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1Proprietary & Confidential

Infection Control and Prevention

Carol Tuminaro, RN, HRM, MBA

Senior Manager, Clinical Operations

Quality and Patient Safety


Objectives

To understand infection control and prevention

To understand infection control and prevention

To know why infection control and prevention is important

To know why infection control and prevention is important

To understand mandatory infection reporting

To understand mandatory infection reporting

To know your role as it relates to infection control and prevention

To know your role as it relates to infection control and prevention


Josie’s Story


“For years, we’ve just been quietly bundling the bodies of patients off to the morgue while infection rates get higher and higher.”

– Dr. Barry Farr

“Infections are most often transmitted from patient to patient on the hands of healthcare workers…”

– Dr. William Jarvis

“A hidden epidemic of life‐threatening infections is contaminating America’s hospitals, needlessly killing scores of thousands of patients every year.”

– Chicago Tribune


• Functions as the central decision‐making and policy‐making body for infection prevention

• The IPC Chair reports either to the medical staff or administration

• The IPC acts as the advocate for prevention and control of infections in the facility, formulates and monitors patient care policies, educates staff, and provides political support that empowers the Infection Prevention TEAM.

Infection Prevention Committee (IPC)


• Because infection and prevention issues and measures often cross departmental lines, it is crucial that the IPC be multidisciplinary

• The IPC should be composed of representatives from administration and clinical and ancillary departments (i.e. nursing, employee health, pharmacy, environmental services, dietary, laboratory, etc.).

• Should meet regularly (monthly or quarterly)

• Disseminates IP information (surveillance data, policy decisions, etc.) throughout the organization.

• It does not have to be a separate committee. It may be combined with any committee, e.g. Utilization Review

More IPC Functions….


Meeting AgendaChairman: Facilitator:Location: Date: Time:Invitees/Committee Members:

ITEM CONTENTS RESPONSIBLE PARTY

I. Call to Order Attendance and Announcements of guests or new membersII. Approval of MinutesIII. Reports

A. Occupational Health 1. BBP Exposures2. TB Skin Testing3. Employee Health Screenings4. Immunizations5. TB Respiratory

B. Health Care-Associated Infections 1. Surgical Site Infections2. ICU & CVSICU

a.Catheter associated Blood Stream Infectionb.Ventilator associated Pneumoniac. Catheter-associated UTIsd.HA MRSA

3. Facility HAI Bacteremias4. CAUTIs5. CLAB SI6. Facility HAI MRSA, VRE, C-Diff

C. Infection Control Reports 1. State Reportable Diseases2. Hand Hygiene Monitoring3. Active Surveillance Culturing for MRSA4. Outbreaks5. Dialysis cultures

D. Safety Related to Infection Control 1. Emergency Preparedness2. Environmental Rounds3. Construction and Renovation

E. Quality 1. SCIP (inpatient & outpatient-F. Laboratory 1. Blood Culture Contamination RatesG. Pharmacy 1. P & T related to Infectious DiseasesH. Surgical Services 1. Operating Room

2. Central Sterile ServicesI. CVSICU and CVSOR 1. CVSICU

2. CVSORIV. Unfinished Business 1. Sharps Safety Review

2. Annual Health Screenings Action Plan3. Universal Decolonization ICU4. CRE surveillance5. C-diff testing with PCR6. Antibiotic Stewardship

V. New Business 1. IC Policies and Procedures2. Other P&Ps for approval3. Meeting dates for 2014

VI. Next MeetingVII. Adjournment


“Privileged and Confidential Quality and Patient Safety Work Product”

Infection Prevention Team Minutes

Date:

Attendance:

TOPIC DISCUSSION/CONCLUSION ACTION/FOLLOW-UP RESPONSIBLE PERSON

Safety Moment

Approval of Minutes

Announcements

Old Business

New Business

Monthly Reports

Periodic Reports

Policy Reviews

FOCUS PDCA

Next Meeting

There being no further business, the meeting was adjourned. Therefore, the next meeting will be ________.

