approaches exist for infection control : broad programs which attempt to reduce the rates of all infections due to all pathogens ; and narrow programs focusing on a single pathogen or single anatomic site . The former is referred to as ‘ horizontal ’ programs and the latter as ‘ vertical .’ There is strong debate in the infection control arena about which is the more beneficial approach . An example of the focus of controversy is the strong advocacy by some infection control experts for methicillin-resistant Staphylococcus aureus ( MRSA ) nasal screening of inpatients ( vertical program ) versus a more broad-based horizontal program .”
As Gauthier acknowledged , “ There are always going to be new microorganisms emerging , but a consistent approach to hand hygiene , PPE use , screening , cleaning and disinfection of high-touch surfaces and other practices can help protect against them .”
He explained that he consulted numerous medical journals to search for protective measures and practices that healthcare personnel should perform consistently , such as hand hygiene or surface cleaning , or use central line-associated infection prevention bundles . He also examined the routine practices and additional precautions for healthcare facilities issued by Canada ’ s public health agencies . “ This PHAC guidance , issued in 2013 , is 195 pages ,” Gauthier pointed out . “ I ’ ve always taken that down to a simple concept captured in just 21 words : ‘ If they are leaking , limit their movement and protect yourself . If , during care , you touched it or used it , disinfect it .’ That ’ s the 195 pages of PHAC guidance taken down to just 21 words . The PHAC document discusses point-of-care risk assessment , before every interaction with every patient and / or the patient ’ s environment , to ensure that appropriate control measures ( routine practices and , if necessary , additional precautions ) are in place to prevent transmission of microorganisms . These measures are what we as infection preventionists talk about all the time .”
ROUTINE PRACTICES
• Hand hygiene program ( including pointof-care ABHR )
• Source control ( triage , early diagnosis and treatment , respiratory hygiene , spatial separation )
• Patient placement , accommodation , and flow
• Aseptic technique
• Use of PPE
• Sharps safety and prevention of bloodborne pathogen transmission
• Management of the patient-care environment
• Cleaning of the patient-care environment
• Cleaning and disinfection of non-critical patient care equipment
• Handling of waste and linen
• Education of patients , families and visitors
• Visitor management
Gauthier emphasized the importance of source control . “ So , if a patient has uncontrolled nasal secretions , productive cough , diarrhea not contained by an incontinence product , and a wound dressing that soaks through every two hours , they are producing a lot of bodily fluids . So , what we need to do is limit their movement , put them into contact , droplet or airborne precautions , and ensure that healthcare workers don their PPE – not just when the patient has a scary-sounding bug , but all the time , if the patient has skin , feces or mucous membranes , and is producing bodily fluids ,” he said .
He continued , “ We wrote a paper published in March 2020 in The Joint Commission Journal of Quality and Patient Safety which discussed cleaning more than once a day . Now , EVS does a phenomenal job when they come in , but we ’ ve got biofilms that accumulate , with organisms that can be spread very easily through the environment . If during patient care you touched it or used it , take the disinfectant wipe and clean up after yourself , as your mom doesn ’ t work here .”
Gauthier explained the sheer numbers of bacteria that are present on surfaces , whether it ’ s skin ( 10 2 - 10 7 / cm2 ), feces ( 10 12 / gram dry weight ) or mucous membranes ( 10 8 / mL ), and the need for compliance with precautions .
“ To provide an example of how big a gram is , a sugar cube is about a square centimeter , or about the size of the end of your finger ,” he said . “ Skin can have anywhere from 100 to 10 million colony-forming units per square centimeter . Feces can have a trillion microorganisms per gram . That ’ s why I say if the patient has skin , feces or mucous membranes , perform hand hygiene ; and if you have contact with this patient or their environment , give it a wipe . That , to me , was always routine practice . PHAC notes that routine practices properly and consistently applied should prevent transmission by the contact route when there is extensive contamination of the environment , microorganisms with a very low infectious dose , and certain conditions / clinical presentations .”
Gauthier added , humorously , “ I ’ ve always felt when I put up a contact precautions sign this is really what it was saying : ‘ We just found out that this patient has a bug that could be carried to the next patient . Now we really mean you have to perform hand hygiene and try not to soil your uniform . We are not sure about the guy next door , yet so do whatever you want !’ Do you ever get the feeling that when you put up a contact precautions sign on the outside of the room where the patient had diarrhea for 12 to 15 hours and they finally got the specimens to the lab , the lab finally got to it , and it comes back positive for C . difficile and you ’ re thinking , ‘ Why didn ’ t that sign go up as soon as they started soiling the environment ?’ I had a nurse tell me one day , ‘ This patient over here has a trait that every once in a while when he coughs , his sputum travels the length of the bed and at least three more feet and it hits the wall .’ I look at the room , there ’ s
Now , EVS does a phenomenal job when they come in , but we ’ ve got biofilms that accumulate , with organisms that can be spread very easily through the environment . If during patient care you touched it or used it , take the disinfectant wipe and clean up after yourself , as your mom doesn ’ t work here .” www . healthcarehygienemagazine . com • july 2023
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