Infection Control

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Infection Control

• Everything you always wanted to know about
  surveyor training but were afraid to ask
• Jeanne Anderson, RN, BSN, CIC
• Minnesota Department of Health
• Phone [phone]
• E-mail jeanne.anderson_at_state.mn.us

2
Goals and Objectives

• Explain Infection Prevention federal regulations
  in LTC.
• Describe components of state surveyor Infection
  Prevention training.

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History of Infection Control

• Pre 1800 Early efforts at wound prophylaxis
• 1800-1940 Nightingale, Semmelweis, Lister,
  Pasteur germ theory
• 1940s Antibiotic era begins
• 1950s First U.S. hospital infection control
  efforts
• 1960s Staphylococcus aureus outbreaks
  surveillance begins
• 1970s National Nosocomial Infections
  Surveillance system (NNIS) and Study of Efficacy
  of Nosocomial Infection Control (SENIC)
• 1980s Hospital Infection Control Practices
  Advisory Committee (HICPAC) Universal
  Precautions
• 1990s Standard and transmission based
  precautions

4
Infection Control Issues

• Patient acuity/staffing issues
• Antibiotic resistance
• Reimbursement issues
• Research and changing practice
• Slaying sacred cows
• Accreditation and regulation

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Goals of Infection Control

• Protect the residents
• Protect healthcare workers (HCWs), visitors, and
  others in the LTCF environment
• Accomplish the previous two goals in a
  cost-effective manner, whenever possible

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Overall Responsibilities of Infection Control

• Problem identification
• Data collection and analysis
• Intervention through changes in policies and
  procedures
• Ongoing data collection to monitor success
• It is extremely helpful to have specialized
  knowledge about epidemiology, biostatisics,
  microbiology, and the transmission of infectious
  diseases

7
Key Functions of Infection Control

• Managing critical data and information, including
  surveillance of nosocomial infections
• Setting and recommending policies and procedures
• Intervening directly to interrupt the
  transmission of infectious diseases (e.g.,
  outbreak investigation)
• Educating and training HCWs and providers, being
  a resource for staff

8
What else??

• Monitor antibiotic resistance and usage
• Consult with the microbiology laboratories
• Provide advice on product selection
• Construction and facility design issues
• Coordination with occupational health, safety and
  other programs (QA)
• Research activities
• Surveillance for community-acquired infections
  and collaboration with public health agencies
• SARS, bioterrorism, pandemic influenza

9
Its a huge job!!!

• and doesnt always receive a lot of
  administrative support.

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An Effective Infection Control Program

• Requires cooperation, understanding and support
  of facility administration and medical and
  nursing leadership
• Follow new regulations (effective 9/30/09)
• There is no simple formula
• every facility is different
• each facility must develop its own unique program

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Nosocomial Infection

• Any infection that is not
• present or incubating at the
• time the resident is admitted

12
Key Functions of Infection Control

• Managing critical data and information, including
  surveillance of nosocomial infections
• Setting and recommending policies and procedures
• Intervening directly to interrupt the
  transmission of infectious diseases (e.g.,
  outbreak investigation)
• Educating and training healthcare workers and
  providers, being a resource for staff

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1. Managing Critical Data and Information

• The most important data management activity of an
  infection control program is SURVEILLANCE!
• The collection, analysis, and dissemination of
  surveillance data has been shown to be the single
  most important factor in the prevention of
  nosocomial infections

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APIC Managing Critical Data

• Surveillance of nosocomial infections must be
  performed
• Surveillance data must be analyzed appropriately
  and used to monitor and improve infection control
  and patient outcomes
• Clinical performance and assessment indicators
  used to support external comparative measurements
  should meet the criteria delineated by SHEA and
  APIC

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What is Surveillance?

• .systematic method for collecting,
  consolidating, and analyzing data concerning the
  distribution and determinants of a disease or
  event, followed by dissemination of information
  to those who can improve the outcomes.

