Learn about the role of environment in disease transmission and how to implement standard and transmission-based precautions to prevent the spread of antibiotic resistant bacteria and other infections in your facility.
1.4 Controlling the spread of antibiotic resistant bacteria
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From the course by The University of North Carolina at Chapel Hill
Infection Prevention in Nursing Homes
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From the lesson
Antibiotic Resistant Bacteria
The goal of this module is to describe and discuss antibiotic resistant bacteria and how to stop these bad bugs from spreading. To obtain CE Credit for this module: Take the Quiz and complete the evaluation at the end of the module, you will be directed to your course completion certificate.
Meet the Instructors
Evelyn CookAssociate Director
North Carolina Statewide Program for Infection Control and Epidemiology (SPICE)
Thousands of people die every day from infections acquired while receiving
health care.
As we've already stated,
hands are the main pathway of germs transmission in health care.
Hand hygiene is the number one most important measure to stop the transmission
of harmful germs and to prevent health care associated infections.
Shown here are the five moments for
hand hygiene developed by the World Health Organization.
Let's take a minute to look at each moment in more detail.
The first moment for hand hygiene occurs when you enter the resident zone and
before touching the resident.
Performing hand hygiene here protects the resident against colonization, and
in some cases, against infections by harmful germs carried by your hands.
An example of a situation where this would be appropriate
is before assisting a resident with personal care activities.
The second moment for
hand hygiene occurs before you perform any clean or aseptic procedure.
This is done to protect the resident against infection with bad bugs,
including their own germs, entering his or her body.
An example of a situation where this would apply would be before preparing food,
medications, injections, or dressing a wound.
The third moment occurs any time there is a body fluid exposure risk.
Performing hand hygiene here protects you from colonization or
infection with the resident's harmful germs and
protects the healthcare environment from the spread of germs.
A good example of this would be after cleaning an incontinent resident, emptying
a urinary catheter bag, changing soiled bed linen or checking a blood sugar.
The fourth moment happens after you have touched the resident.
Hand hygiene at this moment protects you from colonization and infection and
protects the health care environment from the spread of germs.
A good example for this opportunity would be after performing a physical exam or
assisting a resident with personal care needs.
The fifth moment for
hand hygiene occurs any time you touch the resident's surroundings.
This protects you from colonization and infection with resident germs that may be
present on surfaces or objects in the resident's surroundings and
protects the healthcare environment against germs spread.
A good example of this would be after any activity involving physical contact with
the resident's immediate environment, like changing bed linens,
holding a bed rail, clearing a bedside table, or even leaning against the bed.
It is important that you take every opportunity to perform hand hygiene to
keep a resident, yourself, and the environment free from germs.
You should always use an alcohol based hand rub for
hand hygiene unless your hands are visibly soiled.
To effectively reduce the growth of germs on hands, you should have enough product
in your hands to wet all surfaces of your hands for at least 20 to 30 seconds.
You should wash your hands with anti bacterial soap and
water when they are visibly soiled or after caring for a resident with diarrhea.
Otherwise, use an alcohol based hand rub.
You should was your hands for a minimum 15 seconds with soap and water.
You should follow the steps described here to effectively wash your hands.
Standard precautions are a cornerstone of infection control.
They are based on the assumption that all moist body fluids from
all residents are colonized or infected with one or more bad bugs.
The general rule of thumb is that if it is warm, wet and
not yours, standard precautions apply.
We have already reviewed hand hygiene, the first element of standard precautions.
We will review some of the elements of standard precautions that
are important for preventing the spread of bad bugs.
Gowns, gloves, and mask are also an important aspect of standard precautions
and further prevent the spread of bad bugs when they are utilized appropriately.
They are intended to protect the user from contamination and
should always be used when there's potential for contact with blood or
potentially contaminated body fluids such as urine or stool.
Hand hygiene should always be performed before
putting on personal protective equipment or PPE.
