2.3 Preventing device and procedure-associated infections .ppt

MTI, Khyber Teaching Hospital, Peshawar
PATIENT CARE PRACTICES FOR
PREVENTING DEVICE AND
PROCEDURE-ASSOCIATED
INFECTIONS
By
Rehmat Ullah
Nursing Director, MTI KTH, Peshawar

Objectives of the Session
 The participants will be able to;
1. Describe the basic concepts
2. Discuss general guidelines for handling &
reprocessing items
3. Discuss Interventions to Prevent Health Care-
Associated Infections
4. Discuss nursing care bundles

Introduction
 If instruments or medical devices are not
adequately cleaned, health care-associated
infections can result, including;
 Infections with bloodborne pathogens (e.g., hepatitis B
and C, HIV), and
 CLABSI, CAUTI, VAP, SSI, and infectious diarrhea are
common HAIs in both high-income countries and LMIC
 Despite improvements in operating theater (OT) practices,
instrument sterilization methods, and surgical techniques,
and the efforts in IPC by HCWs, SSIs remain a major
cause of HAIs

General Guidelines for Handling &
Reprocessing Items
 Instruments or other reusable items require
appropriate handling and processing to:
 Minimize the risk of injury to staff
 Minimize exposure to blood or body fluids for the
housekeeping, transportation, & reprocessing staff
 Ensure that they are not vectors of health care-
associated infections

Interventions to Prevent Health Care-
Associated Infections
 Establishing systems to track targeted HAIs in a health
care facility and sharing data with the staff and
program managers
 Having dedicated staff for IPC and tracking of HAIs
 Fully adhering to recommended general IPC practices,
including Standard Precautions, Transmission-
 Based Precautions, and hand hygiene (which protect
staff and prevent all types of HAIs)
 Implementing interventions targeting specific HAIs

Health Care-Associated Infections of
Public Health Concern
 Can affect the cardiovascular, respiratory, gastrointestinal,
genitourinary tracts, central nervous systems, and bones
and joints.
 HAIs may also affect skin, soft tissues, and muscles
 HAIs of public health concern in many settings include:
 Urinary tract infection (UTI), including catheter-associated urinary
tract infection (CAUTI)
 Blood stream infection, including central line-associated
bloodstream infection (CLABSI)
 Surgical site infection (SSI)
 Pneumonia, including ventilator-associated pneumonia (VAP)
 Multidrug-resistant infections
 Infectious Diarrhea and Clostridium difficile infections

Care Bundles
 Sets of evidence-based practices that, when
implemented collectively, improve the reliability of their
delivery and improve patient outcomes
 Small number of evidence-based practices that, when
performed collectively, help prevent certain HAIs
 Care bundles contribute to;
 Infection prevention,
 Reduce unnecessary antibiotic prescribing, and
 May limit the development of antibiotic resistance in
healthcare facilities

Nursing Care Bundles
 The following care bundles will be implemented in
MTI KTH, Peshawar
 Catheter-Associated Urinary Tract infections (CAUTI)
 Surgical Site Infection (SSI)
 Central Line-Associated Bloodstream Infections
(CLABSI)
 Ventilator Associated Pneumonia (VAP)

THE THREE AREAS OF FOCUS TO
REDUCE DEVICE RISK

Basic Concepts
 Indwelling urinary catheter: is inserted into the urinary
bladder and left in place for continuous drainage of urine
(e.g., Foley catheter). It should be connected to a drainage
bag
 Urinary tract infection (UTI) is an infection involving any
part of the urinary system, including the urethra, bladder,
ureter, and kidney
 Catheter-associated urinary tract infection (CAUTI) is a
UTI in a patient with an indwelling urinary catheter
 Biofilm is an accumulated thin layer of bacteria &
extracellular material that tightly adheres to surfaces (e.g.,
skin drains, urinary catheters) and cannot be easily
removed

Introduction--- HIA
 An infection that occurs in a patient as a result of care at a
health care facility and was not present at the time of
arrival at the facility.
 The term “health care-associated infection” (HAI)
“nosocomial” or “hospital-acquired” infection are
interchangeably used
 Infections that begin on or after Day 3 of hospitalization
(the day of hospital admission is Day 1), on the day of
discharge, or on the day after discharge. (CDC 2018; WHO
2011)
 They are a major cause of preventable diseases, deaths,
and higher health care costs
HAIs = Hospital Acquired Infections