APIC Text 2006
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Surveillance

• Each facility will have own strategy (housewide
  vs. targeted surveillance)
• Most facilities currently use targeted
  surveillance
• Some examples bloodsteam infections (BSIs),
  surgical site infections (SSIs), ventilator
  associated pneumonias (VAPs), UTIs, antibiotic
  resistance, reportable diseases
• Surgical site infection surveillance (high risk,
  high volume) is complicated
• Review of microbiology reports is an important
  component

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Surveillance Strategy

• Organizations strategic plan
• Common Diagnosis
• Frequency of event
• Impact or cost of bad outcome
• Potential to reduce infection rates
• Public health concerns

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Surveillance Strategy

• Is there a program in place?
• How does the ICP identify infections?

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Surveillance

• Identify Tools
• Report
• Culture
• History and Physical
• Lab Reports

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(No Transcript)
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Surveillance Interventions

• STOP THE INFECTION
• Isolation/use of barriers
• Education
• Contact Families at risk

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Surveillance

• MEASURE INTERVENTIONS
• Measure Rates
• Communicate interventions that worked and those
  that didnt
• Incorporate new procedures into policies

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2. Setting and Recommending Policies
and Procedures to Prevent Adverse Events

• Policies must be based on scientifically valid
  infection prevention and control measures
• Policies must be practical to implement and
  should lead to improved outcomes
• Policies must be reviewed regularly to maintain
  accuracy and validity
• Policies must comply with regulations, guidelines
  and accreditation requirements such as those from
  HICPAC/CDC, SHEA, APIC, JCAHO, OSHA, CMS, FDA,
  EPA, etc.

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APIC Setting and Recommending Policies and
Procedures

• Written infection prevention and control policies
  and procedures must be established, implemented,
  maintained, and updated periodically
• Policies and procedures should be monitored
  periodically for performance

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Also Important Compliance with Regulations,
Guidelines, and Accreditation Requirements

• Facilities should use infection control personnel
  to assist in maintaining compliance with relevant
  regulatory and accreditation requirements
• Infection control personnel should have access to
  medical or other relevant records and to staff
  members who can provide information on the
  adequacy of the institutions compliance
• The infection control program should collaborate
  with, and provide liaison to, appropriate local
  and state health departments for reporting of
  communicable diseases and related conditions to
  assist with control of infectious diseases

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http//www.cdc.gov/ncidod/hip/HICPAC/publications.
htm

• Guidelines for Preventing Healthcare Associated
  PneumoniaPublished 2004
• Guidelines for Environmental Infection Control in
  Health-Care FacilitiesPublished 2003
• Recommendations for Using Smallpox Vaccine in a
  Pre-Event Vaccination ProgramPublished 2003
• Guidelines for Preventing Intravascular
  Device-Related InfectionsPublished 2002
• Guidelines for Hand Hygiene in Healthcare
  SettingsPublished 2002
• Guideline for Infection Control in Healthcare
  PersonnelPublished 1998
• Guideline for the Prevention of Surgical Site
  InfectionsPublished 1999
• Immunization of Health Care Workers Published
  1997
• Guideline for Isolation Precautions in
  HospitalsPublished 1994

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Key Functions of Infection Control

• Managing critical data and information, including
  surveillance of nosocomial infections
• Setting and recommending policies and procedures
• Intervening directly to interrupt the
  transmission of infectious diseases
  (e.g., outbreak investigation)
• Educating and training healthcare workers and
  providers, being a resource for staff

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4. Education and Training

• Ongoing education and training is crucial
• topics include isolation precautions, aseptic
  practices, and prevention of blood and body fluid
  exposures
• Ongoing monitoring of resident care practices is
  required to identify areas of concern and to
  assess effectiveness of educational interventions
• Infection control personnel should be available
  as a resource for staff

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APIC Education and Training of Healthcare Workers

• Facilities must provide ongoing educational
  programs in infection prevention and control to
  healthcare workers
• Educational programs should be evaluated
  periodically for effectiveness
• Bloodborne pathogens training required annually
  by OSHA

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Infection Control Topics

• Exposure Control Plan
• Isolation precautions
• Common Infections in LTCF
• Safer sharps technology
• Blood and body fluid exposures
• Occupational Health
• Antibiotic resistance
• Facility environment
• Laundry/waste

