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Module 10: Prevention of Health Care-Associated Infections Authors Anne Caston-Gaa, MSN, MPH, RNCIC Melanie S

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Module 10: Prevention of Health Care-Associated Infections Authors Anne Caston-Gaa, MSN, MPH, RNCIC Melanie S Reference Manual for Health Care Facilities with Limited Resources Infection Prevention and Control. Module 10: Prevention of Health Care-Associated Infections Authors Anne Caston-Gaa, MSN, MPH, RNCIC Melanie S. Curless, MPH, RN, CIC Julia Gardner, BSN, CIC Melanie A. Gavin, MPH, M(ASCP)CM Patricia Lawson, MS, MPH, RN, CIC The authors have made every effort to check the accuracy of all information, the dosages of any drugs, and instructions for use of any devices or equipment. Because the science of infection prevention and control is rapidly advancing and the knowledge base continues to expand, readers are advised to check current product information provided by the manufacturer of: • Each drug, to verify the recommended dose, method of administration, and precautions for use • Each device, instrument, or piece of equipment to verify recommendations for use and/or operating instructions In addition, all forms, instructions, checklists, guidelines, and examples are intended as resources to be used and adapted to meet national and local health care settings’ needs and requirements. Finally, neither the authors, editors, nor the Jhpiego Corporation assume liability for any injury and/or damage to persons or property arising from this publication. Jhpiego is a nonprofit global leader in the creation and delivery of transformative health care solutions that save lives. In partnership with national governments, health experts, and local communities, we build health providers’ skills, and we develop systems that save lives now and guarantee healthier futures for women and their families. Our aim is revolutionizing health care for the planet’s most disadvantaged people. Jhpiego is a Johns Hopkins University affiliate. Jhpiego Corporation Brown’s Wharf 1615 Thames Street Baltimore, MD 21231-3492, USA www.jhpiego.org © 2018 by Jhpiego Corporation. All rights reserved. Editors: Melanie S. Curless, MPH, RN, CIC Chandrakant S. Ruparelia, MD, MPH Elizabeth Thompson, MHS Polly A. Trexler, MS, CIC Editorial assistance: Karen Kirk Design and layout: AJ Furay Dana Lewison Young Kim Joan Taylor Bekah Walsh Module 10 Jhpiego technical reviewers: Blami Dao, USA Rosemary Kamunya, Kenya Ricky Lu, USA Win Kaythi Lwin, Myanmar Willy Shasha, USA Module 10: Prevention of Health Care-Associated Infections Chapter 1. Preventing Surgical Site Infections......................................................................................... 3 Key Topics............................................................................................................................................ 3 Key Terms ............................................................................................................................................ 3 Background ......................................................................................................................................... 4 Surgical Site Infection Risk Factors ....................................................................................................... 7 Prevention of Surgical Site Infections ................................................................................................... 8 Surveillance of Surgical Site Infections ............................................................................................... 15 Quality Improvement for SSI .............................................................................................................. 16 Summary ........................................................................................................................................... 16 Appendix 1-A. Role of Drapes during Surgery ..................................................................................... 17 Appendix 1-B. Recommendations for Antimicrobial Prophylaxis for Selected Surgical Procedures ...... 20 Appendix 1-C. Recommended Doses and Re-Dosing Intervals for Commonly Used Antimicrobials for Surgical Prophylaxis ........................................................................................................................... 24 References ......................................................................................................................................... 26 Chapter 2. Preventing Catheter-Associated Urinary Tract Infections .................................................... 29 Key Topics.......................................................................................................................................... 29 Key Terms .......................................................................................................................................... 29 Background ....................................................................................................................................... 30 Catheter-Associated Urinary Tract Infections Risk Factors .................................................................. 32 Catheter-Associated Urinary Tract Infection Prevention Strategies .................................................... 33 Monitoring and Surveillance of CAUTI ................................................................................................ 44 Summary ........................................................................................................................................... 45 Appendix 2-A. Daily CAUTI Maintenance Bundle Checklist to Determine Continuation of Urinary Catheter ............................................................................................................................................ 46 Appendix 2-B. High-Level Disinfection of Single-Use, Simple Rubber Catheters by Boiling .................. 47 References ......................................................................................................................................... 49 Chapter 3. Preventing Intravascular Catheter-Associated Bloodstream Infections ............................... 51 Key Topics.......................................................................................................................................... 51 Key Terms .......................................................................................................................................... 51 Background ....................................................................................................................................... 52 Infection Risk Factors Related to Intravascular Catheters ................................................................... 55 Intravascular Catheter-Related Bloodstream Infection Risk Factors .................................................... 56 Intravascular Catheter-Related Bloodstream Infection Prevention Strategies ..................................... 57 Insertion, Maintenance, and Removal of Peripheral Intravenous Lines............................................... 58 Insertion, Maintenance, and Removal of Central Lines ....................................................................... 63 Infection and Prevention Control: Module 10 1 Central line-Associated Blood Stream Infection Prevention and Control Practice Bundles and Initiatives.......................................................................................................... 70 Monitoring and Surveillance of Infections Related to Intravascular Catheter Use (including CLABSI) .. 70 Quality Improvement for Infections Related to Intravascular Catheter Use (including CLABSI) ........... 71 Summary ........................................................................................................................................... 71 References ......................................................................................................................................... 72 Chapter 4. Preventing Hospital-Acquired Pneumonia ........................................................................... 74 Key Topics.......................................................................................................................................... 74 Key Terms .......................................................................................................................................... 74 Background ....................................................................................................................................... 75 Strategies for Preventing Hospital-Acquired Pneumonia .................................................................... 77 Strategies for Preventing Ventilator-Associated Pneumonia............................................................... 78 Monitoring and Surveillance of Infections Related to Health Care-Associated Pneumonia (including VAP) .................................................................................................................................. 84 Quality Improvement for Infections Related to Intravascular Catheter Use (including CLABSI) ........... 85 Summary ........................................................................................................................................... 85 References ......................................................................................................................................... 86 Chapter 5. Preventing Maternal and Newborn Infections in Health Care Settings ................................ 87 Key Topics.......................................................................................................................................... 87 Key Terms .........................................................................................................................................
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