Common pathogens that live on devices are Staphylococcus , Streptococcus , E. coli , Klebsiella , Candida , and C. diff (CDC, 2022). Situations involving devices include inserting an IV, taking vital signs, and performing procedures and surgery. Healthcare workers can prevent potential transmission by performing hand hygiene, wearing appropriate PPE, cleaning and disinfecting devices and surfaces, and following best practices for device sterilization (CDC, 2019; CDC, 2022; McCafferty et al., 2018). In an early study demonstrating pathogen transmission, Casewell and Phillips (1977) found transmission of Klebsiella species from the hands of HCWs working in an intensive care unit (ICU). Klebsiella is known to cause HAIs such as pneumonia, bloodstream infections, and wound and surgical site infections (CDC, 2010). In this study, 17% of the HCWs’ hands had Klebsiella . If this pathogen gets transmitted to a patient, it can lead to colonization and infection. Transmission of a pathogen to HCWs’ hands can occur during minimal contact with the patient. Patient care activities contributing to hand transmission include those within the patient zone: Lifting a patient, taking vital signs (blood pressure, pulse, temperature), washing or touching a patient, and performing respiratory care (e.g., tracheostomy care). Barker and colleagues (2004) determined that contaminated fingers can transfer a virus (i.e., norovirus) up to the next seven surfaces touched. Lax and colleagues (2017) studied colonization and the progression of hospital-associated pathogens as a new hospital was built. Before the hospital was open, the common pathogens were Acinetobacter and Pseudomonas . As soon as the hospital opened, the common areas (e.g., nurses’ station) became colonized with common skin bacteria, Corynebacterium , Staphylococcus , and Streptococcus . The highest concentration of colonization is from a patient’s skin, HCWs’ noses, faucet handles, and new latex gloves. The authors looked at pathogen transmission within the same area over the course of one day and found transmission between patient hands and the bedrails Survivability of pathogens The risk of transmission increases when pathogens live on surfaces for long periods. These pathogens often cause healthcare-associated pathogens and outbreaks. Survival times depend on three factors: Temperature, humidity, and surface type (CDC, 2020). The persistence of pathogens on inanimate (dry) surfaces means gram-positive bacteria such as Enterococcus species (e.g., VRE), Staphylococcus aureus (e.g., MRSA), and Streptococcus pyogenes are able to survive for up to a few days to a few months (Kramer et al., 2006). The following gram- negative bacteria can survive on inanimate surfaces from hours to months (CDC, 2021; Kramer et al., 2006). ● Acinetobacter —Three days to five months. ● Escherichia coli —1.5 hours to 16 months. ● Klebsiella —Two hours to more than 30 months. ● Pseudomonas aeruginosa —Six hours to 16 months. ● Serratia marcescens —Three days to two months. ● Shigella —Two days to five months. ● Clostridioides difficile (a spore, i.e., an inactive form of the germ)—Up to 5 months. ● Candida albicans (fungi or yeast)—One to 120 days. Depending on where a virus is living (e.g., respiratory system, gastrointestinal system, blood) determines its survivability. For example, respiratory viruses (e.g., respiratory syncytial viruses [RSV], severe acute respiratory syndrome [SARS], and influenza)
and HCWs hands and their cell phones or pagers. This study reminds us that microbial contamination is everywhere. In one study, healthcare workers (n = 17) in four outpatient wound care clinics were found to have hand contamination at critical moments during patient care (Bingham et al., 2016). Healthcare workers’ hands became contaminated with MRSA, C. difficile , VRE, or Acinetobacter during 28% of 46 patient care encounters. Cultures were collected before and after patient contact, before clean and aseptic procedures, and after gloves were removed (following a body fluid exposure). The authors found that 17% of the hand cultures were positive for at least one pathogen, and gloved hands were more contaminated (19.6%) than nongloved hands (14.6%). These results highlight ongoing training opportunities regarding the appropriate use of gloves and when to perform hand hygiene at critical moments. An important concept to remember when seeking to minimize the transmission of pathogens in the environment is to work from “clean” to “dirty” tasks during patient care (CDC, 2022). Evidence-Based Practice: How Dirt Is Your QWERTY? Do you ever wonder who is responsible for cleaning the keyboards at work and how often they get cleaned? A study on the risk of pathogen transmission from computer keyboards found that almost half of the samples harbored gram-negative bacteria (Ledwoch et al., 2021). Common multidrug-resistant organisms such as MRSA (72%), VRE (31%), and Acinetobacter (17%) were found on the keyboards. Approximately 70% of the bacteria transferred when wiped with a sterile cloth moistened with sterile water. This study reminds us that keyboards are a (dry) high-touch surface and can harbor pathogens that can be transmitted to a HCW’s hands. If keyboards are not cleaned and disinfected regularly with the appropriate disinfectant, they can become a source of infection. The best practice recommendation is to perform hand hygiene after touching a patient’s surroundings, including a computer keyboard (WHO, 2009a). persist for only a few days. Viruses in the gastrointestinal tract (e.g., rotavirus) can persist for a couple of months, and bloodborne viruses can persist for more than a week. The sexually transmitted virus herpes can persist for up to seven days (Kramer et al., 2006). Self-Assessment Quiz Question #2 In which of the following situations should hand hygiene be performed? 1. Before having direct contact with a patient. 2. Before inserting an invasive device (e.g., intravascular catheter, foley catheter). 3. When moving from a contaminated body site to a clean body site during an episode of patient care. 4. After having direct contact with a patient or with items in the immediate vicinity of the patient. 5. After removing gloves. Choose the best answer : a. B and E.
b. A, B, and D. c. B, D, and E. d. All of the above.
The World Health Organization’s (WHO) five moments of hand hygiene Sax and colleagues (2007) developed “five moments for hand hygiene” to help HCWs visualize critical moments to perform hand hygiene to stop potential transmission. The World Health Organization (WHO, 2009a) published hand hygiene guidance that included the five moments of hand hygiene and introduced the first global patient safety challenge, Clean Care Is Safer Care.
Key moments to perform hand hygiene occur within the patient zone, within the healthcare zone, and at critical sites. The patient zone includes the patient’s immediate surroundings (bedrails, bedside table, bed linen, infusion tubing, and other medical equipment). The patient zone is colonized with the patient’s skin flora within a day of the patient’s admission (Lax et al., 2017).
Page 96
Book Code: RPTTX2024
EliteLearning.com/Pharmacy-Technician
Powered by FlippingBook