This document discusses various infection prevention strategies at CHOMP, including hand hygiene, isolation practices, central line-associated bloodstream infections, multidrug-resistant organisms, and surgical site infections. It emphasizes that hand hygiene is the most effective way to prevent infection spread. It describes an 1847 experiment where a physician implemented hand washing with chlorinated lime solution before patient exams, which dramatically reduced mortality from childbed fever. Proper hand hygiene and use of personal protective equipment like gloves and gowns can help control spread of infectious organisms.

1. Infection Prevention
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2.  Clean Hands
 Isolation At CHOMP
 Central Line Associated Bloodstream Infection
(CLABSI)
 Multiple Drug-Resistant Organism Infection
(MDRO)
 Surgical Site Infection
(SSI)
 Catheter-Associated Urinary Tract Infection
(CAUTI)
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3. From the Centers for Disease Control and Prevention:
Hand hygiene is the most simple, effective, and proven way to prevent the
spread of infection.
The Experiment
In 1847, Dr. Ignaz Semmelweis practiced obstetrics at Vienna General
Hospital where mortality from childbed fever was as high as high as 35%.
He implemented chlorinated lime solution hand rinse for use before
patient exams. Mortality rates from childbed fever fell dramatically.
Mortality on the unit where it was not practiced remained three times
greater.
Alcohol Hand Rub
Recommended by CDC over soap and water
Contains emollients to keep skin intact and smooth
Soap and Water
Use soap and water for 15 seconds or more when hands are visibly dirty, or if
the patient has C. difficile.
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4.  Clean hands
 Gloves for potential contact with blood/body
fluids, contaminated equipment
 Gown if splashing of uniform/clothing is likely
 Protective eyewear if splashing to face is likely
 Surgical mask if coughing & unable to cover
cough
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5.  Contact Precautions
Gloves, blue plastic isolation gown
 Droplet Precautions
Surgical mask
 Airborne Precautions
N95 respirator (mask), negative airflow room with door
closed
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 After a central line is inserted, patient has a
pathogen from one or more blood cultures,
unrelated to an infection at another site
 The bloodstream infection was not present on
hospital admission
 Examples of bloodstream pathogens: (CDC definitions)
◦ Enterococcus
◦ Pseudomonas
◦ Klebsiella
◦ Staph. aureus

8. Increased length of stay -
6.5 days
Increased cost of care -
$50,000
Increased risk of mortality - 50%
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Site infection at central line

9.  Clean hands
 Hair cover, mask, sterile gloves & gown
 Maximum sterile barrier drape
 Site selection – highest risk of infection is femoral site
 Use chlorhexidine to cleanse skin - allow to dry
 Remove the device as soon as possible –
evaluate the need daily
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11.  Judicious antibiotic use
 Prevents development of resistant organisms
 Contact Precautions for resistant
organisms in clinical infections:
(MRSA, VRE, C. difficile, ESBLs, and MDROs)
 Clean hands with alcohol before and after
patient contact (use soap/water if C. difficile)
 Wear gloves, gown to enter room
 If respiratory infection, add surgical mask
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12. Staphylococcus aureus is spread on hands.
 MRSA = Methicillin-resistant Staphylococcus aureus
 Control spread by clean hands, and Contact Precautions
 If respiratory infection with MRSA, Contact PLUS Droplet
Precautions
 MRSA in nares
 Standard Precautions (used for all patients)
 About 10% of admissions to CHOMP have nasal MRSA
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13.  VRE
Vancomycin-resistant Enterococcus faecium/faecalis Group D
Occurs infrequently at CHOMP 
 Infections
Urinary tract, biliary tree, bloodstream, and surgical site
infections
 Transmission
Contaminated equipment, or unwashed hands can carry VRE
and other resistant organisms from room to room; from patient
to patient
 Prevent Spread
Clean hands, Contact precautions
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14.  Risk Factors
 Proton pump inhibitors, antibiotics (especially broad spectrum
cephalosporins and quinolones) chemotherapy, GI surgery, and
among those with previous C. difficile infection
 Infection:
 Diarrhea with abdominal symptoms; can mimic other abdominal
syndromes
 Pseudonym: “Antibiotic Associated Colitis”
 Pseudomembranous colitis seen on CT
 Complications:
Toxic megacolon, perforation, shock, death
 Prevention
 Clean hands with soap and water
 Contact Precautions
 Judicious antibiotic use
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15.  Two types:
 Produce extended spectrum beta-lactamases (ESBL)
 Sensitive to carbapenems (ertapenem, doripenem, imipenem)
 Laboratory will provide a message alert when an ESBL is identified
 Contact Precautions
 Most common among Escherichia coli and Klebsiella pneumoniae
 Gram negative bacteria that are resistant to 3 or more
classes of antimicrobial drugs
 Select a drug to which the bacterium demonstrates sensitivity
 Clean hands, Contact Precautions for both
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Surgical
Site
Infection
Prevention

17. o Prophylactic Antibiotic
◦ Pre-op: within1 hr. (2 hr. for vancomycin) before cut time
◦ Pre-op order sets have been developed to assist you to easily
work within recommendations
◦ Duration of prophylaxis less than 24 hrs (48 hrs. for cardiac
surgery) to meet national standards
◦ Limit hair removal (use clippers, not razors)
◦ Maintain perioperative warmth
◦ Prevent hyperglycemia
◦ Chlorhexidine bath pre-op on day of surgery and P.O. day 1
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18.  No immediate use sterilization (“flash”
sterilization) unless critical need
 All appliances / instruments from outside
vendors must be on site for appropriate
sterilization the day prior
 Chlorhexidine (CHG) skin prep is
recommended. Both betadine and CHG skin
antiseptics have a kill rate of 99%+.
 CHG has antimicrobial persistance for up to a
week (betadine does not).
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19. Please use the form on the webpage to attest that you have read
the module to receive credit.
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