Download 7.0 [The Centre`s] Organisational Approach to

[Enter name of
Centre]
MANUAL OF
INFECTION PREVENTION AND
CONTROL
POLICY AND PROCEDURES.
REVIEWED AND UPDATED: 10th May 2016
VERSION 2
Table of Contents
1.0
Policy Statement .............................................................................................. 4
2.0
Purpose ............................................................................................................ 4
3.0
Objectives......................................................................................................... 4
4.0
Scope ............................................................................................................... 4
5.0
Definitions......................................................................................................... 4
6.0
Responsibilities ................................................................................................ 7
7.0
[the Centre]Organisational Approach to Infection Control ................................ 8
8.0
Preventing Transmission of Infection in the General Practice Setting .............. 8
9.0
Standard and Transmission Based Precautions ............................................... 9
10.0 Resident Placement and Transmission Based Precautions. .......................... 11
11.0 Hand Hygiene ................................................................................................. 12
12.0 Use of Personal Protective Equipment. .......................................................... 18
13.0 The Management of Spillages of Blood and Body Fluids ............................... 24
14.0 Management of Sharps .................................................................................. 26
15.0 Safe Injection Practices .................................................................................. 27
16.0 The Management of Needle Stick Injuries. ..................................................... 31
17.0 Respiratory Hygiene and Cough Etiquette ..................................................... 33
18.0 The Management of Waste ............................................................................ 34
19.0 The Management of Laundry ......................................................................... 36
20.0 Decontamination of Reusable Medical Equipment ......................................... 38
21.0 Decontamination of the Environment. ............................................................ 39
22.0 Cleaning Guidelines Equipment for Resident Care. ....................................... 43
23.0 Products used in [The Centre] ........................................................................ 46
24.0 Aseptic Practice. ............................................................................................. 47
25.0 Urinary Catheterisation ................................................................................... 47
2|87
NMA Infection Prevention and Control Policy and Procedures 10052016
26.0 Enteral Feeding .............................................................................................. 52
27.0 Subcutaneous Infusion ................................................................................... 55
28.0 Wound Care ................................................................................................... 55
29.0 Procedure for Collection and Labeling of Specimens. .................................... 60
30.0 Pets ................................................................................................................ 62
31.0 MRSA ............................................................................................................. 63
32.0 Clostridium Difficile ......................................................................................... 64
33.0 Herpes Zoster (Shingles)................................................................................ 66
34.0 Influenza ......................................................................................................... 68
35.0 Scabies........................................................................................................... 70
36.0 Scabies........................................................................................................... 71
37.0 Norovirus / Winter Vomiting Disease .............................................................. 74
38.0 Legionnaires’ disease ..................................................................................... 75
39.0 Salmonellosis ................................................................................................. 77
40.0 Guidelines for the Prevention and Control of Multi-Drug Resistant Organisms
(MDRO) excluding MRSA. ....................................................................................... 79
41.0 Notifable Diseases ......................................................................................... 82
42.0 Management of an Outbreak .......................................................................... 83
43.0 Staff Health..................................................................................................... 84
44.0 Infection Control Issues Regarding Last Rites................................................ 85
45.0 References ..................................................................................................... 86
3|87
NMA Infection Prevention and Control Policy and Procedures 10052016
Document Title and Code:
Infection Control Policy and Procedures. NMA-ICP
Version:
2
Authors:
Prepared by Nursing Matters & Associates.
Issue Date:
10th May 2016
Review date:
May 2019
Authorised by:
1.0 Policy Statement
It is the policy of [the Centre] that all the prevention and control of infections will comply with
best practice.
2.0 Purpose
To ensure that all staff in collaboration with residents and visitors will participate in safe and
effective infection prevention and control practices.
3.0 Objectives
3.1
To ensure that all staff employed by [the Centre] have knowledge of all relevant
procedures related to infection prevention and control.
3.2
To guide all staff employed by [the Centre] on best practice in the prevention and
control of infection in the home.
3.3
To provide a safe environment for residents, staff, and visitors in [the Centre].
3.4
To reduce the risk of healthcare associated infections in [the Centre].
4.0 Scope
This policy applies to all staff employed by [the Centre].
5.0 Definitions
5.1
Healthcare Associated Infection: A healthcare-associated infection is an infection
that is acquired after contact with the healthcare services. This is most frequently
after treatment in a hospital, but can also happen after treatment in outpatient
clinics, nursing homes and other healthcare settings (HPSC, 2009).
5.2
Standard Precautions are evidence based clinical work practices published by the
Centre of Disease Control (CDC) in 1996 and updated in 2007 that prevent
transmission of infectious agents in healthcare settings (HPSC, 2009).
5.3
Transmission Based Precautions are designed for patients/residents known or
suspected to be colonised or infected by highly transmissible microorganisms for
which additional precautions beyond Standard Precautions are required to interrupt
their transmission. Infection or colonisation of pathogens are spread by the following
routes:
 Contact
 Airborne
 Droplet
(HSE, 2011).
4|87
NMA Infection Prevention and Control Policy and Procedures 10052016
5.4
Contact Precautions are designed to reduce the risk of transmitting microorganisms
by direct or indirect contact. Direct contact transmission involves skin-to-skin contact
e.g. hands of healthcare HCWs. Indirect contact involves contact with contaminated
equipment or environment. Examples of infection spread by the contact route
include: MRSA, and Rotavirus (HSE, 2011).
5.5
Airborne Precautions are designed to reduce the risk of either airborne droplet
nuclei or small particles containing infectious agents that remain infectious over time
and distances. Examples include: Mycobacteria Tuberculosis, Varicella and Measles
(HSE, 2011).
5.6
Droplet Precautions are designed to reduce the risk of droplet transmission of
infectious agents including respiratory droplets which are generated within a 3 foot
(1 meter) proximity when an infected person coughs, sneezes, talks or during
aerosol generating procedures such as suctioning and CPR. Examples of infections
spread by droplets include Neisseria Meningitides, Mumps, Rubella and Influenza
(HSE, 2011).
5.7
Decontamination: the process of removing or neutralizing contaminants that have
accumulated on personnel and equipment. It includes cleaning, disinfecting and
sterilisation.
5.8
Cleaning: A process which physically removes contamination but does not
necessarily destroy germs. Cleaning removes germs and the organic material on
which they thrive (Ayliffe et al, 2000).
5.9
Disinfection: A process used to reduce the number of viable germs to a level where
they are unlikely to be a danger to health but which may not necessarily inactivate
some agents, such as certain viruses and bacterial spores (Ayliffe et al, 2000).
5.10 Sterilisation: A process which achieves the complete killing or removal of all types of
germs, including viruses and spores. Disinfection may not achieve the same
reduction in microbial contamination level as sterilisation (Ayliffe et al, 2000).
5.11 Highly transmissible microorganisms are infectious agents that have one or more of
the following characteristics:

Are readily transmissible.

