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Module 1: Hand Hygiene MOHLTC Core Competencies Adapted for placement students Infection Prevention & Control Department July 2012 Hand Hygiene • 30% of hospital-acquired infections can be prevented by following infection prevention and control strategies (1). • In Canada, 220,000 incidents of Healthcare Associated Infections (HAIs)/YEAR(1) • Responsible for 12,000 death/year in Canada • MRSA infection costs CAD $ 27,661/each patient • All people working in a healthcare facility play a vital role in implementing IPAC strategies which are designed to protect patients, staff and the community. YOU CAN MAKE A DIFFERENCE! Hand Hygiene • Refers to killing or removal of microorganisms on the hands that have been picked up by contact with patients, staff, contaminated equipment or the environment • Includes maintaining good skin integrity 2 Methods of Hand Hygiene • Hand Washing with soap & water – performed when hands are visibly soiled (with organic matters, i.e., food, soil, blood, body fluid-urine, stool) • Hand Sanitation with Alcohol-based Hand Rub (ABHR) – preferred method in healthcare settings to clean hands that are not visibly soiled Types of Hand Soap 1. Liquid soap Used for most patient care Appropriate for most hand washing 2. Antibacterial Soap Not recommended for routine use at Providence Healthcare (used in critical care settings such as surgical suite, Intensive Care Unit) Alcohol-based Hand Rub Why is it a preferred method in a healthcare setting? • Provides a rapid kill or removal of most bacteria on hands • Takes less time than using soap and water • Contains emollients to reduce skin irritation • Remember not to rinse off with water immediately after application Steps in hand washing with soap & water (2) Steps for hand hygiene using alcohol-based hand rub (ABHR) The effectiveness of Hand Hygiene is adversely impacted by: 1. Skin Condition • • • Healthy skin is the 1st line of defense against infection Dry and cracked skin harbor more microbes Apply hand cream to protect skin after frequent hand washing The effectiveness of Hand Hygiene is adversely impacted by: 2. Finger Nails & Jewelry • • • Long nails, chipped polish, artificial nails, jewelry are reservoir for microorganisms. Artificial nails must not be worn in Health Care Facilities by those who do direct patient care and has been implicated in outbreaks Can tear gloves 4 Moments of Hand Hygiene(3) Remember, do hand hygiene…. Before After putting on gloves. removing gloves. Patient Care Environment • Everything within the curtain area in a shared room (washroom is a shared healthcare environment) • Everything within the patient’s single room, including the washroom Healthcare Environment • The environment (including equipment or articles) outside of the patient room or bedspace • Shared space with other patients or healthcare workers Examples of Healthcare Environment Nursing Station Shower Room Dirty Utility Room Medication Room Activity Room Clean equipment Room Must perform hand hygiene when you are moving in between these two environment Patient Environment Healthcare environment Point of Care the right way, in the right place • Refers to three elements occur together and require hand hygiene: (patient + health care provider + care involving contact ) • Where the healthcare worker provides care to patients: could be within the “Patient” or “Healthcare environment” • Point of Care can take place anywhere at Providence Healthcare with our mobile population Example of “Point of Care” • Mobile patient on wheelchair/stretcher • Dinning Room • Activity Room • Lobby • Charting area in Gym: hand hygiene before and after in contact of patient Module 2: Chain of Transmission MOHLTC Core Competencies Adapted for placement students Infection Prevention & Control Department July 2012 Chain of (4) Transmission • There are six links in the chain of transmission for infection to occur • To stop the infection one of the links needs to be broken Chain 1: Infectious Agents • Infectious agents are germs or organisms that are capable of causing disease • These agents could be: – Bacteria – Fungi – Viruses – Parasites • These agents are found everywhere, but not all bacteria cause infections; some are harmless and even protective Chain 2: Reservoirs • Where infectious agents live and reproduce • Reservoirs could be – Humans, (patients, staff, visitors) – The environment (water, patient equipment, surfaces like keyboard, handrails) – Animals (pets or wild animals) Chain 3: Portal of Exit • How they leave the reservoir • Through blood, body fluids – Saliva, wound drainage, feces, mucous, vomitus, semen Chain 4: Mode of Transmission • Three major modes of transmission: – Contact – by touching the infective material (feces, contaminated item) – Droplet – large droplets from the mouth or nose through coughing, sneezing, laughing – Airborne – very small droplets that remain suspended in air and inhaled e.g. TB, chicken pox Other Modes of Transmission • Skin puncture – cuts, lacerations, injections • Common vehicle – contaminated source e.g. water, food, equipment • Vector – animal or insect bite e.g. malaria, rabies Remember, the droplets can disperse to at least 2 meters or more Chain 5: Portal of Entry • Ways how the germs get in the body • Examples: – Breathing in microbes – Eating or drinking contaminated