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Infection Prevention

Clinical Epidemiology and Infection Prevention

Introduction:

The UCLA Clinical Epidemiology and Infection Prevention department’s (CEIP) primary responsibility is to prevent healthcare associated infections (HAIs).  CEIP performs risk-based, targeted surveillance for HAI using CDC definitions. Data generated by CEIP is used by the UCLA Health to drive quality improvement.  CEIP promotes a culture of safety by assisting direct care providers with translating evidence into practice.

CEIP serves patients, staff and visitors across the UCLA Health, which includes: Ronald Reagan UCLA Medical Center, Resnick Neuropsychiatric Hospital, UCLA Medical Center, Santa Monica and licensed outpatient clinics. 

CEIP can be reached via email at:  ceip@mednet.ucla.edu

Current Projects:

Reducing catheter associated blood stream infections (CLABSI)

Reducing the risk of CLABSI is a key focus of CEIP.  UCLA’s CLABSI Task Force has tackled CLABSIs head-on by using a multidisciplinary approach to implement the following:

  • CHG bathing for all ICU patients plus acute care patients with central lines
  • Comprehensive resident and fellow central line insertion training for programs including surgery, medicine, anesthesia, emergency medicine, family medicine, pediatrics, obstetrics & gynecology
  • Ethanol lock therapy
  • Support for direct care provider campaigns such as “Scrub the Hub”
  • Continuous evaluation of new products for line insertion, maintenance and access

Reducing catheter associated urinary tract infections (CAUTI)

CAUTI is an up and coming area for CEIP.  CEIP collaborates with nursing units to reduce the risk of CAUTI and improve patient outcomes.  CEIP is currently involved in the “On the CUSP:  Stop CAUTI” UHC Collaborative, which aims to both improve the unit-based culture of safety and reduce CAUTI rates.  Interventions aimed at insertion and removal of indwelling urinary catheters are on the horizon for CEIP.

Reducing Ventilator associated pneumonia (VAP)

CEIP has worked closely with critical care physician and nursing leadership to implement the VAP bundle.  CEIP (including Antibiotic Stewardship) has been an integral part of creating prevention, diagnosis, and treatment guidelines for physicians, and co-authors order sets for VAP prevention.  CEIP collaborates with physician teams and respiratory therapy regarding utilization of sensitive diagnostic tools and new technology.

Prevention of Surgical Site Infections (SSI)

CEIP performs SSI surveillance and is actively involved in sterile processing and disinfection efforts across UCLA Health.  CEIP is implementing CHG bathing for pre-op patients plus a specific S. aureus decolonization protocol using CHG + intranasal mupirocin.

Prevention of Clostridium difficile Infection (CDI)

A number of important strategies are being implemented to decrease the burden of CDI at UCLA.  Antibiotic Stewardship, led by Dan Uslan, MD, has achieved recent success in curbing antibiotic utilization.  Dr. Uslan is also looking at PPI utilization and its impact on healthcare-associated CDI.  CEIP has partnered with Environmental Services to bring UV disinfection to UCLA.  UV-C disinfection is now being used each shift for C.difficile discharges.

Innovation & Research:

Antimicrobial Stewardship Program:

The Antimicrobial Stewardship Program is involved in numerous multidisciplinary projects including studying antimicrobial benchmarking, risk adjustment, impact of education on antibiotic utilization, and survey research of house staff.

Copper:

UCLA study to determine if copper surfaces can reduce hospital-acquired infections

Hospital-acquired infections are a huge public health burden, and hospital environments play a key role in harboring potentially deadly bacteria such as E. coli, C. difficile and methicillin-resistant Staphylococcus aureus. Copper surfaces, which are not routinely used in hospitals, are known to kill bacteria on contact, and studies have found much lower levels of bacteria living on copper surfaces than on standard hospital surfaces. In one of the first randomized clinical trials of its kind, UCLA researchers will determine if the reduction of surface bacteria due to the use of copper will result in a decreased number of hospital-acquired infections.

Real Time Location Tracking:

While placing patients in contact isolation has become the standard of care for patients colonized or infected with certain microorganisms, there are numerous drawbacks to doing so. These potentially include emotional isolation, fewer or less frequent visits by healthcare providers, and family anxiety. This study is using novel technology produced by Awarepoint to track Internal Medicine residents as they care for patients with and without contact isolation. We are measuring physician visit frequency, contact time, and work flow.