Acceptable indications for
catheterization
 Accurate urinary output monitoring every 1–2
hours
 Managing acute urinary retention and obstruction
 Prolonged surgeries
 Large volume of fluid infusions or diuretic
administration
 Management of incontinence
 Collection of lab specimens

Strategies to limit the use of urinary
catheters
 Provide written guidelines for HCWs, stating
appropriate indications for inserting urinary catheters.
 Require an in-charge clinician’s order in the chart
before an indwelling catheter is placed.
 Develop tools/job aids to remind HCWs, including
clinicians, to remove the catheter when it is no longer
needed.
 Implement an automatic stop order after a specified
number of days, which will require the catheter to be
removed if the order is not renewed.
 Use daily order renewals requiring a reason to be
given each day for continuation of the catheter.

Avoid the following practices for
catheter maintenance
 Avoid disconnecting the catheter from the drainage tubing (unless
deemed medically necessary).
 Do not clean the perineum area with antiseptics
 Do not screen for asymptomatic bacteriuria in catheterized patients.
 Do not treat asymptomatic bacteriuria in catheterized patients except
before invasive urologic procedures.
 Do not perform continuous irrigation of the bladder with antimicrobials
as a routine IPC measure
 Do not use systemic antimicrobial routinely as prophylaxis
 Do not change catheters or drainage bags at routine, fixed intervals
also consider clinical indications
 Do not use antibiotic-coated catheters
 Do not use routine instillation of antiseptic or antimicrobial solutions
 Do not re-use catheters between patients

Interventions to Prevent HAI
Catheter associated urinary tract infection
 Comply with Standard Precautions, including hand hygiene
recommendations.
 Consider alternatives to indwelling urinary catheterization.
 Insert catheter only for appropriate indications.
 Remove catheter as soon as possible.
 Ensure that only properly trained persons insert & maintain
catheters.
 Insert catheters using aseptic technique & sterile equipment.
 Maintain a closed drainage system.
 Maintain unobstructed urine flow.
 Educate patients and families about preventing CAUTI

Components of a Practice Bundle to
Prevent CAUTIs
 Insertion of catheters only when indicated and removal of catheters
when they are not medically necessary.
 Consideration of alternatives for urinary output management,
including condom catheters and in-and-out catheterization, when
appropriate.
 Hand hygiene before insertion and manipulation of catheters.
 Use of as small a catheter as possible.
 Insertion of catheters following IPC practices and sterile
equipment.
 Appropriate management of indwelling catheters, including;
 properly securing indwelling catheters to prevent movement;
 maintaining a sterile, continuously closed drainage system;
 not disconnecting the catheter and drainage tube; and
 replacing the collecting system following IPC practices and after disinfecting
the catheter tubing junction when breaks in IPC practices, disconnection, or
leakage occur.

Basic Concepts
 Phlebitis is an area of swelling, redness, warmth, and
tenderness of the skin around the site where an
intravascular catheter comes out of the skin (i.e., the exit
site).
 Exit site infection is a clinical infection in which there is a
positive culture of the discharge (i.e., pus or fluid) at the
site where the intravascular catheter comes out of the skin
 Central line is an intravascular catheter that terminates at
or close to the heart or in one of the great vessels and is
used for infusion, withdrawal of blood, or monitoring
movement of blood
 Intravascular catheters are devices that are placed in
blood vessels

Bloodstream infections
 One of the most common causes of HAIs
representing 19% of all reported
 HAI bloodstream infections result in a 24%
mortality
 The economic impact of each case of CLABSI has
been estimated at $14,818 (India), 11,591
(Mexico), and 4,888 (Argentina). (WHO 2011)

Indications of Intravascular Catheters
 Infusion of intravenous solution for rehydration
 Emergency venous access
 Hemodialysis: a process of purifying the blood of a
person whose kidneys are not working normally
 Nutritional support
 Administration of certain medications (e.g., vasopressors
used to raise blood pressure)
 Monitoring of central venous pressure
 Pulmonary artery catheterization

Methods to Limit the Use of
Intravascular Catheters
 Use these methods to limit the use of intravascular
catheters:
 Insert intravascular catheters only when indicated.
 Use a peripheral IV when possible.
 Remove a catheter as soon as it is not indicated

Maintaining Central Lines
 assess the need for continuing the line on a daily basis and
remove as soon if not needed
 Keep any lumens covered by injection ports, sterile endcaps, or
needleless connectors
 Minimize the use of stopcocks/three-ways as portals on entry of
infection
 Access the stopcock or injection port only with sterile devices
 Minimize the number of times the line is accessed
 Before every access, disinfect the end, cap, hub, or any port of
entry by scrubbing vigorously to provide mechanical friction for a
minimum of 5 seconds with an alcohol-based chlorhexidine
preparation, 70% alcohol, or povidone-iodine.

