Clean Equipment and Environment Promotes Safe Resident Care

AHRQ Safety Program for Long-Term Care: CAUTI

Slide 1: Clean Equipment and Environment Promotes Safe Resident Care

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Training Module 2

Slide 2: Objectives

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Upon completion of this session, long-term care (LTC) staff will be able to—

  • Describe the chain of infection and identify key strategies to break the chain.
  • Explain catheter care and maintenance strategies that facility staff can use to prevent residents from acquiring catheter-associated urinary tract infection (CAUTI).
  • Explain the role of the environment as a place where pathogens can become a source of infection for residents and staff.
  • List the important steps when using environmental disinfectants.

Slide 3: Protecting Residents Against Infection

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The Chain of Transmission: Six Links

Image: It demonstrates how infectious agents, like bacteria or viruses, can move from one person to the next and possibly spread throughout an entire facility. Microorganisms grow and multiply in or on people (reservoirs), and these infectious agents can be released via an open wound, bodily fluids, stool, etc. This is known as the portal of exit. Next, these pathogens "go mobile." In other words, they are transmitted by our hands, a contaminated surface or a piece of equipment that is used between residents. Then the pathogen enters the body of a new person in the chain (entry portal), continuing and spreading the infection. Indwelling urinary catheters are important medical devices that can be essential to providing quality resident care; however, improper care and maintenance can introduce infections in residents, leading to CAUTIs and other healthcare-associated infections (HAIs).

Each link stands for something (or someone) that helps pass on an infection.

An infection can be passed from one person to another person as long as the links of the chain are joined together.

Slide 4: Breaking the Chain of Infection—The Role of LTC Facility Staff

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The Chain of Transmission: Six Links

Image: It demonstrates how infectious agents, like bacteria or viruses, can move from one person to the next and possibly spread throughout an entire facility. Microorganisms grow and multiply in or on people (reservoirs), and these infectious agents can be released via an open wound, bodily fluids, stool, etc. This is known as the portal of exit. Next, these pathogens "go mobile." In other words, they are transmitted by our hands, a contaminated surface or a piece of equipment that is used between residents. Then the pathogen enters the body of a new person in the chain (entry portal), continuing and spreading the infection. Indwelling urinary catheters are important medical devices that can be essential to providing quality resident care; however, improper care and maintenance can introduce infections in residents, leading to CAUTIs and other healthcare-associated infections (HAIs).

How Can You Break the Chain of Infection?

Education

  • Hand hygiene
  • Gloves
  • Clean rooms
  • Disinfected surfaces
  • Proper medical device care and maintenance

Ensure residents have—

  • Good personal hygiene
  • Covered cuts/wounds
  • Isolation precautions
  • No unnecessary antibiotics
  • Proper waste disposal

Slide 5: Indwelling Urinary Catheter: Entry Pathways for Microbes1

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Bladder

  • Entry during insertion.
  • Bacteria movement up the catheter.

Urethra
(Urinary tract entrance)

  • Breaks in the catheter tubing or drainage bag.
  • Contamination of the catheter tubing or drainage bag.

Adapted from: Maki DG, Tambyah PA. Emerg Infect Dis. 2001 Mar-Apr;7(2):342-7. PMID: 11294737.

1. Maki DG, Tambyah PA. Engineering out the risk for infection with urinary catheters. Emerg Infect Dis. 2001 Mar-Apr;7(2):342-7. PMID: 11294737.

Slide 6: Entry Pathways for Microbes: Urine Collection Opening2

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  • Sterile technique is important when inserting urinary catheters.
  • Routine hygiene is important (e.g., cleansing the area around the urethra during bathing or showering).
  • Disinfect port with alcohol swab for 15 seconds before obtaining a urine culture.
  • Check site for possible disconnection of catheter from drainage bag.
  • System may become an open system if the outlet is left unclamped.

Source: Catheterout.org. Used with permission.

2. The University of Michigan, Veterans Administration Healthcare System. Catheterout.org. Ann Arbor, MI. Fowler K. Accessed on October 13, 2015.