Respectfully submitted by: Chair

IP

This is a privileged and confidential quality and patient safety work product. It is protected from disclosure pursuant to the provisions of the Patient Safety and Quality Improvement Act (42 CFR Part 3) and other state and federal laws. Unauthorized disclosure or duplication is prohibited.


• Including, but NOT limited to the following:

Collection and analysis of infection data

Evaluation of products and procedures

Development and review of policies

Consultation on infection risk assessment, prevention, and control strategies (includes activities related to occupational health, construction, and disaster planning)

Responsibilities of the IP


Education efforts directed at interventions to reduce infection risks

Implementation of changes mandated by regulatory, accrediting, and licensing agencies

Application of epidemiological principles, including activities aimed at improving patient outcomes

Provision of high‐quality services in a cost‐efficient manner

Participation in research processes

IP Responsibilities (Continued)


• Expert on standards, laws, and regulations• Educator for all levels• Resource • Champion of the IC program

•Mentor for the IC and EH practitioners for the leadership roles

• Participation/leader for ALL surveys• Ensure compliance and continuous survey readiness

• Point person for all correction plans and follow up• Ensure integration with Quality oversight

Quality Director’s Role with Respect to Infection Control


§482.42(a) Standard: Organization and Policies

•A person or persons must be designated as infection control officer or officers to develop and implement policies governing control of infections and communicable diseases….

CMS Says………


• The hospital must designate in writing an individual or group of individuals as its infection control officer or officers

• The officer(s) must be qualified through

Education

Training

Experience or certification

• Infection control officers should maintain their qualifications through ongoing education and training, which can be demonstrated by participation in infection control courses or in local and national meetings, organized by recognized professional societies, such as APIC and SHEA

CMS (Continued)


• CMS does not specify either the number of infection control officers to be designated or the number of infection control officer hours that must be devoted to the infection prevention and control programs.

CMS (Continued)


•However, resources must be adequate to accomplish the tasks required for the infection control program

•A prudent hospital would consider patient census, characteristics of the patient population, and complexity of the healthcare services it offers in determining the size and scope of the resources it commits to infection control

CMS (Continued)


Organization Participants

Suggested participants include the infection control coordinator for each program being surveyed, physician member of the infection control team; clinicians from the laboratory; clinicians knowledgeable about the selection of medications available for use and pharmacokinetic monitoring, as applicable; facility or facilities staff; organization leadership; and staff involved in the direct provision of care, treatment, or services.

Logistical Needs

The duration of this session is approximately 30‐60 minutes. The surveyor may need a quiet area for brief interactive discussion with staff who oversees the infection control process. The remaining session is spent where the care, treatment, or services are provided.

Objectives

The surveyor will: Learn about the planning, implementation, and evaluation of your organization’s infection control program

Identify who is responsible for day‐to‐day implementation of the infection control program

Evaluate your organization’s process for the infection control plan development, outcome of the annual infection evaluation process, and oversight of opportunities for improvement

Understand the processes used by your organization to reduce infection

System Tracer – Infection ControlJoint Commission Participants Surveyors

Note: These topics are covered by surveyors during other activities on surveys that do not have a specific system tracer related to infection control.Copyright: 2014 The Joint Commission Organization Guide, January, 2014


Overview

The infection control session begins during one of the individual tracers where the surveyor identifies an individual served/patient/resident with an infectious disease. This session is conducted in two parts. During the first part, surveyors meet with staff from all programs being surveyed to discuss your organization’s infection control program. During the remaining time, surveyors spend their time where care, treatment, or services are provided.

