Some of the major areas or people involved where infections occur include central line catheter insertion sites, dialysis units, catheter-associated urinary tract patients, surgical sites, and ventilator- associated patients who develop pneumonia. Also discussed will be Clostridium difficile infections and MRSA infections. (See endnote 3 for details.) Other portals of entry for microorganisms may include the eyes, ears, nose, skin, and gastrointestinal system. Normal organisms present in certain parts of the body can be transferred to other parts of the body where they may cause a healthcare- associated infection. Hand washing among staff varies with the type of position the individual holds, the facility, and the level of supervision provided for this highly important preventive activity. Physicians and nursing assistants most frequently wash their hands. However, there needs to be improvement in all staff positions.

Best Practices for Preventing Healthcare-Associated Infections Caused by Medical/Nursing

Techniques (See endnote 3 for details on each of the subjects mentioned immediately above)

  • (See endnotes 4, 17)
  • • Establish an infection control committee which meets regularly and on an emergency basis when needed to: review epidemiological surveillance data from all areas of the institution; review case histories of patients and/or employees with healthcare-associated infections; establish a baseline of data concerning healthcare-associated infections and compare to national CDC data to see where the individual institution actually stands in relation to other institutions and the amount of infections present; determine critical areas for use of intensive preventive and control techniques; develop appropriate training measures for all levels of personnel and ensure that the training results in reduced levels of infections; and provide a comprehensive infection control manual.
  • • Provide an infection control team of specialized professionals who can rapidly enter any area of the institution, evaluate the problems, and make necessary changes to stop an outbreak of infectious diseases or prevent one from occurring.
  • • Put special emphasis on catheter-associated urinary tract infections, surgical site infections, ventilator-associated infections, central line-associated bloodstream infections, blood and other bodily fluids procedures, and healthcare personnel exposure.
  • • Establish comprehensive evaluations of the technical knowledge and skills of all medical/ nursing personnel involved in performing the necessary functions in an aseptic manner for various catheterizations, use of dialysis units, a variety of surgeries and invasive procedures, and insertion and use of ventilators.
  • • Provide appropriate supervision especially to new and existing personnel in performing any of the above-mentioned skills when working with these procedures.
  • • Provide necessary in-service training courses and periodic continuing education to refresh individuals in the above-mentioned skills after specialized training.
  • • Teach each of the individuals utilizing invasive procedures all necessary techniques used for the prevention of infection in the patient and spread of infections from the patient to other patients and staff.
  • • Minimize the use of invasive medical devices, enhance and insist upon proper hand hygiene of all personnel, and improve cleaning of all surfaces and equipment to reduce potential for healthcare-associated infections.
  • • Use only specially trained personnel to insert catheters while utilizing all appropriate aseptic techniques.
  • • Increase staffing to appropriate levels to avoid undue fatigue in staff which may lead to improper use of aseptic techniques.
  • • Document on the patient’s record the physician’s order, the catheter placement, and any problems related to insertion and maintenance. Also record catheter removal and if necessary justify continued use of catheters.
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