Slide 7: Indwelling Urinary Catheter: Stabilization Devices Can Help Prevent Microbe Entry3

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Catheter Stabilization Devices

Images: Strap- A person stabilizing a urinary leg bag with a strap.
Catheter stabalization device

Seal over junction between catheter and drainage bag

Image: Junction between the catheter and drainaged device sealed.

Source: Catheter Associated Urinary Tract Infection (CAUTI) Prevention. SHARP.

3. System CAUTI Prevention Team. Catheter Associate Urinary Tract Infection (CAUTI) Prevention. SHARP. Accessed September 9, 2016.

Slide 8: Hand Hygiene4,5

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Good hand hygiene is essential for catheter care and infection prevention. Recall that for almost all pathogens found in the long-term care environment, alcohol-based hand rubs are superior to antimicrobial soaps and should be used to maintain proper hand hygiene.

And remember that there are four main opportunities for hand hygiene:

  1. Before initial contact with the resident or their environment.
  2. Before aseptic or clean procedures, such as placing a urinary catheter or a peripheral IV.
  3. After body fluid exposure risk, including after emptying a urinary catheter drainage bag.
  4. After any contact with the resident or his/her environment as you are exiting the room.

4. Just Clean Your Hands educational resources. Ontario Agency for Health Protection and Promotion. Accessed on April 14, 2015.
5. Boyce JM, Pittet D, Healthcare Infection Control Practices Advisory Committee, et al. Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Recomm Rep. 2002 Oct 25;51(RR-16):1-45. PMID:12418624.

Slide 9: Case Review of an Outbreak6

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The Case of the Common Urinometer

  • A long-term care facility has an outbreak of multidrug-resistant Serratia marcescens urinary tract infections (UTIs).
  • Risk factors
    • Use of common measuring device between residents with indwelling urinary catheters.
    • Hands of health care workers contaminated with outbreak strain after use of device; they helped pass the microbes between residents.
  • The outbreak stopped after the measuring device was disinfected between each use.
  • Dedicate one device per resident.

6. Rutala WA, Kennedy VA, Loflin HB, et al. Serratia marcescens nosocomial infections of the urinary tract associated with urine measuring containers and urinometers. Am J Med. 1981 Mar;70(3):659-63. PMID: 7011020.

Slide 10: Role of Clean Equipment and Environment—7-10 Protecting Residents Against Infection

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Factors associated with increased risk of infection in residents include—

  • Lower level of cleanliness.
  • Higher frequency of odors.
  • High turnover rate of nurses.
  • Fewer certified nurses' aides/100 beds.
Microorganism Survival on Environmental Surfaces
Bacteria
Clostridium difficile (C. diff) spore ≥ 1 year
Methicillin-resistant Staphylococcus aureus (MRSA) 7 days – 7 months
Viruses
Human immunodeficiency virus (HIV) 3 – 4 days
Norovirus 8 hours – 7 days

7. Zimmerman S, Gruber-Baldini AL, Hebel JR, et al. Nursing home facility risk factors for infection and hospitalization: importance of registered nurse turnover, administration, and social factors. J Am Geriatri Soc. 2002 Dec;50(12):1987-95. PMID: 12473010.
8. Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis. 2006 Aug 16;6:130. PMID: 16914034.
9. McFarland LV, Beneda HW, Clarridge JE, et al. Implications of the changing face of Clostridium difficile disease for health care practitioners. Am J Infect Control 2007 May;35(4):237-53. PMID: 17482995.
10. Murphy CR, Eells SJ, Quan V, et al. Methicillin-resistant Staphylococcus aureus burden in nursing homes associated with environmental contamination of common areas. J Am Geriatr Soc. 2012 Jun;60(6), 1012-18. PMID: 22670708.

Slide 11: Disinfection of the Environment and Equipment

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Why is it important to disinfect surfaces in the LTC facility?

  • Surfaces that are touched frequently increase the chance that microorganisms could be spread to residents or staff.
  • While surfaces may look clean, pathogens may be lurking.

What can you do?

  • Cleaning/disinfection offers extra margin of safety.
  • Disinfectant kills bacteria and viruses that can't be seen.
  • Focus disinfection on surfaces that are touched a lot.

Slide 12: Commonly Touched Areas in the LTC Facility

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Let's Chat!

What are some examples of commonly touched surfaces in your facility?

