nsw health[1]. infection control policy

Policy Directive

Department of Health, NSW73 Miller Street North Sydney NSW 2060

Locked Mail Bag 961 North Sydney NSW 2059Telephone (02) 9391 9000 Fax (02) 9391 9101

http://www.health.nsw.gov.au/policies/

spacespace

Infection Control Policyspace

Document Number PD2005_247Publication date 27-Jan-2005

Functional Sub group Population Health - Infection ControlClinical/ Patient Services - Infectious diseases

Summary Outlines the broad principles of infection control for public and privatehealth care settings.

Author Branch Aids and Infectious DiseasesBranch contact 9391 9248

Applies to Area Health Services/Chief Executive Governed Statutory HealthCorporation, Board Governed Statutory Health Corporations, AffiliatedHealth Organisations, Community Health Centres, Dental Schools andClinics, Divisions of General Practice, Environmental Health Officers ofLocal Councils, Government Medical Officers, NSW Ambulance Service,NSW Dept of Health, Private Hospitals and Day Procedure Centres,Private Nursing Homes, Public Health Units, Public Hospitals

Distributed to Public Health System, Community Health Centres, Dental Schools andClinics, Divisions of General Practice, Environmental Health Officers ofLocal Councils, Government Medical Officers, Health AssociationsUnions, Health Professional Associations and Related Organisations,NSW Ambulance Service, NSW Department of Health, Public HealthUnits, Public Hospitals, Private Hospitals and Day Procedure Centres,Private Nursing Homes, Tertiary Education Institutes

Review date 27-Jan-2010File No. 01/336

Previous reference 2002/45Issue date 11-Feb-2002

Status Active

Director-GeneralspaceCompliance with this policy directive is mandatory.

Md Firoz IqbalHighlight


CIRCULAR

File No 01/336 Circular No 2002/45 Issued 11 April 2002 Contact Ms J Hunt (02) 9391 9869 AIDS/Infectious Diseases Unit

Infection Control Policy This Policy sets out the broad principles of infection control for public health are settings; and state government residential aged care, licensed private hospitals, licensed nursing homes, licensed day procedure centres and multi purpose Services. This Policy should be read in conjunction with the following NSW Health Department documents: Circular 96/55 Colour Coding of Cleaning Equipment Circular 97/58 Incidents Reportable to the Department Circular 97/61 Policy and Guidelines for the Safe Use of Glutaraldehyde in NSW Public

Health Care Facilities Circular 98/11 Management of Health Care Workers Potentially Exposed to HIV, Hepatitis

B or Hepatitis C Circular 98/89 Waste Management Guidelines for Health Care Facilities Circular 99/57 Coroners cases and amendments to Coroners Act 1980

(1) Jurisdiction of Coroner; (2) Anaesthetic Deaths; (3) Obligation to Report Death; (4) Guidelines for Nursing Staff and Medical Officers on Coroners Cases

Dying in Hospital; (5) Transfer of Medical Records for Post Mortems; (6) Discharge Type Summaries for Coronial Cases in Hospitals; and (7) Objections to a Post Mortem Examination

Circular 99/88 Health Care Workers Infected with HIV, Hepatitis B or Hepatitis C Circular 99/95 Control of Foodborne Listeriosis in Health Care Institutions Circular 2000/99 Policy Framework and Guidelines for the Prevention and Management of

Latex Allergy Circular 2001/55 Management of Reportable Infection Control Incidents Circular 2001/71 Health Care Worker Tuberculosis Screening & Protection Policy

Distributed in accordance with circular list(s):

A 44 B 4 C 35 D 4 E 7 73 Miller Street North Sydney NSW 2060 F 5 G 10 H 26 I 2 J 18 Locked Mail Bag 961 North Sydney NSW 2059 K 4 L 8 M 5 N 19 P 7 Telephone (02) 9391 9000 Facsimile (02) 9391 9101 In accordance with the provisions incorporated in the Accounts and Audit Determination, the Board of Directors, Chief Executive Officers and their equivalents, within a public health organisation, shall be held responsible for ensuring the observance of Departmental policy (including circulars and procedure manuals) as issued by the Minister and the Director-General of the Department of Health.


