Infection Prevention & Control for Physicians

Infection Prevention & Control Department212-263-5454 (TH 9am-5pm M-F)212-598-6767 (HJD 9am-5pm M-F)212-263-4316 (off-hours beeper)Employee Health/Needle Stick Hotline212-263-5020

Infection types in acute care settings

Apic. Guide to the Elimination of Catheter-Associated Urinary Tract Infections, 2008

Surveillance at NYULMC occurs for the following

Hand hygiene (HH) complianceHospital acquired (HA) multi-drug resistant

organisms (MDROs)HA C. difficileStandard and Isolation PrecautionsSurgical site infections (SSIs)

Hip arthroplasties CABG Colon

Central line associated bloodstream infections (CLABIs)

Catheter associated urinary tract infections (CAUTIs)

Hand Hygiene

Indications Immediately before touching patients After touching patients After contact with the patient’s environment (even if you

don’t touch the patient) Immediately before an invasive procedure After removing gloves

Policy location The Link Departments Infection Prevention and

Control Infection Prevention and Control Policies Hand and Skin Antisepsis Hand Hygiene

Multi-drug Resistant Organisms

Policy Location The Link Departments Infection Prevention and

Control Infection Prevention and Control Policies Standard and Isolation Precautions, MDROs and other diseases requiring precautions Multi-drug Resistant Organisms

C. difficile

Testing Polymerase chain reaction (PCR) -tests for DNA (99.6% specificity) Do not order stool samples x3 to rule out infection Cure of C. difficile is a clinical assessment, do not repeat testing for

“clearance” of toxinAntibiotic Stewardship Program availablePrecautions

Once a PCR is ordered-C. difficile Contact Precautions should be initiated irrespective of C. difficile status.

Discontinue C. difficile Contact Precautions if Test results are negative or Test results are positive and the patient has started on

appropriate anti-microbial treatment and remained symptom free for at least 48 hours.

Policy The Link Departments Infection Prevention and Control

Infection Prevention and Control C. difficile Patient Care Patient Testing

Standard and Isolation Precautions

Policy Location The Link Departments Infection Prevention and

Control Infection Prevention and Control Policies Standard and Isolation Precautions, MDRO and other diseases requiring precautions

Surgical Site Infection Prevention

Limit flash sterilization (book cases correctly)

Pre-admission testing (PAT) patients at TH and HJD are given 2% impregnated Chlorhexadine Gluconate (CHG) wipes for skin antisepsis if they are to undergo the following:

Cardio-thoracic (requiring sternotomies) Major joint procedures Spinal procedures

CLABSI & CAUTI

Housewide surveillance January 1, 2010

Central Line Insertion Bundle For all patients, not just ICU’s!

Central Line Insertion Checklist For all patients, not just ICU’s!

Bloodborne Pathogen Exposure Information

If you have been exposed Stop what you are doing and wash the site immediately Go to EHS (212-263-5020) (or the ED on weekends or off hours)

If you are the ordering physician Obtain NYS source patient HIV consent form (The Link

Hospital Administration Infection Prevention and Control Information for Health Care Workers NYSDOH HIV consent)

Obtain source patient consent for HIV Order patient testing for HIV, HBV and HCV using the ICIS

order set called “Blood/Body Fluid Exposure.”

Bloodborne Pathogen Exposure Information

What NOT to do… Do NOT go to another hospital, such as Beth Israel for

post-exposure care. Do NOT decide what tests the source patient needs on

your own. Employee Health Service will help with getting the appropriate tests for the patient. They have created a pathway in ICIS to get you to the correct tests.

Do NOT try to get anonymous (numbered) testing for source patients. NYS no longer has anonymous testing.

Michael Phillips, MDSandra Hardy, RNTania Williams, RNSteven Bock, RNFaith Skeete, RNAlex Rowan-Hazelrigg, RNRanekka Dean, RNSapna Mehta, MDDelia Valentin

The Infection Prevention & Control Department