______________________________ Infection Control for New York Health Care Professionals ‒ 2024 Update
Case Study 1: Colonization Bob checks into an orthopedic surgical center for knee surgery. He does not show signs of infection and is not screened via lab tests for infection. Bob was given antibiotics through his IV as a normal precaution against postsurgical infection. However, a resistant pathogen starts to develop in Bob’s body, and signs of an infection emerge, including a high fever. The pathogen was transmitted to other patients and staff. Unbeknownst to anyone, it was later determined that Bob was colonized with a drug-resistant pathogen when admitted, or he contracted it soon after admission. This left him susceptible to developing an infection or transmitting the resistant pathogen to staff or other patients. Questions 1. What errors can you identify in this case that could have been addressed through additional screening or procedures to prevent the HAI? 2. As a nurse, what precautions would you implement in this case to protect yourself and others? 3. What guidance from Elements I and II would inform your practice when faced with a similar case? Discussion 1. From the initial intake, medical history, preoperational blood testing/ screening, and interview with the patient before surgery, the emphasis should be placed on infection identification and HAI prevention. In this case, colonization screening/lab tests could have detected pathogen colonization. If the pathogen had been identified, the proper medication may have been administered, control and decolonization procedures implemented, and the surgery postponed. The IV antibiotics may not have been effective in this case and may have caused an imbalance in the microbiome, allowing the pathogen to further invade the body and make Bob more susceptible to infection. In any case, the infection spread to others, endangering staff and patients. 2. Standard precautions should have been in place from the start. Early identification would have allowed for the implementation of contract precautions, environmental controls, PPE, and isolation, as indicated, so the infection could have been contained and the spread controlled. 3. Surveillance investigations should be implemented to determine the source of the pathogen and assess any potential for hospital and community transmission. It is the responsibility of the healthcare agency and staff to implement ICP protocol in all cases.
Protective Environment Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings A protective environment (PE) is designed for allogeneic hema- topoietic stem cell transplant (HSCT) patients to minimize fungal spore counts in the air and reduce the risk of invasive environmental fungal infections. Beyond standard and barrier precautions if infection is confirmed, engineering control and disinfection will be implemented [15]. • Central or point-of-use HEPA (99.97% efficiency) filters capable of removing particles 0.3 μm in diameter for supply (incoming) air • Well-sealed rooms • Ventilation to maintain ≥12 air exchange per hour (ACH) • Daily wet-dusting of horizontal surfaces using cloths moistened with EPA-registered hospital disinfectant/ detergent. See the CDC’s website for further details on establishing a protective environment [15].
infection isolation room (AIIR). An AIIR is a single-patient room that is equipped with special air handling and ventila- tion capacity that meets the American Institute of Architects/ Facility Guidelines Institute (AIA/FGI) standards for AIIR [12]. Healthcare personnel caring for patients on airborne pre- cautions wear a mask or respirator, depending on the disease- specific recommendations, that is donned prior to room entry. Empiric applications of transmission-based precautions based on observation, symptoms, experience, and etiology always include standard precautions and are adjusted once a diagno- sis is confirmed. The CDC explains the process of syndromic and empiric applications of transmission-based precautions [13; 14]. Diagnosis of many infections requires laboratory confirmation. Since laboratory tests, especially those that depend on culture techniques, often require 2 or more days for completion, Transmission-Based Precautions must be implemented while test results are pending based on the clinical presentation and likely pathogens.
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