Orientation

Infection Control/Staff Health

Introduction No Scents is Good Sense Please do not wear perfume, scented

hairspray, cologne, scented deodorant, aftershave or other scented products.

Scented products contain chemicals which cause serious problems for many people, especially those with asthma and allergies.

General Orientation

Infection Control

* Introduction to Infection Control

* Chain of Infection

* Handwashing

* Standard Precautions

* Transmission-Based Precautions

Chain of Infection

CausativeAgent

Reservoir

Portal of Exit

Mode of transmission

Portal of Entry

Susceptible Host

Definition

Nosocomial Infection:

A hospital acquired infection

Causative AgentBacteria-salmonella/campylobacter Viruses-Hepatitis B/influenzaFungi-athlete’s foot/plantars wartsProtozae-beaver fever (giardia)

Colonized vs Infected

Three Common Reservoirs

Common reservoirs associated with

nosocomial infections :

a. Patients

b. Health care workers

c. Health care equipment and environment

Two types of Human ReservoirsCasesCarriers

A Reservoir is anywhere an infectious agent can survive

Portal of Exit

Portal of exit is the path which an infectious agent leaves the reservoir

- respiratory tract- Urinary tract- GI tract- Skin/mucous membrane- Mother to fetus- blood

Mode of Transmission

Mode of transmission is the transfer of an infectious agent from a reservoir to a susceptible host

- Contact (direct/ indirect)- Droplet- Airborne- Common Vehicle ie food,water- Vector-borne

Portal of Entry

Portal of entry is the path by which an infectious agent enters the susceptible host

1. Respiratory tract

2. Urinary tract

3. GI tract

4. Skin/mucous membrane

5. Fetus from mom

6. Blood

Susceptible Host

A susceptible host is a person or an animal lacking effective resistance to a particular organism.

Susceptibility may be influenced by age, underlying diseases, certain treatments, breaks in the first line of defense, immunization status etc.

Handwashing

Handwashing is the single most important infection control procedure to prevent

nosocomial infection.

Hand washing

* Use plain soap for general

hand washing.

* Antibacterial soap for

resistant bacteria.

Happy Birthday

The most effective way to prevent the

spread of infection is handwashing

Do it often -- do it well!

Procedure for Handwashing

Wet handsLather (15-30 seconds)RinseTowel dryTurn off taps with paper towel

When to wash

Hands should be washed between patients, anytime they are soiled, after removing gloves, prior to performing procedures, and after personal body functions such as using the toilet or blowing one’s nose.

Waterless Hand Wash Solutions

Waterless Handwash solution is available for use when you are unable to get to a sink.

It may be used between patients/residents when you are doing care that deals with intact skin.

It is NOT effective for use when you are handling substances that may contain spores such as C-Difficile.

The alcohol content must be at least 60% to be effective.

Standard Precautions

The term Standard Precautions grew out of the need to address the misuse or misunderstanding of various terms used in the past.

Standard Precautions are used to prevent the transmission of pathogens from blood, body fluids and moist body substances.

Reasons for Standard and Transmission Based PrecautionsVariation in the interpretation and use of

Universal Precautions and Body Substance Isolation

Confusion as to which body fluids/substances required precautions

Inappropriate use of TB GuidelinesMulti-drug resistant microorganisms

becoming a new problem (MRSA,VRE)

Standard Precautions apply to:

Blood All body fluids, secretions and excretions, except

sweat Non-intact skin Mucous membranes

* They apply to all patients regardless of their diagnosis or presumed infection status

Components of Standard PrecautionsHandwashingPersonal Protective Equipment (PPE)Environmental ControlLinenDishesWaste Management

Waste Management

Sharps Containers

It is a requirement that you dispose of all sharps (needles, blades etc.) in a sharps container. It is also important to adhere to the guidelines for ensuring that these containers are closed and changed when they are at the full line. This is usually 2/3 of the way up the container. If you notice a container is at the full line, close the top and request that it be changed.

Transmission-Based PrecautionsPurpose: Designed for patients documented or

suspected to be infected with highly infectious pathogens for which additional precautions are needed to interrupt transmission in hospital.

Always used in conjunction with Standard Precautions

Five main routes of Transmission-Based Precautions

AirborneDropletContact*Common vehicle *Vectorborne

* these routes do not usually play a significant role in typical nosocomial infections

Contact Transmission

The most important/frequent mode of transmission

>Direct Contact

>Indirect Contact

CONTACT PRECAUTIONS(in addition to Standard Precautions)

VISITORS: Report to nurse before entering.Patient PlacementPrivate room is indicated.

