Title (Verdana Bold 32)

Title (Verdana Bold 32)

Prevention of Healthcare-Associated Infections Optimal Disinfection of Skin and Critical Contact Surfaces Chonna Bartholomew RN,BS CareFusion Clinical Consultant 2013 CareFusion Corporation or one of its subsidiaries. All rights reserved. HAIs: A Costly Toll to U.S. Healthcare 2. Scott RD. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. March 2009, Centers for Disease Control and Prevention. Accessed August 30, 2010 at: http://www.cdc.gov/ncidod/dhqp/pdf/Scott_CostPaper.pdf 2013 CareFusion Corporation or one of its subsidiaries. All rights reserved.

Best Practice What Does It Mean To The Clinician? Provide consistent and repeated education on management and prevention of complications with intravenous catheters (IVs) and central venous catheters (CVCs) Education results in improved practice which reduces complications SHEA/IDSA HAI Prevention Compendium 2008. Sherertz R, et al. 2000 Ann Inter Med. Coopersmith C, et al. 2002 Crit Care Med Warren D, et al. 2003 Crit Care Med

OGrady N, et al. 2002 CDC Guidelines 2013 CareFusion Corporation or one of its subsidiaries. All rights reserved. Skin Antisepsis Best Practice Preferred antisepsis 2% Chlorhexidine gluconate (CHG) with 70% Alcohol

CHG used for prepping prior to IV/CVC placement may help to reduce skin flora and maintains a residual effect for at least 48 hours Use a gentle back and forth scrub for 30 seconds on a dry site (i.e. arm, abdomen) and a 2 minute scrub on a moist site (i.e. inguinal folds, axilla) Allow the area to air dry for 3 minutes Do not blot or wipe away Do not drape or use ignition source (e.g., cautery, laser) until solution is completely dry (minimum of 3 minutes on hairless skin; up to 1 hour in hair)

2013 CareFusion Corporation or one of its subsidiaries. All rights reserved. The Importance of Using an Applicator vs. 2013 CareFusion Corporation or one of its subsidiaries. All rights reserved. Best Practice Disinfection Procedures Surface Time Solution Technique

Depends on: 2013 CareFusion Corporation or one of its subsidiaries. All rights reserved. Importance of Our Skin #1 Function: Protective Barrier Microorganisms 80% of resident and transient skin flora reside in the top 5 layers of the Stratum Corneum Copyright CareFusion 2012 1.

2. Brown E, Wenzel RP, Hendley JO. Exploration of the microbial anatomy of normal human skin by using plasmid profiles of coagulase-negative staphylococci: search for the reservoir of resident skin flora. J Infect Safdar N, Maki DG. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Int Care Med. 2004;30:62-67. 2013 CareFusion Corporation or one of its subsidiaries. All rights reserved. Extra-luminal Contamination Greatest source of Central Venous Catheter (CVC) contamination that are in place for 10 days or less is the patients own skin flora

2013 CareFusion Corporation or one of its subsidiaries. All rights reserved. Possible Causes: Most often caused from poor site maintenance. Not using full barrier Precautions with CVC insertion Not maintaining Dry/Intact dressing Not changing dressing per policy Not securing CVC and allowing CVC to piston in

and out of entry site Normal bacterial flora seen on the skin: The most commonly reported pathogens causing HAIs: Staphylococcus epidermidis Staphylococcus aureus Micrococcus species Nonpathogenic neisseria

species Alpha-hemolytic and nonhemolytic streptococci Diphtheroids Propionibacterium species Candida species Acinetobacter species Peptostreptococcus species Coagulase-negative staphylococci, Staphylococcus aureus Methicillin-resistant Staphylococcus aureus

(MRSA) now account for more than 50% of all Staphylococcus aureus isolates obtained in ICUs Candida spp Enterococci Gram negative bacilli Chapter 11:NORMAL MICROBIAL FLORA OF THE HUMAN BODy . 202.120.143.131/G2S/Template/ShowNoMeau.aspx?type=3... 2013 CareFusion Corporation or one of its subsidiaries. All rights reserved. Naomi P. O'Grady, M.D., et al. Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011

The Ideal Antimicrobial Agent for Skin No or minimal systemic absorption Persistence Rapid Broad spectrum No inactivation by organic matter 1) Larson E. Guideline for use of topical antimicrobial agents. Am J Infect Control. 1988;16(6):253266 2013 CareFusion Corporation or one of its subsidiaries. All rights reserved. Choosing A Skin Prep Antiseptic