CENTRAL LINE DRESSING CHANGE

Removing a Central Line
 Several serious risks associated with removal of a central
line, including;
 Infection, air embolisms, bleeding, & catheter fractures
 The following are general guidelines
 Assess the patient and check the insertion site for signs of
infection: redness, tenderness, and drainage.
 Use a trolley or kit containing all supplies needed for the procedure
and practice sterile technique.
 Stop the infusion.
 Put on non-sterile gloves.
 Remove the old dressing.
 Remove gloves, perform hand hygiene, and put on sterile gloves

Removing a Central Line
 Prepare the site and drape the area to produce a
sterile field.
 Cut sutures & withdraw the central line slowly and
steadily without resistance. Stop and seek assistance
if resistance is encountered.
 Apply firm pressure to the catheter exit site until
bleeding stops.
 Inspect the catheter to ensure it is intact; if it is not,
seek assistance.
 Apply a sterile, dry dressing to the exit site and cover
with an airtight bandage

CLABSI PREVENTION STRATEGIES
 Educate and train staff:
 Offer competency-based training
 Conduct periodic assessment of competency & refresher training
 Have a team of trained competent staff assigned to perform
insertion of central lines
 Choose appropriate catheter type, insertion site, &
technique
 Weigh the risk and benefits of placing central lines
 Use upper extremities & avoid femoral veins in adult
 Choose catheter types ased on duration of IV therapy & type of
fluids (pH/osmolarity)
 Use a central line with a minimum number of lumens
 Use ultrasound-guided insertion technique

CLABSI PREVENTION STRATEGIES
 Comply with IPC recommendations for insertion,
maintenance, and removal processes
 Full barrier precautions, including drapes and PPE for
insertion
 Sterile technique for insertion
 Skin antisepsis for insertion site and dressing
 Implementation of bloodstream infection surveillance
and quality improvement interventions
 Remove peripheral & central lines as soon as
possible

 Comply with Standard Precautions, including with recommended
hand hygiene practices.
 Choose proper central line insertion sites
 Provide staff education on central line maintenance & insertion
 Follow and monitor proper insertion practices
 Use appropriate agents for skin antisepsis
 Follow and monitor proper central line maintenance practices
 Perform adequate hub/access port disinfection
 Remove unnecessary central lines
 Also consider:
 Daily chlorhexidine bathing
Central Line Associated Blood-Stream Infection

BARRIERS TO PREVENT CLABSI
 Barriers to implementation of evidence-based
practices to prevent CLABSI include:
 The type of ICU facilities available
 Overcrowded in-patient wards
 Insufficient rooms for isolation
 Poor hand hygiene compliance
 Lack of IPC supplies & other medical supplies (e.g.,
personal protective equipment [PPE], antiseptics, and needleless
connectors)
 Non-compliance with recommended IPC practices

Hospital Acquired Pneumonia:
Basic Concepts
 Aspiration, the breathing in of material (such as
food, liquids, or stomach contents) from the
oropharynx or gastrointestinal tract into the larynx
and lower respiratory tract, including the lungs
 Intubation is the medical procedure in which an
endotracheal tube is placed in the trachea via the
mouth or nose
 Ventilator-associated pneumonia (VAP) is
pneumonia that develops more than 2 calendar
days after the patient is placed on mechanical
ventilation

 90% of health care-associated pneumonia episodes occur among ICU
patients receiving mechanical ventilation.
 VAP occurs in 9–27% of intubated patients on ventilators in ICUs.
 The risk of VAP increases 1–3% for every day a patient is on a
ventilator.
 The majority of non-ventilator-associated pneumonia and VAP is
caused by bacteria.
 The highest risk of developing VAP is during the first 96 hours of
mechanical ventilation.
 Those with early onset (within 96 hours of being on a ventilator) of VAP
have a better prognosis
Patients who acquire VAP have poor outcomes, surveillance and
prevention efforts are usually focused on VAP
Hospital Acquired Pneumonia
Epidemiology