Topics of discussion include:

How individuals with infections are identified

Laboratory testing and confirmation process, if applicable

Staff orientation and training activities

Current and past surveillance activity

Analysis of infection control data

Reporting of infection control data

Prevention and control activities (for example, staff training, staff and licensed independent practitioner vaccinations and other health‐related requirements, housekeeping procedures, organization‐wide hand hygiene, food sanitation, and the storage, cleaning, disinfection, sterilization and/or disposal of supplies and equipment)

Staff exposure

Physical facility changes that can impact infection control

Actions taken as a result of surveillance and outcomes of those actions

System Tracer – Infection ControlJoint Commission Participants Surveyors

Note: These topics are covered by surveyors during other activities on surveys that do not have a specific system tracer related to infection control.Copyright: 2014 The Joint Commission Organization Guide, January, 2014


•An annual risk assessment must be performed to determine goals and objectives for the infection prevention program

• The IP program goals and objectives should be based on the institution’s strategic goals and institutional data and findings from the previous year’s activities

Risk Assessment


• Risk Assessment should contain the following elements:

Demographics

Geographic location

Community

Population served

Care, treatment, and services provided

Analysis of surveillance activities

Annual review

Prioritization

Infection Control Risk Assessment


Surveillance Plan

The Surveillance Plan should describe the following:

Type of healthcare setting

Services provided

Population served

Surveillance program’s purpose, goals and objectives

The indicators (i.e., events monitored) and criteria

used


Surveillance Plan (Continued)

The Surveillance Plan should describe the following:

Reason for selecting each

indicator (outcome, process, and other event)

Methodology used for case identification, data collection, and analysis

Types of reports

generated and to whom they are provided

The process used to

evaluate the surveillance program


• Important to outline achievements and activities of the program and describe support requirements

• Emphasize value of the IP Program to the institution, along with patient outcomes and cost savings

• Evaluation should be widely disseminated to organization leaders, including, the chief executive officer, chief medical and nursing executives, and board members

Annual Evaluation of the IP Program


• Involvement in risk assessment

• Positional authority

• Provision of resources (human and material)

•Alignment of strategic goals within the organization

• Collaborative support

• Interprofessional education

Administrative Support


• Based upon monitoring processes of programs and strategies (processes and outcomes) that enhance adherence to best practices

• Align with elements included in risk assessment

• Standardized monitoring tools and definitions that enable widespread use

• Staff (users) trained on performance monitoring concepts, data collection, and practice observation skills

• Include assessment of performance monitoring processes and practices in the overall performance monitoring program

• Regular feedback (processes and outcomes) to staff responsible for performance monitoring and improvement

Performance Monitoring and Feedback


The Role of the Environment

“We know that the hands of health care workers are the primary route for transmission of pathogens and it’s now recognized that they acquire these pathogens from the environment.

Second, it has also been demonstrated that patients admitted to rooms where a previous patient was a carrier of a pathogen, their risk of acquiring the same pathogen is increased. These two things suggest very strongly that patients are picking up those organisms in the environment.”

Curtis Donskey, MD, associate professor of medicine at Case Western Reserve University and an infectious disease physician at Louis Stokes Cleveland VA Medical Center


• Can colonize or infect the host and are transmissible during both colonization or infection

•Generally can survive in the environment for long periods of time, i.e., days and weeks, not just hours

• Transmission has been linked to poor cleaning as well as direct healthcare worker‐to‐patient contact

Organisms on Inanimate Objects…

Hospital Epidemiology & Infection Control410.955.8384 www.hopkinsmedicine.oirg/heic


• Routine or random, undirected microbiological culturing of air, water, and environmental surfaces in healthcare facilities is not recommended

•However, environmental culturing is recommended for selected quality assurance purposes, such as:

Biological monitoring of sterilizer using bacterial spores

Cultures of water and dialysate in hemodialysis units

As part of an outbreak investigation if there is indication of an environmental source and results can be used to direct infection prevention decisions

Environmental Culturing

Source: Centers for Disease Control and Prevention. Guidelines for environmental infection control in health-care facilities, 2003


“In view of the evidence that transmission of many healthcare acquired pathogens (HAPs) is related to contamination of near‐patient surfaces and equipment, all hospitals are encouraged to develop programs to optimize the thoroughness of high touch surface cleaning as part of terminal room cleaning.”

