Infection Control

The purpose of Infection Control/Prevention is to identify and reduce the risks of acquiring and transmitting infections among patients, employees, healthcare providers, contract service workers, volunteers, students, and visitors. The Infection Control Office at St. Dominic Hospital works closely with Employee Health to promote a proactive, prevention program designed to reduce the risk of infection among patients, families and employees.

For more information, please contact the Infection Control Department at extensions 6028, 6824 or 6822.

The proceeding information will assist medical staff in being proactive to help prevent healthcare associated infections in the hospital and provide a safer environment for our patients and yourselves.

Healthcare-Associated Infections (HAIs)

Surgical site infections, central line-associated bloodstream infections, ventilator-associated pneumonia, multidrug-resistant organisms, Clostridium difficile, and catheter-associated urinary tract infections can all be considered HAIs. Each is determined by definitions published by the Centers for Medicare and Medicaid Services (CMS), Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN).

Hand Hygiene

St. Dominic’s follows the Centers for Disease Control and Prevention Hand Hygiene guidelines. Use soap and warm water. Rub your hands vigorously for at least 15 seconds. Rub your palms, fingernails, in between your fingers and the back of your hands.

Or, if your hands are not visibly soiled, clean them with an alcohol-based hand sanitizer, such as the alcohol foam. Rub the sanitizer all over your hands, especially under your nails and between your fingers, until your hands are dry.

Clean your hands upon entering and exiting a patient’s room; when going between clean and dirty processes in patient care; before touching or eating food; after you use the bathroom, etc.

Standard Precautions

Standard Precautions synthesize the major features of Universal Precautions (Blood and Body Fluid Precautions; designed to reduce the risk of transmission of blood borne pathogens) and Body Substance Isolation (designed to reduce the risk of transmission of pathogens from moist body substances) and applies them to all patients receiving care in hospitals, regardless of their diagnosis or presumed infection status.

Standard Precautions apply to
•Blood
•All body fluids, secretions, and excretions except sweat, regardless of whether or not they contain visible blood
•Non-intact skin
•Mucous membranes

Standard Precautions are designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection in hospitals.

Transmission-Based Precautions

Transmission-based Precautions are designed for patients documented or suspected to be infected with highly transmissible or epidemiologically important pathogens for which additional precautions beyond Standard Precautions are needed to interrupt transmission in hospitals. There are three types of Transmission-Based Precautions: Airborne Precautions, Droplet Precautions, and Strict Contact Precautions. They may be combined together for diseases that have multiple routes of transmission. When used either singularly or in combination, they are to be used in addition to Standard Precautions.

The signage for transmission based precautions is displayed on the patient’s chart and door to indicate the PPE that is required prior to entry into the patient’s room. Always read and follow the instructions on this signage.

Multidrug Resistant Organism (MDRO) Prevention

To prevent MDRO infections (i.e. MRSA, VRE, Multidrug resistant Acinetobacter, etc), all healthcare workers should:
•Perform hand hygiene according to the hospital’s policy.
•Carefully clean/disinfect the patient’s room and medical equipment.
•Use strict contact precautions when caring for patients with an MDRO.

Strict contact precautions means:
•Healthcare providers will put on gloves and wear a gown over their clothing while taking care of patients with MDROs.
•Visitors will also be asked to wear a gown and gloves.
•When leaving the room, hospital providers and visitors remove their gown and gloves and clean their hands.
•Dedicated equipment will be used when caring for MDRO patients, i.e. disposable blood pressure cuff and stethoscope.

Clostridium difficile Infection Prevention

To prevent C. diff. infections, all healthcare workers should follow previous MDRO prevention guidelines with the addition of the following:

•Carefully clean/disinfect the patient’s room and medical equipment with a bleach disinfectant.

•Only give antibiotics when it is necessary.

•Clean your hands with soap and warm water – do not use alcohol foam with C. diff. patients.

Catheter-Associated UTIs

St. Dominic Hospital has taken steps toward decreasing catheter-associated urinary tract infections (CAUTIs), including general education to all staff who handle urinary catheters.

Please adhere to the following when considering the use of a urinary catheter:
•Catheters are used only when necessary and are removed as soon as possible.
•Ensure the catheter is placed using sterile technique.
•The skin in the area where the catheter will be inserted is cleaned before insertion.
•Do not routinely change catheter at regular intervals.
•Do not irrigate unless medically necessary.

Central Line Infections

Studies show that hospital-acquired central line infections can be prevented by utilizing a set of guidelines developed by the Centers for Disease Control.