Have a tendency toward causing outbreaks.

Are difficult to treat.

May be associated with severe outcome (CDC, 2007).

Examples include, Clostridium difficile, MRSA (methicillin resistant
Staphylococcus aureus), VRE (Vancomycin resistant Enterococcus), Norovirus,
Influenza virus (HSE, 2011)
5.12 Antiseptic: refers to disinfectants that are applied to the skin or to living tissues, but
as the purpose of antiseptics is to disinfect i.e. skin disinfection, the word antiseptic
is less frequently used. It is useful as an indicator that the compound can be safely
applied to tissues.
5.13 Colonisation: the presence of multiplying micro-organisms, without a host reaction.
5.14 Contamination: the soiling of inanimate objects or living material with harmful,
potentially infectious or unwanted matter.
5|87
NMA Infection Prevention and Control Policy and Procedures 10052016
5.15 Cross-Infection: infection acquired in hospital from other people, e.g. patients, staff
or visitors. Food and the environment may also be factors in cross-infection.
5.16 Infection: the term infection is used to refer to the deposition and multiplication of
bacteria and other micro-organisms in tissues or on the surfaces of the body with an
associated host reaction.
5.17 Infectious Disease: a disease caused by a microorganism that can be passed from a
person, animal or the environment to another susceptible individual.
5.18 Outbreak of Infection: an outbreak may be defined as a higher than expected rate of
infection compared with the usual background rate for a particular place and time or
the sudden appearance of an increasing incidence of one type of infection.
5.19 Microorganism: any organism that is too small to be visible to the naked eye, e.g.
bacteria, fungi, viruses and protozoa.
5.20 Transient Microorganisms: are superficial, transferred easily to and from hands,
recognised as an important source of infection, but are removed easily with good
hand washing.
5.21 Resident Microorganisms: are deep-seated, difficult to remove, part of the bodies’
natural defenses mechanism and associated with infection, following surgery or
invasive procedures.
5.22 Normal Bacteria Flora: the bacteria that normally live on and in the skin, gut, mouth
and upper respiratory tract of humans. Also called commensal organisms, they do
not normally cause disease and provide some protection from disease. When
antimicrobial agents are used to treat infectious disease, they can affect the normal
bacterial flora and their ability to provide protection from infection.
5.23 Pathogenic: potentially disease producing micro-organisms. The ability to cause
infection depends on the virulence of the microbe, the number present and the
patients’ immune defenses.
5.24 Sharps: any objects capable of inflicting a penetrating injury and includes needles
and syringes, scalpel blades, disposable razors, wires, auto lancets, stitch cutters
and broken glassware.
5.25 Terminal cleaning is the disinfecting of the bed, bedside cabinet, and general area of
the patient care unit with a detergent/germicidal agent after the patient is discharged
or transferred from the nursing care unit. It is performed at every patient care unit
before the area is prepared for the next patient.
6|87
NMA Infection Prevention and Control Policy and Procedures 10052016
6.0 Responsibilities
Actions
Responsible Person.
This policy will be disseminated to and read by all staff in [the Centre], Person in Charge [or
particularly those staff involved in resident care.
specify other person].
A record will be kept of all those who have signed the policy
acknowledgement forms.
Person in Charge [or
specify other person].
Where a new version of this policy is produced, the previous version
will be removed and filed away.
Person in Charge [or
specify other person].
An explanation of this policy will be given on induction to all nursing
Person in Charge [or
and care staff and any other health care professional involved in
specify other person].
providing direct care to residents.
Resources will be available to prevent the spread of infection and
Person in Charge [or
management of infection during an outbreak e.g. hand washing
specify other person].
facilities, personal protective equipment, etc.
Staff will be provided with the opportunity to attend training /updates
Person in Charge [or
on infection control every year or where there is a significant change
specify other person].
to practice in this area.
All staff will implement standard precautions at all times.
All staff.
All registered nurses and
Visitors and residents will be advised of infection prevention and
healthcare assistants.
control requirements such as hand hygiene and cough etiquette
Any illness as a result of occupational exposure will be reported to the
All staff.
person in charge [or specify other person] immediately.
Staff will maintain their competence in infection prevention and control All staff.
and standard precautions and communicate any competency /
knowledge deficits to [specify e.g. the clinical nurse manager /line
manager].
Staff will not wear any jewelry (except wedding band) while on duty All staff.
and adhere to bare below the elbows (catering staff do not need to
adhere to bare below the elbows)
Staff will report to the [specify e.g. clinical nurse manager / line All staff.
manager] any allergies or reactions as a result of wearing gloves e.g.
allergy to latex, dermatitis, rashes or eczema.
7|87
NMA Infection Prevention and Control Policy and Procedures 10052016
7.0
[The Centre’s] Organisational Approach to Infection Control
7.1
The prevention and control of Healthcare Associated Infections in [the Centre] is
managed according to national policies and procedures and is in line with current
legislation and evidence-based best practice.
7.2
As part of the quality and safety framework for [the Centre], information on infection
rates e.g. urinary tract infections, respiratory tract infections, catheter associated
infections, soft tissue infections, device infections, vomiting and diarrhea, is
gathered by the clinical nurse managers to identify, analyse, prioritise and eliminate
or minimise risk relating to healthcare associated infections. This data is discussed
[specify when this is discussed e.g. at each clinical governance committee meeting
or infection control meetings] and any actions required are determined and
implemented. Data on infection rates will be gathered by [specify person(s)
responsible for this e.g. pic, adon, cnm].
7.3
The person in charge [or specify who is responsible] will perform an analysis of any
incident that has compromised, or could compromise, the prevention and control of
healthcare associated infections.
7.4
The person in charge [or specify who is responsible] will also analyse any healthcare
associated infection related adverse events, incidents and complaints and where
deemed appropriate will conduct a root cause analysis.
7.5
Internal systems are in place to communicate any information relating to the
prevention and control of Healthcare Associated Infections to all staff. This is the
responsibility of the person in charge [or specify who is responsible].
7.6
All notifiable infectious diseases and outbreaks of infectious diseases, including
Healthcare Associated Infections, are reported to the Medical Officer of Health
(HSE) and the Health Protection Surveillance Centre (HPSC).
7.7
The person in charge will notify HIQA of an outbreak of infectious disease within
three working days of the incident using NF02 form.
7.8
Staff will receive Infection prevention and control updates on an annual basis.
7.9
Infection prevention and control will be addressed in [the Centre’s] Annual Quality
and Safety Review.
8.0
Preventing Transmission of Infection in the General Practice Setting
8.1
Potential sources of pathogens in general practice include bacteria, viruses,
pathogenic fungi, protozoa, worms and prions. Every interaction in general practice
should include a risk assessment of the potential for infection transmission.
8.2
The spread of infection can occur by direct and indirect contact
8.2.1 Direct contact: Direct spread of infection occurs when one person infects the next;
by person-to-person contact e.g., chicken pox, tuberculosis, etc.
8.2.2 Indirect: Indirect spread of infection is said to occur when an intermediate carrier is
involved in the spread of pathogens e.g., the hands of a healthcare worker can
become contaminated with infectious organisms from contact with a contaminated
item of equipment; these may then be spread to a patient/resident.
8.3
The chain of infection describes how infection is transmitted from one living thing to
another. Transmission of infection can occur when the elements forming the “Chain
of Infection” are present. (HPSC Standard Precautions, 2009). These six elements
are composed of:
 Infectious agent e.g., bacteria, virus, prion: This can be endogenous (self-infection),
which occurs when organisms which are harmless in one site, cause infection when
transferred to another e.g., E.coli or exogenous (cross infection), which occurs when
organisms are transferred from another source e.g. doctor, nurse, other patient or the
environment.
8|87
NMA Infection Prevention and Control Policy and Procedures 10052016
 Reservoir: A reservoir is a place where an infectious agent lives and grows (e.g.,
large intestine, blood, mouth).
 Portal of exit: A portal of exit is any opening that allows the infectious agent to leave
(e.g. mouth, nose, rectum, and breaks in the skin).
 Means of transmission: The means of transmission is how the infectious agent
travels from the infected person to another person e.g., air, contact (direct e.g.,
hands of healthcare worker and indirect e.g., equipment).
 Portal of entry: The portal of entry is any opening that allows the infectious agent to
enter (e.g. nose, mouth, eyes, a break in the skin)
 A susceptible host: A susceptible host is a non-infected person who could get
infected.
Chain of Infection
8.3.1




