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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. 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 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