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                                                                                                           APA Reference 

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Preventing, Controlling, and Surveying to Reduce Infection Rates:

Strategies for reduction of HAIs

Zero tolerance policy

Hand Hygiene Improvement

Environmental surveillance

Priority of lines and drains

Drivers to prevent re-occurrence

Patient pressure, regulations, fear of legal action, financial assistance, and governing guidelines.

Reducing morbidity and mortality rates

Preventing them before they happen

Factors contributing to HAIs:
Healthcare related factors include the use of invasive devices, surgical procedures, and selection pressure from excessive antibiotic use.

Central-line associated bloodstream infections (CLABSI)

Clostridium difficile infections

Pneumonia

Methicillin-resistant Staphylococcus aureus (MRSA) infections

Surgical site infections

Urinary tract infections

Reservoirs and transmission:
Determinants:

Environment:

Poor hygiene conditions and inadequate waste disposal

Susceptibility:

Prolonged antibiotic use, prolonged stays, immunocompromised patients, Central lines, and the elderly.

Unawareness:

Poor knowledge of disinfection and sterilization techniques

Inappropriate use of invasive devices

Lack of control policies

Transmission

Bacteria transferred to surgical site

Staff to patient

Equipment transmission

Control of HAIs:

Infection control programs

Standard precautions

Transmission based precautions

Guidelines for the sterilization and disinfection of invasive devices

Antibiotic control policy

Avoid antimicrobial overuse and the misuse of antibiotics

Changing the culture of an organization so that everyone can speak up if they detect unsafe practices

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"Nurses play a pivotal role in preventing hospital-acquired infections (HAIs), not only by ensuring that all aspects of their nursing practice is evidence based, but also through nursing research and patient education." (AMN Healthcare, 2018).  This includes:

Following the Universal Precaution Rule

Wearing personal protection equipment (PPE) such as gloves, gowns, and face mask/shield.

Full barrier precautions when preparing for the insertion and cleaning of central venous catheters

Effective hand-washing with antimicrobial soap and water or alcohol based sanitizer in between patient care

Irrigating cutaneous wounds thoroughly between dressing changes and dressing a wound appropriately

Adopt a safety minded attitude and report errors immediately

Improving or Worsening?
Although a zero tolerance policy is important, it is debatable as to whether all HAIs are truly preventable. The shortage of nurses and the increased patient load can make our work overwhelming, but with strict adherence to policy and constant reminding we are making improvements!

Attached is a policy that Sentara follows to provide a hospital environment that is safe and clean for all:

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IC 401 Environmental Aspects - Infection Prevention Control 2016-09 FINAL

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Problem:
In American hospitals alone, the Centers for Disease Control (CDC) estimates that HAIs account for an estimated 1.7 million infections and 99,000 associated deaths each year. Of these infections:

32 percent of all healthcare acquired infection are urinary tract infections

22 percent are surgical site infections

15 percent are pneumonia (lung infections)

14 percent are bloodstream infection

"Patients who acquire infections from surgery spend, on average, an additional 6.5 days in the hospital, are five times more likely to be readmitted after discharge and twice as likely to die." (Healthcare-Acquired Infections (HAIs), 2018, para 1).

Who:
All hospitalized patients are susceptible to contracting a nosocomial infection. "Some patients are at greater risk than others-young children, the elderly, and persons with compromised immune systems are more likely to get an infection (Healthcare-Acquired Infections, 2018).
How:
During hospitalization, patient is exposed to pathogens through different sources of the environment, healthcare staff, and other infected patients. Nosocomial pathogens can be transmitted through person to person, environment or contaminated water and food, infected individuals, contaminated healthcare personnel's skin or contact via shared items and surfaces. (Khan, Ahmad, & Mehboob, 2015).
Where:

"These infections occur worldwide both in developed and developing countries. Nosocomial infections accounts for 7% in developed and 10% in developing countries." (Khan, Beig, & Mehboob, 2017, p. 478).