Circular 2001/91 Occupational Screening and Vaccination of Health Care Workers Against Infectious Diseases

Circular 2002/19 Effective Incident Response: A Framework For Prevention And Management In The Health Workplace

NSW Health Cleaning Service Standards, Guidelines and Policy for NSW Health Facilities, 1996

The policy supersedes the following NSW Health Department documents: Circular 86/7 AIDS and the Use of Human Blood Products in Laboratories Circular 97/95 Disinfection of Transvaginal Ultrasound Transducers Circular 99/87 Infection Control Policy IB2000/13 Creutzfeldt-Jakob Disease (CJD) and other Transmissible Spongiform Encephalopathies The NSW Infection Control Resource Centre has developed a series of resources to assist with local implementation of this policy. The Centre can be contacted on (02) 9332 9712 or by e-mailing [email protected]. Robert McGregor Acting Director-General

Table of Contents 1. Introduction ...................................................................................................................... 1

2. Infection Control Systems ................................................................................................ 3

3. Hand Washing, Hand Cleaning and Hand Care .............................................................. 9

4. Protective Gowns ........................................................................................................... 10

5. Gloves ............................................................................................................................ 11

6. Masks, Face Shields and Protective Eyewear ............................................................... 13

7. Safe Handling, Use and Disposal Of Sharps ................................................................. 14

8. Management of Clinical Waste ...................................................................................... 16

9. Processing of Instruments and Equipment .................................................................... 17

10. Environmental Cleaning ................................................................................................. 26

11. Blood and Body Substance Spills .................................................................................. 27

12. Food Services ................................................................................................................ 28

13. Laundry and Linen Services........................................................................................... 29

14. Procedures for Specific Clinical Practices...................................................................... 30

15. Procedures for Specific Clinical Settings ....................................................................... 33

16. Prevention of Antimicrobial Resistance in Hospitals ...................................................... 35

17. Creutzfeldt-Jakob Disease and Other Forms of Transmissible Spongiform Encephalopathies........................................................................................................... 38

18. Outbreak Management, ................................................................................................. 44

Glossary................................................................................................................................. 46

References............................................................................................................................. 48

NSW Health Infection Control Policy 3

INTRODUCTION 1.1. Background NSW Health is committed to ensuring the health and safety of all patients in health care settings and providing a safe and healthy working environment for all employees. This commitment includes adopting an infection control policy position that minimises the risk of health care consumers and providers acquiring a healthcare associated or occupational infection. This goal is best achieved by having an evidence based infection control program within each health care facility. 1.2. Purpose This document outlines the broad principles of infection control for public health care settings; and licensed private hospitals, nursing homes, extended care facilities and day procedures centres. It is intended as a framework within which Area Health Services and health care facilities can develop detailed operational guidelines appropriate to their own setting. Variation in the type of public and licensed private health care facilities in NSW, and the range of clinical services provided in each facility, dictate that locally applicable infection control programs and policies be developed and implemented. In this document the term:

must indicates a mandatory practice required by law or by Departmental directive. A Departmental directive is only issued where it is considered necessary in the interests of patient and health care worker safety;

should indicates a strongly recommended practice; patient includes all consumers of health care in NSW including residents in nursing

homes and long term care facilities; and

health care facility includes all types of health facilities and services, the NSW Ambulance Service, Corrections Health Services and residential facilities.

It is recommended that when referencing any Australian and New Zealand Standards or other guidelines or legislation relevant to this document the current edition of the referenced document is reviewed. 1.3. Development and review This policy has been developed in accordance with available evidence; and in consultation with key infection control stakeholders and experts including the NSW Health Department Infection Control Advisory Group and the NSW Health Department Infection Control Practice Group. This policy is subject to regular review. 1.4. Key elements Key elements of the infection control policy continue to be incorporated in regulations that define the registration requirements for medical practitioners, nurses, physiotherapists, dentists, dental technicians and podiatrists in NSW. Under the relevant Act, a practitioner must not, without reasonable excuse, fail to comply with the infection control regulations. The key elements constitute the minimum standard for infection control in all NSW public and licensed private health care settings. All health care facilities and health care workers have a common law duty of care to take all reasonable steps to safeguard patients, staff and the general public from infection. The Occupational Health and Safety (OH&S) Act 2000 prescribes the employers duty of care to provide a safe and healthy working environment for all employees and other persons on their premises. The OH&S Act also prescribes responsibilities for managers (who manage OH&S within the areas that they control and influence) and employees (who must cooperate with







the employer and not put anyone at risk by their acts or omissions). There is also a requirement for employers to provide the information, instruction, training and supervision necessary to ensure the health and safety of employees at work. 1.5. Local infection control program To facilitate implementation of this policy and a coordinated approach to infection control,1 public health care facilities and licensed private health care facilities must have an infection control program in place that includes the following:

coordination by a suitably experienced and qualified health care worker. In smaller facilities this function may be combined with other tasks;

development of an annual strategic plan for infection control that includes surveillance, education and staff health strategies;

strategies to modify procedures and equipment associated with increased risk of occupational exposure to blood and/or body substances and ensure management of such in accordance with Circular 98/11: Management of Health Care Workers Potentially Exposed to HIV, Hepatitis B and Hepatitis C.

