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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
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Infection Control
Introduction to Infection Control
Chain of Infection
Handwashing
Standard Precautions
Transmission-Based Precautions
Chain of Infection
Causative
Agent
Reservoir
Susceptible Host
Portal of Entry
Portal of Exit
Mode of transmission
Definition
Nosocomial Infection:
A hospital acquired infection
Causative Agent
Bacteria-salmonella/campylobacter
Viruses-Hepatitis B/influenza
Fungi-athlete’s foot/plantars warts
Protozae-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
Reservoirs
Cases
Carriers
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 hands
Lather (15-30 seconds)
Rinse
Towel dry
Turn 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 CDifficile.
 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 Precautions
Variation 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 Guidelines
Multi-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
Precautions
Handwashing
Personal Protective Equipment (PPE)
Environmental Control
Linen
Dishes
Waste 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
Precautions
Purpose:
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 TransmissionBased Precautions
Airborne
Droplet
Contact
*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 Placement
Private room is indicated.
Wash Hands
Before and after every patient contact. Hands must be
washed after removing gloves.
When Providing Direct Patient Care
Wear gloves and a gown.
Patient Transport
Limit transport of patient from room to essential purposes
only.
Patient Care Equipment
Dedicate the use of non critical patient-care equipment. If
common 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 Placement
Use a private room.
Mask
Wear mask when providing direct patient care.
Patient Transport
Limit transport of patient from room to essential purposes
only.
•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)
AIRBORNE PRECAUTIONS
(in addition to Standard Precautions)
VISITORS: Report to nurse before entering.
Patient Placement
Use a private room.
Keep room door closed and patient in room.
N95 or equivalent Respirator
This mask must be worn when entering the patient room
and removed upon exiting the room.
Patient Transport
Limit transport of patient from room to essential purposes
only. Use surgical mask on patient during transport.
• Very few conditions require
•Tuberculosis, Varicella - zoster, Measles
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
contamination
Remove 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 first
Mask or respirator
Goggles or face shield
Gloves
*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 gowns
Gown #1 ties in front
Gown #2 ties in back
How to Don a Mask
Place over nose, mouth and chin
Fit flexible nose piece over nose bridge
Secure on head with ties or elastic
Adjust 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 last
Select correct type and size
Insert hands into gloves
Extend gloves over isolation gown cuffs
How to Safely Use PPE
Keep gloved hands away from face
Avoid touching or adjusting other PPE
Remove 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
PPE
Contaminated – 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
Gloves
Face shield or goggles
Gown
Mask 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 face
Place in designated
receptacle for
reprocessing or
disposal
Removing Isolation Gown
Unfasten ties
Peel gown away from
neck and shoulder
Turn contaminated
outside toward the
inside
Fold or roll into a
bundle
Discard
Removing a Mask
Untie the bottom,
then top, tie
Remove from face
Discard
Removing a Particulate Respirator
Lift 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 education
Immunization program
Surveillance and management of job
related illness and exposure
Maintenance of health records
Immunizations
Tetanus/Diptheria (every 10 years)
Hepatitis B
Rubella Vaccine (MMR)
Varicella (chicken pox)
Influenza Vaccine
PPD (TB skin test)
Work Restrictions
Diarrhea
Influenza
Herpes Simplex
Conjunctivitis
Sore 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 clothing
For 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-up
Source 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
Patient
The 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?