Hand Hygiene
What is the single most important action you can take to reduce healthcare associated infections?
What is hand hygiene?
When would you use Standard Precautions?
Standard precautions are used in every interaction with every patient, every time.
What is the type of isolation used when a patient has a positive culture for a Multi Drug-Resistant Organism (MDRO) such as Methicillin-resistant Staphylococcus aureus (MRSA)?
Contact Precautions
Extra Credit:
What PPE are required for Contact Precautions?
California State law requires patient screening and education for what drug-resistant organism?
MRSA
Extra credit: Which patients must be screened?
What are “Bundles”?
- Evidence based
- Term coined by the Institute for Healthcare Improvement (IHI)
- Usually 3-5 elements
- When performed collectively and reliably, improve patient outcomes
When do we encourage patients to do hand hygiene?
•Before and after eating food
•After using the toilet
•Before and after treatment/procedure (wound dressing change, dialysis)
•After blowing nose, coughing, or sneezing
•When hands look dirty, after touching garbage/waste
Name three strategies from the Bloodborne Pathogen Exposure Prevention Plan
Engineering controls:
- safety devices
- sharps disposal containers
- needleless systems
Work Practice controls:
- training
- neutral zone (hands-free technique when passing sharps)
- no sharps left on trays
PPE
When would you implement Droplet Precautions?
When a patient tests positive for an infection spread via droplets
Extra credit:
Name two illnesses spread by respiratory droplets
How can antibiotic stewardship impact the development of drug resistance?
Antibiotic use leads to resistant organisms, especially if:
• undertreated (too short duration)
• overprescribed (when not needed- such as for viral infections or at patient request), or
• mismatched (organism is not sensitive to antibiotic)
Antibiotic Stewardship Program (ASP):
• ID, Pharmacy, IPC Team
• develops a formulary based on antibiogram
• using the narrowest drug possible for the shortest amount of time needed
Name 2 elements of the CLABSI Bundle
- Hand Hygiene
- Ensure dressing clean, dry, and intact and change when not
- Daily Theraworx bath
- Daily assessment of line necessity
- Curos caps (alcohol impregnated caps) on unused ports
- Scrub the Hub when accessing
State hand hygiene practice after contact with a patient who has C. diff.
Use only soap and water for hand hygiene, lather and friction for 20 seconds, and use paper towel to turn off faucet
Define one component of Respiratory Hygiene/Cough Etiquette
- Cover your Cough
- Signage throughout facility
- PPE supplies available and accessible
- Don face mask if coughing
When would a patient be placed on Contact Plus Precautions?
When patient has tested positive for Clostridium difficile diarrhea or Norovirus or is being tested for infectious diarrhea, follow Contact Plus Precautions.
Extra credit:
What does the “Plus” in Contact Plus mean?
How long does C. diff live on surfaces?
C. diff spores are known to survive on surfaces for up to 5 months.
Name two elements found in both the CLABSI Bundle and the CAUTI bundle
Hand Hygiene- it’s always hand hygiene
Daily line necessity assessment- get the line out to remove the risk.
What are three actions that one can take to reduce dryness and prevent cracking skin due to frequent hand hygiene?
1. Use hand sanitizer over hand washing whenever appropriate
2. Liberal use of hospital approved hand lotions
3. If dermatitis develops, consider reporting to Occupational Health for a skin evaluation and different hand hygiene products.
Name three safe injection practices
Patient focused practices:
- One needle, One syringe, only One time
- Single-dose vials
- Aseptic technique
Nurse focused practices:
- Safety sharps
- Sharps disposal boxes
- Needless connectors
How will you assist a patient on Contact Plus isolation to ambulate in the hall?
Patient must be continent, or all diarrhea contained.
Assist patient to clean hands and don clean gown or pajamas.
After assisting patient, nurse will doff PPE, wash hands, and then ambulate patient.
What can a nurse do to prevent transmission of an MDRO?
• Perform Hand hygiene
• Review lab results
• Initiate appropriate isolation
• Call MD to put in an isolation order
• Reliable performance of standard and transmission-based precautions
• Remind others to observe proper isolation
Name 2 elements of the SSI Bundle
- Appropriate pre-op antibiotics (and appropriate redosing)
- No shaving of operative area
- Antimicrobial washes before surgery
- Antiseptic scrub in the OR
- Normothermia
- Glucose control
What are the 5 Moments of Hand Hygiene?
1. Before touching a patient
2. Before any clean/aseptic procedure
3. After body fluid exposure risk
4. After touching a patient
5. After touching patient surroundings
What is the meaning of “We touch it, We move it, We clean it”?
Environmental cleaning is also a part of standard precautions.
Anyone who uses or moves a piece of reusable patient care equipment is responsible to clean that equipment.
Extra credit:
What do we use to clean reusable patient care equipment?
The Cal-OSHA Airborne Transmissible Diseases Standard refers to what?
Preventing transmission of Airborne and Droplet spread conditions, such as SARS, Shingles (disseminated), TB, chickenpox, bacterial meningitis.
Extra Credit: Name three components of Airborne Isolation.
Why is Clostridioides difficile considered a significant organism?
- Significant morbidity and mortality for our patients
- Spore forming: resistant to usual cleaning products
- May be resistant to hand sanitizers
What are two elements of the VAE bundle?
- Head of bed elevated 30-45 degrees
- Oral care
- Daily awakening trial/sedation vacation
- Daily assessment of readiness to extubate