the hot zone: preventing infections in the healthcare settingsofi.ucla.edu/workfiles/documents/the...

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The Hot Zone:

Preventing Infections in the

Healthcare Setting

… Journey towards High Reliability and Zero Harm

UCLA Health Healthcare Quality Week 2019October 23, 2019

Clinical Epidemiology and Infection Prevention (CEIP)

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Healthcare Associated Infections

(HAIs)

Definition of HAIs

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HAIs…

are infections people get while they are receiving health care for another condition

are a significant cause of illness and death

cause financial and medical consequences to both the patient and the healthcare facility

Factors that increase risk of HAIs

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• Catheters (bloodstream, endotracheal, and urinary)

• Surgery

• Injections

• Improperly cleaned and disinfected environment

• Overuse or improper use of antibiotics

• Lack of hand hygiene compliance amongst healthcare

workers

Common HAIs

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Central-line associated

bloodstream infection (CLABSI)

Catheter-associated urinary

tract infection (CAUTI)

Surgical Site Infection (SSI)

Ventilator-associated event

(VAE)

Clostridioidesdifficile (C.diff)

HAI Public Reporting Requirements

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In 2006, CA passed legislation mandating public reporting and

later established the CA Department of Public Health

Healthcare-Associated Infection Program.

Purpose of public reporting requirements:

Public disclosure intended as driver for infection prevention

Encourages healthcare providers to take action

Better informed public = higher quality healthcare

California Mandates

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2006, Senate Bill 739

Requires hospitals to collect HAI data

Requires hospitals to establish

Antibiotic Stewardship programs

Established CDPH Hospital Infections

Program

2008, Senate Bill 1058 & 158

Requires hospitals to publicly report

HAI data

CLABSI

CAUTI

SSI

C.diff, MRSA, VRE

Requires hospitals to offer free

Influenza vaccine to all employees

Requires MRSA screening of “high

risk” patients in hospitals

Tableau HAI Dashboard

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CAUTI Data for RR Medical Center

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Date Range: 4/1/19 – 8/1/19

Key Takeaways

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1

• HAIs can have significant impacts to both the patient and the healthcare facility.

2• Reporting HAIs helps to drive quality improvement.

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• You can use Tableau to identify infections on your unit/facility.

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Hand Hygiene

Clean Hands Saves Lives

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CDC estimates that each year nearly 2 million patients in the US get an

infection in hospitals, and about 90,000 of these patients die as a result of

their infection 1

The most common mode of transmission of pathogens is via hands

Hand hygiene reduces the incidence of healthcare associated infections

1https://www.cdc.gov/handwashing/why-handwashing.html

UCLA Health Policy – Hand Hygiene,

HS IC 001

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Purpose

To state the expectation that HCWs practice

hand hygiene as outlined below, thereby

reducing the risk of HAIs.

When to practice hand hygiene

Indications for hand hygiene

How to practice hand hygiene

Nails standard

Correct of use of gloves

Form #17081 on

Forms Portal

Indications for Hand Hygiene

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Before patient contact; includes before

putting on gloves

Before a clean or aseptic task

After body fluid exposure risk

After patient contact; includes after glove

removal

After contact with patient surroundings,

including medical equipment

If moving from contaminated body site to

a clean body site during patient care

Before eating

https://www.who.int/infection-prevention/campaigns/clean-hands/5moments/en/

Recommended Hand Hygiene

Technique: Soap and water

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Lather your hands for 20 seconds

Avoid using hot water

Use towel to turn off faucet

To be practiced for

• Visibly soiled hands

• After use of restroom

• Caring for a patient with C.diff

https://www.who.int/gpsc/clean_hands_protection/en/

Recommended Hand Hygiene Technique:

Alcohol-based hand rub (ABHR)

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Preferred method for hand hygiene with

the following exceptions:

Not for visibly soiled hands

Not for when caring for patients with

C.diff

Rub hands together, covering all surfaces

of the hands, fingers, and nails until hands

are dry

>60% alcohol in the ABHR

Efficacy of Hand Hygiene

Preparations in Killing Bacteria

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Good

Plain soap

Better

Antimicrobial

soap

Best

Alcohol-based hand

rub

Perceived Barriers to Hand Hygiene

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Agents cause irritation and dryness

Sinks are inconveniently located

Lack of sinks

Busy environment/overcrowding

“I am not going to touch anything”

“Too busy”

“Low risk of acquiring infections from patients”

“I wear gloves instead of practicing HH”

Fingernail Standard

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Staff who work in patient care areas, or who are involved in patient care, shall

have natural nails that are kept clean, neatly trimmed and ¼" long.

Nail polish in good repair (i.e., not cracked) is permitted.

Artificial nails, gel overlay (e.g., OPI Axxium Gel, CalGel, CND Shellac,

Harmony Gelish), nail art (e.g., glitters, piercings, 3D art, and adding accessories

like studs, rhinestones, beads, aluminum foil), tips and/or fillers are not allowed in

direct patient care areas, including where food is prepared.

Correct Use of Gloves

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Wear gloves that fit appropriately

Do not wear the same pair of gloves for the

care of more than one patient

Do not wash gloves for the purpose of reuse

Change gloves when they have been in

contact with mucous membranes, blood or

potentially infectious material

Carefully remove gloves to prevent hand

contamination

Key Takeaways

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1

• Many potentially deadly germs are spread from patient to patient on the hands of healthcare workers.

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• Your actions can put you, your colleagues, and your patients at risk of infection.

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• Practice appropriate hand hygiene to protect yourself and others.

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Transmission Based Precautions

Chain of Infection – Break the Chain!

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• Infectious agent: pathogens to cause infection

• Reservoir: microbes live and where the

microorganisms can survive, thrive and reproduce

• Portal of exit: pathogens to leave reservoir (sneezing,

coughing, body excretions)

• Mode of Transmission: The way the organism moves

or is carried from one place to another (touching/poor

hand hygiene)

• Portal of entry: an entry or opening allowing the

pathogen to enter host

• Susceptible host: persons carrying the pathogen

UCLA Health Policy – Standard and

Transmission Based Precautions, HS IC 002

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Purpose

To provide guidance on when and how to use Standard

and Transmission Based Precautions.

Standard Precautions

Hand Hygiene

Use of PPE

Respiratory hygiene/cough etiquette

Safe injection practices

Transmission Based Precautions

Used in addition to Standard Precautions

Targeted specifically at how organisms are

transmitted

For questions, contact CEIP at (ceip@mednet.ucla.edu) or 310-794-0187

Contact/ Spore Precautions: C. auris

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• Candida auris (C. auris): an emerging multi-drug

resistant fungus that is difficult to treat, difficult to

identify, and difficult to clean from the patient care

environment

• Early detection of C. auris and rigorous adherence to

infection control measures is essential for containing

its spread in healthcare facilities

• Process is in place for screening high risk patients for

C. auris

• There is no isolation clearance process for C. auris

For questions, contact CEIP at (ceip@mednet.ucla.edu) or 310-794-0187

How to Prevent C. auris Transmission

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What YOU can continue to do to help prevent the spread of C. auris:

Practice proper hand hygiene

Appropriately wear personal protective equipment (gown and

gloves)

Use hospital approved bleach wipes to clean and disinfect

equipment and surfaces

Dedicate the use of equipment (e.g., stethoscope, blood

pressure cuff) to a single patient

Use single-patient disposable items whenever possible

Disinfect reusable patient care equipment using dilute bleach

wipes before use on another patient

Minimize patient transport

Ensure that patients with C. auris or a history of C. auris

remain on contact/spore isolation indefinitely

Page IP on call (9-4040) upon discharge of a patient with C.

auris or a history of C. auris

Clorox bleach germicidal wipes

Wet contact time: 3 minutes

For questions, contact CEIP at

(ceip@mednet.ucla.edu) or 310-794-0187

Key Takeaways

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1

• Isolation based precautions help prevent the spread of infection.