And following removal.
Gloves should be worn anytime there is anticipated contact with blood or
other potentially infectious material.
Glove should be changed during resident care if the hands move
from a dirty body site like the groin to a clean body site, like the face.
The same pair of gloves should not be used for more than one patient and
should never be washed and reused.
Hands should be washed after glove removal.
Gowns are used to protect the user's clothes and
bare skin from contamination that could occur during resident care.
Like with gloves, gowns should be worn when there is the potential for
contamination of the skin or clothes during resident care.
Gowns should not be reused or used for
multiple residents, even those in the same room.
Mask and eye protection should be worn when there is potential for
splash or spray of blood, respiratory secretions, or other body fluids.
Masks should be changed if they become wet and discarded after care of the resident.
You may be able to disinfect and reuse eye protection depending on the manufacturer.
Another very important part of controlling the spread of bad bugs is room placement.
A private room is preferred for residents who are colonized or
infected with a bad bug.
If a private room is not available,
the next best option is to place the colonized or
infected resident into a room with another resident with the same type of bad bug.
Meaning MRSA positive resident rooms with an MRSA positive resident or VRE with VRE.
Residents with two different bad bugs should never be put in the same
room together.
The third option is to place a resident with the bad bug
in a room with the healthiest resident possible
because the healthiest resident has the lowest risk for getting the bad bug.
A clean resident care environment is as important as hand hygiene
in preventing the transmission of bad bugs in nursing homes.
We all ready know that residents with bad bugs such as MRSA and
VRE, have the bacteria present on all or parts of their skin.
These bacteria shed onto environmental surfaces such as bed rails and
table tops and the resident's immediate environment.
These organisms can survive on dry environmental surfaces from several hours
to many weeks and serve as a source of hand, glove, and clothing contamination.
All surfaces and
equipment should be cleaned with an EPA registered hospital surface disinfectant.
Daily cleaning of surfaces within the residents immediate environment,
shared resident care equipment, and common areas,
lowers the level of contamination and the risk of cross transmission is reduced.
Similarly, thoroughly cleaning a room after a resident is discharged
protects the next resident who will be occupying the room
from potentially getting a bad bug.
Soiled linens such as sheets, towels, incontinence pads and patient gowns,
are contaminated with bad bugs even if visible soil is not evident.
All linen should be handled with care and as little agitation as possible to avoid
contamination of the air, surfaces, and people in the immediate area.
Linen should be placed immediately into a leak resistant container and
should not be sorted or placed in any surface prior to containment.
Just as it is important for staff to maintain their hygiene,
it is also very important that residents are able to maintain their hygiene.
This includes bathing residents regularly,
insuring that incontinence care is done appropriately and thoroughly, and
residents wash their hands frequently, including before and after eating,
before and after group activities and after using the bathroom.
For relatively healthy residents, such as those who are mainly independent,
standard precautions may be all that are needed.
Making sure that gloves and gowns are used for contact with uncontrolled secretions,
pressure draining wounds, stool incontinence and ostomy tubes or bags.
When there are ill residents such as those totally dependent upon healthcare
personnel for health care and activities of daily living and for
those residents whose infected secretions or drainage cannot be contained,
standard precautions alone may not be enough to control the spread of bad bugs.
This is when additional measures are added to standard precautions,
called Contact Precautions.
Contact Precautions are an extension of standard precautions, in that gowns and
gloves are required for all resident contacts,
as well as contact with the environmental surfaces in the residents room.
After viewing this program you know know that antibiotic resistant bacteria
are common in nursing homes causing frequent colonization and
10% of all in factions in nursing homes.
You also know that by practicing good hand hygiene and
standard precautions, you protect the residents, yourself and
the nursing home environment from the spread of bad bugs.
If you have any questions related to infection control, you should contact
your facility's infection preventionist for advice and assistance.
Thank you for viewing this module and
good luck with your infection prevention efforts.
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