12. Healthcare-Associated Infections Flashcards
Healthcare-Associated Infections (HAI), aka healthcare-associated conditions, were recently added to exam.
Be prepared to understand the role of the RN in prevention of these infections, which are considered indicators of the quality of care that is provided to pts.
In general, an infection that develops more than __ hours after admission to the hospital is considered
48 hrs
healthcare-associated.
If the infection is identified within 48 hours after admission to hospital, it is considered community-acquired.
Hospitals are now required to report cases of HAIs to government agencies, and some cases are publicly reported.
Guidelines for the prevention of VAP, CLABSIs and CAUTIs have been provided by several national organizations including the Centers for Disease Control and Prevention (CDC), the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Association for Professionals in Infection Control and Epidemiology (APIC).
“Care Bundles” are sets of evidence-based practices that lead to improved outcomes IF all elements are completed.
VAE
Ventilator-Associated Event
-VAEs are complications that may occur as a result of mechanical ventilation. Coplications include pneumonia, barotrauma, ARDS, atelectasis, and/or fluid overload.
-VAE is a term that was created by the CDC to better describe an occurrence of ventilator-associated pneumonia (VAP). VAP is a type of VAE.
For exam, understand VAP and strategies to prevent VAP (in Resp section); you will not be expected to understand the complex VAE algorithm.
CLABSI
Central Line-Associated Bloodstream Infection (CLABSI)
CLABSI is a laboratory-confirmed blood-stream infection that develops within 48 hours of a central line placement and is not related to an infection at any other sites.
A CLABSI results in longer hospital stays, increased costs, and an increased risk of death. CLABSI mortality rates of 12%-25% have been reported.
Guidelines for prevention of CLABSI:
-Develop standardized, evidence-based policies/procedures with indications for central line use, insertion, and maintenance.
-Insertion
-Maintenance
-Monitoring
Guidelines for prevention of CLABSI:
- Insertion
-Ensure that processes are in place for insertion according to the guidelines (e.g., central line cart, checklists).
-Optimize site selection (subclavian vein) as able; avoid femoral or internal jugular site if at all possible.
-Ensure that the team utilizes aseptic technique during insertion.
-Utilize maximal barrier precautions and personal protective equipment during insertion.
-Prepare the skin using chlorhexidine skin antisepsis.
-Use chlorhexidine patch/gel dressing over the insertion site (unless there is an allergy).
Guidelines for prevention of CLABSI: Maintenance
-Practice hand hygiene prior to line manipulation/care.
-Provide a head-to-toe chlorhexidine bath daily for ICU pts.
-Disinfect catheter hubs, needless connectors, and injection ports with mechanical friction for no less than 5 seconds with an antiseptic before accessing the catheter.
-Ensure the potency of he dressing, and change the dressing & tubing according to hospital policy.
-Do not routinely replace central lines (e.g. q 72h) unless it is known that the insertion was performed emergently without antisepsis.
-Discontinue a central line if there are signs of an infection.
-Perform a daily review of line necessity.
-Use aseptic technique for dressing changes, ensuring dressing patency at all times.
-Ensure that there is an appropriate nurse-to-pt ratio and limit the use of float nurses in ICUs.
Guidelines for prevention of CLABSI: Monitoring
-Perform root cause analyses on the line infections and develop action plans for improvement accordingly.
-Develop processes for measuring compliance with policies/procedures
-Share quality monitoring and infection results w/staff.
-Assess competency of the staff who insert/care for lines.
CLABSI: Require that all health care personnel, who are involved in the section, care, and maintenance of central venous catheters (CVCs), be ___
educated about CLABSI prevention.
CAUTI (definition)
Catheter-Associated Urinary Tract Infection (CAUTI)
The CDC defines a catheter-associated urinary tract infection as an infection of the urinary tract, where an indwelling urinary Cather was in place for more than 2 consecutive days in an inpt location on the date of the event, with day of device placement being Day 1 AND an indwelling urinary catheter in place on the date of event or the day before.
CAUTI guidelines:
-Develop standardized, evidence-based policies/procedures with criteria for catheter use.
-Utilization practices
-Insertion and maintenance practices
-Process measures
CAUTI guidelines: Utilization practices
-Avoid inserting an indwelling urinary catheter, if at all possible.
-Develop standardized, evidence-based reasons for insertion such as select operative procedures, acute urinary retention or bladder outlet obstruction, gross hematuria, a need for an accurate measurement of urine output, to assist in the healing of open sacral or perineal wounds in incontinent pts, or for pts who require prolonged immobilization (e.g. potentially unstable thoracic or lumbar spine, multiple traumatic injuries such as pelvic fractures).
-Perform a daily review of catheter need based on agreed upon hospital standardized criteria.
-Remove catheters as soon as they are no longer necessary; as per the CDC, when a catheter is placed during surgery and remains in place post-op, remove the catheter as soon as possible, preferably within 24 hours, unless there are appropriate indications for continued use.
-implement a nurse-driven protocol to empower nurses to evaluate and discontinue unnecessary urinary catheters.
-Utilize alternative strategies (external catheters, intermittent straight catheterization as able).
CAUTI guidelines: Insertion and Maintenance practices
-use aseptic technique during insertion
-Make insertion a 2-person activity to reduce breaks in aseptic technique during insertion.
-Practice hand hygiene prior to/following catheter mainpulation/care.
-Utilize standard precautions, including the use of gloves and gowns, as appropriate.
-Employ routine catheter care, cleansing the meatal area (antiseptic solution is not needed); replace basin bathing with plain wipes.
-Maintain an unobstructed urine flow (e.g. ensure proper securement of the catheter, maintain tubing free of kinks or dependent loops, maintain the collection bag below the level of the bladder).
-Do not disconnect/reconnect system components.
-Collect urine samples from the sampling port using aseptic technique.
CAUTI guidelines: Process measures
-Assess the competency of the clinicians who insert catheters; provide periodic training and competency assessments.
-Identify unit “CAUTI champions” whose role is to monitor pts with indwelling urinary catheters and ensure that standards for infection prevention are utilized by caregivers.
-Develop quality measures and share outcomes with the staff.
-Perform a root cause analysis for each infection and implement action plans based on those analyses.
