Download Infection Prevention and Control

Principles of
Infection Control
Care Homes IPC Study Day
Sue Barber
Lead Nurse, Infection Prevention & Control
AV & Chiltern CCG’s
Why Infection Prevention & Control is
important
• A healthcare associated infection (HCAI) is an infection caused by any type of
healthcare contact.
• Damage the patient’s quality of life – painful, unpleasant, scary and in severe
cases can be fatal
• Cost the NHS approx. £1 billion per year
• Prevention of healthcare associated infections is covered by legislation in The
Health & Social Care Act 2008
• Monitored by the Care Quality Commission
• 10 criteria against which health & social care providers must be compliant
• Increasing numbers organisms are becoming resistant to all our standard
antibiotics
• Infections and outbreaks can attract high profile media attention and damage
the organisations reputation
• Possibility of litigation with Health Care Associated Infections
• Risk of emerging pathogens such as pandemic influenza strains
Responsibilities
• Staff must be appropriately trained in infection
prevention & control practice and knowledge
updated on a regular basis (records must be
kept)
• All staff are required to be familiar with, and
comply with infection control policies
• Don’t put residents or colleagues at risk if you
are unwell e.g. norovirus - do not return to work
until 48 hours without symptoms
• Identify and report IPC related risks
Risk of infection
• Some people will be more at risk of
infection than others.
• Elderly
• Young babies
• Immunocompromised
• Those with invasive devices e.g.
catheters, PEG tubes
• Malnourished
Chain of infection
Infectious agent
Eg bacteria, virus
Prompt treatment and
rapid identification of
infection can break
the chain
Susceptible Host
Elderly, neonates,
immunosuppressed
Recognise high risk
patients, strict IPC
precautions &
immunise when able
Reservoir
People,,equipment or
environments
Good hygiene & clean
environments
Take any of these links
out of the chain and
prevent the spread of
infection
Portal of Exit
Excretions and secretions
Use of PPE, safe
management of clinical
waste and used linen
Portal of Entry
Mode of transmission
Mucous membranes, broken
skin, invasive devices
Contact, airborne
Aseptic technique, hand
hygiene, management of
invasive devices
Hand hygiene, cleaning
environments and
equipment
How infections can spread
There are 6 modes of spread
•
Airborne
•
Contact
•
Ingested e.g. food poisoning
•
Environmental e.g. water
•
Vectors e.g. malaria
•
Sexual
Different types of Micro-organisms
• Bacteria
• Viruses
• Fungi
• Parasites
• Millions of different species
• Have the ability to cause a variety of
diseases
• Pathogen - is the term used for germs that
cause disease
Types of illness caused by Bacteria
• Throat infections
• Boils, pimples
• Blood poisoning
• Meningitis & Meningococcal septicaemia
• Wound infections
• Urine infections
• Chest infections
• Clostridium difficile
Types of illness caused by Viruses
• Respiratory infection
• Flu
• Sore throat
• Diarrhoea & Vomiting
• Slapped cheek syndrome
• Hand foot and mouth
• Measles
• Chicken pox
• Rubella
Note: Antibiotics do not work on
viruses
Types of illness caused by Fungi
• Thrush
• Ring worm
• Athletes foot
Types of illness caused by vectors
• Malaria
• Sleeping sickness
• Leptospirosis
– Weil’s Disease
Types of infection caused by parasites
• Scabies
• Head lice
• Body lice
• Tapeworm
• Many tropical diseases
Standard Precautions
Should be used at all times with all residents – you cannot always
tell if someone has an infection therefore standard precautions
protect both you and the resident.
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Effective hand hygiene practices
Maintenance of skin integrity
Protection of open wounds/skin lesions
Use of appropriate personal protective clothing
Avoidance of sharps injury through safe use and disposal of
sharps
Appropriate decontamination of instruments and equipment,
including safe management of blood spillage
Maintaining a clean environment
Safe disposal of waste
Safe handling and laundering of used linen
Standard Precautions
Should be used at all times with all resident – you cannot always tell if
someone has an infection therefore standard precautions protect bot you
and the resident.