FAQs:

Q1: I want to know what UCLA’s infection rates are.  Where can I find this  information?
Q2: I am visiting a patient. What can I do to keep the patient I’m visiting free of infection?
Q3: I am a patient.  What can I do to lower my risk of infection in the hospital?
Q4: UCLA is one of the top hospitals in the county. What is UCLA doing to keep me free of infection? 
Q5: What is MRSA?
Q6: What is VRE?
Q7: What is C. diff?
Q8: I had MRSA a long time ago. Why do I still need isolation at UCLA?
Q9: I had VRE a long time ago.  Why do I still need isolation at UCLA? 
Q10: I am a patient and am on isolation when I’m in the hospital.  Can I still go for walks outside my room?

Q1: I want to know what UCLA’s infection rates are.  Where can I find this information?
A1: Select rates are now publicly reported and can be viewed on the California Department of Public Health website.

Q2: I am visiting a patient. What can I do to keep the patient I’m visiting free of infection?
A2: The #1 thing you can do to protect the patient you are visiting is to wash your hands!  Also, it’s important to cover your cough and make sure to STAY HOME if you are sick.  In certain situations, you may be asked to wear gloves, gowns, or masks for added protection.  See the patient’s nurse if you need assistance with wearing these items. 

Q3: I am a patient.  What can I do to lower my risk of infection in the hospital?
A3: The #1 thing you can do to reduce the risk of infection is make sure that anyone coming into your room (e.g. visitors, doctors, nurses) has washed their hands. We encourage you to ask our staff if they have practiced hand hygiene before caring for you.

Q4: UCLA is one of the top hospitals in the county. What is UCLA doing to keep me free of infection? 
A4: Delivery of safe, quality care is a key focus of the UCLA Health.  Some of the many things UCLA is doing to help keep patients infection-free are: using UV disinfection to rid surfaces of germs, consistent monitoring staff hand hygiene practices, and providing certain populations of patients with topical antiseptic bath treatments during hospitalization.

Q5: What is MRSA?
A5:  Staphylococcus aureus or “Staph” is a very common germ on the skin or in the nose.  This germ does not cause any problems for most people who have it on their skin. But sometimes it can cause serious infections such as skin or wound infections, pneumonia, or infections of the blood. Antibiotics are given to kill Staph germs when they cause infections. Some Staph germs are resistant, meaning some antibiotics cannot kill them. “Methicillin-resistant Staphylococcus aureus” or “MRSA” is a type of Staph that is resistant to some of the antibiotics that are often used to treat Staph infections.

Q6: What is VRE?
A6: VRE refers to vancomycin-resistant enterococcus. Enterococcus is a germ that lives in the intestinal tract and in the female genital tract. Usually, enterococcus does not cause a problem. This is called colonization. Occasionally, enterococcus can cause an infection of the urinary tract, bloodstream, or wounds. Vancomycin is an antibiotic that can be used to treat those infections. However, some enterococcus germs are no longer killed by vancomycin and are known as vancomycin-resistant enterococcus or “VRE.” These germs are often resistant to many antibiotics in addition to vancomycin.

Q7: What is C. diff?
A7: Clostridium difficile (pronounced Klo-STRID-ee-um dif-uh-SEEL), also known as “C. diff” (See-diff), is a germ that can cause diarrhea. Most cases of C. diff infection occur in patients taking antibiotics. The most common symptoms of a C. diff infection include: watery diarrhea, fever, loss of appetite, nausea, and belly pain and tenderness.

Q8: I had MRSA a long time ago. Why do I still need isolation at UCLA?
A8:  Once you have tested positive for MRSA, it is UCLA’s policy to apply special precautions as recommended by the CDC during each encounter we have with you until you are ‘cleared.’  ‘Clearance’ involves a detailed protocol that must be followed by UCLA staff.  If you would like to be ‘cleared’ of MRSA isolation, please ask your UCLA practitioner to provide you with more information.    

Q9: I had VRE a long time ago.  Why do I still need isolation at UCLA? 
A9:  Once you have tested positive for VRE, it is UCLA’s policy to apply special precautions as recommended by the CDC during each encounter we have with you until you are ‘cleared.’  ‘Clearance’ involves a detailed protocol that must be followed by UCLA staff.  If you would like to be ‘cleared’ of VRE isolation, please ask your UCLA practitioner to provide you with more information.   

Q10: I am a patient and am on isolation when I’m in the hospital.  Can I still go for walks outside my room?
  A10:  In many instances, patients on isolation can leave their room with assistance.  You may be required to wear protective gear such as a surgical mask when leaving your room.  It is important to have clean clothing and clean hands when leaving your room.  Certain health conditions, however, may require you stay in your room.