Hospital-Acquired Infections - Distance Learning

CIS Self-Study Lesson Plan
Lesson No. CIS 242 (Instrument Continuing Education - ICE)
by Nicolas Casati, DBA,
and Isabelle Casati, MD
Sponsored by:
Hospital-Acquired
LEARNING OBJECTIVES
1. Provide background information about
hospital-acquired infections in
healthcare facilities
2. Emphasize the importance of using
gloves and proper hand washing
procedures to reduce hospital-acquired
infections
3. Answer common questions about the
role of Certiﬁed Instrument Specialist
technicians in preventing hospitalacquired infections
Instrument Continuing Education (ICE) lessons
provide members with ongoing education in
the complex and ever-changing area of surgical
instrument care and handling. These lessons are
designed for CIS technicians, but can be of value
to any CRCST technician who works with surgical
instrumentation.
Earn Continuing Education Credits:
Online: You can use these lessons as an in-service
with your staff, or visit www.iahcsmm.org for online
grading at a nominal fee.
By mail: For written grading of individual lessons,
send completed 15-question quiz and $15
to: PEC Business Ofﬁce, Purdue University, Stewart Center Room 110, 128 Memorial Mall, West
Lafayette, IN 47907-2034.
Scoring: Each 15 question online quiz with a
passing score of 70% or higher is worth two points
(2 contact hours) toward your CIS re-certiﬁcation
(6 points) or CRCST re-certiﬁcation (12 points).
IAHCSMM provides online grading service for
any of the Lesson Plan varieties. Purdue University
provides grading services solely for CRCST and
CIS lessons.
More information: Direct any questions about
online grading to IAHCSMM at 312.440.0078.
Questions about written grading are answered by
Purdue University at 800.830.0269.
W
HILE HOSPITAL-ACQUIRED INFECTIONS CAN BE SPREAD BY
patients, visitors, employees, and others, Certiﬁed Instrument Specialist
(CIS) technicians play an important role in preventing them. These
infections can be deadly. They are one reason why outpatient surgery
facilities have gained popularity: they may reduce exposure to hospital-acquired infections by decreasing the time patients are exposed to them.
Fortunately, the consistent use of several basic practices can reduce the incidence of
these infections, and these tactics are the topic of this lesson.
BACKGROUND
Concerns about the potential for transmitting hospital-acquired infections are
an ongoing issue in all healthcare facilities
and all Central Service (CS) departments.
These infections are those that are not
present when a patient is admitted to the
facility, but which then occur within 48
hours after admission.
Hospital-acquired infections affect approximately 10% of all patients admitted
and about 20% of those are in intensive
care units (ICUs). It has been noted
that, on average, patients with hospitalacquired infections spend 2.5 times
longer in the hospital than their peers
who do not.1
A patient with a hospital-acquired infection may require intravenous antibiotic
therapy and prolonged hospitalization,
both of which increase healthcare costs.
In some cases, such as when an abscess
develops or an implanted device such as
an artiﬁcial hip or shunt become infected,
additional surgeries might be required.
One-third of the American population
carries some type of potentially patho-
genic (disease-causing) bacteria. These
infections are a common cause of sepsis,
which occurs in approximately two million patients per year in the United States
leading to about 90,000 deaths.2 Note: As
deﬁned by the IAHCSMM CSSD Dictionary and Reference Guide, sepsis is the
condition, usually with fever, that results
from the presence of microorganisms or
their by-products in the bloodstream or
other tissues.
The frequent use of antibiotics has
led to the emergence of resistant bacteria. For example, the rate of reported
Methicillin-Resistant Staphylococcus
Aureus (MRSA) infections is increasing
in the United States, and about 3% of
the population is colonized with this
bacteria strain every year. Approximately
one-third of the US population has been
exposed to MRSA. In an effort to prevent
the spread of these infections, the Centers
for Disease Control and Prevention is
tracking them and is promoting wiser use
of existing antibiotics and the development of new ones.3
CIS Self-Study Lesson Plan
Proper handwashing is part
of the ﬁrst line of defense
to control hospital-acquired
infections.