Wash HandsBefore and after every patient contact. Hands must bewashed after removing gloves.

When Providing Direct Patient CareWear gloves and a gown.

Patient TransportLimit transport of patient from room to essential purposesonly.

Patient Care EquipmentDedicate the use of non critical patient-care equipment. Ifcommon equipment is used, clean between patients.

•Antibiotic Resistant Organisms (AROs)•VRE, MRSA, Clostridium difficile

Droplet Transmission

Transmission occurs when droplets are generated from the source person, primarily during coughing,sneezing and talking and during the performance of certain procedures such as suctioning and bronchoscopy.

* Not to be confused with Airborne

DROPLET PRECAUTIONS(in addition to Standard Precautions)

VISITORS: Report to nurse before entering.

Patient PlacementUse a private room.

MaskWear mask when providing direct patient care.

Patient TransportLimit transport of patient from room to essential purposesonly.

•Most respiratory tract conditions requiring precautions• e.g. Mycoplasma, Meningococcal disease, Pertussis,

Influenza, Rubella

Airborne Transmission

Occurs by dissemination of small airborne nuclei containing microorganisms that remain suspended in the air for long periods of time. These microorganisms may be widely dispersed by air currents and may become inhaled over a longer distance from the host.

Airborne Transmission

Examples:

>Mycobacterium tuberculosis (TB)

>Rubeola (red measles)

>Varicella viruses (chicken pox)

• Very few conditions require•Tuberculosis, Varicella - zoster, Measles

AIRBORNE PRECAUTIONS(in addition to Standard Precautions)

VISITORS: Report to nurse before entering.

Patient PlacementUse a private room. Keep room door closed and patient in room.

N95 or equivalent RespiratorThis mask must be worn when entering the patient roomand removed upon exiting the room.

Patient TransportLimit transport of patient from room to essential purposesonly. Use surgical mask on patient during transport.

PPE Use in Healthcare Settings:

How to Safely Don, Use, and Remove PPE

Key Points About PPE

Don before contact with the patient, generally before entering the room

Use carefully – don’t spread contaminationRemove and discard carefully, either at the

doorway or immediately outside patient room; remove respirator outside room

Immediately perform hand hygiene

Sequence* for Donning PPE

Gown firstMask or respiratorGoggles or face shieldGloves

*Combination of PPE will affect sequence – be practical

How to Don a Gown

Select appropriate type and size

Opening is in the back

Secure at neck and waist

If gown is too small,

use two gownsGown #1 ties in front

Gown #2 ties in back

How to Don a Mask

Place over nose, mouth and chinFit flexible nose piece over nose bridgeSecure on head with ties or elasticAdjust to fit

How to Don Eye and Face Protection

Position goggles over eyes and secure to the head using the ear pieces or headband

Position face shield over face and secure on brow with headband

Adjust to fit comfortably

How to Don a Particulate Respirator

Select a fit tested respirator Place over nose, mouth and chin Fit flexible nose piece over nose bridge Secure on head with elastic Adjust to fit Perform a fit check –

Inhale – respirator should collapse Exhale – check for leakage around face

How to Don Gloves

Don gloves lastSelect correct type and sizeInsert hands into glovesExtend gloves over isolation gown cuffs

How to Safely Use PPE

Keep gloved hands away from faceAvoid touching or adjusting other PPERemove gloves if they become torn;

perform hand hygiene before donning new gloves

Limit surfaces and items touched

PPE Use in Healthcare Settings:

How to Safely Remove PPE

“Contaminated” and “Clean” Areas of PPEContaminated – outside front

Areas of PPE that have or are likely to have been in contact with body sites, materials, or environmental surfaces where the infectious organism may reside

Clean – inside, outside back, ties on head and back

Areas of PPE that are not likely to have been in contact with the infectious organism

Where to Remove PPE

At doorway, before leaving patient room or in anteroom*

Remove respirator outside room, after door has been closed*

* Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub

Sequence for Removing PPE

GlovesFace shield or gogglesGownMask or respirator

How to Remove Gloves (1)

Grasp outside edge near wrist

Peel away from hand, turning glove inside-out

Hold in opposite gloved hand

How to Remove Gloves (2)

Slide ungloved finger under the wrist of the remaining glove

Peel off from inside, creating a bag for both gloves

Discard

Remove Goggles or Face Shield

Grasp ear or head pieces with ungloved hands

Lift away from facePlace in designated

receptacle for reprocessing or disposal

Removing Isolation Gown

Unfasten tiesPeel gown away from

neck and shoulderTurn contaminated

outside toward the inside

Fold or roll into a bundleDiscard

Removing a Mask

Untie the bottom, then top, tie

Remove from faceDiscard

Removing a Particulate RespiratorLift the bottom

elastic over your head first

Then lift off the top elastic

Discard

FIT TESTING

Western Health has a program in place to ensure employees who are required to wear high filtration masks (N95) are FIT tested.