 Effective hand hygiene practices
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Maintenance of skin integrity
Protection of open wounds/skin lesions
Use of appropriate personal protective clothing
Avoidance of sharps injury through safe use and disposal of sharps
Appropriate decontamination of instruments and equipment, including
safe management of blood spillage
 Maintaining a clean environment
 Safe disposal of waste
 Safe handling and laundering of used linen
We will return to hand hygiene later
Personal Protective Equipment (PPE)
Many pathogenic organisms are present in
body fluids, protective clothing is used to
minimise their transmission onto clothing or
skin
Would you like a
cup of tea Mrs
Jones?
Choice of protective clothing
depends upon the
anticipated risk of different
activities.
Risk assessment and protective clothing
Activity
No contact
with blood
or body
fluids
No PPE BUT
remember
organisms are
always present
- hand hygiene
Contact with
blood or body
fluid but
LOW risk of
splashing
Gloves +/apron
Contact with
blood or body
fluid but HIGH
risk of
splashing
Gloves, mask,
eye protection,
water-resistant
gown/apron
Types of PPE
Commonly used items
• Gloves
• Sterile
• Non sterile
• Aprons/gowns
Rarely used items – a small stock should be kept for
use if required
• Face masks
• Surgical
• Eye protection
• Goggles
• Face visor
Gloves and Aprons
Gloves are not a substitute for hand hygiene
Hand hygiene after glove removal is essential
Non-latex, powder-free gloves should always be used
Wear aprons if there is a possibility of contamination/
splashing to clothing
Change between residents and between a dirty and clean
task for the same resident
Clean hands after removal
Remember all PPE are single use items
Decontamination
Environments
• The environment needs to be clean to prevent cross
contamination
• Detergent is suitable for most cleaning but
disinfectants are required in some areas and for
outbreaks e.g.. chlorine based
• Higher risk areas should take higher priority i.e. clinical
rooms, toilets
• Keep clean & dirty areas separate where possible
• Ensure carpets and soft furnishings can be cleaned
effectively (steam cleaning)
Decontamination
Equipment
• All reusable equipment must be decontaminated between
each resident’s use
• Cleaning - Dirt always has to be removed first with
detergent & water –Detergent wipes are practical
• The item may then also need to be disinfected
• Chlorine-releasing product e.g. Actichlor, Milton
• Alcohol
• If the item needs to be sterile - use single use
Body Fluid Spillages
Body fluid spillages should be cleaned up immediately and protective
clothing worn
Body Fluid
Surface
Method
Blood/blood
stained fluid
Hard surface
Treat spill with chlorine
releasing agent e.g. Milton,
Actichlor. Then clean area with
detergent & water
Blood/ blood
stained fluid
Carpets or soft
furnishings
Clean with detergent & water
then steam clean where possible
Non-blood stained
body fluids
Any surface
Clean with detergent & water
Chlorine products should not be applied directly to urine or vomit spills
Spillages during outbreaks will be discussed later
Body fluid spill kit
• Have a spill kit or the separate
components
• chlorine releasing granules or
tablets, gloves, apron,
cleaning cloths, disposal bag,
detergent wipes
• Know where the spill kit is kept
• Make sure you know how to use
it
Management of waste
• Waste management systems are
designed to protect all people who will
handle waste from production to final
disposal
• There are many regulations regarding
waste and these must be complied
with, most notably in healthcare • Safe Management of Healthcare Waste
• Waste must be segregated into the
appropriate categories or streams
Waste Streams (some waste streams you might use)
Domestic
waste
Paper,
packaging, food, flowers etc.
Disposed of in landfill - so must not contain
contaminated items
Clinical
waste
For
Offensive
waste
(tiger
stripe)
Waste contaminated with body fluids but is not
infectious
Sharps
waste
Yellow lidded sharps containers are for all clinical
sharps including those containing partially
discharged medicine, but not for cytotoxic waste
Cytotoxic
sharps
waste
For any sharps waste contaminated with cytotoxic
waste
any infectious or potentially infectious items
Dressings, gloves, aprons, body fluids etc.