HAND WASHING AND GLOVES
The use of proper hand washing procedures and gloves can help reduce the
incidence of hospital-acquired infections.
Hand hygiene (washing hands with
soap and water or using an alcohol-based
hand rub) is the most important procedure to prevent and control the transmission of microorganisms from one person
to another or from one site to another.
CIS technicians should wash their
hands upon entering and leaving their
work area, and whenever their hands
become soiled or contaminated. Infection
control experts recommend that hands
be washed immediately and thoroughly
if they become soiled with blood, body
ﬂuids, secretion, or excretions. In the absence of visible soil following contact of
bare hands with contaminated items, an
alcohol-based hand rub should be used
following the manufacturer’s recommendations (see below).
Effective hand washing consists of
wetting, soaping, lathering, and vigorously rubbing one’s hands together (making
sure to lather between ﬁngers and around
nails) for at least 15 seconds. Washing
should be followed by rinsing with running water and thorough drying with a
disposable towel. It is also helpful to use
approved lotions after hand washing to
keep the skin healthy and to minimize
skin irritation and excessive drying. Note:
some hand lotions may promote bacterial
growth so lotions designed to work with
other hand hygiene products must be used.
Fingernails of personnel working in
high-risk areas should be maintained at
a length of ¼ inch or less to minimize
passing along carried microorganisms.
Also, long nails increase the risk of
tearing gloves. Note: ﬁngernail polish and
artiﬁcial nails should not be worn in the
CS department.4
Personnel with open or weeping
wounds or excessive skin irritations
should refrain from handling any patient
care equipment until medically evaluated
and the condition is resolved.
Every CIS technician must consistently
follow dress codes and hand washing protocols to help prevent hospital-acquired
infections.
Disinfection gels provide fast disinfection of hands that are visibly clean
and dry. The gel must cover all areas of
the hands including ﬁngernails. Note:
gels are alcohol-based and have little to
no effect on hands contaminated with
CIS SELF-STUDY LESSON PLAN
Figure 1: Common Causes of Patient Infections
Type of Infection
Comment
Source (Reference)
Clostridium difﬁcile
CDC Urgent Threat
3
Carbapenem-resistant
Enterobacteriaceae (CRE)
CDC Urgent Threat
3
Drug-resistant Neisseria
gonorrhoeae
CDC Urgent Threat
3
Inﬂuenza virus
Germs enter eyes, nose, or
mouth
2
Legionnaires’ disease
Water
2
Bacterial meningitis
Germs enter eyes, nose, or
mouth
2
Measles
Persons coughs, sneezes, or
shares food or drinks
2
West Nile virus
Infected mosquitoes
2
Tularemia
Insect bite
2
Hepatitis A
Shared food or drink
2
Rotavirus
Infected person’s stools
2
Norwalk virus
Infected person’s stools
2
Multidrug resistant
Pseudomonas
Causes pneumonia
2
Super-resistant Klebsiella
Causes pneumonia
2
Methicillin Resistant Staphylococcus Aureus (MRSA)
Increases risk of lethal
infections
2
Vancomycin Resistant
Enterococcus
Increases risk of lethal
infections
8
Gram-negative bacilli (GNB)
Causes bloodstream infection
7
protein soils or potentially contaminated
with Clostridium difﬁcile, a bacterium that
causes gastrointestinal symptoms and
commonly affects older adults in hospitals and long-term care facilities, and
children at daycare. Clostridium difﬁcile
infection typically occurs after treatment
with antibiotic medications.
HOSPITAL-ACQUIRED INFECTIONS:
QUESTIONS AND ANSWERS
The control of hospital-acquired infections can be reviewed from several
different perspectives.