Example: Caring for a patient on Airborne

Precautions

FIT TESTING (cont’d)

Employees in any department who are required to wear an N95 mask must be FIT tested.

FIT testing is in compliance with the Occupational Health & Safety Regulations.

The specific regulations are outlined in the OH & S Guidelines.

FIT Testing (cont’d)

The process for FIT testing will be provided for you prior to your appointment or when you start work in your designated area.

Your responsibility in use of the respirator will be explained to you by your tester.

Infection Control Components of Employee Health

Pre-employment and periodic health assessments

Occupational health and safety educationImmunization programSurveillance and management of job

related illness and exposureMaintenance of health records

Immunizations

Tetanus/Diptheria (every 10 years)Hepatitis BRubella Vaccine (MMR)Varicella (chicken pox)Influenza VaccinePPD (TB skin test)

Work Restrictions

Diarrhea InfluenzaHerpes SimplexConjunctivitisSore Hands

Work Restrictions

Exposure to :

-Tuberculosis (PPD skin test/ chest x-ray done as screening)

- Chicken Pox (Varicella titre checked)

*If titre non-reactive, employee must not work from tenth to twenty-first day after the exposure.

Blood and/or Body Fluid Exposure If a health care worker has a parenteral or

mucous membrane exposure to blood or body fluids or a cutaneous exposure involving large amounts of blood (especially if the skin is not intact), the source patient should be informed. Consent for HIV testing should be obtained by the attending physician. The source patient will also be screened for HBV and HCV.

If the source for the exposure is unknown, the protocol for this situation is initiated.

Cont’d

Immediately following the incident the appropriate first aid treatment should be administered.

The immediate supervisor or designate is notified, an incident report filled out and the appropriate copy sent to Infection Control

The Infection Control Nurse is notified as soon as possible (within 24 hours) on weekdays.

Cont’d

If the nurse is not available, leave message on voice mail.

On weekends and after hours, register in the Emergency Dept. for follow-up

PROMPT reporting of the incident is important for follow-up.

First Aid Treatment

Remove contaminated clothingFor parenteral exposure, allow bleeding of

the wound, wash with soap and water and apply antiseptic if available

For mucous membrane exposure, rinse well with tap water or saline and proceed to the nearest eyewash station if available

Cont’d

For human bites resulting in blood exposure to either person involved, wash wound and skin with soap, flush mucous membranes with water

If blood gets on the skin and there are no cuts or puncture wounds, wash well with soap and water

No follow-up is required

Bloodwork

Should be done on the source patient as soon as possible after the puncture. The required bloodwork is HIV,HBV & HCV.

Consent for HIV testing must be obtained by the attending physician.

Laboratory must be notified that it is an exposure so that HBV and HIV testing will be done at WMRH site.

Blood Borne Pathogens

Risk following exposure:Hepatitis B – 6% - 30%Hepatitis C – 0.5% - 10%HIV – 0.1% - 0.3%

Protocol for Hepatitis C Virus (HCV) Known Source If the source patient is known, ask the patient to

consent for Hepatitis C screening.Source neg for HCV – no further follow-upSource pos for HCV – employee to have screening

for Hepatitis C completed. If negative repeat in 6 months. If positive the employee should receive counseling. Results are reported to Public Health.

Unknown source: As for Positive

HIV Post Exposure Prophylaxis

Post exposure assessment

Known Source:*Nature of Exposure*Likelihood of HIV Infection in the Source

PatientThe risk of infection should be weighed against

the potential toxicity of antiretroviral agents.Prophylaxis should be started within one to two

hours after exposure.

Cont’d

Unknown Source* Exposure risk to be assessed* HCW counseled re HIV

Chemoprophylaxis Drugs.* Consent Post exposure prophylaxis should be

decided case by case based on exposure risk and possible source patients.

Questions?