Infection Control Discussion Continued

Today's Wound Clinic's editorial board member Harriet Jones, MD, BSN, FAWCP continues the discussion on Infection Control from the February 2010 issue of the journal.

Today's Wound Clinic (TWC): Is Infection Control Important in the Wound Care clinic?
Harriet Jones (HJ): It is critically important. We see patients who have wounds due to many reasons: post operative dehisced abdominal wounds; neurotrophic; vascular; & orthopedic with hardware involved just to name a few. Making sure that the patient doesn’t leave with something they didn’t come in with may mean the difference between life & death OR limb salvage or loss.

TWC: Please list what you consider the top priorities for clinicians in the wound clinic regarding infection control.
HJ:
1) Education of patients, hand washing, and disinfecting surfaces, instruments and equipment.
2) Limiting the number of patients that have wounds that get infected
3) Protecting the spread of diseases that pts may bring into the clinic (possibly TB; H1N1; HIV; etc.)
When patients do present with a cough that can’t be quieted, we do try to get them back as quickly as possible in an effort to isolate them from the other patients. In terms of wound infections however, there really aren’t many cases of aerosolized infections.

TWC: Tell us more about your clinic's infection control plan …
a. Who developed it?
HJ: Our clinic follows the Infection Control protocols of the hospital that we are under. It was developed by the Infection Control nurse at that facility.

b. Can you share some of the highlights of your list with our readers?
HJ: Rooms are cleaned w/ CaviWipesXL after each patient is dismissed from the room; instruments are placed in a soaking solution until the end of the day when they are cleaned w/ a brush, rinsed and placed in a bag to be sterilized.

c. How is this shared with staff?
HJ: Infection Control Policy and Procedure Directive

TWC: What types of products are used or practices are done by your employees in the following areas:
a. To wipe down or clean surfaces –
HJ: We use Caviwipes XL.

b. To clean tools and instruments -
HJ: Prolystica made by Steris

c. To dispose of used bandages or other hazardous material -
HJ: Separate red garbage bins that are then picked up by Stericycle and incinerated.

d. Clean or disinfect large equipment such as HBO tanks -
HJ: HBO tech cleans daily and prn

e. Other – please list -
HJ: Phones; cabinet doors; door handles etc are wiped down throughout the day.

TWC: In your opinion, how common are infections caused by MRSA in the Wound Care Clinic environment?
HJ: Very common; probably more so than is recognized. I’m not suggesting that every single wound get cultured, but if it’s not cultured properly, it will be missed.

TWC: What types of populations do you believe are the most at risk for MRSA infections?
HJ: I addressed this in my article in the February 2010 issue of Today's Wound Clinic and want to emphasize that MRSA is the great masquerader. A wound can be rocking along and just ‘stall’ due to MRSA or it could be looking great and quickly go south and become a life or limb threatening situation.

TWC: In which ways do you attempt to educate staff on Infection Control?
HJ: Our staff has been “spoiled” to some extent due to my having had Fellowship training in Infectious Diseases. I frequently share tidbits that I come across about many different germs; antibiotics; trends etc. Because I am usually the provider in our clinic to make antibiotic treatment decisions I pay attention to what organisms are reported back on our particular patients. If I think there are trends developing, I check with our lab and alert our staff of my concerns. It’s like I’m the germ guru and that seems to make us all more conscientious about hand washing and sticking to the infection control practices that we have in place.

TWC: Are there specific types of procedures or practices where you encourage staff to use a respiratory mask or device?
HJ: Only when there is likely to be aerosolization of irrigation.

TWC: Explain when and why you instruct the use of respiratory masks by staff.
HJ: They’re worn to protect the staff member’s mucous membranes of the eyes, nose and mouth during procedures and patient – care activities that are likely to generate splashes, or sprays of blood or body fluids. They’re to be worn any time there is likelihood of aerosolization with irrigation.

TWC: Are there specific brands of products or services that you always use for infection control?
HJ: We do use surgical face masks with shields by Kimberly Clark. These are designed for use in procedures and in environments where risk of splash exposure to blood and body fluids. They can be worn with or without glasses; are resistant to fogging, and are really clear for maximum visibility. 3M N95 Respirators are available if needed – meets CDC guidelines and has a filter efficiency level of 95% or greater against particulate aerosols. It is fluid resistant and disposable.

TWC: Are there any types of products that you suggest that patients use at home to fight infections?
HJ: If a patient has an open wound on the plantar surface of their feet/foot, I do NOT let them stand in their shower without a ‘shower shoe’ (if you want to be grossed out, culture your shower floor); I advise patients, no matter where their wound is, that it cannot be submerged in standing water; once some wounds reach a point that I’m confident that there is no communication deeper than subcutaneous tissue, as long as it’s physically possible for the patient, I do allow them to shower with running water and they are instructed to use a separate cloth and antibacterial soap on their wounds on the days that the dressing is changed.

TWC: What type of infection control literature do you provide patients and how do you provide it?
HJ: I teach the pt and their families about everything from how to clean the wound; how to change the dressing (how it should be changed); the importance of wearing gloves and hand washing and the proper way to take any antimicrobial agents that I may have prescribed. Our staff teaches the patient and their families also. We developed a handout specifically about MRSA that is reader friendly and has some suggestions that I have found helpful in breaking the cycle of MRSA colonization/infection with some patients.

TWC: Do you feel that some of your colleagues don’t take infection control as seriously as they should?
HJ: ABSOLUTELY. Just look around at the folks who aren’t in the O.R. anymore but still have on the nearly worn out shoe covers; or masks which are now draped around their neck or are wearing the disposable gowns for warmth in the O.R. theater but still have it on in the cafeteria. If so, what advise do you have for them? Please change your spots; at least try to. Oh, and did I mention HANDWASHING? Probably the only thing that the CDC, IDSA, Nursing Councils and Medical Associations all agree on as the number one way to lessen transmission of disease.