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Standard Precautions

• The basic level of infection control precautions,
  which are to be used, at a minimum, in the care
  of all patients
• Standard Precautions apply to blood all body
  fluids, secretions and excretions (except sweat)
  whether or not they contain visible blood
  non-intact skin and mucous membranes

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Standard Precautions Handwashing

• Wash hands after touching blood, body fluids,
  secretions, excretions, and contaminated items,
  whether or not gloves have been worn
• Wash hands immediately after gloves are removed,
  between patient contacts, and when otherwise
  indicated to avoid transfer of microorganisms to
  other patients or environments

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Semmelweiss was right!

• In 1847 Ignaz Semmelweiss, a physician in a
  Vienna hospital, discovered that infections were
  spread among patients by doctors who failed to
  wash their hands between examinations
• Nobody listened then!
• Are things much different today? Study after
  study shows that many healthcare workers do not
  comply with handwashing protocols and that
  interventions to improve compliance have only
  temporary effectsSO
• is there anything we can do about it?

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Another Idea Alcohol-based Hand Rubs

• Less time consuming than washing
• Effective in reducing microbial loads
• Improve access since no dependence on sinks and
  plumbing
• Improve tolerance as they can be less irritating
  to the hands than soap and water
• Do not promote antimicrobial resistance
• Caveat Organic material inactivates alcohol,
  must wash to remove visible soil

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Hand Hygiene

• Alcohol-based hand rubs replaced soap and water
  as the leading recommended tool for hand
  disinfection in the 2002 CDC update of the
  Guideline for Hand Hygiene in Health-Care
  Settings
• Such such preparations usually contain 60-95
  ethanol or isopropanol alcohol
• When done properly handwashing is effective, but
  improper handwashing techniques and low
  compliance with existing handwashing protocols
  make current hand hygiene recommendations
  ineffective

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Guideline for Hand Hygiene in Health-Care
Settings Recommendations of the Healthcare
Infection Control Practices Advisory Committee
and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task
Force (comprising members of the Healthcare
Infection Control Practices Advisory Committee,
the Society for Healthcare Epidemiology of
America, the Association for Professionals in
Infection Control and Epidemiology and the
Infectious Disease Society of America)

• Morbidity and Mortality Weekly Review
• October 25, 2002 51(RR16)1-44
• http//www.cdc.gov/handhygiene

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Quotes from the Guideline for Hand Hygiene in
Health-Care Settings

• If hands are not visibly soiled, use an
  alcohol-based hand rub for routinely
  decontaminating hands
• Alcohol-based products are more effective for
  standard handwashing or hand antisepsis by HCWs
  than soap or antimicrobial soaps
• Alcohol can prevent the transfer of
  healthcare-associated pathogens

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Standard Precautions Gloves

• Wear gloves (clean, non-sterile gloves are
  adequate) when touching blood, body fluids,
  secretions, excretions, or contaminated items
• Don clean gloves just before touching mucous
  membranes and non-intact skin
• Remove gloves promptly after use, before touching
  non-contaminated items and environmental
  surfaces, and before going to another patient
• Wash hands immediately after glove removal to
  avoid transfer of microorganisms to other
  patients or environments

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Standard Precautions Gowns

• Wear a fluid resistant gown (a clean,
  nonsterile gown is adequate) to protect skin and
  to prevent soiling of clothing during activities
  that are likely to generate splashes or sprays of
  blood, body fluids, secretions, and excretions

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Standard Precautions Masks

• Wear a mask and eye protection or a face
  shield to protect mucous membranes of the eyes,
  nose, and mouth during activities that are likely
  to generate splashes or sprays of blood, body
  fluids, secretions, and excretions

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Standard Precautions Patient Care Equipment

• Handle used patient care equipment soiled with
  blood, body fluids, secretions, and excretions in
  a manner that prevents skin and mucous membrane
  exposures, contamination of clothing, and
  transfer of microorganisms to other patients and
  environments
• Ensure that reusable equipment is not used for
  the care of another patient until it has been
  cleaned, disinfected and reprocessed
  appropriately
• Ensure that single use items are discarded
  properly

