in the neck, chest, or groin. It is used to provide the patient with medication or fluids, or to collect blood for medical testing.  Central lines are different from peripheral IV sites as these catheters access a major vein that is close to the heart and can remain in place for extended periods of time, weeks or months.

qhr.knowledgebase.co

What is a central line associated bloodstream infection?

• Abbreviated CLABSI
• Serious infection
• Occurs when germs such as bacteria or viruses enter the bloodstream through the central line
• In some cases, germs are introduced into the blood stream when the central line is accessed days or weeks after being inserted

Modifiable Risk Factors

“Insertion circumstances (Emergency > Elective)

Skill of inserter (General > Specialized)

Insertion Site (Femoral > Subclavian)

Skin antisepsis (70% alcohol, 10% povidone, chlorhexidine)

Catheter lumens (Multilumen > Single lumen)

Duration of catheter use (Longer duration of use greater risk of infection)

Barrier precautions”   Source: http://www.healthcare.gov

Diagnosis

According to Dr. Jeffery Band from http://www.uptodate.com/ one must meet at least one of the following criteria:

“Patient has a recognized pathogen cultured from one or more blood cultures and the pathogen is not related to an infection at another site.

Patient has fever, chills, and/or hypotension as well as positive laboratory cultures from two or more blood samples drawn on separate occasions which are not related to infection at another site and do not reflect contamination.

Patient <1 year of age has at least one of the following signs or symptoms: fever, hypothermia, apnea, or bradycardia (in addition to above criteria).”

Drawing blood cultures

Should be obtained from two to four blood draws from separate sites (right hand left forearm)

Should be drawn simultaneously

References:

http://www.healthcare.gov/compare/partnership-for-patients/safety/clabsi.html

http://www.cdc.gov/hai/pdfs/toolkits/CLABSItoolkit_white020910_final.pdf

http://www.hsag.com/