When:
These infections can occur during healthcare delivery for other diseases and even after the discharge of the patients.
Why:
Risk factors for acquiring HAIs are long hospital stays, the use of indwelling catheters, failure of healthcare workers to wash their hands, and overuse of antibiotics (Healthcare-Acquired Infections, 2018). These infections that our patients acquire are due to lack of infection control, missteps in sterilization and disinfection, and improper protocol of evidence based practice.

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Center For Disease Control and Prevention

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Center For Disease Control and Prevention

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Centers for Disease Control and Prevention (CDC)

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Healthcare-Associated Infections in the United States

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ANALYSIS: Importance of Nurse Involvement 

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ANALYSIS: Importance of Nurse Involvement 

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Nurses are at the forefront of

preventing these infections.

"By leading and participating in prevention efforts, nurses can play a major role in reducing these infections. Recently, nurses have been collaborating with infection preventionists, physicians, quality-improvement specialists, pharmacists, and others to significantly decrease HAIs and reduce their impact on patients, families, nurses and other caregivers, and hospital bottom lines. " (Hessels, 2015, p. 2).

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Challenges:

Creating a system to monitor healthcare workers' handwashing practices without creating a system in which workers instinctively wash their hands only when the monitors – whose identities will quickly become known – are present.

Identifying selected antibiotic-resistant nosocomial pathogens

MRSA, C. diff

Identifying agents of nosocomial infections before they are spread from patient to staff to other patients.

Staphylococcus, E. coli, K. pneumonia, P. aeruginosa

Having visitors and patients comply with universal precautions to prevent environmental contamination

Decisions to decolonize certain patients, discovered to be carriers, with antibiotics create the risk of emergence of resistant bacterial strains.

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Handwashing is key!!!

Patient units can be revamped at minimal expense so that dispensers are placed as conveniently as possible to patient care practices, and become an automatic step for the care provider entering and leaving the room.

Detect before it's too late!

Swabbing every patient upon admission for Methicillin-Resistant Staphylococcus aureus, or just every patient admitted to the intensive care unit, or just certain patient populations such as those undergoing dialysis or those in pediatric settings.

Empowering nurses to recognize patients with diarrhea as potentially harboring C. diff, isolating them and testing them immediately to minimize the chance of the spread of the bacteria

Know your hospitals infection preventionists!

Your Infection Preventionists at Sentara are:

Gail Rudder RN, CRNI, Infection Preventionist

Regina Coste BSN, CIC, Infection Preventionist

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1. Universal Precautions

For universal precautions, protective barriers reduce the risk of exposure to blood, body fluids containing visible blood, and other fluids to which universal precautions apply. Examples of protective barriers include gloves, gowns, masks, and protective eyewear.

Always wear a protective barrier (surgical gloves) when in contact with blood, body fluids or feces.

Assess the need for isolation: Neutropenia and immunological disorder, diarrhea, skin rashes, known communicable disease, & known carriers of an epidemic strain of bacterium.

According to Hillyard (2009), we must always follow these 5 steps:

Patient and staff education

Hand washing

Use of protective barriers (Personal Protective Equipment (PPE))

Cleaning of contaminated surfaces

Safe handling/disposal of contaminated material

2. Leadership

Nurses in all roles and settings can demonstrate leadership in infection prevention and control by using their knowledge, skill and judgment to initiate appropriate and immediate infection control procedures. Practice diligently and keep your patient safe.

Advocating for patient safety through handwashing and enforcing strict handwashing when required

"All Hands on Deck"

Educate patients on why we use precautions and explain procedures and interventions of care for them.

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Nosocomial infections, also called healthcare associated  infections (HAIs), are infections that patients get while receiving treatment for medical or surgical conditions while in a healthcare facility.

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hospital-acquired infection (disease or medical condition)

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Hospital Acquired Infections & How To Prevent Them | Curos

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http://www.curos.com/staying-safe-hospital-acquired-infections/ Healthcare-acquired infections are a highly prevalent and deadly issue affecting hospitals across the United States. The improper use of devices and disinfection procedures cause the most common HAI's. Applying best practices and tools to properly disinfect devices such as central line catheters can greatly reduce risk and improve prevention.

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Introduction

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ALWAYS KEEP YOU SAFE!