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Transmission Based Precautions

• In addition to Standard Precautions, the
  following transmission based precautions should
  be used when indicated
• Airborne, Droplet, and Contact

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Airborne Precautions

• Implemented for patients known or suspected to be
  infected with microorganisms transmitted by
  airborne droplet nuclei (small particle residue
  of evaporated droplets containing microorganisms
  that remain suspended in the air and can be
  dispersed widely by air currents within a room or
  over a long distance)
• Airborne precautions consist of employee
  respiratory protection and patient placement in a
  room with negative air pressure, if one is
  available
• Examples TB, measles, varicella (chickenpox)

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Droplet Precautions

• Implemented for a patient known or suspected to
  be infected with microorganisms transmitted by
  large particle droplets
• Droplets can be generated by the patient during
  coughing, sneezing, or talking and generally
  travel no more than 3 feet (approximately an
  arms length) from the patient
• Droplet precautions require the employee to wear
  a surgical mask when working within 3 feet of the
  patient, unless the patient is no longer
  infectious
• Examples Neisseria meningitidis, pertussis, GAS

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Contact Precautions

• Indicated for certain patients known or
  suspected to be infected or colonized with
  epidemiologically important microorganisms that
  can be transmitted by direct contact with the
  patient (hand or skin-to-skin contact that occurs
  when touching the patients dry skin) or indirect
  (touching) contact with environmental surfaces or
  items in the patients environment

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Contact Precautions

• Use gloves when having contact with an infected
  patient or their environment
• A gown should be worn if substantial contact with
  the patient or their environment is anticipated
• Indicated for diapered or incontinent persons
  with gastrointestinal (diarrheal) illnesses
• Other examples RSV, MRSA, VRE, scabies, and C.
  difficile toxin in a resident with diarrhea

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Resident Placement

• Appropriate resident placement is an essential
  component of infection control
• Placement decisions are guided by the residents
  diagnosis and ability to comply with precautions
• A private room is not always possible or
  necessary there ARE alternatives
• This will be discussed in more detail in the
  second part of this presentation

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Transport of Residents on Precautions

• Transport of such residents should be limited to
  essential purposes only
• When transport is necessary appropriate barriers
  are worn or used by the resident
• Notify staff in receiving department of the
  precautions to be taken

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Routine and Terminal Cleaning

• The rooms of most residents on transmission based
  precautions are cleaned using the same procedures
  that are used for residents on standard
  precautions
• Additional cleaning and disinfection measures may
  be indicated during a facility outbreak of acute
  gastrointestinal illness due to norovirus

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Equipment Cleaning

• Use EPA approved disinfectant
• Wash item first to remove any visible soiling
• Spray enough disinfectant to coat all surfaces
  thoroughly
• Allow adequate contact time (per manufacturers
  recommendations)
• Wipe surfaces with vigorous friction
• Stethoscopes can be wiped with alcohol

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Dishes, Glasses, and Eating Utensils

• No special precautions are needed for the dishes,
  glasses and eating utensils of any resident
• The combination of hot water and detergents used
  in facility dishwashers is sufficient to
  decontaminate them
• Lets slay this sacred cow!

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Common Infections in LTC

• Urinary Tract Infections
• Pneumonia
• Influenza
• Tuberculosis
• Norovirus
• Scabies

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Urinary Tract Infections

• Often the leading nosocomial infection in LTCF
• Indications for catheters

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Pneumococcal Polysaccharide Vaccine

• Put this vaccine on your standing orders
• Vaccine should be administered routinely to all
  adults 65 years of age and older.

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Pneumococcal Polysaccharide Vaccine

• LTCFs should make it a priority to ensure that
  residents are vaccinated and the absence of an
  immunization record should not hinder
  vaccination. Persons with uncertain vaccination
  status should be vaccinated.

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Pneumococcal Polysaccharide Vaccine

• The vaccine is also indicated for adults with
  normal immune systems who have chronic illnesses,
  including cardiovascular disease, pulmonary
  disease, diabetes, alcoholism, cirrhosis, or
  cerebrospinal leaks.
• Immunocompromised adults who are at increased
  risk of pneumococcal disease or its complications
  should also be vaccinated.

