Transcript IPRO HAI LAN Reducing C-difficile Transmission in a

IPRO HAI LAN
Reducing C-difficile Transmission
in a Community Hospital
Contributors
Presented by
Jessica Hayashi MS RN CIC
Samaritan Hospital
Mary Beth Farley BS RN CIC
St. Mary’s Hospital
Tom Wright
Manager EVS
Samaritan Hospital
Martha Luzinas MT ICP
Albany Memorial Hospital
7/18/2015
C-difficile: What it Is
• Clostridium difficile infection, or C.
difficile, is an infection in your colon
caused by a spore forming bacteria.
• If the C. difficile bacteria grow rapidly,
this can disrupt the healthy balance of
the colon.
•
This can cause the lining of the colon
to swell, which leads to an infection.
C-diff: How is it
Transmitted
• The bowel movement of a person with a
C. difficile infection contains C. difficile
bacteria.
• Infected people who do not wash their
hands after having a bowel movement
can spread the infection.
• C. difficile bacteria may also be on
surfaces, such as the tops of tables.
• A person can pick it up on their hands
and ingest it.
C-diff Incidence in the US: All
Onset
• September 2, 2011 / 60(34);
C-diff Onset: Inpatient vs. Outpatient
•
FIGURE 1. Percentage of Clostridium difficile infection (CDI) cases (N = 10,342), by inpatient or outpatient
status at time of stool collection and type/location of exposures* — United States, Emerging Infections
Program, 2010
http://www.cdc.gov/mmwr/preview/mmw
rhtml/mm6109a3.htm?s_cid=mm6109a3_w
#fig1
The Hospital Problem
• Patients are admitted with C-diff and
increase risk to others.
• C-diff spores persist in the environment.
• Uninfected patients ingest spores from
environment and become ill with C-diff.
What Increases Risk to
Patients
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Antibiotics
Hospital stay
Age
Medical conditions
Dormant infection
Antacids
C-diff: Trajectory
Symptoms
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Fever
Cramping pain in your abdomen
Diarrhea
Nausea or vomiting
Dehydration
Possible ileus
Samaritan Hospital:
HO C-diff 2012-2013
12
10
8
6
4
2
C-diff policy in
compliance with
recommendations
Review
best
practices
with
Nursing
and EVS
Special cause
analysis:
admitting
assessment
and prompt
CDIF_facIncHOCount
CDIF_HOIncRate
0
NHSN data analysis Oct. 2013
Bundle Strategies:
Antimicrobial Use Restrictions
• Antimicrobial stewardship program
• Minimize the frequency and
duration of antimicrobial therapy
and the number of antimicrobial
agents prescribed
• Discontinue therapy with the
inciting antimicrobial agent(s) as
soon as possible
Bundle Strategies:
Diagnosis and Treatment
• Diagnosis
o Unformed stool- being done
• GDH Glutamate Dehydrogenase (antigen screen)
• EIA immunoassay- confirms toxigenic A/B
o Consider patient with ileus
• Need more education to staff
• Treatment
o Per medical management
o Usually Flagyl and Vanco PO
o Fidaxomicin -mild to moderate disease
Bundle Strategies: Contact Isolation
• Suspected or confirmed cases with “soap and
water” hand wash reminder
• Private room or cohort
o If patient identified as positive while in a semi private consider moving the
room mate to another room
• Precautions maintained for duration of admission
• Alert to Housekeeping
• Use PPE when entering the patient room
o Glove use only when indicated, not in hallway
•
http://www.cdc.gov/HAI/toolkits/Environmental-Cleaning-Checklist-10-6-2010.pdf
Bundle Strategies: Hand
Hygiene
Efficacy of Handwashing Methods for
Removal of C. difficile on Hands of
Experimentally Inoculated Volunteers
counts
Method
Warm water & soap
Cold water & soap
Warm water
& antibacterial soap
Antiseptic hand wipe
Alcohol hand rub
Decrease in mean colony
Log10 CFU/mL
-0.09
95%CI
1.76
1.76
1.47 – 2.05
1.29 – 2.23
1.36
0.59
0.99 – 1.73
0.25 – 0.92
-0.58 – 0.41
Oughton MT, et al. 47th ICAAC Meeting, 2007
C-diff: Environmental
Cleaning
• Disposable rectal thermometers
• Virocept (H2O2) room cleaning
• Bleach equipment wipes
• Ensure commode cleaning
• Ensure equipment that is not dedicated
gets cleaned
o with bleach or other effective cleaner
o before leaving the patient room.
C-diff: Environmental Cleaning
Troy Acute Care Terminal Cleaning Check list
Date:______________
Time:___________________ Initials:___________________
*perform hand hygiene and don PPE before entering room
Evaluate the following priority sites for each patient room:
High-touch Room Surfaces
Bed rails / controls
Overbed table
IV pole (grab area)
Call box / button (including cord)
Telephone
Bedside stand
Chair(s)
Top/outside trash can and hamper
Room sink (if present)
Room light switch(es)
Room door knob (front and back)
Sanitizer and soap dispenser
Outside needle box/cup holder
Replace cubicle / room curtains
Suction containers (non-disposable portion)
Patient locker/closet
Bathroom door knob / plate (front and back)
Bathroom light switch (es)
Bathroom handrails by toilet
Bathroom sink
Toilet seat / raised seat
Toilet flush handle
Toilet bedpan cleaner
Discard toilet tissue & replace with new roll
Commode
Cleaned
Additional items that may be present in some rooms:
High-touch surface
Cleaned
Hovermat (air mat and pump)
IV pump
Monitor touch screen/leads
Compression Pump machine (leg pumps)
Not Present in Room
• Daily clean of high
touch surfaces
o Updated check list for EVS with
pictures
o Cell phones!
o Terminal clean at d/c or if you
do discontinue precautions
before discharge, clean room
with appropriate cleaner.
Not present in room
*Remove PPE and perform hand hygiene when room complete.
* Remove isolation sign
8/22/13
Prevention Strategies:
Lessons Learned
• Thorough admission assessment and testing where
indicated
• Presumptive isolation for symptomatic patients pending
CDI confirmation
• Soap and water hand washing before exiting the room
o Reminder signs
• Extended use of Contact precautions beyond duration
of diarrhea (eg 48 hours)
• Bleach cleaning or other approved product
• Consider universal glove use on units with high CDI rates
CDC HICPAC 2007 except for extended isolation
Resources
• Centers for Disease Control
• IPRO HAI Resources
• Healthcare Infection Control Practices Advisory
Committee (HICPACC)
• Agency for Healthcare Research and Quality
(AHRQ)
• Association for Professionals in Infection Control
(APIC)
• Society for Healthcare Epidemiology (SHEA)
• Troy Acute Care, St. Peter’s Health Partners
Thank You
Questions?