Potential modes of transmission of infection in the general practice setting
Hands: The hands of practice staff are the most important vehicles of crossinfection. The hands of patients can also carry microbes to other body sites,
equipment and staff.
Equipment: Items of equipment can become contaminated with an infective
organism, which can subsequently be transmitted to another person, either
directly, or via the hands of healthcare workers.
Inhalation: Pathogens exhaled into the atmosphere by an infected person can be
inhaled by and infect another person e.g., influenza.
Ingestion: Infection can occur when organisms capable of infecting the
gastrointestinal tract are ingested. This most commonly occurs by ingestion of
contaminated food and water, or by faecal-oral spread e.g., Hepatitis A,
Salmonella, and Campylobacter.
9.0 Standard and Transmission Based Precautions
9.1
The purpose of Standard Precautions is to break the chain of infection.
Standard Precautions are a set of practices that should be used in the care and
treatment of all patients, regardless of whether they are known or suspected to be
infected with a transmissible organism. Standard Precautions apply when there is the
potential for contact with:
 Blood (including dried blood)
 Body fluids and secretions (except sweat)
 Non-intact skin
 Mucous membranes
9.2
Standard Precautions are work practices designed to reduce the risk of transmitting
microorganisms from both recognised and unrecognised sources of infection. They
must be used for all residents regardless of diagnosis or presumed infection status.
Standard Precautions must be used when handling blood, body fluids, secretions,
9|87
NMA Infection Prevention and Control Policy and Procedures 10052016
excretions (except sweat) non-intact skin and mucous membranes. These practices
include:
 Hand hygiene.
 Use of personal protective equipment.
 Management of spillages of blood and body fluids.
 Appropriate resident placement.
 Management of sharps.
 Safe injection practices.
 Respiratory hygiene and cough etiquette.
 Management of needle stick injuries.
 Management of waste.
 Management of laundry.
 Decontamination of reusable medical equipment.
 Decontamination of the environment.
9.3
Transmission Based Precautions.
9.3.1 Transmission Based Precautions are applied for residents known or suspected to
be infected or colonised with highly transmissible or epidemiologically important
micro-organisms spread by airborne, droplet or contact transmission and who
need additional precautions to prevent transmission.
9.3.2 Transmission Based Precautions ideally require the use of a single room with ensuite toilet facilities and with or without special air handling and ventilation.
9.4
Transmission Based Precautions are Contact, Droplet and Airborne Precautions.
9.4.1 Contact Precautions: Should be used for infections that can be transmitted by
direct contact with the resident e.g. Clostridium difficile, norovirus (winter vomiting
bug). Residents who present with diarrhoea may have an infectious origin. When
examining such residents Contact Precautions should be adhered to, to prevent
staff and staff clothes, equipment getting contaminated.
 Wear a disposable plastic apron and gloves for all interactions that may
involve direct contact with the resident.
 Wear gloves if there is a risk of exposure to blood, body fluids, secretions or
excretions.
 Perform hand hygiene after resident contact/removal of gloves.
9.4.2 Droplet Precautions: Should be used for infections such as influenza and
meningococcal meningitis which can be transmitted by droplets that are generated
by the resident during coughing, sneezing, talking, or while performing coughinducing procedures, e.g., sputum induction, administration of aerosolised
medications, airway suctioning.
 Wear a disposable plastic apron, gloves and surgical facemask for all
interactions that may involve direct contact with the resident and within close
proximity (i.e. 3 feet/1 meter) from the resident wear surgical face mask.
 Wear gloves if there is a risk of exposure to blood, body fluids, secretions or
excretions.
 Perform hand hygiene after resident contact/removal of gloves.
 Respirator masks (FFP2/3) masks maybe required for specific suspected or
confirmed infections during aerosol generating procedures such as above
procedures for influenza. (See point 10.4 for further information)
9.4.3
Airborne Precautions: Should be used for infections that can be transmitted by
very small respiratory particles that remain suspended in the air e.g. infective
pulmonary or laryngeal TB.
 Wear a disposable plastic apron, gloves and respirator mask (FFP2/3) for all
interactions with the patient.
10 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
 Wear gloves if there is a risk of exposure to blood, body fluids, secretions or
excretions
 Perform hand hygiene after resident contact/removal of gloves.
9.5
Recommended Measures for Residents that Require Transmission Based
Precautions
9.5.1
Resident placement. If possible, symptomatic residents who present a risk of
droplet transmission e.g., influenza, or airborne transmission e.g., TB should be
placed in a dedicated waiting area, away from other residents. If a dedicated
waiting area is not available then these residents should be placed at least one
meter away from other residents if possible.
9.5.2
Consider provision of a surgical mask for residents requiring droplet and airborne
precautions to wear while in the practice.
9.5.3
Have appropriate PPE readily available for any practice staff that require it.
9.5.4
Once the resident leaves, clean and decontaminate equipment and the
environment as appropriate.
10.0 Appropriate Resident Placement and Transmission Based Precautions.
10.1.1
Transmission based precautions are for residents who are known or suspected to
be infected or colonised with highly transmissible or epidemiologically important
microorganisms spread by airborne, droplet or contact transmission and who need
additional precautions to the standard precautions applied to all residents.
10.1.2
These precautions should commence on clinical suspicion: a laboratory
confirmation is not always necessary.
10.1.3
Residents with three or more episodes of diarrhoea must be isolated and
precautions put into place.
10.1.4
Transmission- Based Precautions ideally require the use of a single room.
10.1.5
For any resident that requires additional precautions, such as isolation, the nurse
on duty in the area must ensure that a notice is placed on the bedroom door