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Pneumococcal Polysaccharide Vaccine

• Antibody levels decline after 5-10 years persons
  who have not received vaccine within 5 years (and
  were lt 65 years of age at the time of
  vaccination) should be revaccinated.

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HCWs and Influenza

• HCWs are a significant source of influenza
  transmission a review of acute care hospital
  outbreaks between 1959-1994 implicated HCWs in 5
  of 17 reported outbreaks
• Evans, et. al., Am J Infect Control
  199425357-362
• Vaccination of HCWs in LTCFs has been associated
  with a substantial decrease in resident
  mortality
• Potter, et. al., JID 19971751-6
• Carman, et. al., Lancet 200035593-97

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Influenza Vaccine Works!

• Influenza vaccine can reduce the mortality rate
  in the elderly by 31-48
• The absolute reductions were 2.4-4.7 fold higher
  among high-risk subjects
• The data are clear vaccination of elderly
  persons, whether they are healthy or have
  high-risk chronic medical conditions, saves lives
  and decreases hospitalization rates

Hak E, et. al. CID 200235370-377.
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Tuberculosis (TB)

• An airborne, communicable disease caused by
  Mycobacterium tuberculosis
• Spread by tiny airborne particles (droplet
  nuclei) which are expelled into the air when a
  person who has infectious TB disease coughs,
  sneezes, talks, or sings
• Droplet nuclei can remain suspended in the air
  for several hours and if inhaled, infection may
  occur

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Number of Tuberculosis Cases by Countryof
Origin, Minnesota, 1992-2001
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Tuberculosis Program Am I ready?
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MDH TB Waivers

• Effective March 9, 2009
• Start with facility specific TB risk assessment
• Remember to update this assessment at least
  annually
• MUST go back to this date to complete pieces
• Baseline screens/TSTs for new residents
• Baseline screens/TSTs for new employees
• If the TSTs for residents or employees were
  recorded as neg instead of mm, must go back and
  complete a one-step TST and record it in mm

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TB waiver for Minnesota nursing homes

• Is your TB program individualized for your
  facility including TB risk assessment results
• Review/document in QA minutes that you have
  completed the assessment and TB program
• Complete problem evaluation if suspected or
  confirmed employee/resident TB case noted and
  developed a plan for transfer to a different
  facility.
• Ensure environmental controls written/in place
• Ensure respiratory protection controls available

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Conditions of waiver continued

• Did you assign administrative responsibility for
  your TB IC program/committee?
• Are you screening all new residents and HCWs for
  TB All paid and unpaid HCWs and new residents
  must receive baseline TB screening. Screen must
  be done along with two-step TST.
• Place resident screen/TST form in admission
  packet and the HCW screen/TST in new hire packet
• Have you met with contractors, students etc who
  work in your facility to ensure they have this
  completed?
• If your risk assessment category is medium risk,
  are you performing one-step TSTs on your
  employees make sure you are staggering these
  and not giving all at once. (ROUTINE serial TB
  screening of residents may be done at the
  discretion of the infection control team)
• Have you given all staff initial education on
  your TB program remember to then complete this
  annually going forward

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Conditions of waiver (cont.)

• Are you doing f/u on HCWs and residents with
  abnormal TB screening results? They must receive
  follow-up medical evaluation according to current
  CDC recommendations for the diagnosis of TB. See
  www.cdc.gov/tb
• Did you audit your current charts to ensure your
  residents have TST results in their charts look
  back in the medical records record the results
  on the current immunization sheet. If you are
  unable to find the results do baseline screen
  on that resident?
• Are you ensuring that ALL TSTs being completed
  are recorded in mm and not charted as negative or
  positive?
• Are you ensuring nurses are administering and
  reading TSTs according to the CDC guidelines?
• Posters and rulers available AT NO COST on the
  CDC website.

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Rules for TB Screening, Prevention and Control in
MN LTCFs Employees ?

