AHRQ Clean Safety Program for Long-Term Care: HAIs/CAUTI
AHRQ Clean Safety Program for Long-Term Care: HAIs/CAUTI Equipment and Environment Promotes Safe Resident Care Training Module 2 AHRQ Pub. No. 16(17)-0003-9-EF March 2017 Objectives Upon completion of this session, long-term care (LTC) staff will be able to Describe the chain of infection and identify key strategies to break the chain Explain catheter care and maintenance strategies that facility staff can use to prevent residents from acquiring catheter-associated urinary tract infection (CAUTI)
Explain the role of the environment as a place where pathogens can become a source of infection for residents and staff List the important steps when using environmental disinfectants AHRQ SAFETY PROGRAM FOR LONG-TERM CARE: HAIs/CAUTI Env./Equip. 2 Protecting Residents Against Infection The Chain of Transmission: Six Links Each link stands for something (or Infectious Agent New Resident (Susceptible Host) Entry of
New Resident someone) that helps pass on an infection. (Viruses or Bacteria) Resident Chain of Infection (Reservoirs) An infection can be passed from one person to another person as long as the links of the chain are joined together. Exit Resident (Portal of Exit) (Entry Portal) Mode of Transmission
AHRQ SAFETY PROGRAM FOR LONG-TERM CARE: HAIs/CAUTI Env./Equip. 3 Breaking the Chain of Infection The Role of LTC Facility Staff The Chain of Transmission: Six Links Infectious Agent New Resident (Susceptible Host) Entry of New Resident Education (Viruses or Bacteria) Resident Chain of
Infection How Can You Break the Chain of Infection? (Reservoirs) Exit Resident (Portal of Exit) (Entry Portal) Mode of Transmission AHRQ SAFETY PROGRAM FOR LONG-TERM CARE: HAIs/CAUTI Hand hygiene Gloves Clean rooms Disinfected surfaces Proper medical device care and
maintenance Ensure residents have Good personal hygiene Covered cuts/wounds Isolation precautions No unnecessary antibiotics Proper waste disposal Env./Equip. 4 Indwelling Urinary Catheter: Entry Pathways for Microbes1 Bladder Entry during insertion Bacteria movement up the catheter Urethra (Urinary tract entrance)
Urine Drainage Bag Breaks in the catheter tubing or drainage bag Contamination of the catheter tubing or drainage bag Adapted from: Maki DG, Tambyah PA. Emerg Infect Dis. 2001 Mar-Apr;7(2):342-7. PMID: 11294737. AHRQ SAFETY PROGRAM FOR LONG-TERM CARE: HAIs/CAUTI Env./Equip. 5 Entry Pathways for Microbes: Urine Collection Opening2 Sterile technique is important when inserting urinary catheters Routine hygiene is important (e.g., cleansing the area around the urethra during bathing or showering)
Disinfect port with alcohol swab for 15 seconds before obtaining a urine culture Check site for possible disconnection of catheter from drainage bag Source: Catheterout.org. Used with permission. System may become an open system if the outlet is left unclamped AHRQ SAFETY PROGRAM FOR LONG-TERM CARE: HAIs/CAUTI Env./Equip. 6 Indwelling Urinary Catheter: Stabilization Devices Can Help Prevent Microbe Entry3 Catheter Stabilization Devices Seal over junction between catheter and
drainage bag. Source: Catheter Associated Urinary Tract Infection (CAUTI) Prevention. SHARP. AHRQ SAFETY PROGRAM FOR LONG-TERM CARE: HAIs/CAUTI Env./Equip. 7 Hand Hygiene4,5 Source: Public Health Ontario Good Plain soap Better Antimicrobial soap AHRQ SAFETY PROGRAM FOR LONG-TERM CARE: HAIs/CAUTI Best Alcohol-based hand rub Env./Equip. 8 Case Review of an Outbreak6
The Case of the Common Urinometer A long-term care facility has an outbreak of multidrug-resistant Serratia marcescens urinary tract infections (UTIs) Risk factors Use of common measuring device between residents with indwelling urinary catheters Hands of health care workers contaminated with outbreak strain after use of device; they helped pass the microbes between residents The outbreak stopped after the measuring device was disinfected between each use Dedicate one device per resident AHRQ SAFETY PROGRAM FOR LONG-TERM CARE: HAIs/CAUTI Env./Equip. 9 Role of Clean Equipment and Environment7-10 Protecting Residents Against Infection Factors associated with increased risk of infection in residents include Lower level of cleanliness Higher frequency of odors High turnover rate of nurses Fewer certified nurses aides/100 beds Microorganism Bacteria
Clostridium difficile (C. diff) spore Methicillin-resistant Staphylococcus aureus (MRSA) Viruses Human immunodeficiency virus (HIV) Norovirus AHRQ SAFETY PROGRAM FOR LONG-TERM CARE: HAIs/CAUTI Survival on Environmental Surfaces > 1 year 7 days 7 months 3 4 days 8 hours 7 days Env./Equip. 10 Disinfection of the Environment and Equipment Why is it important to disinfect surfaces in the LTC facility? Surfaces that are touched frequently increase the chance that microorganisms could be spread to residents or staff While surfaces may look clean, pathogens may be lurking What can you do? Cleaning/disinfection offers extra margin of safety