Options for Evaluating Environmental Cleaning 10‐2010

CDC Recommendations

National Center for Emerging and Zoonotic Infectious Diseases

Division of Healthcare Quality Promotion


•Hospital Acquired Infections/ Healthcare Associated Infections

• Central Line Associated Blood Stream Infections (CLABSI)

• Catheter Related Urinary Tract Infections (CAUTI)

•Ventilator Associated Pneumonia/Events (VAP‐VAE)

• Surgical Site Infections (SSI)

What are HAI’s?


•Nationally: 1.7 million HAIs in hospitals per year

90,000‐100,000 deaths per year

Approximately 280 patients die each day

28‐33 billion $$$ in added healthcare costs

So What’s the Problem with HAIs?


Hospital‐acquired MRSA

Multi‐Drug Resistant Organisms

C‐difficile

Bacteremias

UTIs

Ventilator‐associated pneumonias

Others

Problem: Healthcare‐Associated Infections

What Infections?Success RequiresCollaboration


Ignaz Semmelweis ‐ (July 1, 1818 – August 13, 1865)

“The Savior of Mothers”


Hand hygiene is the single, most important thing to do to

prevent infections!


• Comply with either the current Centers for Disease Control and Prevention (CDC) hand hygiene guidelines or the current World Health Organization (WHO) hand hygiene guidelines

Joint Commission’s NPSG.07.01.01


Fingernails

No artificial nails:

• Including solar, gel, shellac, acrylics, extenders, overlays, etc.

Natural nails only:

• Length should be ¼ inch or shorter

• Limit jewelry worn to hands/wrists


• The subungual area of the nails harbors…

many microorganisms

•Artificial nails and long natural nails harbor more microbes than short natural nails, even after handwashing/hand hygiene

•Artificial nails are a risk factor for persistent pathogen carriage by HCWs

• Long nails can tear gloves easier, cause potential patient injury, and require additional time to properly wash

Summary of the Evidence


•Nurses, doctors, and other healthcare workers can get 100s or 1,000s of bacteria on their hands by doing simple tasks, such as:

Pulling patients up in bed

Taking a blood pressure or pulse

Touching a patient’s hand

Rolling patients over in bed

Touching the patient’s gown or bed sheets

Touching equipment like bedside rails, over‐bed tables, IV pumps

Many Staff Members Don’t Realize When They Have Germs on Their Hands!

Hospital Epidemiology & Infection Control 410.955.8384 www.hopkinsmedicine.org/heic

Culture plate showing growth of bacteria 24 hours

after a nurse placed her hand on the plate.


Three Common Sources of HAI Transmission in Healthcare Settings

Source: A Collaborative Approach to Targeting Zero Healthcare Associated Infections: A Focus on Hand Hygiene and Environmental Hygiene: A Patient Safety Perspective, J. Hudson Garrett Jr., PhD, MSN, MPH, FNP‐BC, CSRN , VA‐BC, Senior Director, Clinical Affairs | PDI Healthcare

Contaminated Skin of the Patient

Contaminated Hands of Patient or Healthcare Worker

Contaminated Environmental

Service


Infection Prevention and Control Rounds

(Facility Name)

Location:

Date:

Surveyor:

Compliance Survey Tool

ITEM KEY POINTS METNOTMET N/A COMMENTS

Infection Control ManualBBP Exposure control TB Control Plan

Available, Current Date

Engineering Controls Sharps container: less than ¼ fullAccessiblePlacement between 49-54” from floor

Work Practice Controls Specimen Transport (Utilize bio-bags)Biohazard label if unable to view content

Regulated Waste Lids in good repair, tight fittingBiohazardous Waste holding area labeled and securedBiologicals disposed as biohazardous wasteBlood/Body substance disposed as regulated