strategies to monitor the effectiveness of the infection control program and ongoing compliance with regulatory and licensing requirements; and

contingency plans to manage outbreaks of healthcare associated infections and infection control critical incidents.

A variety of infection control measures are used for reducing the risk of transmission of micro-organisms in health care settings. These measures make up the fundamentals of Standard Precautions and include:

hand washing and gloving; masks, respiratory protection, eye protection, face shields; gowns and protective apparel; patient placement; and routine cleaning and cleaning on separation. Each of these fundamentals is addressed in this document.



2. INFECTION CONTROL SYSTEMS 2.1 Introduction The two-tiered approach to infection control NSW Health has endorsed includes, firstly and most importantly, those precautions designed for the care of all patients, regardless of their diagnosis or presumed infection status. These precautions are known as Standard Precautions and constitute the minimum acceptable level of practice in infection control. The second tier includes precautions that are applicable only for the care of specified patients. These additional Transmission Based Precautions are for patients known or suspected to be infected by pathogens spread by airborne or droplet transmission or by contact with dry skin or contaminated surfaces or by any combination of these routes. 2.2 Standard Precautions Standard Precautions apply to all patients receiving care in health care facilities, regardless of their diagnosis or presumed infection status. Standard Precautions apply to:

blood; all body substances, secretions and excretions except sweat, regardless of whether or

not they contain visible blood;

non-intact skin; and mucous membranes. Standard Precautions are designed to reduce the risk of transmission of micro-organisms from both recognised and unrecognised sources of infection in health care facilities. Standard Precautions involve the use of safe work practices and protective barriers including: 2.2.1 Hand washing Wash hands after touching blood, body substances, and contaminated items, whether or not gloves are worn. Wash hands immediately after gloves are removed, between patient contacts, and when otherwise indicated to avoid transfer of micro-organisms to other patients or environments. It may be necessary to wash hands between tasks and procedures on the same patient to prevent cross-contamination of different body sites. 2.2.2 Gloving Wear gloves (clean non-sterile gloves are adequate) when touching blood, body substances, and contaminated items; put on clean gloves just before touching mucous membranes and non-intact skin. Remove gloves promptly after use, before touching non-contaminated items and environmental surfaces, and before going to another patient, and wash hands immediately to avoid transfer of micro-organisms to other patients or environments. 2.2.3 Masking Wear a mask and eye protection or a face shield to protect mucous membranes of the eyes, nose, and mouth during procedures and patient care activities that are likely to generate splashes or sprays of blood, body fluids, secretions and excretions. 2.2.4 Gowning Wear a fluid-resistant gown or apron made of impervious material to protect skin and prevent soiling of clothes during procedures and patient care activities that are likely to generate splashes or sprays of blood, body fluids, secretions and excretions or cause soiling of









clothing. 2.2.5 Appropriate device handling Handle used patient care equipment soiled with blood and body substances in a manner that prevents skin and mucous membrane exposures, contamination of clothing and transfer of micro-organisms to other patients and environments. Ensure that reusable equipment is not used for the care of another patient until it has been appropriately cleaned and reprocessed; and that single use items are properly discarded after use. 2.2.6 Appropriate handling of laundry Handle, transport and process linen soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous membrane exposures; contamination of clothing; and transfer of micro-organisms to other patients and environments. 2.3 Transmission Based Precautions Transmission Based Precautions are designed for patients known or suspected to be infected with pathogens for which additional precautions beyond Standard Precautions are needed to interrupt transmission in health care facilities. 2.3.1 Types of Transmission Based Precautions There are three types of Transmission Based Precautions:

Airborne Precautions; Droplet Precautions; and Contact Precautions. A combination may be required for diseases that have multiple routes of transmission. The use of Transmission Based Precautions should always be in addition to Standard Precautions. Health care facilities should provide suitable accommodation with appropriate equipment and trained staff for the treatment of patients requiring Transmission Based Precautions. 2.3.2 Airborne Precautions Airborne Precautions apply to patients known or suspected to be infected with pathogens that can be transmitted by the airborne route. Airborne Precautions are designed to reduce the risk of airborne transmission of infectious agents. Airborne transmission occurs by dissemination of either airborne droplet nuclei (small-particle residue [5 m or smaller in size] of evaporated droplets that may remain suspended in the air for long periods of time) or dust particles containing the infectious agent. Patient placement and special air handling and ventilation requirements must be considered. Controlling Tuberculosis in New South Wales2 contains guidelines for the application of Transmission Based Precautions for the management of patients with active tuberculosis. 2.3.3 Droplet Precautions Droplet Precautions apply to any patient known to be or suspected of being infected with pathogens that can be transmitted by droplet. Droplet Precautions are designed to reduce the risk of droplet transmission of infectious agents. Droplet transmission involves contact of the conjunctivae or the mucous membranes of the nose or mouth of a susceptible person with large particle droplets (larger than 5 m in size) containing micro-organisms generated from a person who has a clinical disease or who






is a carrier of the micro-organism. Because droplets do not remain suspended in the air, special air handling and ventilation are not required to prevent droplet transmission. 2.3.4 Contact Precautions Contact Precautions are designed to reduce the risk of transmission of micro-organisms by direct or indirect contact. Direct contact transmission involves skin-to-skin contact and physical transfer of micro-organisms to a susceptible host from an infected or colonised person, such as when health care workers reposition patients, bathe patients, or perform other patient care activities that require physical contact. Direct contact transmission can also occur between two patients (eg. by hand contact), with one serving as the source of infectious micro-organisms and the other as a susceptible host. Indirect contact transmission involves contact of a susceptible host with a contaminated intermediate object, usually inanimate, in the patients environment. Contact Precautions consist of:

appropriate patient placement in a single room. When a single room is not available, the infected patient should be placed with a patient(s) infected with the same micro-organism;

wearing of gloves (clean non-sterile gloves are adequate) when entering the room for cleaning or general patient care other than aseptic procedures where sterile items are used. During the course of providing care for a patient, change gloves after having contact with infective material that may contain high concentrations of micro-organisms (eg. faecal material and wound drainage). Remove gloves before leaving the patients room and wash hands immediately with an antiseptic agent. After glove removal and hand washing, ensure that hands do not touch potentially contaminated environmental surfaces or items in the patients room to avoid transfer of micro-organisms to other patients and environments;

wearing a gown when entering the room if you anticipate that your clothing will have substantial contact with the patient, environmental surfaces, or items in the patients room, or if the patient is incontinent, or has diarrhoea, an ileostomy, a colostomy, or wound drainage not contained by a dressing. Remove and dispose of the gown before leaving the patients room. After gown removal, ensure that clothing does not contact potentially contaminated environmental surfaces to avoid transfer of micro-organisms to other patients and environments;

limiting the movement and transport of the patient from the room for essential purposes only. Transfer to other wards should also be limited. If the patient is transported out of the room, ensure that precautions are maintained to minimise the risk of transmission of micro-organisms to other patients and contamination of environmental surfaces or equipment;

ensuring that patient care items, bedside equipment, and frequently touched surfaces receive daily cleaning; and

when possible, dedicating the use of non-critical patient care equipment and items such as stethoscope, sphygmomanometer, bedside commode, or electronic rectal thermometer to a single patient to avoid sharing between patients. If use of common equipment or items is unavoidable, then clean before use on another patient.

Table 1 provides a guide for recommended infection control precautions for a variety of








infected patients. It purposely does not include all infectious diseases or conditions. 2.4 Routine use of Airborne, Droplet, or Contact Precautions In many instances, the risk of healthcare associated transmission of infection may be highest before a definitive diagnosis can be made and before precautions based on that diagnosis can be implemented.

The routine use of Standard Precautions for all patients should greatly reduce this risk for conditions other than those requiring Airborne, Droplet, or Contact Precautions.

While it is not possible to identify prospectively all patients needing Airborne, Droplet, or Contact Precautions, certain clinical syndromes and conditions carry a sufficiently high risk to warrant the addition of enhanced precautions while a definitive diagnosis is pursued.



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nsw health[1]. infection control policy

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