informing visitors to contact the nurse on duty before entering the room and the
door must remain closed at all times.
10.1.6
Staff must not sit on the resident’s bed.
10.1.7
Visitors must be informed that they should not sit on the resident’s bed.
10.1.8
Visitors must be informed that they should not visit other residents in [the Centre]
or frequent communal areas such as dining rooms.
10.1.9
The nurse on duty must inform the resident and/or representative of the presence
of an infection.
10.1.10
Equipment for the resident’s room should be supplied on a daily basis to prevent
overstocking. Equipment should include:
 Appropriate colour coded bins.
 Disposable plastic aprons.
 Disposable Gloves.
 Appropriate masks as recommended.
10.1.11
All waste is to be considered as healthcare risk waste.
11 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
10.1.12
Ideally, the resident will have dedicated equipment, however if this is not possible
at the time, shared equipment will be used e.g. sphygmomanometer. However,
staff must ensure that it is cleaned and disinfected before removal from the room.
10.1.13
Only immune staff should enter the room of residents with known or suspected
chickenpox, measles, or rubella. Staff who have immunity do not need to wear
respiratory protection.
10.1.14
Only staff who need to care for the resident are permitted access to the resident.
10.1.15
If an ambulance is being used for transport, then the nurse on duty must inform the
ambulance service of any extra precautions needed.
10.1.16
If the resident is being discharged home, the nurse on duty must inform the Public
Health Nurse and the resident’s GP.
10.1.17
In the event that a resident with a known or suspected infection needs to be
transferred to another facility e.g. general hospital, the nurse on duty must ensure
that the accepting facility is notified of the resident’s infection status.
10.1.18
In the event that a resident is being transferred from another facility to [the Centre]
it may be necessary to perform a risk assessment.
10.1.19
A potential resident should not be discriminated against because he/she has an
infection.
10.1.20
If staff are unsure of how to manage an infection they must contact the infection
prevention and control department / team in [enter name of local general hospital
with an infection control nurse / team and contact details] or the Health Protection
Surveillance Centre [email protected] or phone: 01-8765300 for support and advice.
.
11.0 Hand Hygiene
11.1 All staff working in the clinical environment must be ‘Bare Below the Elbows’ (BBE),
(http://www.npsa.nhs.uk/cleanyourhands).
11.1.1
All staff (clinical and non-clinical), and volunteers must remove any long sleeved
jackets / cardigans / jumpers / coats before commencing activities in the clinical
environment.
11.1.2
Wristwatches, bracelets (all types), all rings (except for a plain flat band), and false
nails must be removed. Wrist jewelry prevents the wearer from washing hands
adequately, especially around the wrists (WHO, 2009).
11.1.3
Fingernails should be kept short, clean and free from nail polish.
11.1.4
Nail brushes for staff hand hygiene are not recommended.
11.2 All healthcare staff in [the Centre] must clean their hands according to the “My 5
Moments of Hand Hygiene” which are:
 Before touching a resident.
 After touching a resident.
 Before clean/aseptic procedures.
 After touching resident surroundings.
 After body fluid exposure/risk.
11.3 Hand hygiene should also be performed in a range of other situations e.g.
 Before and after each work shift
 When the hands are visibly contaminated
 Before putting on and after removing PPE
 Before eating and drinking food
 After handling waste
 After cleaning clinical areas
12 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
Fig 1: Five Moments of Hand Hygiene.
1.
Before touching a
resident.
When?
Why?
2.
Before clean/aseptic
procedures.
When?
Why?
3.
After body fluid
exposure/risk.
When?
Why?
4.
5.
After touching a
resident.
After touching
resident surroundings
When?
Clean your hands before touching a resident when
approaching him/her.
To protect the resident against harmful
microorganisms carried on your skin.
Clean your hands immediately before performing
out a clean/aseptic technique.
To protect the resident against harmful
microorganisms, including the residents own from
entering his/her body.
Clean your hands immediately after an exposure
risk to body fluids (and after glove removal).
To protect yourself and the healthcare environment
from harmful resident microorganisms.
Clean your hands after touching a resident and
his/her immediate surroundings, when leaving the
residents side.
Why?
To protect yourself and the healthcare environment
from harmful resident microorganisms.
When?
Clean your hands after touching any object or
furniture in the resident’s immediate surroundings,
when leaving – even if the residents has not been
touched.
Why?
To protect yourself and the healthcare environment
from harmful microorganisms.
(WHO Guidelines on Hand Hygiene in Health Care, 2009)
13 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
11.3.1
Staff must decontaminate their hands using soap and water or, if hands are
physically clean, using an alcohol based hand rub/gel.
11.3.2
Staff must decontaminate their hands before and after handling food, eating,
drinking and following smoking.
11.3.3
Staff must apply waterproof dressings to cuts and abrasions that are likely to be
exposed to any pathogenic microorganism or body fluid.
11.3.4
Residents must be reminded to wash their hands after toileting and before meals.
Nurses or healthcare assistants should assist those residents unable to perform
hand hygiene independently.
N.B. Gloves are not a replacement for good hand hygiene. Staff must decontaminate
their hands before putting gloves on and after glove removal.
11.4 Alcohol based hand rub gel / foams are the preferred method for hand hygiene
when the hands are not soiled and are physically clean.
11.4.1 There are 2 situations where alcohol hand rub alone is not sufficient:
 After contact with a patient with known or suspected diarrhoea (e.g.
Clostridium Difficile or Norovirus.)
 Where hands are visibly soiled.
11.5 In these instances hand wash with antiseptic soap or plain soap followed by use of
an alcohol rub is recommended.
11.6 Routine Hand Washing with Soap and Water.
11.6.1
Staff must comply with the following practices for routine hand washing with soap
and water:

Wash their hands with soap and water for socially clean hands and to remove most
transient micro organisms




Use elbows to turn taps on and off.

In order for all hand surfaces are to be adequately covered, the hands must be
rubbed together vigorously for approximately 40 - 60 seconds (HSE, 2011).


Thoroughly rinse water off hands after washing.
11.6.2
Moisten hands with water before adding soap.
Add 3 to 5ml to cupped hands and then massage thoroughly to contact all surfaces.
Ensure contact of the solution with all surfaces: the palm, dorsum, tips of the fingers,
inter digital spaces, wrists and thumbs.
Dry hands thoroughly with soft, absorbent disposable paper towels.
Hands can be further protected by applying good quality hand cream at the end of
the shift and before retiring, with special attention paid to areas that look or appear
dry or red. Large, communal jars of hand cream are not desirable as the contents
can become contaminated, promoting cross-infection.
11.7 Decontamination with alcohol gels/rubs.
11.7.1
Alcohol gel should be used on visibly clean hands.
11.7.2
Approximately 3 - 5mls of alcohol gel should be applied onto the palm of hands.
14 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
11.7.3
Rub onto all areas of hands and wrists using the same technique as that of
washing hands using warm water and soap, taking approximately 30 seconds
(HSE, 2011).
11.7.4
Allow hands to dry completely.
11.8 Hand Drying
11.8.1
Effective drying of hands after washing is important, as wet surfaces transfer micro
- organisms more effectively than dry ones. Inadequately dried hands are prone to
skin damage.
11.8.2
Paper disposable towels should be used. In addition to drying the skin, these rub
away transient micro-organisms and dead skin cells attached to the surface of the
hands.
11.8.3
They should be conveniently placed in a wall-mounted dispenser.
11.8.4
If hand taps are used these can be turned off with a paper towel after hands have
been washed.
11.8.5
Dispose of used paper towels in a conveniently placed foot operated pedal bin.
11.9 The 2005 “Guidelines for Hand Hygiene in Irish Health Care Settings” apply to all
healthcare facilities including the community setting. They state that: 
Mandatory attendance (at least two yearly) at hand hygiene education and practice is
required for all HCWs involved in clinical areas.

Audit of compliance with hand hygiene guidelines and hand hygiene facilities is
required in all healthcare settings.
11.10 Caring for Your Hands
11.10.1 Bacterial counts increase when the skin is damaged. Hands should therefore
be protected by:

Proper technique of hand washing and wetting hands prior to application of
soaps and antiseptic detergents.

Proper drying method.

Applying a good quality emollient hand cream regularly to protect skin from
drying effects of regular hand decontamination.

Wall mounted dispensers for hand cream should be used.
N.B. Rashes or eczema of the hands or forearms must always be reported to [specify
person].
15 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
Fig 2: Routine/Social Hand Hygiene Poster
16 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
Fig 3: Alcohol Rub Hand Hygiene Poster
17 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
12.0 Use of Personal Protective Equipment.
12.1 Personal protective equipment (PPE) refers to a range of barriers and respirators
used alone or in combination to protect mucous membranes, airways, skin, and
clothing from contact with infectious agents. The selection of protective equipment
required depends on an assessment of the risk of transmission of microorganisms to
the resident, and the risk of contamination of the healthcare practitioner’s clothing
and skin by residents’ blood, body fluids, secretions or excretions.
12.1.1
Staff should make a risk assessment of the planned procedure/action and select
PPE, depending on:
The nature of the procedure