Not for uncontaminated paper or packaging
Waste bins
• Have bins in the right place
• Black bags next to hand wash sinks
• Orange bags in sluice or treatment
rooms
• Waste must be stored securely and safely.
• Yellow bins must be locked
• Remember to keep
external bin areas
clean
Management of sharps
• Safe management of sharps protects the user
and also others working in that environment
• If a needle free version can be used then do so
• Use safety devices wherever possible
• Do not re-cap needles
• Take sharps bin with you to the resident where
possible
• Dispose of sharps as soon as finished
Sharps waste containers
• Only use approved sharps containers
• Must be assembled correctly and labelled with
date and service
• Keep off the floor when in use
• Must not be overfilled
• Temporary closure mechanism should be used in
between use
• Must be kept in a secure area for collection
• Must be closed when ¾ full or after a maximum of
3 months use
• Must never be placed inside a clinical waste bag
Accidents and Inoculation injury
Sharps, bites, scratches,
Blood splashes to eyes, mouth, broken skin
Encourage bleeding from site (Sharps)
Wash with soap/water
Irrigate eye with saline or tap water.
Cover injury with waterproof dressing
Notify OHD, A&E or GP promptly
Record the incident - including reflection
Hand Hygiene
Hand Decontamination
Hand hygiene remains the
single most effective
means of preventing the
spread of infection.
When to clean your hands
Your 5 moments for hand hygiene
at the point of care*
*Adapted from the WHO Alliance for Patient Safety 2006
Why to clean year hands?
Resident Micro-Organisms
 Deep seated
 Don’t generally cause
infections and not easily
removed
 Part of the
body’s natural
defence mechanism
 Have been associated with
infection following surgery
Transient Micro-organisms
 Superficial
 Easily picked up and passed
on
 An important
cause of
cross-infection.
 Easily removed by good hand
hygiene.
Before hand decontamination
After good hand
decontamination
After poor hand
decontamination
Areas most frequently missed
How – Hand Hygiene Technique
Applies whether using alcohol foam/gel or soap & water
1
Palm to palm
4
Finger tips
2
3
Backs of hands
Between fingers
5
6
Thumbs and wrists
Nails
Hand hygiene facilities
• An accessible hand hygiene sink compliant with HTM
64 i.e.
• Elbow/wrist operated mixer taps
• No plug or overflow
• Water outlet not directly above drainage aperture
• Hand hygiene sinks must be designated for this use
only
• Any new service, refurbishment or new build must
ensure sinks are compliant and IPC principles are
taken into consideration
• If you have problems with hand hygiene facilities this
must be flagged up as a risk
Soap vs Alcohol
Both are equally effective at decontaminating hands
but they work in different ways
Soap
Alcohol
• Cleans
• Lather lifts dirt off the
hands
• Dirt and germs are
mechanically flushed
away
• Disinfects
• Kills germs immediately on
contact
• Doesn’t remove dirt and
the dirt can protect germs
from the alcohol
Alcohol hand gel/foam
• Just as effective as soap & water
• Can be carried with you to use when you can’t
get to a sink
• Can be applied as often as required until hands
feel sticky.
Remember
• It does not remove dirt - hands require washing
if physically dirty
• Less effective against C.difficile and Norovirus so
soap & water must be used
• Must be sited and stored safely
‘Bare below the elbows’
• Uniform and Dress Code guidance (DH)
state that ‘bare below the elbows’
principles should be followed when
carrying out clinical procedures and hand
hygiene
• No ornate jewellery – plain wedding
band only
• Remove wrist watch
• Short sleeves, or rolled up
• Nails should be short, no false nails or
nail varnish
Hand hygiene for residents
• Remember that residents/service users
also need to clean their hands,
especially before meals and after
using the toilet
• Ensure hand hygiene facilities
are made available in toilets
• Ensure relatives & visitors know where
they can clean their hands – clearly
Hand hygiene
signpost hand hygiene facilities
Now let’s practice