• Employees (with some exceptions) must have a TB
  skin test lt 3 months prior to employment
• The two-step method must be used for employees
  who have not had a negative skin test performed lt
  12 months (if first test negative, second test
  done 1-3 weeks later)
• The frequency of repeat testing is determined by
  the risk assessment of the facility, but MDH
  recommends that employees be tested no less than
  every two years even in minimal risk facilities

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Clostridium difficile toxin ?

• Sequence of events
• Disruption of normal bowel flora after even a
  brief exposure to antibiotics
• Exposure to toxigenic C. diff strain
• Presence of host or virulence factors
• Contact Precautions indicated for duration of
  diarrhea
• Follow-up cultures not needed

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Scabies

• Crusted or Norwegian scabies may develop in
  immunocompromised or elderly people and may be
  unrecognized
• Prolonged skin to skin contact needed to transmit
  classic scabies (lt50 mites) minimal contact may
  transmit crusted scabies (thousands of mites)
• Bedding and clothing worn next to the skin in the
  4 days before treatment should be washed in hot
  water and dried in hot cycle
• Clothing that cannot be laundered should be
  bagged for a week mites cannot survive more than
  3-4 days without skin contact
• Environmental disinfestation is unnecessary and
  unwarranted vacuum rooms of residents with
  crusted scabies

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Blood and Body Fluid Exposures

• Infections with pathogens such as HIV, hepatitis
  B virus, and hepatitis C virus can be acquired
  after exposure to an infected persons blood or
  body fluids
• Preventing exposures is the key to preventing
  occupationally acquired bloodborne pathogen
  infections
• Strict compliance with Standard Precautions is
  essential to prevent percutaneous, mucous
  membrane and skin exposures to these pathogens
  

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Body Fluids That Are Potentially Infectious for
HIV

• Blood
• Semen and vaginal secretions
• Cerebrospinal, synovial, pleural, peritoneal,
  pericardial, and amniotic fluids with no visible
  blood (these body fluids have an undetermined
  risk for transmitting HIV)
• Other body fluids contaminated with visible blood
  
• Concentrated HIV in a research laboratory or
  production facility

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Exposure to Other Body Fluids

• Saliva, in the absence of visible blood, is not
  considered a risk for HIV transmission
• Exposure to tears, sweat, or non-bloody urine or
  feces does not require post-exposure follow-up
• Occupational exposure to human breast milk has
  not been implicated in HIV transmission

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Significant Routes of Exposure

• Percutaneous injury such as a needlestick, cut,
  scratch, puncture, or bite
• Contact with mucous membrane such as a splash to
  eyes, nose or mouth (including CPR without
  respiratory protection)
• Contact with non-intact skin such as when the
  exposed skin is chapped, abraded, afflicted with
  dermatitis, or has an open wound
• Contact with intact skin when the duration of
  contact is prolonged (several minutes or more) or
  involves an extensive area

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Post-exposure Prophylaxis (PEP)

• Considered after significant exposures to blood
  or high-risk body fluids
• Occupational exposure to blood or body fluids
  must be considered an URGENT medical concern to
  ensure timely administration (within 1-2 hours of
  exposure) of PEP, if it is indicated

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PEP Resources
Website http//www.needlestick.mednet.ucla.edu
/ June 29, 2001/ 50(RR11)1-42 Updated U.S.
Public Health Service Guidelines for the
Management of Occupational Exposures to HBV, HCV,
and HIV and Recommendations for Postexposure
Prophylaxis http//www.cdc.gov/mmwr/PDF/rr/rr5011.
pdf PEPLINE 1-888-448-4911
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Elements of Employee Health

• Coordination with other departments
• Medical evaluations
• Employee health and safety education
• Immunization programs
• Management of work related illnesses and
  exposures
• Health counseling
• Maintenance of records, data management and
  confidentiality

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Judicious Antibiotic UseWhats the Problem?

• Increasing bacterial resistance
• Treatment failures
• Increasing antibiotic prescriptions
• Increasing antimicrobial resistance is both an
  individual and a public health issue

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Judicious Antibiotic UseWhat is it?