What are standard precautions and
how do they help reduce hospital-acquired infections? The concept of
standard precautions involves the use of
appropriate barriers to prevent transmission of infectious organisms from contact
with blood and all other bodily ﬂuids,
non-intact skin, and mucous membranes;
it applies to all patients, regardless of
diagnosis or presumed infectious status.5
Its history can be traced to the mid-1850s
when an Austrian surgeon and obstetrician, Dr. Semmelweis, observed that the
after-delivery survival rate of women
whose child was delivered by physicians
and medical students was much lower
than that of women attended by midwives or their trainees. He implemented
a required hand washing policy and
other practices for medical students and
physicians which resulted in a reduced
mortality rate for their patients.2
CIS technicians take precautions for
themselves and for the patients whom
they serve. They do so as they frequently
wash their hands and as they wear full
personal protective equipment (PPE)
when handling bio-burden in decontamination. In addition, numerous other
factors impact infection rates, including
proper storage conditions and transport
methods to prevent contamination of
the exterior of sterile items. Those who
open sterile products must be trained to
inspect packages for integrity prior to
use. They must also know how to identify
contamination, including the presence of
soils, moisture, and wrapper abrasions.
Transport vehicles also must be cleaned
after each use. Even “minor” precautions,
such as the proper disinfection of high
transit surfaces (i.e., computer keyboards) are very important.
Which microorganisms need to be
monitored by CIS technicians when performing their work responsibilities? Many
types of organisms can cause patient infections, and some of the most common
are listed in in Figure One.2
Some of the organisms listed in Figure
One enter the CS department in or on
instruments after being in contact with
the eyes, nose, mouth, or skin of surgical
patients. Therefore, it is very important
that PPE always be worn in the decontamination area.
How can CIS technicians transmit hospital-acquired infections to patients? CIS
technicians may spread hospital-acquired
bacteria in several ways. Patients may
become contaminated if a CIS technician
with contaminated hands takes a package
out of the sterilizer and the contaminants
come in contact with the hands of the
circulating or scrub nurse in the OR.
Cross-contamination can also occur
between the decontamination area and
the clean side. For example, cross-contamination would happen if a technician
conducting inventory in the decontami-
CIS Self-Study Lesson Plan
nation area – without wearing appropriate PPE – were to become contaminated
and spread contaminants to the clean
side. This emphasizes the need to wash
hands and follow standard precautions,
including hand washing, and wearing
gloves.
Another potential contamination
hazard occurs when soap injectors on
cart washers are not properly operating, and dirty carts are then sent to the
clean side. Similarly, if washer disinfectant (non-sterilizing) machines are
not properly functioning and not being
monitored, dirty trays may move from
decontamination into the tray preparation area.
How does a person know if they are
a potential carrier? Most persons are
unaware of their carrier status. However,
some may know based on their previous
medical histories. More rarely, a carrier
may have a MRSA skin infection which
looks and feels like spider bites.6 Those
who know they are carriers should be
vigilant around those with weakened
immune systems.
What is the role of a facility’s Infection Control Committee in preventing
hospital-acquired infections? A multidisciplinary team comprised of medical and
nursing staff, the Infection Prevention
and Control Professionals, and the CS
manager should meet regularly.7 The
team’s role should include the examination of errors in the application of
principles that could cause hospitalacquired infections and to implement
cleaning and other improvements that
could prevent them.
What is the best strategy to prevent
hospital-acquired infections? Healthcare
personnel must ensure that they properly
and frequently wash their hands.
IN CONCLUSION
Readers should recall three basic principles from this lesson. First, proper hand
washing and the use of PPE are critical
to prevent the transmission of hospital-acquired infections including MRSA.
Second, CIS technicians can prevent
the spread of hospital-acquired bacteria
when they use proper PPE when working in the decontamination, staging, and
sterilization areas. Third, since current
antibiotics may not be effective in the face
of emerging infectious bacterial diseases,
special attention to the prevention of hospital-acquired infection is critical.
4. International Association of Healthcare Central
Service Materiel Management (2007). Central
Service Technical Manual. (pp. 100 – 101).
REFERENCES
1. Inweregbu, K., Jayshree, D. & Pittard, A.
(2005). Nosocomial Infections. Continuing
education in anesthesia. Critical care and
pain, 5 (1) 14-17.