 Surgery, intubation, and mechanical ventilation greatly increase the risk of
infection because they:
 Block the normal body defense mechanisms—coughing, sneezing, and
the gag reflex
 Prevent the washing action of the cilia (fine hair in the airways that aid in
the movement of particles in the nose and lungs) and mucus-secreting cells
lining the upper respiratory system that aid in removing foreign substances
 Cause pooling of secretions in the subglottic area where
microorganisms can grow and then migrate to the lower respiratory tract
 Reduce oral immunity leading to accumulation of dental plaques, which
may then be colonized by oral microorganisms
 Provide a direct pathway for microorganisms to get into the lung
Mechanism

Reducing the Risk of Pneumonia
among Surgery Patients
 Preoperative pulmonary care using deep
breathing techniques, moving in bed, coughing
frequently, and moving soon after the operation
(e.g., sitting up and walking)
 Postoperative management Optimizing the
use of pain medication, Moving and exercising
patients on a regular schedule, Encouraging deep
breathing

When caring for all patients:
 Comply with Standard Precautions, including recommended hand hygiene practices.
 Teach patients and staff to follow respiratory etiquette.
 Apply recommended Transmission-Based Precautions for patients with signs & symptoms of
respiratory illness.
 Exclude staff with respiratory illness from contact with patients.
 Avoid crowding patients in wards and waiting areas.
 Provide or recommend appropriate vaccinations for staff and patients.
 Teach caregivers to recognize danger signs of pneumonia and treat appropriately.
 Clean, disinfect/sterilize, and maintain respiratory care equipment properly.
 Teach patients to:
 Use deep-breathing techniques.
 Move frequently, even while in bed.
 Cough frequently.
 Optimize pain medication to keep the patient comfortable but able to cough.

VAP Prevention Bundle: Adult
1. Elevate the head of the bed more than 30–45°.
2. Provide daily sedative interruptions to allow HCWs to evaluate when
the patient is ready to have the breathing tube removed.
3. Provide regular oral care
 Brush teeth, gums, and tongue every 4 hours
 Moisturize oral mucosa and lips every 2–4 hours
 Use an oral antiseptic such as chlorhexidine gluconate (0.12%) rinse twice a
day.
4. Use specific endotracheal tubes (tubes that enter the trachea) to
facilitate suctioning of secretions.
 Use oro-tracheal (by mouth) rather than naso-tracheal (by nose) intubation
when possible.
 If available, use a cuffed endotracheal tube with an endotracheal cuff pressure
of 20 cm H2O and in-line (part of a closed system) or subglottic suctioning.
5. Make the patient mobile as quickly as possible, even when still
attached to the breathing machine.

VAP Prevention Bundle: Pediatric
1. Elevate the head of the bed 30–45°.
2. Assess readiness to extubate daily, using
spontaneous moderate breathing trials in patients
without contraindications.
3. Provide regular oral care (i.e., tooth brushing or
gauze if no teeth).
4. Avoid unplanned extubation.

VAP Prevention Bundle: Neonates in
NICU
1. Perform hand hygiene and put on gloves before
any patient.
2. Oral care every 3–4 hours with sterile water
3. Evaluate daily patient’s readiness to extubate.
4. Manage patients without sedation if possible

Prevention of Surgical Site Infections
 There are many opportunities for the conditions under
which an SSI may develop during the perioperative
process.
 The complete process (preoperative, intraoperative, and
postoperative) contains a multitude of complex steps that
are performed by a large group of HCWs (including
cleaning staff, sterilization personnel, laundry workers,
nurses, doctors, anesthesia personnel, etc.).

 Before surgery:
 Use antimicrobial prophylaxis in accordance with evidence-based
standards and guidelines.
 Treat remote infections whenever possible before elective
operations.
 Avoid removing hair at the operative site unless it will interfere with
the operation; do not use razors.
 Use appropriate antiseptic agent and technique for skin preparation
(chlorhexidine or alcohol-containing iodine solution).
 Consider also:
 Screening and decolonization of the nose for S. aureus carriers
for selected procedures (i.e., cardiac, orthopedic, neurosurgery
procedures with implants)
 Screening of pre-operative blood glucose levels and
maintaining tight glucose control
Surgical site infection

During surgery:
 Keep operating-theater doors closed during surgery, except
as needed for passage of equipment, personnel, & the
patient.
 Follow strict procedures to maintain sterility.
 Maintain normothermia.
 Consider also:
 Adjusting the antimicrobial prophylaxis dose for obese
patients (body mass index > 30)
 Using at least a 50% fraction of inspired oxygen
intraoperatively and immediately postoperatively in
selected procedures

 After surgery:
 Protect primary closure of incision with a sterile
dressing.
 Control blood glucose levels during the immediate
postoperative period (for cardiac surgery).
 Discontinue antibiotics after surgery according to
evidence-based standards and guidelines.
 Maintain staff and patient hand hygiene.

