Infection Control for New York Health Care Professional ‒ 2024 Update ________________________________
Sepsis in Adults Survival is dependent on a high index of suspicion of sepsis, early recognition, and timely intervention. Findings are generally nonspecific and secondary to primary infection. They include malaise, leukocytosis, tachypnea, tachycardia, and altered mental status. Patients with evidence of sepsis, including signs of organ dysfunction, require immediate hospital assessment. Empiric broad-spectrum antibiotic therapy, based on the most probable pathogens and site of infection, should be administered as soon as possible, and preferably within the first hour if the patient is progressing to shock. Blood cultures, as well as cultures of all potentially infected body fluids, should be obtained as indicated by symptoms and the risk profile of the patient, ideally before the initiation of antimicrobial treatment. Any source of infection should be controlled as a matter of urgency within 6 to 12 hours following recognition. Evidence of hypoperfusion or shock should be identified and treated with immediate intravenous fluid challenges if present. Shock that fails to respond to fluid challenges necessitates urgent critical care referral for consideration of vasopressors and/ or inotropes.* Source: [40] *Vasopressors are agents that constrict blood vessels to increase blood pressure. Inotropes are agents that increase or decrease the force of the heartbeat.
Patients and families should receive information and be informed of their role in breaking the chain of infection. Healthcare staff, in every setting of patient care , are the front line of IPC and share the responsibility for delivering the highest quality of healthcare. GLOSSARY OF TERMS The following terms are taken directly from the New York State Department of Health, Hospital-Acquired Infections in New York State Part 2: Technical Report and the New York State Department of Health, Healthcare. Provider Infection Control Training [1; 6]. Carbapenem : There are four antibiotics considered last resort: ertapenem, meropenem, doripenem, and imipenem. Carbapenem-resistant Enterobacteriaceae (CRE): Bacteria resistant to carbapenems. Central line days (device days): The total number of days a central line is used. Clostridioides difficile : A bacterium that naturally resides in the bowels of some people without symptoms of infection, but which can cause infections in some situations. Overgrowth of C. difficile in the bowel may occur after a patient takes antibi- otics, which can kill good bacteria in the bowel. Symptoms range from mild to severe diarrhea; in some instances, death can occur. Community onset (CO): Documented infection occurring within 3 days of hospital admission.
CONCLUSION In our increasingly mobile world, infectious agents do not remain static, often mutating and accelerating around the globe. MDRO continue to appear, and a rapid response is needed to stop the continuum from Tier 1 to endemic Tier 4. Now more than ever, healthcare professionals must commit to their professional responsibility to continue education and training in scientific, evidence-based best practice for IPC. Standard precautions, including PPE and EBP, must be a priority in all cases to prevent the spread of infection. It is impossible to anticipate all interactions with patients that may lead to direct or indirect contact with infectious agents, so IPC protocols must be in place at all times to stop the transmission of pathogens. Healthcare professionals must stay current on evidence-based research and continuous training to inform their practice for ICP. One critical area is the early recognition of sepsis, differ- ent presentation in children and the elderly, parent/patient rights, and early treatment protocols. The emphasis on the importance of interprofessional com- munication and collaboration is a common theme in effective infection control at all levels of healthcare. Professionals must be committed to identify and address implicit bias, social, political, environmental, and economic factors that interfere with quality healthcare. Administration and leadership roles are essential to ensure all personnel are trained and committed to comply with IPC protocols. It is the healthcare professional’s legal responsibility to adhere to all federal, state, and local laws and regulations for IPC.
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