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• Refer to the back of the isolation signs for further detailed information.

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• If you have questions, contact CEIP at (ceip@mednet.ucla.edu) or 310-794-0187.

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Environment of Care

Environment of Care (EOC)

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• The goal of Environment of Care is to provide a safe environment for our

patients, visitors and staff based on regulatory requirements and guidelines

(e.g., Occupational Safety and Health Administration (OSHA))

Infection Prevention

Environmental Health & Safety

Facilities

Environmental Services

Construction/Renovation Projects

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Holes

through

barrier

Open

barrier

Open

barrier

Environmental Surfaces

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• Environmental cleaning is an

important principle of infection

prevention in the healthcare

setting

• Contaminated surfaces play a

significant role in the

transmission of dangerous

pathogens that can be easily

spread

• Improperly cleaned or

disinfected items can lead to

infections amongst patients,

visitors, and staff

Disinfection Strategies

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• Approved disinfectants

• Best selection for type of pathogen and environment

• Proper solution mix, application & dwell time

• “No-touch” disinfection enhancements systems

• Ultraviolet (UV) light

3 min dwell time 1 min dwell time

3 min dwell time

(Only for equipment

that requires

disinfection with a

alcohol free product)

High Touch Wipe Down (HTWD)

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• High touch surfaces include, but are not limited to:

• Medical equipment knobs or handles (e.g.,

knobs or handles on x-ray machines, cardiac

monitors)

• Blood pressure cuffs

• Bedrails

• Handheld television controls

• Nurse call lights

• Doorknobs

• Light switches

• Telephones

• Computer keyboards/iPads

Instruction for use (IFU) cleaning protocols

must be followed, otherwise may damage

equipment

Environment of Care (EOC) Rounds

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• CEIP conducts monthly EOC rounds on each inpatient unit

• 8 areas of focus during rounds:

IP Knowledge Questions

(6 Questions)

Front Desk/Main Nurses Station

(3 Opportunities)

IP Practices

(28 Opportunities)

Clean Utility Rooms

(8 Opportunities)

Dirty Utility Rooms

(6 Opportunities)

Kitchen

(12 Opportunities)

Isolation Rooms (8 Opportunities)

Linen Rooms/Carts

(6 Opportunities)

IP Practices: Expectation vs. Observation

• Staff food is not

found in patient

care areas

• The lids of

disinfectant wipes

are closed

• Items are not stored

in inappropriate or

unsafe locations

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IP Practices Continued

• High/low level dusting

has been done

throughout the unit

• Staff belongings,

including personal hand

lotions are not stored in

PCA

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Clean Utility Rooms: Expectation vs. Observation

• All clean and sterile

supplies are

appropriately packaged

• No outdated items in

clean area

• No doors propped

open. i.e. doors leading

to corridors or nurses

station

Observed in

September

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Dirty Utility Rooms: Expectation vs. Observation

• Soiled linen is collected

and transported to a

designated dirty utility

area in a covered leak

proof container

• Trash barrels are clean,

covered and not

overfilled

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Linen Room/Cart: Expectation vs. Observation

• No linen on the floor

• Linen is covered and

impermeable and is

stored in carts and

always covered. No

items stored on top

of carts

• Clean pillows are

stored in bags

Report Notification for EOC Rounds

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• All findings are formally put into a report, which includes pictures

(if any are taken)

• Emailed out to the unit leadership, including unit directors

• Ancillary areas are also copied, when necessary for follow-up

• EVS

• ECMO

• Materials management

Key Takeaways

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1

• Infection Prevention is more than just cleaning/disinfection.

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• Just because you can’t see it doesn’t mean it isn’t there.

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• Infection Prevention conducts rounds with real time feedback – ask questions when you see us on the unit!

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Clinical Epidemiology & Infection Preventionceip@mednet.ucla.edu

310-794-0187IP on call: 9-4040