The risk of exposure to blood, body fluids, mucous membranes and nonintact skin

The risk of contamination.
Types of protective clothing available
Gloves
18 | 8 7
Should be worn for:1. Invasive procedures
2. Contact with sterile sites
3. Contact with non-intact skin/mucous membranes
4. All actions that have been assessed as carrying a risk of exposure to
blood, body fluids, secretions/excretions, or to sharps or contaminated
instruments (including handling of laboratory specimens).
Gloves are single use items and should conform to European Community
Standards.
Gloves should be changed between different treatment activities for the
same resident.
Sensitivity to natural rubber latex in residents/staff should be documented,
and alternatives to natural rubber latex gloves must be available. Nitrile
gloves are a good alternative for latex sensitive individuals.
Glove use does not remove the need to comply with hand hygiene.
Hands should be cleaned prior to putting on gloves and hand hygiene (hand
washing/alcohol hand rub) must be performed immediately after glove
removal.
Hand washing with soap and water is advised when gloves are removed
because of a tear or a puncture and the staff member has had contact with
blood or another body fluid; this situation is considered to be equivalent to a
direct
Gloves should be disposed of into the appropriate waste stream.
Non Sterile Gloves
Should be used when hands may come into contact with body fluids or
equipment contaminated with body fluids, or touching mucous membranes
for example handling specimens.
Sterile Gloves
Should be used when the hand is likely to come into contact with normally
sterile areas or during the introduction of an invasive device or during any
surgical procedure.
NMA Infection Prevention and Control Policy and Procedures 10052016
Types of protective clothing available
Disposable
Aprons
Full-body
fluid-repellent
gowns
Should be worn
1. When there is a risk that clothing may be exposed to blood, body fluids,
secretions or excretions, with the exception of sweat.
Plastic aprons should be worn as single-use items and then discarded into
the appropriate waste stream.
Should be worn
1. Where there is a risk of extensive splashing of blood, body fluids,
secretions or excretions, with the exception of sweat, onto the skin or
clothing of healthcare staff.
Face masks
Should be worn
(surgical) and 1. Where there is a risk of blood, body fluids, secretions or excretions
eye protection splashing into the face and eyes.
(visor/goggles)
Respiratory
protective
equipment
Should be worn
1. Surgical masks should be worn by staff where there is a risk of droplet
transmission.
2. A particulate filter mask (respirator) FFP2/3 should be worn by practice
staff where there is a risk of airborne transmission (when clinically
indicated) See point 12.4.9 for further information
12.2 Glove use
12.2.1
Disposable gloves are recommended to be worn for two main reasons:
 To reduce the risk of
contamination of healthcare workers’ hands with blood and
other body fluids.
 To reduce the risk of spreading germs to the environment and transmission from
the healthcare worker to the resident and vice versa, as well as from one resident
to another.
12.2.2
Gloves must not be worn unnecessarily as their prolonged and indiscriminate use
may cause adverse reactions and skin sensitivity, (Yassin et al 1994)
12.2.3
Gloves must be worn as single use items and discarded in a domestic waste bin
after each care activity for which they were worn.
12.2.4
Hand hygiene must be performed prior to donning gloves where indicated by the ‘5
Moments of Hand Hygiene’.
12.2.5
When wearing gloves, change or remove gloves during resident care if moving
from a contaminated body site to either another body site (including non-intact
skin, mucous membrane or medical device) within the same resident or the
environment
12.2.6
Hands must be decontaminated following the removal of gloves.
12.2.7
All Staff should choosing appropriate gloves based on the risk assessment in Fig 4
and Fig 5 the World Health Organisation (WHO) Pyramid of Glove use.
12.2.8
When performing a risk assessment, staff should consider the following:
 Who is at risk i.e. the staff member or the resident and whether sterile or nonsterile gloves are required.
 The potential for exposure to blood, body fluids, secretions and excretions.
 Contact with non-intact skin or mucous membranes during general care and
invasive procedures.
19 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
Fig 4: Risk Assessment and Glove Use Chart.
Has the risk assessment identified
that there is a risk of exposure to?
 Blood/body fluids
 Non-intact skin
 Mucous membranes
 Chemical/hazardous substances.
Yes
No
Gloves required
Gloves not required
20 | 8 7
Resident risk
User risk
Sterile
Non Sterile
NMA Infection Prevention and Control Policy and Procedures 10052016
Fig 5: Pyramid of Glove Use.
Sterile
Gloves
Indicated
invasive
procedure
s
E.g. Urinary
catheterisation
Clean Gloves Indicated
Potential for touching blood, bodily
fluids, secretions, excretions and
items visibly soiled with bodily fluids
e.g. contact with blood, mucous
membranes and non-intact skin.
Potential
presence
of
highly
dangerous and infection organisms,
IV insertion and removal, withdrawing
blood, pelvic or vaginal examination.
Also handling waste and cleaning up
Catheterisati
spills of bodily
fluids
on.eg
Gloves Not Indicated
No potential exposure to blood or bodily fluids or
contaminated environment.
e.g. taking blood pressure, temperature or pulse, giving
Subcut or I.M. injections, bathing and dressing a resident,
caring for eyes and ears (without secretions), giving oral
medications.
Using the telephone, writing in a residents chart,
distributing or collecting dietary trays, removing or
replacing linen from a resident’s bed, moving resident
furniture.
,
Adapted from the WHO, 2008.
21 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
12.3 Aprons
12.3.1
Staff in [the Centre] should only wear disposable plastic aprons when there is a
risk that clothing or uniform may become exposed to residents’, blood, body fluids,
secretions (except sweat) or excretions.
12.3.2
Following use, the apron should be discarded, and hands washed between dealing
with different residents and before any other activity.
12.4 Eye Protection/Masks
12.4.1
The use of protective eye wear and fluid shield masks are not normal practice in
[the Centre] and if the need arises, this should be discussed with the person in
charge [or specify other person].
12.4.2
Protective eye wear and fluid shield masks are required to protect the mucous
membranes of the eyes, nose and mouth, and are only required during any
procedure or resident care activity where there is a risk of blood and/or body fluids
splashing onto the face.
12.4.3
Masks should be worn by staff where there is a risk of droplet transmission e.g.
influenza.
12.4.4
Masks should be fluid resistant, single use and disposable and should be