2013 CareFusion Corporation or one of its subsidiaries. All rights reserved. Additional Best Practices Meticulous hand hygiene Daily bathing with CHG for patients with a CVC CHG-impregnated dressings Antimicrobial catheters Intentional catheter selection Maximum sterile barriers when inserting a CVC Daily assessment of site necessity Use of Needleless Connector (NC) Process improvement plan 2011 Infusion Nursing Standards of Practice

2013 CareFusion Corporation or one of its subsidiaries. All rights reserved. Bacterial transmission The Risk of Hand-to-Patient Contact The transmission of bacteria from one person to another happens almost exclusively via the hands, especially the hands of health care practitioners (HCPs) Studies show hand washing and glove-wearing protocols lack effectiveness An observational study was conducted at an oncology hospital to examine hand hygiene practices observed during 612 procedures that were performed by 67 HCPs. RESULTS: The compliance was only 34.3% (n = 210)

1. Siegel JD et al. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, June 2007. http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf. Accessed January, 2008. 2. Sacar S. Poor hospital infection control practice in hand hygiene, glove utilization, and usage of tourniquets. Am J Infect Control. 2006;34(9):606-609. 3. Korniewicz DM, El-Masri M. Exploring the factors associated with hand hygiene compliance of nurses during routine clinical practice. Appl Nurs Res. 2010 May;23(2):86-90. Epub 2009 2013 CareFusion Corporation or one of its subsidiaries. All rights reserved. Intra-luminal Contamination Possible Causes: Most likely caused by improper hub manipulation Healthcare workers not washing hand or wearing

gloves Inadequate disinfection of the Needleless Connector Not changing tubing per policy Contaminated Infusate 2013 CareFusion Corporation or one of its subsidiaries. All rights reserved. Critical Surface Disinfection Needleless Connector (NC) Surface Disinfection depends on: Surface, Solution, Friction and Time Cannula activated Split septum

Slit on top Solid Solid Hub and Thread contamination depends on: Protocols, Practice, Technique and Antimicrobial Agents 2013 CareFusion Corporation or one of its subsidiaries. All rights reserved. Antimicrobial Different Surfaces May Require Different Time

Casey AL, Elliot TSJ et al A Laboratory Comparison of Microbial Ingress into Eight Different Needleless IV Access Devices Presentation, 2012 ID Week Conference 2013 CareFusion Corporation or one of its subsidiaries. All rights reserved. Ideal Antimicrobial for for Inanimate Disinfection ALCOHOL CHG Immediate microbial kill Dissolves oils and other

residue from inanimate objects Leaves no sticky residue Maximum efficacy in vitro around 30 seconds No affinity for inanimate objects Leaves a sticky residue that can attract dirt and/or microorganisms 2013 CareFusion Corporation or one of its subsidiaries. All rights reserved.

Effectiveness Of Disinfecting Caps Depends On The Surface 2013 CareFusion Corporation or one of its subsidiaries. All rights reserved. Disinfecting Caps May Reduce Bacteria With Some NCs Smith, JS et al, Optimal Disinfection Times for Needleless Connectors Journal of the Association for Vascular Access Vol 17 No 3, July 2012, http://dx.doi.org/10.1016/j.java.2012.07.008 2013 CareFusion Corporation or one of its subsidiaries. All rights reserved. Disinfecting Caps May Eliminate

Bacteria On Other NCs Lange, V et al, Advances in Infection Control Practice Curos Port Protectors: An Evaluation of a New Disinfection Device Presentation, 2009 APIC National Conference 2013 CareFusion Corporation or one of its subsidiaries. All rights reserved. Scrub the Hub Keep in mind Hub disinfection (tubing or cap changes) Technique is always the same.15 seconds, juicing an orange; let dry Keep line closed as long as

possible between NC changes NC (every access) Technique and Time may depend on the manufacturers directions for use; always let dry 2013 CareFusion Corporation or one of its subsidiaries. All rights reserved. Ultimately, advancements in Technology can help Standardize Best Practice Proper Protocol Standardize Practice Reduce Waste Improve Healthcare

Save Healthcare dollars 2013 CareFusion Corporation or one of its subsidiaries. All rights reserved. Thank you 2013 CareFusion Corporation or one of its subsidiaries. All rights reserved. All other trademarks are the property of the respective owners.

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