  • Door handles
  • Call button
  • Telephone
  • Bed rail
  • Tray table
  • Bedside table
  • Light switches
  • Bedside commode

Slide 13: Disinfection in LTC Facilities: Read the Label First!

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Follow instructions for use — check the label on disinfectants for the following key safety steps:

  • Precautions you should take when applying the product, such as wearing gloves.
  • If the disinfectant is safe for the surface.
  • Whether the disinfectant needs to be diluted with water before use.
  • How to apply the disinfectant to a surface.
  • How long you need to leave it on the surface to be effective (contact time).
  • If the surface needs to be cleaned first and rinsed after using.

Slide 14: Disinfectant Wipes

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  • Keep It Wet—The surface being disinfected needs to be wet long enough to meet the contact time stated on the label.
  • Cover the Surface Well—Use the right size wipe based on the size of the surface.
    • Small wipes are fine for bedside tables
    • Larger wipes for larger areas, like mattress covers
  • Keep the Cover Closed and Secure After Use—Keep the top of the dispenser closed to prevent the wipes from drying out.
    • Also think about where the dispenser is stored – can residents access the wipes?

Slide 15: Improving Cleaning and Disinfection

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Let's Chat!

  1. Where are your cleaning and disinfection supplies?
  2. What would help remind you to clean and disinfect surfaces thoroughly?
  3. What is your role in ensuring surfaces are clean and disinfected?

Slide 16: Wrapup

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READ THE LABEL!

  • Clean environment and clean equipment keep residents safe.
  • Know how to safely and properly use disinfectants utilized at your facility.
  • Clean and disinfect surfaces that are touched a lot and that are soiled with body fluids.
  • Follow routine catheter care and maintenance to prevent catheters from becoming an entry portal for bacteria.

Slide 17: References

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  1. Maki DG, Tambyah PA. Engineering out the risk for infection with urinary catheters. Emerg Infect Dis. 2001 Mar-Apr;7(2):342-7. PMID: 11294737.
  2. The University of Michigan, Veterans Administration Healthcare System. Catheterout.org. Ann Arbor, MI. Fowler K. Accessed on October 13, 2015.
  3. System CAUTI Prevention Team. Catheter Associate Urinary Tract Infection (CAUTI) Prevention. SHARP. Accessed September 9, 2016.
  4. Just Clean Your Hands educational resources. Ontario Agency for Health Protection and Promotion. Accessed on April 14, 2015.
  5. Boyce JM, Pittet D, Healthcare Infection Control Practices Advisory Committee, et al. Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Recomm Rep. 2002 Oct 25;51(RR-16):1-45. PMID:12418624.
  6. Rutala WA, Kennedy VA, Loflin HB, et al. Serratia marcescens nosocomial infections of the urinary tract associated with urine measuring containers and urinometers. Am J Med. 1981 Mar;70(3):659-63. PMID: 7011020.
  7. Zimmerman S, Gruber-Baldini AL, Hebel JR, et al. Nursing home facility risk factors for infection and hospitalization: importance of registered nurse turnover, administration, and social factors. J Am Geriatri Soc. 2002 Dec;50(12):1987-95. PMID: 12473010.
  8. Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis. 2006 Aug 16;6:130. PMID: 16914034.
  9. McFarland LV, Beneda HW, Clarridge JE, et al. Implications of the changing face of Clostridium difficile disease for health care practitioners. Am J Infect Control 2007 May;35(4):237-53. PMID: 17482995.
  10. Murphy CR, Eells SJ, Quan V, et al. Methicillin-resistant Staphylococcus aureus burden in nursing homes associated with environmental contamination of common areas. J Am Geriatr Soc. 2012 Jun;60(6), 1012-18. PMID: 22670708.
  11. Duckro, AN, Blom DW, Lyle EA, et al. Transfer of vancomycin-resistant enterococci via health care worker hands. Arch Intern Med. 2005 Feb 14;165(3):302-7. PMID:15710793.
Page last reviewed March 2017
Page originally created March 2017
Internet Citation: Clean Equipment and Environment Promotes Safe Resident Care. Content last reviewed March 2017. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/implementaion/education-bundles/infection-prevention/environment-and-equipment/environ-equip-slides.html