Bundle for Prevention of SSIs
 Patient preoperative bathing with plain or antiseptic soap
 Appropriate hair removal (avoid removal or use clippers)
 Optimize patient skin preparation with alcohol-based and
chlorhexidine-based skin disinfection products
 Optimize surgical hand preparation
 Appropriate antibiotic prophylaxis, based on local
guidelines, given within 1 hour preoperatively and
discontinued postoperatively
 Improved OT discipline, including sterile technique, limits
on the number of individuals and reductions in
intraoperative traffic

Diarrhea (including C. difficile diarrhea)
 Diarrhea is common in health care facilities
 10% of pediatric patients
 Bacterial Gastroenteritis:
 Mostly gram negative (e.g., Salmonella, E. coli, Shigella, Campylobacter)
 Releasing enterotoxins (e.g., E. coli,C. difficile)
 Rotaviruses are the most common community causes of diarrhea,
making up 15–25
 Noroviruses is easily aerosolized
 C. difficile is the most common cause of health careassociated
infectious diarrhea
 Risk factors include;
 Extremes of age (newborns and the elderly); poor nutrition; impaired immunity;
 Decreased gastric acidity; disruption of normal GI function from medical or
surgical conditions; and altered, protective microorganisms in the gut, which
occur from antibiotic treatment.

 Apply Standard Precautions including gloves use for
patient care.
 Comply with recommended hand hygiene practices.
 Use Contact Precautions for the duration of diarrhea,
include isolating symptomatic patients presumptively.
 Clean and disinfect patient care equipment.
 Carry out environmental cleaning using a disinfectant as
per the health care facility protocol.
 Educate HCWs, housekeeping, administration, patients,
and families about prevention of health care-associated
diarrhea, including diarrhea caused by C. difficile infection
(if relevant in the setting).

For settings with C. difficile consider also:
 Extending use of Contact Precautions beyond the duration of diarrhea
 Conducting laboratory tests to isolate C. difficile, if the capacity to perform
laboratory testing is available
 Isolating symptomatic patients presumptively, pending confirmation of C. difficile
infection
 Cleaning and disinfecting patient-care equipment with disinfectants effective
against spores.
 Carrying out environmental cleaning using a disinfectant effective against spores
as per the health care facility protocol
 Implementing an antimicrobial stewardship program
 Carrying out active surveillance for health care-associated diarrhea particularly
caused by C. difficile
 Making soap and water available for HCWs’ hand hygiene after contact with a
patient with C. difficle infection in case of an outbreak of C. difficile diarrhea

Maternal & Newborn Infections
Basic Concepts
 Puerperal sepsis is any bacterial infection of the
genital tract that occurs after the birth of a baby
 Sepsis is a life-threatening condition that occurs when
an infection enters the bloodstream and the body’s
response injures its own tissues and organs. It is also
known as bloodstream infection
 HAI in obstetrical patients is an infection that occurs
in a patient as a result of care in a health care facility
and was not present at the time of arrival at the facility
 HAI in newborns is an infection of the newborn that
occurs after birth in a health care facility. Timeframes
between 72 hours and 7 days are often used

 Maternal and newborn care is unique and complex
 The outcomes for the mother and her newborn are
dependent upon one another and are determined by;
 Mother’s state of health, Infection risk factors,
 Care of the mother & the newborn from preconception to
after the birth.
 As many as 5.2 million cases of maternal sepsis,
resulting in 62,000 maternal deaths, are thought to
occur annually (Hussein et al. 2011).
 Puerperal sepsis causes about 11% of maternal deaths

