Latest / Culture Positive: An Infection Prevention Podcast / Paging Infection Prevention
Transcript
- Ally: Welcome to Culture Positive, an infection prevention podcast where healthcare, public health, and real life meet. I'm Allie, and by day I work in infection prevention at an academic hospital, bringing my background in epidemiology and public health into everyday practice. Each episode will dive into healthcare stories. Public health conversation, workplace reality, historical context, and the human side of this work. This is a space for curiosity, honesty, and hopefully some inspiration. I'm glad you're here. Growing up, I dreamed of having a pager with a microphone headset to answer calls. Do you remember how cool Hilary Duff looked in the Lizzie McGuire movie? Singing into that microphone headset in the Coliseum. Truly what dreams are made of. I now know I need to be careful with what I manifest. Sadly, I do not have a microphone headset at work, but I do have a pager. Infection prevention is a 24-hour business and some weeks your pager never turns off. Interested in hearing what a day in the life can look like for an infection preventionist? Let's get into it. Since I've already touched on having a pager, let's start there. I mentioned before that it's possible to be on call 24 hours a day. For a lot of organizations, it is asked that infection prevention be available all hours of the day. You never know when a consult from infection prevention will be needed. A lot of times, how often you are on call after hours depends on the size of your team. At the moment, infection preventionists are greatly needed across the United States. So if you find any of this day in the life interesting, there might be an open IP position in your city to check out. I know that being on call 24 hours a day can sound intimidating. But the more exposure you have to on call, the more comfortable you get. Let's go back to talking about what an average day can look like. When speaking about having your pager for an average day, that means being available during quote-unquote normal business hours. Let's just say normal work hours are from 8 to 5 p.m. Pages that you can get range from questions about isolation for a particular organism, what PPE needs to be worn during an aseptic procedure. To there being a water event where infection prevention is needed to assess any sort of potential infection risk. Okay. You have arrived at work, coffee is ready, and your pager is retrieved. I am assuming you drink coffee, but I won't judge if you're a tea or morning diet coat kind of person. The first thing that most people do is scan emails to see if anything of high priority has come in that needs immediate attention. If all looks well via email, you can start working on your isolation mismatches. Mismatches is when you look at all of the patients on your assigned units to ensure that they are on proper isolation. What do you think of when you hear the word isolation? Maybe isolating at home? Sorry if that brought up some COVID PTSD. In healthcare, isolation helps separate infected and vulnerable patients to prevent the spread of any sort of contagion. It helps protect healthy individuals, staff. patients and immunocompromised patients from contracting illnesses while also containing the infection to a certain area. When we think about isolation in the hospital environment, in general there are three different isolations that are followed. Before we dive into the different isolations, let's chat about standard precautions. This applies to all patients in the hospital. Regardless of their presumed infection status or diagnosis. The first and most important practice in standard precautions is hand hygiene. Hand hygiene is the most effective way to prevent infections. Hand hygiene in the hospital is performed with hand sanitizer or soap and water. There are some instances where you should only use soap and water. certain infections like C. diff, and if hands are visibly soiled. The World Health Organization, WHO, came up with five moments of hand hygiene that should be followed in a healthcare setting. The five moments are before touching a patient, before a clean or aseptic procedure, after exposure to body fluid, After touching a patient and after touching a patient's surroundings. When washing your hands with soap and water, you should scrub your hands for around 20 seconds. If singing the alphabet song while washing your hands isn't your vibe, may I suggest the chorus of Sweet Caroline? Another element of standard precautions is the use of personal protective equipment, also known as PPE. Based on the task being done by staff and the risk of exposure to bodily fluids, PPE can include gloves, gowns, eye protection, mass, and face shields. some other elements included in standard precautions, use of aseptic techniques for invasive procedures, along with safe use and disposal of sharps, environmental cleanliness, and proper waste management. Now that I have reviewed standard precautions, let's talk about the three isolations I mentioned earlier. Those are contact, droplet, and airborne. Various infections or conditions require