Supplies Sterile items stored to maintain integrity of package in a clean dry area


Adhere to the Basics


USA Today May 11, 2006 ‐ Atlanta Journal Constitution,March 14, 2003


•MDRO are organisms that are resistant to one or more classes of antibiotics usually used to treat them

MRSA – Methicillin Resistant Staph

ESBL – Extended Spectrum Beta lactamase Resistant organisms –

VRE – Vancomycin Resistant Enterococcus

CRE – Carbapenem Resistant Enterobacteriaceae

C. diff‐Clostridium difficile

Multi Drug Resistant Organisms (MDROs)


Clostridium DifficileCoronavirus


Influenza Virus

MRSA


Smallpox

Yellow Fever


Human Immunodeficiency

Virus (HIV)

Measles Virus


AAAAAAA………CHOO!!


Hospital construction generates dust and debris. Construction dust, including dust released from the removal of ceiling tiles, may contain molds that can cause serious infections in high risk patients.

Renovation and Construction



•According to the CDC, ~76 million people in the U.S. suffer food borne illness every year

• 5,000 of them will die

•An illness is caused by bacteria that has contaminated the food

• Proper food handling can reduce food contamination

Food Poisoning Is a People Problem


• Fruit bats are the reservoir of virus ‐ drop partially eaten fruits

• Bats infect chimps, gorillas, forest antelope, and porcupines

•Humans handle and eat bush meat (bats, chimps, and gorillas

• Infected humans pass the disease from person to person

EBOLA or One More Worry


The registration staff should ask all patients presenting to the ER…..

“Have you recently been out of the country?”

If yes, staff need to ask where they have been

Asking the Question


• Incubation period of 8‐10 days (range 2‐21)

• Sudden onset of fever >38.6 C or >101.5 F

• Flu‐like symptoms: chills, myalgias, malaise, and sore throat

•Nausea, vomiting, abdominal pain, and diarrhea

• Respiratory symptoms: chest pain, shortness of breath, and cough

• CNS symptoms: headache, confusion, and coma

Clinical Manifestations


• Rash may occur around day five

• Hypotension, peripheral edema

• Bleeding manifestations develop in > 50% (internal/external)

• Can vary from petechiae and bruising to mucosal hemorrhage, uncontrollable bleeding, and massive GI blood loss

• Multi‐organ dysfunction: kidneys and liver

• Laboratory abnormalities

Thrombocytopenia and leukopenia

Elevated transaminases (AST>ALT), amylase, D‐dimer

Reduced albumin

Clinical Manifestations (Continued)


• The Joint Commission is focusing on cleaning, disinfection, and sterilization of equipment

• Key points:

Follow manufacturer’s instructions

Standardize process for cleaning the same types of equipment

Establish a methodology whereby everyone knows what is clean and what is dirty

Orientation and training of the staff that mix solutions for disinfection

Make sure they are not following someone else’s bad habits

Sterilization logs and Quality checks must be kept up

Endoscopy is still a problem

Infection Control Helpful Tips


• Hospital accrediting agencies Private, independent accreditation organizations with standards; certify compliance with CMS requirements

TJC – The Joint Commission (formerly JCAHO)

NIAHO – National Integrated Accreditation for Healthcare Organizations (DNV Healthcare)

HFAP ‐ Healthcare Facilities Accreditation Program

• Ambulatory Surgery Center Certification

American Association of Ambulatory Surgery Centers (AAASC)

American Association for the Accreditation of Ambulatory Surgical Facilities (AAAASF)

Accreditation Association for Ambulatory Health Care (AAAHC)

Accreditation Agencies


• Centers for Disease Control and Prevention (CDC)

HICPAC: Healthcare Infection Control Practices Advisory Committee

NHSN: National Healthcare Safety Network

• Institute for Healthcare Improvement (IHI)

•National Quality Forum (NQF)

• Professional organizations and societies (SHEA, APIC, CSTE, IDSA)

