Infection Control Workshop Dr Brittney Jones DPM Dr

Infection Control Workshop Dr. Brittney Jones DPM Dr. Cory Jacoby DPM Midwest Podiatry Conference 2017

Outline • • • CDC/OSHEA recs Office Protocols Infection 101 Podiatry based infections Workshop: • Sterile Gloves • Sterile Gowns • Sharps

Infection Terms • MRSA: Methicillin-resistant Staphlococcus Aureus • Gram positive cocci bacteria • On susceptibility tests negative to oxacillin • Antibiotic options: Clindamycin, Bactrim, Doxycycline, Linezolid, Vancomycin, tigacyline • Ca-MRSA is community acquired and Ha-MRSA is hospital acquired • VRE: Vancomycin-resistant Enterococcus • Found in the intestine and female genital tract • ESBL: Extended Spectrum Beta-Lactamases • Commonly E. coli or Klebsiella • Resistant to penicillins and cephalosporins • Hospital aquired UTI most common but can be cause other infections in the immunocompromised

Infection Terms • C. Diff: Clostridium difficile • Causes severe colitis (colon irriitation) with watery diarrhea, fever, loss of appetite, nausea • Transferred via spores which can live for long periods of time on surfaces • Common treatments of IV Flagyl or oral Vanc • • HAI: Hospital acquired infections Cellulitis: Infection of skin and underlying soft tissues Osteomyelitis: Infection of bone SIRS: Septic inflammatory response sydrome includes • Criteria are HR, Temp, WBC, Respiratory Rate Sepsis: SIRS in the presence of infection

Infection Terms • Bacteria: Single cell organisms • • They are prokaryotic Can be Gram + or Gram – Can be multiple shapes, commonly cocci or bacillus Treated with anti-biotics or natural immunity • Viruses: Infectious agent that replcates within host cell • Treated with anti-virals or natural immunity • Common Viruses: HIV, HPV, Influenza • Fungus, molds, yeasts: Eukaryotic organisms

Common Infections Seen by Podiatrist In the Podiatry Office Cellulitis Osteomyelitis Post-Operative Infections Drug resistant infections (VRE, ESBL, MRSA) • Systemic illness not related to foot (Flu, GI distress, C. diff, ect) • Blood Borne Pathogens (HAV, HBV, ect. ) • • Hospital Based • Central line associated blood infections • Catheter associated UTI • MRSA bacteremia • Surgical site Infection • C. difficile Infections • Airborn/Droplet (TB) • Drug resistant local infection (VRE, ESBL, MRSA) • Blood Borne Pathogens (HIV, HBV)

Local Signs of Infection • 4 Classic Signs of Inflammation: • • Rubor: Redness Calor: Heat Tumor: Swelling Dolor: Pain • Purulent Drainage • Mal odor

Systemic signs of infection • • Fever/Chills Nausea/Vommiting Increased blood sugars Increased While Blood Cell count > 12000 cells/mm^3 Increased Inflammatory Markers (ESR, CRP) Increased Heart Rate and Respiratory Rate Blood pressure can be increased in infection though can drop when in sepsis

Post Operative Infection • Surgical site infection (SSI) considered an infection of the incision site within 30 days of surgery or 1 year of an implant • SSI incidence is 2. 55% annually • Higher in trauma cases than elective cases • High incidence >55 years old • Higher incidence in immunocompromised • Higher with increased ASA score over 1

Post-Operative Infections • Can be superficial and involve only skin 5 weeks post-op 6 weeks post-op after 1 week of antibiotics

Post-Operative Infections • Can be deep and involve bone and/or hardware • This often requires major intervention • Long term antibiotics • Removal of hardware • Revision surgery

Why is this an issue? • Infections of the foot and ankle can lead to loss of limb or life • Post-operative infections and hospital based infections are often preventable and pose risks to patient overall health • SSI infections decrease patient satisfaction • SSI lead to longer hospital stays • Annual cost of SSI estimated at 10 billion • Annual deaths of SSI estimated at 8000

• In 1992 the annual direct costs for hospital acquired infections was 4. 5 billion dollars • In 2007 the annual direct costs for HAI ranges from 28. 4 billion – 45 billion dollars based on CPI adjustment models • Epidemiology of infections is changing and price of treatments inflating Douglas Scott II, R. "Direct Medical Costs. " Encyclopedia of Public Health (n. d. ): 267. Why is this an issue?

Infection Control • As podiatrists and podiatric assistants we must aim to prevent and control lower extremity infections • Today we are also focusing on systemic infection control and ways to prevent the spread of disease • Being proactive and educated is a major factor in infection control and prevention

Goal is prevention • The goal is to follow proper office protocols to prevent infections. • This includes proper room cleaning, sharps management, glove use, instrument use/turnover/cleaning

Goal is prevention • Even with perfect technique and protocols, infections will still happen. • Secondary goal is early identification of infection to lead to early treatment and reduction of complications • If you see something, say something

Disease Transmission

Disease Transmission • As health care providers we most protect ourselves and our patients considering all possibilities of infection transmission in our offices • • • Patient to another patient Patient to the community Patient to a health care provider Health care provider to a patient Patient to themselves (Consider spread of warts from one foot location to another)

At Risk Patients • Immunocompromised • • Diabetes HIV Cancer/Chemotherapy Medications: e. g. Methotrexate, long term steroid use

At Risk Patients • Non-vaccinated: By choice or medically unable to vaccinate • Children? Child with open growth plates who developed a hematogenous infection

We DO NOT only treat feet • Patient’s are more than just their feet • As health care professionals we are responsible for helping control spread of all infectious disease • This includes influenza, c. diff, blood born pathogens • Patients cough in our waiting rooms • Patients bleed in our offices • We obtain a detailed medical history, not just a chief complaint. This includes a review of systems.

Hand Washing • CDC has a 56 page “Guideline for Hand Hygiene in Health-Care Settings” • Moral of the story: Hand washing reduced infection spread

Hand Washing Alcohol Based Soap and Water > 15 seconds • Faster • Often more accessible • More efficient at killing most bacteria • Cases less dryness than frequent soap and water • Work via denaturing proteins • Does not kill Clostridium difficile spores • More time consuming • Higher bacteria count post cleaning than alcohol based • Removes debris • Effective in removing C. Diff spores reducing spread.

Hand Washing • Chlorhexidine: Effective against many viruses but not against spores • Iodine Based: Have bactericidal activity against most bacteria and many spores including c. diff • 25% nurses relate to some level of dermatitis due to hand washing • Allergic contact dermatitis can be associated with hand hygiene products

Thank you • Questions • Take a short break and then we will work hands on with gloves, gowns and sharps with goals being to learn to reduce the spread of infection.

Work Cited • Douglas Scott II, R. "Direct Medical Costs. " Encyclopedia of Public Health (n. d. ): 267. • Cdc. CDC_IC_Assessment_Tool_Outpatient_v 2_3 (n. d. ): n. pag. CDC. Web. 25 Apr. 2017. • "Guideline for Hand Hygiene in Health-Care Settings. " Psyc. EXTRA Dataset (n. d. ): n. pag. Web. 25 Apr. 2017. • Al-Mulhim, Fahad A. , Mohammed A. Baragbah, Mir Sadat-Ali, Abdallah S. Alomran, and Md Q. Azam. "Prevalence of Surgical Site Infection in Orthopedic Surgery: A 5 -year Analysis. " International Surgery. The International College of Surgeons, World Federation of General Surgeons and Surgical Specialists, Inc. , 2014. Web. 26 Apr. 2017. • Centers for Disease Control and Prevention, 17 Apr. 2017. Web. 26 Apr. 2017.