certain isolations. A great reference can be found on CDC called Appendix A. It lists various infections and what the recommendation is for isolation. I can give an example of infections for the three remaining isolations: contact, droplet, and airborne. A very common infection, multi-drug-resistant organism, like MERSA or VRE, require contact isolation. Remember, every patient should be on standard precautions. Contact precautions: you must wear gloves and an isolation gown when in patient's room. For droplets, surgical masks are needed, and the first infection that comes to mind is influenza. There are some infections that call for both droplet and contact isolation, like adenovirus. The final isolation, airborne, requires gloves, gowns, and instead of surgical mask, an N95 mask. Airborne isolation is needed for one of my least favorite infections to work on: tuberculosis. It is possible for some infections to be both airborne and contact. An infection that has unfortunately been in the news a lot is one of them: measles. Now that you have some background information on various isolations, I hope this gives you a better idea. As to why performing mismatches is so important. It's important to make sure proper PPE and hand hygiene are being followed to mitigate any spread of infection. Checking on patients' infection statuses is crucial to ensuring patients and staff are staying safe. Alright, getting back to your day. You have sorted through patient list and all looks well with mismatches. What are you off to next? Looks like environment of care grounds. Such an important part of ensuring patient and staff safety is making sure the environment itself is clean. Infection preventionists, along with environmental services staff and unit leaders, routinely inspect patient units to ensure proper protocols are being followed, like cleaning and upkeep of patient rooms. Overall unit cleanliness and routine dusting. There are several different spaces in the hospital, and hospital units specifically, APIC has a great resource for environmental rounds. I will include that resource in the show notes. Walking back from environmental care rounds, you get a page about construction happening on one of your units. Did you expect infection preventionists to be involved in construction work? I sure didn't expect it to be a part of my job before I entered the field. If there is any building maintenance, renovation, or construction, infection preventionists should be a part of the project. As an IP, you utilize an infection control risk assessment. Also known as an ICRA. It is essentially a planning process that determines the level of risk to patients in the hospital based on the work that is being done. From that, various controls are put into place to reduce risk of harm to patients and staff members. Activities like demolition, Wall removal or drilling create dust and can disrupt ventilation or plumbing systems, which can lead to bacteria or dangerous fungi like Aspergillus to enter the environment. And ICRA provides protocols and procedures that should be followed so hazards are contained and the hospital can continue with their normal operations safely. before construction work begins, you identify the activity. It could be minor or major construction that will be performed and also pay attention to where the work is being done. As an example, There is a lower risk with construction in administrative area versus an intensive care unit due to the vulnerability of the occupants in those areas. Once you are able to define the activity type and patient risk group, you are able to set precautions that should be followed during the time of any construction being done. from putting up plastic walls, utilizing a HEPA vacuum. There are several precautions that can take place. And ICRA is actually a regulatory requirement from the Joint Commission and CMS, Centers for Medicare and Medicaid Services. If you are ever in the hospital and it looks like any sort of construction work is being done, there should be an ICRA permit posted outside that has been signed off by an infection preventionist that clearly states what controls should be followed to maintain a safe environment. Ashie American Society for Healthcare Engineering has an ICRA 2.0 toolkit that provides the ICRA matrix, along with a permit and other educational opportunities that go into ICRAs in more detail. I will also include that in the show notes. Construction work has been reviewed and the ICRA document itself has been signed and sent off. Next on the calendar are device rounds. If you were able to listen to the first professional spotlight, Columbus did what? Myself and Kaylee briefly chatted about device rounds. So what are they and why do we do them? Invasive devices, specifically central lines and fully catheters, increase the likelihood of someone getting an infection. due to the devices themselves being so invasive. with the increase in possibility for infection, device rounds can be implemented to review care and necessity of the device. Fully catheters are primarily used when a patient cannot urinate normally, but a fully catheter can also be used during