Non‐Regulatory “Influencers”


• Centers for Medicare & Medicaid Services (CMS)

CMS provides health insurance through Medicare, Medicaid

Social Security Act (SSA) requires meeting Conditions of Participation (COP) in order to receive Medicare and Medicaid funds SSA Section 1861

“Surveys and certifies” health care facilities (including nursing homes, home health agencies, and hospitals)

•DHHS requires that state health agencies enforce

Federal Oversight


• Public disclosure intended as driver for infection prevention; encourages healthcare providers to take action

• Public reporting favored by consumers as means to assess quality of healthcare

• Better informed public can drive demand for higher quality healthcare

•Assumption: lower costs to hospitals and society

Demand for HAI Transparency


Healthcare Facility HAI Reporting Requirements to CMS via NHSN – Current RequirementsCMS REPORTING

PROGRAM HAI EVENT REPORTING SPECIFICATIONSREPORTING START

DATE

Hospital InpatientQuality Reporting (IQR) Program

CLABSI Adult, Pediatric, and Neonatal ICUs January 2011

CAUTI Adult and Pediatric ICUs January 2012

SSI: COLO Inpatient COLO Procedures January 2012

SSI: HYST Inpatient HYST Procedures January 2012

MRSA Bacteremia LablD Event FacWideIN January 2013

C. difficile LablD Event FacWideIN January 2013

Healthcare Personnel Influenza Vaccination All Inpatient Healthcare Personnel January 2013

Medicare Beneficiary Number All Medicare Patients Reported into NHSN July 2014

CLABSI Adult & Pediatric Medical, Surgical, & Medical/Surgical Wards January 2015

CAUTI Adult & Pediatric Medical, Surgical, & Medical/Surgical Wards January 2015

Hospital OutpatientQuality Reporting (OQR) Program

Healthcare Personnel Influenza Vaccination All Outpatient Healthcare Personnel October 2014

ESRD Quality Incentive Program

(QIP)

Dialysis Event (includes Positive blood culture, I.V. antimicrobial start, and signs of vascular access infection)

Outpatient Hemodialysis Facilities January 2012

Long Term Care Hospital* Quality

Reporting (LTCHQR) Program

CLABSI Adult & Pediatric LTAC ICUs & Wards October 2012

CAUTI Adult & Pediatric LTAC ICUs & Wards October 2012

Healthcare Personnel Influenza Vaccination All Inpatient Healthcare Personnel October 2014

MRSA Bacteremia LablD Event FACWideIN January 2015

C. difficile LablD Event FACWideIN January 2015

Inpatient Rehabilitation Facility Quality

Reporting Program

CAUTI Adult & Pediatric IRF Wards October 2012

Healthcare Personnel Influenza Vaccination All Inpatient Healthcare Personnel October 2014

Ambulatory Surgery Centers Quality

Reporting Program

Healthcare Personnel Influenza Vaccination All ASC Healthcare Personnel October 2014

*Long‐Term Care Hospitals are called Long‐Term Acute Care Hospitals in NHSN ‐ Updated December 2013


CMS REPORTINGPROGRAM HAI EVENT REPORTING SPECIFICATIONS

REPORTING STARTDATE

PPS – Exempt Cancer Hospital Quality

Reporting (PCHQR) Program

CLABSI All Bedded Inpatient Locations January 2013

CAUTI All Bedded Inpatient Locations January 2013

SSI: COLO Inpatient COLO Procedures January 2014

SSI: HYST Inpatient HYST Procedures January 2014


• Subchapter G standards and certification

Part 482 Conditions of Participation for hospitals

o 482.42 Condition of Participation: Infection control

• Part 483 requirements for states and long term care facilities

• Part 484 home health services

• Part 493 laboratory requirements

• Part 494 conditions for coverage of end‐stage renal disease facilities 17

Federal CMS Title 42 Regulations


• Centers for Medicare and Medicaid Services (CMS) http://www.cms.hhs.gov/

• Regulations & Guidance http://www.cms.hhs.gov/home/regsguidance.asp

• Hospital Center http://www.cms.hhs.gov/center/hospital.asp

• Conditions of Participations (CoPs) http://www.cms.hhs.gov/CFCsAndCoPs/06_Hospitals.asp

