Healthcare-Associated Infections and Prevention (HAI)

What is CDI?

Clostridium difficile [pronounced Klo-STRID-ee-um dif-uh-SEEL] infection (CDI) or C. Diff is a germ that can cause diarrhea. Most cases of CDI are in patients taking antibiotics.

CDI is defined as a case of diarrhea or toxic megacolon without other known etiology that meets 1 or more of the following criteria:

• the stool sample yields a positive result of a laboratory assay for C. difficile toxin A and/or B, or a toxin-producing C. difficile organism is detected in the stool sample by culture or other means;
• pseudomembranous colitis is seen on endoscopic examination or surgery; and
• pseudomembranous colitis is seen on histopathological examination.

Symptoms of CDI are watery stools, fever, loss of appetite, nausea and belly pain.

C. difficile was estimated to cause almost half a million infections in 2011, and is associated with increased lengths of hospital stay, morbidity, and mortality among adult patients. Approximately 83,000 of the patients who developed C. difficile experienced at least one recurrence and 29,000 died within 30 days of the initial diagnosis. CDI may cause illness, death, increased hospital cost, and more days in the hospital.

CDI can be prevented by:

1. Only take antibiotics as needed and as prescribed by your health care provider.
2. Cleaning your own hands often, especially after using the bathroom and before eating

Make sure that all doctors, nurses, and other healthcare providers clean their hands with soap and water or an alcohol-based hand rub before and after caring for you.

Resources:

• CDC- Clostridium difficile Infection
• Preguntas frecuentes- Clostridium difficile

Resources for CDI Prevention:

• IHI Reducing HAIs
• NHSN C diff Module
• Management of Multi Drug Resistant Infections
• MMWR: Preventing CDI

Articles Related to CDI

• Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2010 Updates by SHEA and IDSA

What is CAUTI?

CAUTI is an infection of the urinary tract caused by a tube (urinary catheter) that has been placed to drain urine from the bladder. The urinary tract consists of the kidneys, ureters (tubes joining the kidneys to the bladder), bladder, and urethra (tube leading from the bladder to the outside of the body).

Urinary catheters are used to drain urine in patients who are not able to urinate on their own, to measure the amount of urine produced during intensive care, or during and after surgery or tests of the kidneys and bladder. Germs can travel along the urinary catheter and cause an infection in your bladder or your kidney; this type of infection is called a catheter-associated urinary tract infection (or "CAUTI").

The definition of CAUTI falls into two groups:

• symptomatic urinary tract infection and
• asymptomatic bacteremic urinary tract infection

CAUTI includes those infections in which a patient had an indwelling urinary catheter at the time or within 48 hours before onset of the event. There is no minimum period of time that the catheter must be in place in order for the UTI to be considered catheter-associated.

CAUTI is the most common type of HAI and causes 1of 3 HAIs in patients in hospitals. Among urinary tract infections acquired in the hospital, approximately 75% area associated with a urinary catheter. There are an estimated 13,000 annual death attributed to CAUTI.

CAUTI can be prevented by things such as hand washing, not using urine drain tubes and if they must be used, inserting them properly and keeping them clean. Catheters should be put in only when necessary, and removed as soon as possible.

Core Prevention Strategies:

• Insert catheters only for appropriate indications
• Leave catheters in place only as long as needed
• Ensure that only properly trained persons insert and maintain catheters
• Insert catheters using aseptic technique and sterile equipment (acute care setting)
• Following aseptic insertion, maintain a closed drainage system
• Maintain unobstructed urine flow
• Hand hygiene and Standard Precautions

Resources:

• An Overview of Catheter-Associated Urinary Tract Infections (UTI)
• APIC CAUTI Elimination Guide
• CDC- CAUTI Information
• Facts about CAUTI
• Preguntas frecuentes- Infeccíon urinaria asociada al catéter urinario

Guidelines for CAUTI prevention:

• CAUTI Guideline Appendices 2009
• CDC-CAUTI Information
• CDC CAUTI Tool kit
• CDC NHSN CAUTI Event
• HICPAC Guideline for Prevention of Catheter-Associated Urinary Tract Infections
• Prevention Tools and Resources for Healthcare Professionals

What is CLABSI?