or after surgeries and monitoring for urine output in critical care areas. The catheter itself is a thin tube inserted into the bladder through the urethra to continuously drain urine. The urine flows through the tube and collects into an external drainage bag. For device rounds, there are a couple of things to look for. Firstly, is the fully catheter still needed? It is great to have discussions with the care team to see if there are any other options for this patient, like an external catheter, or if there could be a trial void to see if the patient can urinate properly on their own. Securement is another important aspect of Fully Care. A securement device is utilized, often anchored to a patient's thigh, to prevent any tugging or trauma at the insertion site. While checking the securement device, we also want to make sure the tube that runs from the insertion site to the external drainage bag does not have any kinks or loops to ensure urine can flow freely into the drainage bag. Finally, We want to make sure the drainage bag where the urine collects is positioned below the level of the bladder. Why do we care about that? If the drainage bag was positioned above the bladder, this could possibly lead to backflow of urine. Gravity can cause the urine to backflow, sometimes back into the bladder, which can introduce bacteria. This significantly increases the risk of developing a CADI, a catheter-associated urinary tract infection. CAUDIS are a reportable patient safety metric submitted to CDC, NHSN, National Healthcare Safety Network. Another safety metric that gets submitted to NHSN are collapsies, central line associated bloodstream infection. Let's now shift gears and focus on what central lines are and what we look for during central line device rounds. A central line is a long tube that is inserted into a large vein in the arm, neck, chest, or groin. allows for more direct delivery of medications, fluids, and nutrients. Once again, this is considered an invasive device, and being that these lines lead to your superior vena cava. The large vein that sends blood to your heart makes central lines a priority for device rounds. Similar to the fully catheter, we want to see if there is truly a necessity for the line we are looking at. If not, take the line out. Statistically speaking, the longer a line is in, the chance of infection increases. Next, we look at the dressing for the central line. A lot of dressings have what we call a CHG gel patch in the middle that should be directly placed on the insertion site. What is CHG? I'm glad you asked. CHG, chlorohexine gluconate, is a broad-spectrum antiseptic. It sits on the insertion site and continuously prevents bacteria from entering the site. The gel is also clear, so it allows staff to monitor the site for any possible signs of infection, like redness, swelling, or drainage. You also want to look at the overall integrity of the dressing. If any issues are seen or noted, it might be appropriate to go ahead and change the dressing itself. To summarize, we check for line necessity, do an insertion site check for any signs of infection, and also verify the dressing is intact, clean, and dry. Any infection preventionist would tell you that we strive. For zero harm, and device rounds are a great way to collaborate with the care teams to ensure continued excellence in care is occurring when it comes to our invasive devices. Device rounds are wrapped up and you are finally back at your office. You will end the day with answering emails oop spoke too soon. A page just came in about a water event. The collar doesn't have a lot of information on what the water event is, but a water event can range from a simple hand washing sink leak to a sewer line breaking. Just know this: there is never a dull day when you work in infection prevention. For our Huddle Corner, a section for some takeaways before signing off. I think it's safe to say that infection preventionists are a part of various aspects in the hospital. Not only will you see infection preventionists rounding on patient units, but you'll see them checking the supply room for dust or consulting on construction sites to ensure patients are kept safe. In this podcast episode alone, I wasn't able to cover all components of infection prevention. The amount of surveillance done, investigations, education, the list can truly go on and on. If you would be interested in hearing more about what infection preventionists do, maybe I could start a series breaking down each aspect. Send me an email at culturepositivepod at gmail.com or Message me on Instagram if that's something you would enjoy at Culture Positive Pod. Infection preventionists work so hard to reduce patient harm and I can say I'm very honored to do that work. Thank you for listening to Culture Positive. If you have any questions or ideas for an episode, please send me an email at culturepositivepod at gmail.com. References for the episode can be found in the show notes. Infection prevention is about more than policies and protocols. It's about people. Until next time, stay curious. Stay compassionate and keep building a culture that's truly positive.