The central line insertion bundle has five components: hand hygiene, maximum barrier precautions, Chlorhexidine skin antisepsis, optimal catheter site selection and daily review of line necessity with prompt removal of unnecessary lines. An antimicrobial patch is applied to the catheter exit site at insertion and with every dressing change. A nurse can provide the central line checklist.

Central Line Maintenance
• Staff should clean their hands, wear gloves and clean the catheter opening with an antiseptic solution before using the catheter to draw blood or give medications.
•Staff should also clean their hands and wear sterile gloves when changing the bandage that covers the area where the catheter enters the skin.
•Carefully handle medication and fluids that are given through the catheter.
•Daily review of line necessity with prompt removal of unnecessary lines (decide every day if the patient still needs to have the line). The line should be removed as soon as it is not longer needed.

Ventilator Associated Pneumonia Prevention

To prevent ventilator associated pneumonia, medical staff, nurses and other healthcare providers should:
•Keep the head of the patient’s bed raised between 30 and 45 degrees unless other medical conditions do not allow this to occur.
•Check the patient’s ability to breathe on his or her own every day so that the patient can be taken off of the ventilator as soon as possible.
•Clean their hands with soap and water or an alcoholbased sanitizer before touching and after touching the patient or the ventilator.
•Clean inside of the patient’s mouth on a regular basis.
•Clean or replace equipment between uses on different patients.

Surgical Site Infections

Risk factors for a surgical site infection include diabetes, nicotine use, steroid use, obesity, malnutrition, prolonged preoperative stay, preoperative nares colonization and perioperative transfusion.

To prevent SSIs, doctors, nurses, and other healthcare providers:
•Clean their hands and arms up to their elbows with an antiseptic agent just before the surgery.
•Clean their hands with soap and water or an alcoholbased hand sanitizer before and after caring for each patient.
•May remove some of the patient’s hair immediately before surgery using electric clippers only if the hair is in the same area where the procedure will occur. Do NOT shave hair with a razor and do NOT remove hair in the OR.
•Wear caps, masks, gowns, and gloves during surgery to keep the surgery area clean.
•Administer appropriate antibiotics to the patient before the surgery starts. In most cases, the patient should get antibiotics within 60 minutes before the surgery starts and the antibiotics should be stopped within 24 hours after surgery.
•Clean the skin at the site of the surgery with an antiseptic that kills bacterial skin flora.
•Control patient serum blood glucose levels and avoid hyperglycemia perioperatively.
•Inspect sterile items for contamination before opening.
•Remove indwelling catheters by post-op day #2 as appropriate.
•Remove all PPE prior to exiting the OR suite. Do NOT wear PPE (including masks and shoe covers) outside of the OR suite.

Body fluid exposure and needle sticks

If you sustain an exposure:
•Wash and rinse wound area thoroughly and with germicidal soap.
•Obtain source patient information and account number.
•Report to the Employee Health office immediately. If after hours, report to the nursing supervisor.
•Seek treatment for individuals who have an HIVpositive exposure must occur within two hours.

Influenza

Influenza ("flu") is a contagious disease that spreads around the United States every winter, usually between October and May. Symptoms come on suddenly and may last several days. They can include fever/chills, sore throat, muscle aches, fatigue, cough, headache and runny or stuffy nose.

Flu is caused by influenza viruses, and is spread mainly by coughing, sneezing, and close contact. People with the flu should stay away from other people and stay home if sick. It also is important for everyone to wash hands often with soap and water to prevent the spread of flu. If soap and water are not available, use an alcohol-based hand rub. Practice respiratory etiquette by covering your cough or sneeze to contain droplets.

Flu vaccine is the best protection against flu and its complications. The effectiveness of the vaccine depends on a number of factors, including the accuracy of the match between vaccine strains and circulating strains as well as the age and health of the recipient. These strains usually change each year, which is why the vaccine is given annually. Even if you get the flu from a strain of the virus that wasn't included in the vaccine, having the vaccine can make your illness milder.

Beginning with the 2014-2015 flu season, as a condition of employment and/or access to patients, clinical or resident areas, all medical and allied health services staff, temporary workers, trainees, employees, volunteers, students, interns, and other healthcare personnel must receive an annual influenza vaccination by December 15, unless granted an exemption for medical conditions, religious beliefs or other conditions. The Mandatory Influenza Vaccinations policy can be accesses via the Reference Manual on Dominet accessible through the hospital's intranet.

Influenza vaccinations are offered annually to personnel at no cost.