RISK FACTORS FOR MOTHERS &
NEWBORNS

Preventing Maternal & Newborn
Infections in Health Care Settings
 Education of the mother and family
 Preconception and prenatal care (e.g., providing education, screening,
prevention; managing infections; addressing risk factors and behaviors)
 Appropriate interventions during labor and delivery, both at home and in the
health care facility (e.g., perineal cleaning, aseptic technique during the delivery or in
the operating theater, safe medication practices, rational antibiotic use and prophylaxis
only as indicated, limiting of invasive procedures and vaginal examinations, proper
insertion and care of invasive medical devices)
 Postpartum care for the mother (e.g., regular perineal care, breast care, care of
breast pumping equipment)
 Care of the newborn (e.g., hand hygiene; bathing; cord, skin, and eye care; appropriate
handling of infant nutrition; restrict use of antibiotics to recommended indications;
immunoprophylaxisantibodies)
 Prevention of postnatal transmission of infection from mother to newborn (e.g.,
education on hand hygiene, general hygiene, Transmission-Based Precautions when
appropriate)
 Screening of birthing support persons and visitors for signs and symptoms of
infections (e.g., fever, respiratory viruses, draining skin lesions, diarrhea)

Preventing Maternal & Newborn Infections
 Ensuring excellent compliance to hand hygiene,
 Following Standard Precautions and
Transmission-Based Precautions
 Meticulous environmental cleaning,
 Careful disinfection and sterilization practices, and
 Appropriate care of infants with invasive medical
devices are key to preventing maternal and
newborn infections during labor and childbirth.

IPC Interventions during Pregnancy:
Prenatal Care
 Identify and stabilize pre-existing diseases (such as
malaria, diabetes, heart disease, parasitic infestations).
 Provide vaccinations: Tetanus, Influenza
 Assess and maximize nutrition including; Daily iron, folic acid
supplementation, Calcium and vitamin A and protein supplements,
Counseling on healthy diet and exercise, and weight loss or weight
gain
 Assess for anemia, asymptomatic bacteriuria & gestational
diabetes
 Screen for GBS, HIV, syphilis, and TB
 Routine antibiotic prophylaxis during the second or third
trimester with the aim of reducing infectious morbidity is
NOT recommended

Intrapartum Care
 Preventing infection during labor & vaginal delivery
 Minimizing HCWs’ risk of infection
 Selecting gloves for intrapartum procedures
 Antibiotic use
 PPE for delivery
 Ensure availability of equipment for vaginal
delivery

Postpartum Care of the Mother
 Infection prevention education: Hand hygiene,
wash the perineal area, Signs and symptoms of infection,
care for her breasts and nipples (mastitis), Nutrition and birth
spacing
 Limit use of antibiotics after birth to recommended
indications
 Preventing infection in the mother after C-section:
Surgical wound care,

Monitoring, Surveillance & Quality
Improvement
 Surveillance is an effective tool that can be used to
improve IPC practices and decrease HAIs
 Once infection rates are known, efforts should be
made to improve.
 Reducing infections can improve patient outcomes
and reduce facilities’ cost of providing care.
 The formation of multidisciplinary teams has been
shown to be an effective method to support quality
improvement efforts
 The multidisciplinary team works together to plan, do
and sustain the work of quality improvement guided
by surveillance data and evidence-based practices

Management of the NICU

 Adhere to Standard Precautions, most importantly hand hygiene and
Transmission-Based Precautions (e.g., Contact Precautions) and cohorting
patients with MDRO.
 Clean environment thoroughly.
 Develop/adapt guidelines for reporting and managing MDRO infections.
 Train HCWs in IPC including prevention of MDRO infections.
 Improve compliance with hand hygiene in health care facilities.
 Strengthen implementation of an antibiotic stewardship program.
 Monitor antibiotic susceptibility patterns for key targeted MDROs (e.g.,
carbapenemresistant Enterobacteriacae (CRE), methicillin-resistant S. aureus,
vancomycin-resistant Enterococcus (VRE), multidrug-resistant extended-
spectrum beta-lactamase-producing organisms).
 Conduct active surveillance to identify MDRO infections in the facility.
 Consider chlorhexidine bathing for patients in ICUs.
Multi-drug resistant organisms (MDROs)

 Adhere to Standard Precautions, most importantly hand
hygiene and cough etiquette.
 Apply Transmission-Based Precautions (e.g., Airborne
Precautions) for patients suspected of having TB.
 Ensure IPC measures for TB, including respiratory
hygiene, cough etiquette, and appropriately ventilated
rooms.
 Screen patients for TB.
 Adhere to the wearing of appropriate respiratory protection
for staff, N-95 mask, when interacting for patients with
suspected or confirmed TB.
 Conduct routine screening for staff
Mycobacterium tuberculosis (TB)

THANKS
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