Objectives Describe frequently encountered MDROs or significant - - PDF document
Chasing Zero Infections - Connecting the Thursday, May 25, 2017 Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship MDROs and the Environment Linda R. Greene, RN, MPS,CIC Manager, Infection Prevention UR Highland
1
Linda R. Greene, RN, MPS,CIC Manager, Infection Prevention UR Highland Hospital Rochester, NY linda_greene@urmc.rochester.edu
2
patients is frequently contaminated with the pathogen.
surfaces and medical equipment for a prolonged period of time.
by healthcare personnel frequently leads to contamination of hands and/or gloves.
correlates with the frequency of hand and/or glove contamination of healthcare personnel.
surfaces of colonized or infected patient are demonstrated to be due to person-to-person transmission or shared medical equipment.
patient colonized or infected with a pathogen (e.g., MRSA, VRE, C. difficile, Acinetobacter) has an increased likelihood
rate of infections. .
3
Epidemiologic triangle of cross transmission Most MDRO*s are transmitted via hands of HCWs Kramer A BMC Infect Dis 2006;6:130
4
American Journal of Infection Control 45 (2017) 336-8 CONCLUSIONS We found that floors in patient rooms were frequently contaminated with health care-associated pathogens and demonstrated the potential for indirect transfer of pathogens to hands from fomites placed on the floor. Further studies are needed to investigate the potential for contaminated hospital floors to contribute to pathogen transmission.
5
Schaefer MK, et al. JAMA. 2010;303(22):2273-2279.
100-1,000 bacteria transferred by:
Pulling patients up in bed
Taking a blood pressure or pulse
Touching a patient’s hand
Rolling patients over in bed
Touching patient’s gown or bed sheets
Touching equipment like bedside rails, over-bed tables, IV pumps
6
53% of HCWs Hand Imprint Cultures + After Occupied Room vs 24%
Bhalla A, et al. Infect Control Hosp Epidemiol. 2004;25(2):164-167.
Chemlay et.al Ther Adv Infect Dis (2014) 2(34) 7990
7
Pathogen able to survive for prolonged periods of time on environmental surfaces (all pathogens)
Ability to remain virulent after environmental exposure (all)
Contamination of the hospital environment frequent (all)
Ability to colonize patients (Acinetobacter, C.difficile, MRSA, VRE)
Ability to transiently colonize the hands of health care workers (all)
Transmission via the contaminated hands of healthcare workers (all)
Small inoculating dose (C. difficile, norovirus)
Relative resistance to disinfectants used on environmental surfaces (C.difficile, norovirus) Weber DJ, et al. AJIC 2010
8
9
Microbiology – Gr+ cocci with many virulent factors
Frequent nosocomial- and community-acquired pathogen
Mode of transmission – contact
Clinical manifestations:
10
11
Furuncle Carbuncle Cellulitis Bursitis Deep tissue abscess Necrotizing fasciitis
Gram positive cocci in chains Human colon is a reservoir Intrinsically rugged organism Translocation across mucosa; systemic spread Biofilm
12
Account for 110,000 urinary tract infections 25,000 cases of bacteremia 40,000 wound infections 1,100 cases of endocarditis Most infections occur in hospitals Since 1989, a rapid increase of VRE
Risk factors for colonization/infection in USA
Reservoirs, routes of dissemination not fully understood
13
Hayden M, et al. Poster presented at the 41st Interscience Conference on Antimicrobial Agents and Chemotherapy December 16-19, Chicago, IL. Available at: http://www.cdc.gov/handhygiene/download/hand_hygiene_supplement_minus_notes.pdf
represents VRE culture positive sites
recoverable readily from moist and dry surfaces.
(including fruits and vegetables), and on healthy skin and other body sites.
and has been shown to be readily recoverable from dry environmental niches.
durability in and on surfaces during outbreaks.
14
15
16
Contamination in healthcare environments has been identified on many surfaces and equipment, including:
17
http://www.cdc.gov/vitalsigns/hai/cre/
18
Cultures of environmental samples from rooms of CRE carriers Sampled pillow, groin, legs, bedside table and infusion pump on 2
wards
Percent positive higher closer to patient
Lerner A et al. J Clin Micro 2013; 51:177-181 Lerner A et al. J Clin Micro 2013; 51:177-181
19
20
“She needs to get a life!” “No, not shiny enough.”
21
22
Item Picture By Whom Frequency Hand gel dispensers EVS Daily and as needed BP cuff After use – nursing. Terminal Clean - EVS After use and terminal clean IV pumps Nursing Between individual patients
23
Method Ease of use Identifies pathogens Useful for individual teaching Directly evaluates cleaning Published use in programatic improvement Covert practice
Low No Yes Yes 1 hospital Swab cultures High Yes Not studied Potentially 1 hospital Agar slide cultures Good Limited Not studies Potentially 1 hospital Fluorescent gel High No Yes Yes 49 hospitals ATP system High No Yes Potentially 2 hospitals
Carling P, Bartley J. Am J Infect Control. 2010;38:S41-S50.
24
O² sat monitor Call bell
25
ATP Fluorescent Marker
26