discarded after use.
12.4.5
Masks should be fitted correctly to be effective.
12.4.6
Replace the mask if it becomes wet or soiled.
12.4.7
Remove mask by pulling on the strings – do not touch the front of the mask, as this
is likely to be heavily contaminated.
12.4.8
Dispose of the mask into the healthcare risk waste bin.
12.4.9
Perform hand hygiene after mask is removed.
o
o
FFP2 masks are designed is to help prevent particles (droplets) being expelled into
the environment by the wearer. Masks are also resistant to fluids, and help protect
the wearer from splashes of blood or other potentially infectious substances.
FFP3 masks (respirators) are to help reduce the wearer's exposure to airborne
particles. They resemble surgical face masks. They are made to defined national
standards (European standard EN149:2001 FFP3 respirator). The standards define
the performance required of the respirator, including filtration efficiency. When worn
correctly, they seal firmly to the face, thus reducing the risk of leakage. Usually
required when caring for a person with SARS.
12.5 Removal of PPE
Step 1: Remove gloves
Step 2: Remove apron/gown
Step 3: Decontaminate hands
Step 4: Remove eye wear
Step 5: Remove mask (do not touch the front of mask)
Step 6: Decontaminate hands
22 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
Fig 6: Donning and Removal of Personal Protective Equipment.
23 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
13.0 The Management of Spillages of Blood and Body Fluids
The person who discovers the spill is responsible for making it safe.
13.1 Blood Spills
13.1.1
Spills of blood and other high risk body fluids represent an infection risk and
should be removed as soon as possible as described below.
13.1.2
Body fluids/tissue that should be handled with the same precautions as blood
includes:
Anybody fluid containing visible blood.
Vaginal secretions, semen, synovial fluid, cerebrospinal, peritoneal fluids.
Saliva in association with dentistry.
13.2 Precautions to be taken with all Blood Spills
13.2.1
Position a warning sign “cleaning in progress” beside the contaminated area.
13.2.2
Keep other persons away from the contamination until it is effectively and
appropriately dealt with.
13.2.3
Cuts/abrasions or breaks in the skin must be covered with waterproof dressing.
13.2.4
All necessary equipment to deal with a spillage must first be gathered, including
personal protective equipment (PPE) and spillage kits (if used). For ease of use
spillage kits can be used as they contain all the necessary materials. These are
stored in the clinical room and should be checked to see that they are in date prior
to use.
13.2.5
Consider which PPE is required. Single use, non-sterile disposable gloves and a
plastic apron must be worn when dealing with a spillage. If there is the potential of
a splash to the conjunctiva or mucous membranes, face protection such as a mask
and visor or goggles must be worn.
13.2.6
Glass fragments must be picked up using a scoop and placed in a sharps bin. Eye
protection must be worn when dealing with glass fragments.
13.3 Spots/Splashes of Blood or Small Volume Spills of Blood (less than 30 mls)
13.3.1
Wear a disposable plastic apron and gloves.
13.3.2
Wipe up the spots/splashes/small volume spills with paper towels which have been
soaked in a freshly prepared solution of sodium hypochlorite 1,000ppm. Place
waste into a yellow healthcare risk waste bag.
13.3.3
Clean the area with a solution of detergent and warm water.
13.3.4
Disinfect with solution of sodium hypochlorite 1,000 ppm
13.3.5
Remove gloves and apron and place into a yellow healthcare risk waste bag
13.3.6
Perform hand hygiene
OR if using spill kit [enter where these are located / stored]
13.3.7
Cover the spillage with sodium hypochlorite granules
13.3.8
Leave for 2-3 minutes to allow for disinfection.
13.3.9
When the fluid is completely absorbed, scoop up with a disposable scoop
(contained in some spill kits) or mop up with disposable cloth or paper towel and
place in a yellow healthcare risk waste bag.
24 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
13.3.10
Clean the area with a solution of detergent and warm water.
13.3.11
Disinfect with solution of sodium hypochlorite 1,000 ppm
13.3.12
Remove gloves and apron and place into a yellow healthcare risk waste bag.
13.3.13
Perform hand hygiene.
Where hypochlorite granules not available follow method for large spill (see below) using
freshly prepared solution of sodium hypochlorite 10,000 ppm.
13.4 Large Volume Spill of Blood (greater than 30 mls)
13.4.1
Concentrated chlorine granules are not suitable for dealing with large spills as
large amounts can act as a respiratory irritant.
13.4.2
Ventilation is essential during the cleaning process.
13.4.3
Wear a disposable plastic apron and gloves.
13.4.4
If there is a risk of splashing, wear a mask and eye protection (visor or goggles).
13.4.5
Place paper towels over the spillage.
13.4.6
Pour freshly prepared solution of sodium hypochlorite 10,000ppm over the blood
soaked towels.
13.4.7
Leave for 2-3 minutes.
13.4.8
Gather the soiled paper towels (fresh paper towels may be required to soak up all
the liquid) and discard into a yellow healthcare risk waste bag, or into yellow rigid
bin if there is a risk of leakage.
13.4.9
Clean the area with a solution of detergent and warm water.
13.4.10
Disinfect with solution of sodium hypochlorite 1,000 ppm
13.4.11
Allow to dry.
13.4.12
Remove personal protective equipment and place in yellow healthcare risk waste
bag.
13.4.13
Perform hand hygiene immediately after removing gloves.
13.5 All items used during a spillage must be disposed of, or decontaminated
appropriately.
13.6 Spillage of Urine Faeces or Vomit
13.6.1
Wear a disposable plastic apron and gloves.
13.6.2
Chlorine based disinfectants should not be added to spillages of urine or vomit as
it may result in the release of toxic chlorine vapour.
13.6.3
Cover the spill (urine, faeces or vomit) with disposable paper towels and allow
being completely absorbed.
13.6.4
Using the paper towels, mop up the area of spillage.
13.6.5
Place the paper towels into a non-risk healthcare waste bag. If urine is bloodstained or faeces is from a resident known or suspected to have a gastrointestinal
infection, then place the paper towels into a yellow healthcare risk waste bag.
13.6.6
Clean the area with a solution of neutral detergent and warm water. Allow to dry.
13.6.7
Then disinfect the contaminated area using a disposable cloth or paper towels
soaked with a freshly made solution of sodium hypochlorite 1,000ppm
13.6.8
Remove personal protective equipment and place in a non-risk healthcare waste
bag. If dealing with a faeces spill from a resident known, or suspected to have a
25 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
gastrointestinal infection, place into a yellow healthcare risk waste bag if
contaminated.
13.6.9
Perform hand hygiene immediately after removing gloves.