7. Joint Committee on Administrative Rules
(2010). Public Health. Retrieved from
http://www.ilga.gov/commission/jcar/
admincode/077/077002500I11000R.html.
2. Neuhauser, M., B. (2004). Ignaz Semmelweis
and the birth of infection control. Quality
Safety Health Care 13(3) 233-234.
5. International Association of Healthcare Central
Service Materiel Management (2010). CSSD
Dictionary and Reference Guide.
6. Washington State Department of Health
(2006). Living with MRSA. Retrieved from
http://www.tpchd.org/ﬁles/library/2357
adf2a147d1aa.pdf.
8. McDermott, C. (2012). Central Sterile Supply
Department Safety Practices. Retrieved from
https://www.distance.purdue.edu/training/
cssp/lessons/pdf/crcst125.pdf.
3. Centers for Disease Control (2013). Antibiotic
Resistant Threats in The United States.
Retrieved from http://www.cdc.gov/
drugresistance/threat-report-2013/pdf/
ar-threats-2013-508.pdf#page=6.
CIS SELF-STUDY
LESSON PLANS
TECHNICAL EDITOR
CARLA MCDERMOTT, RN, CRCST
Clinical Nurse III
South Florida Baptist Hospital
Plant City, FL
SERIES WRITER/EDITOR
JACK D. NINEMEIER, PH.D.
Michigan State University
East Lansing, MI
IAHCSMM is seeking volunteers to write
or contribute information for our CIS SelfStudy Lessons. Doing so is a great way to
contribute to your own professional development, to your Association, and to your
Central Service department peers.
Our Team will provide guidelines and
help you with the lesson to assure it will be
an enjoyable process. For more information,
please contact Elizabeth Berrios
([email protected]).
Sponsored by:
CIS Self-Study Lesson Plan Quiz Hospital-Acquired Infections
,ESSON.O#)3)NSTRUMENT#ONTINUING%DUCATION)#%s,ESSONEXPIRES-ARCH
1. Hospital-acquired infections can be
spread by:
a. Visitors
b. Employees
c. Patients
d. A and B above
e. All the above
2. Hospital-acquired infections are
those that are not present when a
patient is admitted, but which then
occur within ________ hours after
admission to the facility.
a. 24
b. 48
c. 72
d. 96
3. Hospital-acquired infections affect
approximately ________ percent of all
patients admitted.
a. 5
b. 10
c. 15
d. 20
4. The frequent use of antibiotics has led
to the emergence of resistant bacteria
that, when they cause hospital-acquired
infections, can be very difﬁcult to treat.
a. True
b. False
5. What is the most important procedure to
prevent and control transmission of
microorganisms from one person to
another?
a. Wearing gloves
b. Wearing PPE
c. Washing hands with soap and water
d. Checking patients for contagious
infections
6. CIS technicians should wash their
hands when leaving their work area.
a. True
b. False
7. For how long should one’s hands be
rubbed together for effective hand
washing?
a. 1 minute
b. 45 seconds
c. 30 seconds
d. 15 seconds
8. Which should not be worn or used in
the CS department?
a. Fingernail polish
b. Artiﬁcial nails
c. Lotions after hand washing
d. All of the above
e. A and B above
9. Disinfection gels are effective when
used on hands contaminated with:
a. Protein soils
b. Clostridium difﬁcile
c. Both of the above
d. Neither of the above
10. Standard precautions involve using
barriers to prevent transmission of
infectious organisms from contact with:
a. Blood
b. Non-intact skin
c. Mucus membranes
d. All of the above
11. Use of standard precautions is only
necessary for patients who are
presumed to be infectious to others.
a. True
b. False
12. How frequently should instrument
transport vehicles be cleaned?
a. Once time each month
b. After each use
c. Weekly
d. Daily
13. Factors that impact infection rates
include:
a. Storage conditions
b. Transport conditions
c. Not checking sterile trays for
integrity prior to opening
d. All the above
14. Most people are aware if they are a
carrier of an infectious organism.
a. True
b. False
15. Current antibiotics may not be effective
in the face of emerging infectious
bacterial diseases.
a. True
b. False
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