• Interpretive Guidelines www.premierinc.com/safety/topics/guidelines/cms‐guidelines‐4‐infection.jsp

CMS_Infection_control_interpretive_guidelines

Finding Federal Regulations


•Hospitals must be sanitary

•Have active IC program and someone overseeing it

• Surveillance must be systematic

• Leadership must ensure problems identified by IC are addressed

• Take responsibility for corrective action plans when problems identified

CMS CoP Interpretive Guidelines for Infection Control

Read Them!


• Is your IC program “survey ready”‐ OSHA, Joint Commission, state,……?

If a surveyor came to your hospital TOMORROW, would Infection Control be ready?

o If not, why not?

oWhat will it take to BE READY?

Are policies, procedures, and plans “survey ready”?

Points to Ponder


•Does your IP conduct infection control rounds?

Do rounds include all settings and services?

Are actions being taken to correct problems?

Is there integration with Environment of Care initiatives?

Do you participate in the rounds?

Points to Ponder (Continued)


•Do you have mandatory infection reporting in your state?

What is being monitored?

Is the data that is reported correct data?

Are appropriate corrective actions being taken?



• Is your Infection Control Committee all that it should be?

Is membership appropriate?

Are agendas and minutes appropriate?

Is meeting attendance appropriate?

Are meetings occurring as scheduled?



• Is IC integrated in your facility’s emergency preparedness plans?

Do you have a current bioterrorism plan and pandemic influenza plan?

Do the scopes of the plans include all settings and services?

Have the plans been approved by the EOC Committee?



•Do you know the prevalence of the MDROs in your facility?

Is hand hygiene being monitored?

Are patients who are infected or colonized with MDROs isolated?



• Is your IP participating in core measures?

• Is your IP appropriately trained and educated?

• Is IC department adequately staffed?

•Does your IP have a recent copy of the APIC Text of Infection Control and Epidemiology, published by APIC?



Fun Facts

Monks in a small religious monastery in India are not allowed to bathe any part of their bodies besides their hands and feet.

Their religion believes it is wrong to kill any living creature, even microorganisms!


The word soap comes from this

mythological mountain

Mount Sapo

When women washed their clothes in the Tiber River, the dirt on the shore was a mixture of fat and wood ash from animal sacrifices coming down from the

mountain. They used this as a cleaning agent.


TRUE OR FALSE?

• If you drop something on the floor but pick it up in less than four seconds, it will be OK.

• False. There is no 5‐second rule when it comes to food on the ground. Bacteria needs no time at all to contaminate food.

5‐Second Rule


It is now believed President James Garfield did not die from the bullet fired by Charles Guiteau

The Bullet Did NOT Kill Him

Some of the medical team that treated the President were also farmers with manure‐stained hands. The wound developed a severe infection that killed him three months later.


In 1843, Oliver Wendell Holmes Sr. campaigned for basic sanitation in hospitals. However, this clashed with social ideas of the time concerning upper class citizens, like doctors. Charles Meigs, a prominent American physician, retorted, “ Doctors are gentlemen, and our hands are always clean.”

Don’t Insult a Gentleman

However, up to a quarter of all women giving birth in European and American hospitals in the 17th thru 19th centuries died of an infection spread by unhygienic nurses and doctors.



Intended for internal guidance only, and not as recommendations for specific situations. Readers should consult a qualified attorney for specific legal guidance.

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Infection Control and Prevention - c.ymcdn.comc.ymcdn.com/sites/ · Infection Control and Prevention ... FOCUS PDCA Next Meeting There ... procedures, organization‐wide hand hygiene,