Quality assurance of infection control (Best Practices for Infection…
Quality assurance of infection control
Introduction of Infection control-literature search
Research based of the cost of infection in healthcare
nosocomial infections- Each year over 2 miillion patients suffer from nosocomial infections or health care associated infections (HAI). About 90,000 die from these infections. These infections cost the hospitals between 28-45 billion dollars.
problems with infection control- Many HAI's are resistant to drugs and therefore are increasing in number. Multiple Drug Resistant Organisms or MDRO such as MRSA are problematic as nosocomial infections increasing the risk of inpatient mortality.
causes of infection in healthcare
Standard precautions- perform hand hygeine, use personal protective equipment whenever there is a possible exposure to infections, proper patient positioning, coughing ettiquette, properly handle and disenfect medical equipement and health care worker safety.
potential causes in ultrasound departments
gel bottles- SHEA (2013) Gel bottles in the manufacturing process were cotaminated with the bacteria strain p. aeruginosa. This bacteria was found in patients after cardiovascular surgery where ultrasound was used. The gel was not contaminated from multiple use, but it was contaminated during the manufacturing process and once the center got rid of all the contaminated gel and invested in single use packets, there were no more cases of this strain of bacteria. Prior to this, there were no federal guidelines in the US for the use of gel and surgery.
Endocavitary probes-known as semi critical steralization (Us endocavitary probes, body fluids, and open wounds). With even just non-crtitical probes it is possible to cross contaminate MRSA and other staph infections. A recent lawsuit against a hospital in PA recovered that more than 200 patients were potentially exposed to unclean endocavitary probes. One of the patients explained of her worry when she was given a list of possible infections she could have contracted such as HIV, Hepatitis and various STD's.
According to Nhysen (2016), a study of 946 people working in ultrasound in th UK, only 89% used a probe cover when doing endovaginal US. 69% of respondents would wipe off the gel on the endocavitary trasnducer and only use foam or a wipe instead of high level disenfection.
Joint commission and AIUM- Sterile gel is reccomended when risk of infection is possible such as interventional procedures, open wounds, and internal probes. Non-sterile gel is used when skin is intact and infection is not a worry. Non-sterile gel comes in single packets and gel bottles. It is reccomended to not refill gel bottles, properly seal gel bottles when not in use and when using the gel avoid direct contact with skin, the transducer, and any other surface. If gel is used with a patient with droplet or contact precaution, use single packets or discard bottle of gel after use.
Best Practices for Infection Control Techniques
Endocavitary probe cleaning- accoridng to GE, transdcuer cover should be removed and discarded. Probe is then wiped of all the gel and disconnected from the machine, and placed under running water. Then either wipe with a sani wipe and dry and place in the trophon or cidex. After cleaning it should be dried and stored properly.
Gel (single use vs refillable)- gel is not sterile unless the manufacturer states that on the packaging and therefore should only be used if it is sterile in sterile procedures. Gel bottles should not be refilled and the tips of the bottle should be cleaned with alcohol wipes daily.
Look at AIUM and manufacturer guidelines- AIUM reccomends probe covers and high level disenfection for endocavitary and transesophageal transducers. External transducers are to be cleaned after every patient if used in contact with intact skin and no bodily fluids. If the probe comes in contact with bodily fluids then it needs to be disenfected properly.
Other- A study showed that implementing alcohol rubs is very cost effective ranging from 0 to $20,000 per hospital. Many states have issued into the mandatory publc reporting of hospitals of their HAI's and their performance on reducing these numbers since the majority are preventable.
Transabdominal probe cleaning- should be disenfected after each patient using a T-Spray or alcohol wipes. Use what the manufacturer of the probes reccomends. Sonographers mih also serve as the source of nosocomial infections so it is important to wash hands before and after every patient.
FDA Listed HLD-Glutaraldehyde, Hydrogen peroxide, Peracetic acid, Ortho-phthalaldehyde, Hypochlorite/hypochlorous
acid, Phenol/phenolate, and Hibidil.
Best practices for compliance of department
monitoring of compliance-weekly checks (random) will be done to see if employees are complying such as looking at the schedule that day and seeing if the endocavitary probe was disenfected after the patient and the times to see if they match up. Also if an employee is not following the gel and transducer infection control guidelines they will have a warning, have a meeting and then have disciplinary action. If they do follow then they will be compensated.
Education of staff on personnel, equipment, probe covers, ect.- there will be monthy meetings on education of infection control and education. These staff will be paid the extra overtime to compensate for the extra time they will be needed.
assigning responsibilities-all employees will fill out log books pertaining to each patient with an endovaginal probe and what times the probe went into the trophon or cidex and when it was taken out. They all have to document when the trophon and cidex is cleaned/changed, ect. The employee will include a list of the schedules for each day to be matched. One employee will be in charge of collecting the weekly log pages, two employees will be in charge of checking the log pages to the schedules and one employee will research the hospitals statistics on nosocomial infections each month.
monitoring infection control in department- swabs of transducers and gels will be tested monthy to see the amount/if there is bacteria on these surfaces. It is a gol to try and reduce the amount of bacteria trasnferred to patients.
reward for compliance- gift cards, candy bars, extra hour of vacation time, ect.