food or water – Broken skin – Touching mucus membranes with dirty hands – Sexual contact e.g. Hepatitis B, HIV Chain 6: Susceptible Host • Any person who is at risk of infection (that means, anyone) • Risk factors: – Age: very young or old – Poor nutrition – Weakened immune system – Breaks in skin – Lack of sleep – High stress levels – Poor personal hygiene Breaking the Chain of Infection The aim of infection control is to stop the spread of infection by breaking one of the chains! Breaking the Chain at the link… Infectious agent: • Medications – antibiotics, antivirals, antifungals, antiparasitic agents • Disinfection • Sterilization Breaking the Chain at the link … Reservoirs: • • • • Cleaning of environment Proper food storage Get rid of standing water Water treatment Breaking the Chain at the link … Portal of Exit: • • • • Hand hygiene Cough etiquette (cover coughs/sneezes) Barrier protection - band aids, condoms Disposal of waste and contaminated materials Breaking the Chain of the link… Mode of Transmission: • Hand hygiene • Cleaning, disinfection and sterilization • Barrier protection - mosquito nets, gown gloves, mask • No sharing of drinks/cigarettes Breaking the Chain at the link … Portal of Entry: • Hand hygiene • Barrier protection - gown, gloves, mask, wound covering, condom Breaking the Chain at the link… Susceptible Host: • Immunization • Good nutrition, rest, low stress level • Treatment of ill person Module 3: Routine Practices MOHLTC Core Competencies Adapted for placement students Infection Prevention & Control Department July 2012 Routine Practices(5) The infection prevention and control practices should be applied routinely for • all patients/residents • at all times Routine Practices in infection control start with • Risk assessment before providing care: – What is the risk of exposure (microbes, nonintact skin, body fluid & substance, mucous membrane, contaminated equipment, etc.) – How is this organism transmitted? – Is the patient cooperative? – How can I prevent spreading the microbes to others? Know the risk: Ask the question: “What task am I going to perform?” Know the risk: Ask the question: “What PPE do I need to wear to protect myself and help stop the spread of infection?” Assess your risk “Will my hands be exposed to blood, body fluids or objects contaminated with these, or to broken skin?” If yes, perform hand hygiene & wear gloves! Assess your risk “Will my face be exposed to a splash, spray, cough or sneeze?” If yes, wear mask with eye shield! Assess your risk “Will my clothing or skin be exposed to splashes/sprays or items contaminated with blood or body fluids? If yes, wear a gown! Routine Practices Prevent Transmission of Microbes From From From From patient to patient patient to staff staff to patient staff to staff Routine Practices Include Hand hygiene Environmental cleaning Cleaning of shared equipment Laundry management Sharps management Waste management Routine Practices include Appropriate use of Personal Protective Equipment (PPE) Wear: Gloves when touching non-intact skin, blood, body fluid, contaminated equipment Gown when risk of splashing on clothes Mask/face shield when taking care of coughing/sneezing patient, splashing of body fluids Additional Precautions • Precautions in addition to Routine Practices • Used for patients identified with infectious organisms • Based on Mode of transmission of the organism – either Contact, Droplet/Contact, Airborne precautions Additional Precaution Signs C-Diff./VRE MRSA/ESBL/ Diarrhea Fever & Respiratory Symptoms, Influenza, Vomiting & Diarrhea TB/Chicken Pox & Measles Placed on the door of the patient’s room. Placed on the wall over the bed in multi-bed room Important tips • Hand hygiene before touching medication cart to prepare medication & after touching healthcare environments • Remove any part of contaminated PPE and apron where they were used (Whatever belongs to that patient should stay in the same patient’s room including pathogens) • Put on any part of PPE immediately before providing care to keep it clean for the patient • Staff with apron, gloves, isolation gown should not be at the nursing station • Do not touch yourself, healthcare environment (clean linen carts, charts, hampers, etc.) with contaminated gloved hands • Remove gloves that have come in contact with shared equipment, soiled linen, garbage bag, blood & body fluid before touching patient/pt environment again Remember… Infection Prevention and Control is EVERYBODY’S business. Please do your part! References: 1.Provincial Infectious Diseases Advisory Committee (PIDAC). Surveillance of health care-associated infections in patients and resident populations. Oct. 2011 http://www.oahpp.ca/resources/PIDACknowledge/best-practicesmanual/surveillance-of-health-care-associatedinfections.html 2. PIDAC. Best Practice for Hand Hygiene in All Health Care Settings. Revised Dec. 2010. http://www.oahpp.ca/resources/pidacknowledge/handh-hygiene.html 3. Ministry of Health and Long-term Care (MOHLTC). Just Clean Your Hands Program. http://www.oahpp.ca/services/jcyh/hospitals-educationtraining.html 4. MOHLTC. IPAC Core Competency Education for all healthcare providers: The first three acute care modules. March, 2007 5. PIDAC. Ontario Agency for Health Protection & Promotion. Routine Practices and Additional Precautions in All Health Care Settings. Revised July 2011