A CLABSI is a serious infection that occurs in the blood stream due to catheter use. A central catheter is placed into a patient’s large vein, typically in the neck, chest, arm, or groin to draw blood, or give fluids or medication. A blood stream infection can occur when bacteria travel down the central line and into the blood; this type of infection is called a central line-associated blood stream infection (CLABSI).

CLABSI symptoms include fever, chills, and sore and red skin around the catheter.

Central line-associated blood stream infections (CLABSI) are a major cause of healthcare-associated morbidity and mortality. This type of infection is serious, but often can be successfully treated with antibiotics.

CLABSI can be prevented by choosing a vein where the catheter can be safely inserted and where the risk for infection is small, proper hand washing and use of protective equipment like gloves and a sterile gown, and careful cleaning of the area around the catheter. Every day, healthcare providers should assess whether the patient needs to have the catheter, and remove it as soon as it is no longer needed. If you do not see your providers clean their hands, please ask them to do so.

Prevention Measures:

• Perform daily audits to assess whether each central line is still needed
• Follow proper insertion practices, like performing hand hygiene before insertion, adhering to aseptic technique, use maximal sterile barrier precautions, performing skin antisepsis with >0.5% chlorhexidine with alcohol, and choosing the best site to minimize infections and mechanical complications.
• Handle and maintain central lines appropriately, by complying with hand hygiene requirements, scrubbing the access port immediately prior to each use with appropriate antiseptic, accessing catheters only with sterile devices, and performing dressing changes under aseptic technique.

Resources:

• CDC- CLABSI Information
• FAQ’s-CLABSI
• Preguntas Frecuentes-Infecciones sanguíneas asociadas al catéter intravenoso

Guidelines for CLABSI Prevention:

• AHRQ Tools for Reducing CLABSI
• Bloodstream Infection Event
• Prevention Tools and Resources for Healthcare Professionals
• Strategies for Preventing CLABSI in Acute Care Hospitals

What is SSI?

A surgical-site infection (SSI) is an infection that occurs after surgery in the part of the body where the procedure took place. Out of every 100 patients who have surgery, 1 to 3 will develop an infection. An SSI can sometimes be superficial, involving the skin only, but can become more serious if it involves tissues under the skin, organs, or implanted material. Annually, there are approximately 300,000 surgical site infections, which accounts for 17% of all HAIs, and second only to UTI. SSIs lead to an increase in mortality and morbidity, and often add 7-10 days to hospital time.

The symptoms of SSI include redness and pain around the area where surgery occurred, drainage of cloudy fluid from the surgical wound, and fever.

To prevent SSI, healthcare providers should practice good hand hygiene before and during surgery, wear sterile protective equipment, and thoroughly clean the skin at the site of surgery. Patients can prevent SSI by making sure that providers are cleaning their hands before and after surgery, by avoiding shaving near where the surgery will occur (as this can irritate skin and make it easier to develop an infections), and asking for explanation of everything to know about taking care of a wound before leaving the hospital.

Preoperative Measures:

• Administer antimicrobial prophylaxis in accordance with evidence based standards and guidelines
• Identify and treat any remote infections before elective operation
• Do not remove hair at the operative site unless it will interfere with the operation; do not use razors

Intraoperative Measures:

• Maintain Operating Room Traffic
• Maintain surgical wound dressing
• Control blood glucose level during the immediate post-operative period
• Discontinue antibiotics within 24 hours after surgery end time

Postoperative Measures:

• Feedback of surgeon specific infection rates

Resources:

• CDC-Surgical Site Infections (SSI)
• IHI-Surgical Site Infection
• SHEA/IDSA Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update