Disinfectant kills bacteria and viruses that cant be seen Focus disinfection on surfaces that are touched a lot AHRQ SAFETY PROGRAM FOR LONG-TERM CARE: HAIs/CAUTI Env./Equip. 11 Commonly Touched Areas in the LTC Facility Lets Chat! What are some examples of commonly touched surfaces in your facility? Door handles Call button Telephone Bed rail
Tray table Bedside table Light switches Bedside commode AHRQ SAFETY PROGRAM FOR LONG-TERM CARE: HAIs/CAUTI Env./Equip. 12 Disinfection in LTC Facilities: Read the Label First! Follow instructions for use check the label on disinfectants for the following key safety steps: Precautions you should take when applying the product, such as wearing gloves If the disinfectant is safe for the surface Whether the disinfectant needs to be diluted with water before use How to apply the disinfectant to a surface How long you need to leave it on the surface to be effective (contact time) If the surface needs to be cleaned first and rinsed Source: Environmental Protection Agency after using
AHRQ SAFETY PROGRAM FOR LONG-TERM CARE: HAIs/CAUTI Env./Equip. 13 Disinfectant Wipes Keep It WetThe surface being disinfected needs to be wet long enough to meet the contact time stated on the label. Cover the Surface WellUse the right size wipe based on the size of the surface. Small wipes are fine for bedside tables Larger wipes for larger areas, like mattress covers Keep the Cover Closed and Secure After UseKeep the top of the dispenser closed to prevent the wipes from drying out. Also think about where the dispenser is stored can residents access the wipes? AHRQ SAFETY PROGRAM FOR LONG-TERM CARE: HAIs/CAUTI Env./Equip. 14 Improving Cleaning and
Disinfection Lets Chat! 1. Where are your cleaning and disinfection supplies? 2. What would help remind you to clean and disinfect surfaces thoroughly? 3. What is your role in ensuring surfaces are clean and disinfected? AHRQ SAFETY PROGRAM FOR LONG-TERM CARE: HAIs/CAUTI Env./Equip. 15 Wrapup Clean environment and clean equipment keep residents safe. Know how to safely and properly use disinfectants utilized at your facility. READ THE LABEL! Clean and disinfect surfaces that are touched a lot and that are soiled with body fluids.
Follow routine catheter care and maintenance to prevent catheters from becoming an entry portal for bacteria. AHRQ SAFETY PROGRAM FOR LONG-TERM CARE: HAIs/CAUTI Env./Equip. 16 References 1. Maki DG, Tambyah PA. Engineering out the risk for infection with urinary catheters. Emerg Infect Dis. 2001 Mar-Apr;7(2):342-7. PMID: 11294737. 2. The University of Michigan, Veterans Administration Healthcare System. Catheterout.org. Ann Arbor, MI. Fowler K. http://catheterout.org. Accessed on October 13, 2015. 3. System CAUTI Prevention Team. Catheter Associate Urinary Tract Infection (CAUTI) Prevention. SHARP. http://www.sharp.com/instructors-students/upload/CAUTI_Prevention_Netlearning_11_22_2011_FINAL.pdf. Accessed September 9, 2016. 4. Just Clean Your Hands educational resources. Ontario Agency for Health Protection and Promotion. http://www.publichealthontario.ca/en/BrowseByTopic/InfectiousDiseases/JustCleanYourHands/Pages/JCYH-ltch-Education-and-trai ning.aspx . Accessed on April 14, 2015. 5. Boyce JM, Pittet D, Healthcare Infection Control Practices Advisory Committee, et al. Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Recomm Rep. 2002 Oct 25;51(RR-16):1-45. PMID:12418624. 6. Rutala WA, Kennedy VA, Loflin HB, et al. Serratia marcescens nosocomial infections of the urinary tract associated with urine measuring containers and urinometers. Am J Med. 1981 Mar;70(3):659-63. PMID: 7011020. 7. Zimmerman S, Gruber-Baldini AL, Hebel JR, et al. Nursing home facility risk factors for infection and hospitalization: importance of
registered nurse turnover, administration, and social factors. J Am Geriatri Soc. 2002 Dec;50(12):1987-95. PMID: 12473010. 8. Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis. 2006 Aug 16;6:130. PMID: 16914034. 9. McFarland LV, Beneda HW, Clarridge JE, et al. Implications of the changing face of Clostridium difficile disease for health care practitioners. Am J Infect Control 2007 May;35(4):237-53. PMID: 17482995. 10. Murphy CR, Eells SJ, Quan V, et al. Methicillin-resistant Staphylococcus aureus burden in nursing homes associated with environmental contamination of common areas. J Am Geriatr Soc. 2012 Jun;60(6), 1012-18. PMID: 22670708. 11. Duckro, AN, Blom DW, Lyle EA, et al. Transfer of vancomycin-resistant enterococci via health care worker hands. Arch Intern Med. 2005 Feb 14;165(3):302-7. PMID:15710793. AHRQ SAFETY PROGRAM FOR LONG-TERM CARE: HAIs/CAUTI Env./Equip. 17
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