• Only prescribing antibiotic therapy when it is
  likely to be beneficial
• Using an appropriate agent
• targeted to likely pathogens, narrower spectrum
• Using the appropriate dose and duration

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Association Between Recent Antibiotic Use and
Resistant Infections

• Invasive disease with non-susceptible pneumococci
  is higher among patients with recent antibiotic
  use compared to invasive disease among patients
  with susceptible pneumococci
• Colonization with non-susceptible pneumococci is
  higher among children with recent antibiotic use
  compared to children without recent antibiotic
  use

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Infectious Waste

• Minnesota law defines infectious waste as blood
  and six regulated body fluids (cerebrospinal
  fluid, pleural fluid, pericardial fluid,
  peritoneal fluid, amniotic fluid, and synovial
  fluid)
• Infectious wastes need to be separated from
  regular waste and placed in marked red bags for
  disposal if an item is saturated or dripping with
  any of the above named fluids
• Devices and containers filled with any of these
  fluids also need to be placed in red bags or
  sharps containers
• Contaminated needles and other sharps are to be
  in placed in sharps containers

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How dangerous is it?

• There is no epidemiological evidence that
  hospital waste is any more infective than
  residential waste
• There is also no evidence that traditional
  hospital waste disposal methods have caused
  disease in hospitals or the general community
• Therefore, identifying wastes for which handling
  and disposal precautions are indicated is largely
  a matter of judgment about the relative risk of
  disease transmission

Source CDC/HICPAC Draft Guideline for
Environmental Infection Control in Healthcare
Facilities, 2001
82
Regulations
Oh my!!
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Federal Regulations F441 F445

• Current
• F441 Infection Control Program
• F442 Prevent Spread of Infection
• F443 Prevent Spread of Communicable Disease
• F444 Handwashing
• F445 Handling Linens
• F315 Bowel and Bladder UTI
• These change 9/30/09!

84
Changes in Infection Control Regulations - Federal

• Will change F441- F445 to just F441
• Intent of regulation is to assure that LTC
  facilities, through infection prevention program
  has systems in place to
• Provide surveillance, investigation and
  monitoring to prevent, to the extent possible,
  the onset and the spread of infection
• Control outbreaks, by clustering or cohorting
• of residents to reduce spread of infection

85
Changes in Infection Control Regulations
Federal (cont)

• Develop, implement, maintain nursing home
  processes using data records of incidents,
  corrective action taken, and staff education to
  improve infection outcomes
• Determine nursing home precautions (e.g.
  isolation) as a means of preventing
  cross-contamination and
• Demonstrate proper storage and handling of linens
  to minimize contamination.

86
F315 Bowel and Bladder - UTI

• Indications to Treat a UTI
• Because many residents have chronic bacteriuria,
  the research-based literature suggests treating
  only symptomatic UTIs. Symptomatic UTIs are based
  on the following criteria

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F315 Bowel and Bladder - UTI

• Residents without a catheter should have at least
  three of the following signs and symptoms
• Fever (increase in temperature of gt2 degrees F
  (1.1 degrees C) or rectal temperature gt99.5
  degrees F (37.5 degrees C) or single measurement
  of temperature gt100 degrees F (37.8 degrees C)
  )14
• New or increased burning pain on urination,
  frequency or urgency
• New flank or suprapubic pain or tenderness
• Change in character of urine (e.g., new bloody
  urine, foul smell, or amount of sediment) or as
  reported by the laboratory (new pyuria or
  microscopic hematuria) and/or
• Worsening of mental or functional status (e.g.,
  confusion, decreased appetite, unexplained falls,
  incontinence of recent onset, lethargy, decreased
  activity).15

88
F315 Bowel and Bladder - UTI

• Residents with a catheter should have at least
  two of the following signs and symptoms
• Fever or chills
• New flank pain or suprapubic pain or tenderness
• Change in character of urine (e.g., new bloody
  urine, foul smell, or amount of sediment) or as
  reported by the laboratory (new pyuria or
  microscopic hematuria) and/or
• Worsening of mental or functional status. Local
  findings such as obstruction, leakage, or mucosal
  trauma (hematuria) may also be present.16

89
MN Infection Control Regulations

• 4658.0800 INFECTION CONTROL