Chasing Zero Infections - Connecting the Thursday, May 25, 2017 Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship MDRO’s and the Environment Linda R. Greene, RN, MPS,CIC Manager, Infection Prevention UR Highland Hospital Rochester, NY linda_greene@urmc.rochester.edu Objectives Describe frequently encountered MDRO’s or significant pathogens that live in the environment. Discuss the clinical significance of these MDROs. Identify prevention and control strategies associated with these pathogens. Mission to Care FHA HIIN 1
Chasing Zero Infections - Connecting the Thursday, May 25, 2017 Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Key Concepts The surface environment in rooms of colonized or infected patients is frequently contaminated with the pathogen. The pathogen is capable of surviving on hospital room surfaces and medical equipment for a prolonged period of time. Contact with hospital room surfaces or medical equipment by healthcare personnel frequently leads to contamination of hands and/or gloves. The frequency with which room surfaces are contaminated correlates with the frequency of hand and/or glove contamination of healthcare personnel. Key Concepts Clonal outbreaks of pathogens contaminating the room surfaces of colonized or infected patient are demonstrated to be due to person-to-person transmission or shared medical equipment. The patient admitted to a room previously occupied by a patient colonized or infected with a pathogen (e.g., MRSA, VRE, C. difficile , Acinetobacter ) has an increased likelihood of developing colonization or infection with that pathogen. Improved terminal cleaning of rooms leads to a decreased rate of infections. . Mission to Care FHA HIIN 2
Chasing Zero Infections - Connecting the Thursday, May 25, 2017 Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship WHO 5 Moments of Hand Hygiene Basic, But Important Principle Epidemiologic triangle of cross transmission Most MDRO*s are transmitted via hands of HCWs *MDRO= Multi-Drug Resistant Organisms Kramer A BMC Infect Dis 2006;6:130 Mission to Care FHA HIIN 3
Chasing Zero Infections - Connecting the Thursday, May 25, 2017 Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Another Look American Journal of Infection Control 45 (2017) 336-8 CONCLUSIONS We found that floors in patient rooms were frequently contaminated with health care-associated pathogens and demonstrated the potential for indirect transfer of pathogens to hands from fomites placed on the floor. Further studies are needed to investigate the potential for contaminated hospital floors to contribute to pathogen transmission. Transmission Mission to Care FHA HIIN 4
Chasing Zero Infections - Connecting the Thursday, May 25, 2017 Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship 19% of facilities did not appropriately clean high-touch surfaces in patient care areas Schaefer MK, et al. JAMA. 2010;303(22):2273-2279 . “ I just touched the bed rail…” 100-1,000 bacteria transferred by: Pulling patients up in bed Taking a blood pressure or pulse Touching a patient’s hand Rolling patients over in bed Touching patient’s gown or bed sheets Touching equipment like bedside rails, over-bed tables, IV pumps Mission to Care FHA HIIN 5
Chasing Zero Infections - Connecting the Thursday, May 25, 2017 Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship 53% of HCWs Hand Imprint Cultures + After Occupied Room vs 24% of Clean Empty Rooms Bhalla A, et al. Infect Control Hosp Epidemiol. 2004;25(2):164-167. How Long Do Pathogens Survive ? Chemlay et.al Ther Adv Infect Dis (2014) 2(34) 7990 Mission to Care FHA HIIN 6
Chasing Zero Infections - Connecting the Thursday, May 25, 2017 Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Microbiologic Factors That Can Facilitate Surface Environment-Mediated Transmission of Selected Pathogens Pathogen able to survive for prolonged periods of time on environmental surfaces (all pathogens) Ability to remain virulent after environmental exposure (all) Contamination of the hospital environment frequent (all) Ability to colonize patients (Acinetobacter, C. difficile , MRSA, VRE) Ability to transiently colonize the hands of health care workers (all) Transmission via the contaminated hands of healthcare workers (all) Small inoculating dose (C. difficile , norovirus) Relative resistance to disinfectants used on environmental surfaces (C. difficile , norovirus) Weber DJ, et al. AJIC 2010 Studies to Examine The Effect of Environmental Contamination Mission to Care FHA HIIN 7
Chasing Zero Infections - Connecting the Thursday, May 25, 2017 Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship The Case for Environmental Hygiene Previously contaminated rooms increase transmission risk Many patient rooms not well cleaned Cleaning process can be improved in most organizations Improved cleaning decreases environmental contamination Improved cleaning decreases acquisition of pathogens Difference in Risk From Prior Room Occupant Mission to Care FHA HIIN 8
Chasing Zero Infections - Connecting the Thursday, May 25, 2017 Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship MRSA Staphylococcus aureus Microbiology – Gr+ cocci with many virulent factors Frequent nosocomial- and community-acquired pathogen Mode of transmission – contact Clinical manifestations: • Skin and soft tissue infections • Pneumonia • Osteomyelitis /Arthritis • Bacteremia/Sepsis • Endocarditis • Toxin-mediated disease MRSA Environmental Contamination Mission to Care FHA HIIN 9
Chasing Zero Infections - Connecting the Thursday, May 25, 2017 Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship MRSA Common Risk Factors for CA-MRSA The 5 C’s 1. Crowding 2. Frequent Contact 3. Contaminated Common surfaces 4. Cleanliness 5. Compromised skin integrity Mission to Care FHA HIIN 10
Chasing Zero Infections - Connecting the Thursday, May 25, 2017 Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Clinical Presentations of CAMRSA Furuncle Cellulitis Carbuncle Necrotizing fasciitis Bursitis Deep tissue abscess VRE Enterococcus Gram positive cocci in chains Human colon is a reservoir Intrinsically rugged organism Translocation across mucosa; systemic spread Biofilm Mission to Care FHA HIIN 11
Chasing Zero Infections - Connecting the Thursday, May 25, 2017 Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship VRE: Epidemiology Account for 110,000 urinary tract infections 25,000 cases of bacteremia 40,000 wound infections 1,100 cases of endocarditis Most infections occur in hospitals Since 1989, a rapid increase of VRE Epidemiology of VRE Risk factors for colonization/infection in USA • Severe underlying disease (malignancy, ICU, long hosp); antibiotics (vancomycin) Reservoirs, routes of dissemination not fully understood • Multiple patterns are seen in some institutions (endogenous infection from intestinal source?) • Clonal outbreaks are seen in others (transmission by HCWs?, fomites?) Mission to Care FHA HIIN 12
Chasing Zero Infections - Connecting the Thursday, May 25, 2017 Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship The Inanimate Environment Can Facilitate Transmission represents VRE culture positive sites Hayden M, et al. Poster presented at the 41st Interscience Conference on Antimicrobial Agents and Chemotherapy December 16-19, Chicago, IL. Available at: http://www.cdc.gov/handhygiene/download/hand_hygiene_supplement_minus_notes.pdf Acinetobacter • Acinetobacter species are widely distributed in nature and are recoverable readily from moist and dry surfaces. • Acinetobacter can be found in soil, sewage, water, consumables (including fruits and vegetables), and on healthy skin and other body sites. • The organism is relatively resistant to low humidity (drying) conditions and has been shown to be readily recoverable from dry environmental niches. • The ability of Acinetobacter to participate in biofilm formation promotes durability in and on surfaces during outbreaks. Mission to Care FHA HIIN 13
Chasing Zero Infections - Connecting the Thursday, May 25, 2017 Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship Contamination Environmental Contamination Mission to Care FHA HIIN 14
Chasing Zero Infections - Connecting the Thursday, May 25, 2017 Dots to Reduce Patient Harm: Hot Topics in Infection Prevention and Stewardship My Experience 6 patients colonized with resistant Acinetobacter in a surgical ICU All patients were in the same pod Environmental source suspected Culture obtained ICU Mission to Care FHA HIIN 15
Recommend
More recommend