Staff should deal with a blood and body fluid spillage immediately or as soon as it is
safe to do so.

Residents, staff and visitors should be kept away from the spillage until the area has
been cleaned and dried.

Care should be taken if there are sharps present and sharps should first be disposed of
appropriately into a sharps container.

Spills should be removed before the area is cleaned.

Area should be well ventilated if using chlorinating agents.

Adding liquids to spills increases the size of the spill and should be avoided.

If non-disposable cloths/mops are used to clean spillage area they must be thermally or
chemically disinfected – thermally disinfect by washing at a temperature of 65° for 10
minutes or 71° for 3 minutes.
14.0
Management of Sharps
14.1.1
Any staff member in [the Centre] using a sharp is personally responsible for the
safe use and disposal of that sharp.
14.1.2
After use, needles and syringes should be disposed of as a single unit and put
directly into a yellow sharps container with a red lid.
14.1.3
Sharps must not be passed directly from hand to hand and handling should be
kept to a minimum.
14.1.4
Sharps container should always be taken to the point of usage to ensure
immediate disposal of the sharp.
14.1.5
Temporary closure must be applied when Healthcare Worker is transporting a
sharp container (e.g. going to a bed side to give an injection) and when sharp
container is not in use.
14.1.6
Needles should never be recapped, bent, broken or disassembled before disposal.
14.1.7
Sharps containers should be securely stored out of reach of residents, visitors and
children.
14.1.8
The containers should be sealed when 3/4 full.
14.1.9
Sealed containers should be stored in the locked treatment room awaiting
collection.
14.1.10
The person assembling the sharps container must ensure this is done correctly.
14.1.11
On closing the container, the person doing so must sign that the container is
sealed securely. The date and the name of the Nursing Home must also be
identified.
14.1.12
Sharps containers should be removed for disposal only when the above
information is completed.
26 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
Sharps Containers with a Red or Blue Lid
Yellow rigid puncture-resistant box/bin used
for:
 All used sharps
 Needles and syringes
 Blood stained /contaminated glass
 Stitch cutters
Excluded items:
 Cytotoxic waste
 Chemicals/pharmaceuticals
 Free liquids
Place sharps containers out of the reach of
children and all unauthorized people at ALL
times.
Always dispose of sharps safely
15.0 Safe Injection Practices
15.1.1
The following recommendations apply to the use of needles, cannula’s that replace
needles, and, where applicable intravenous delivery systems.
15.1.2
Staff should use aseptic technique to avoid contamination of sterile
injection equipment.
Medication from a syringe should not be administered to multiple
residents, even if the needle or cannula on the syringe is changed.
Needles, cannula and syringes are sterile, single-use items; they
should not be reused for another resident or to access a medication
or solution that might be used for a subsequent resident
15.1.3
Use fluid infusion and administration sets (i.e. intravenous bags, tubing and
connectors) for one resident only and dispose appropriately after use.
15.1.4
Consider a syringe or needle/cannula contaminated once it has been used to enter
or connect to a resident's infusion bag or administration set
15.1.5
Do not administer medications from single-dose vials or ampoules to multiple
residents or combine leftover contents for later use.
15.1.6
If multidose vials must be used, both the needle or cannula and syringe used to
access the multidose vial must be sterile.
15.1.7
Multiple dose vials should be restricted to single resident use only.
15.1.8
The vial should be labeled with the residents name and date opened.
15.1.9
Do not keep multidose vials in the immediate resident treatment area and store in
accordance with the manufacturer's recommendations; discard if sterility is
compromised or questionable.
15.1.10
Do not use bags or bottles of intravenous solution as a common source of supply
for multiple residents.
27 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
15.2 Single Dose Vials
 Use single dose vials wherever possible.
 Do not use single dose vials for multiple residents.
 Do not combine leftover medication from different vials for later use.
15.3 Multiple Dose Vials
 Multiple dose vials should only be used when absolutely necessary (i.e., where
there is no alternative).
 Restrict wherever possible the use of multiple dose vials to a single resident. Label
vial with resident name and date opened.
 Discard if sterility is compromised or questionable.
 Use a sterile syringe and needle every time a medication vial is accessed, even if
it to obtain a second dose for the same patient.
15.4 Safe Handling of Sharps.
Sharps include items such as syringes, needles, scalpel blades, phials, razors, etc.
15.4.1
Sharps containers must always be handled carefully.
15.4.2
Staff must transport a sharps container by the handle and away from the body.
15.4.3
Sharp containers must be transported and placed in an upright position.
15.4.4
Temporary closure must be applied when the nurse or healthcare worker is
transporting a sharp container (e.g. going to a bed side to give an injection) and
when sharp box not in use.
15.4.5
If a sharp object is found, protect self, remove item carefully and place into a
sharps container. Do not physically handle a sharp object use a dustpan to
manipulate the sharp instead.
15.4.6
Inform the clinical nurse manager if there is a breach in the system.
15.4.7
Do not pass sharps from hand to hand. Use kidney dish / tray.
15.4.8
When using sharps during a procedure, ensure that they do not become obscured
by dressings, paper toweling or drapes etc.
15.4.9
Ask for assistance when taking blood / giving injections to uncooperative or
confused residents.
15.5 Disposal of Used Sharps
15.5.1
All sharps must be discarded directly into a sharps container with a red lid.
15.5.2
Syringes and needles should be disposed of as a single unit.
15.5.3
Needles should not be re-capped, bent, broken or disassembled.
15.5.4
Sharps should not be passed from person to person by hand.
15.5.5
Sharps containers should always be taken to the point of usage to ensure
immediate disposal of the sharp.
15.5.6
Sharps containers should never be over filled.
15.5.7
Sharps containers should not contain free fluids that may spill.
28 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
15.5.8
Sharps containers should never be left on the floor.
15.5.9
The designated person responsible for the removal / disposal of Sharp containers
must ensure sharp containers are tagged, sealed / locked before removal for
disposal.
15.5.10 Personnel involved in the removal of Sharp containers for disposal must wear
heavy duty gloves and protective clothing.
15.6 Blood and Body Fluid Exposures
15.6.1 Such exposures include:
 All sharps/needle stick injuries.
 Contamination of abrasions with blood or body fluids.
 Human scratches/bites causing bleeding.
 Splashes of blood/body fluids onto mucous membranes (e.g. mouth and eyes).
 Aspiration or ingestion of blood, blood components or other body fluids.
15.6.2
The wound should be washed with running water and soap.
15.6.3
Do not scrub or use a nailbrush.
15.6.4
Do not suck the wound.
15.6.5
The wound should be covered.
15.6.6
Skin, eyes or mouth should be washed out with copious amounts of water.
15.6.7
The incident should be reported immediately to [specify who].
15.6.8
An incident form should be completed.
15.6.9
The staff member who sustained the wound should attend the [specify local]
Accident and Emergency Department or Occupational health Department
immediately.
15.6.10
The situation will then be assessed and arrangements made for blood samples to
be taken from the person exposed.
15.6.11
Consent needs to be requested by the residents GP, and arrangements may be
made for the resident’s blood samples to be taken also.
15.6.12
All blood samples from the resident should be sent to the Microbiology laboratory
and the form marked ‘Innoculation Injury’.
15.6.13
A Root Cause Analysis should be carried out by person in charge [or specify who
is responsible] to inform future practice.
29 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
Fig 7: Blood and Body Fluids Exposure
Stop what you are doing immediately
If body fluid splash to eyes
If sharps Injury
If body fluid splash to
mouth
Encourage Bleeding
DO NOT SUCK
Irrigate with cold
water
Wash well with running soap and
water
Do not swallow fluid.
Rinse out mouth
several times with cold
water
Dry and apply dressing
Report incident to [specify person]
and complete an Incident Form
Risk Assessment by G.P or A&E Dept.
(HSE - Guidelines for Infection Control in Nursing/Residential Homes, 2006)
30 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
16.0 The Management of Needle Stick Injuries.
(NB: Employers have responsibility to protect staff from sharps injuries and to manage
sharps injuries appropriately. These are based on Council Directive 2010/32/EU of the 10th
May 2010. For further information download the Prevention of Sharps Injuries in Healthcare
Information Sheet from the Health and Safety Authority Website www.hsa.ie)
16.1 [The Centre] is committed to the protection of all employees, residents and visitors
from risk of injury and infections from the presence and use of medical sharps in [the
Centre]. For this reason, [the Centre] employs the following management framework
to provide a safe working environment for all employees and protect all employees,
residents and visitors from risk of sharps injury and /or infection.
16.1.1
A risk assessment has been completed which identifies hazards, risks and control
measures in place to address the risks. This is recorded in [the Centre’s] Risk
Register.
16.1.2
The following control measures are in place to address the risk:


All staff who handle sharps are offered the Hepatitis B Vaccine.
All staff receive training on standard precautions at induction, every year and
where there is any significant change in practice.

Personal protective equipment, including gloves, aprons, masks and eye
goggles are provided for staff for use whenever there is a risk of exposure to
blood/body fluids.


Sharps containers comply with National Standards (UN 3291, BS 7320).

Sharps containers awaiting removal by the external contractor are locked in
the treatment room.

The following procedures outline work practices that must be followed for the
safe use and disposal of sharps and management of sharps injuries.
Sharps containers are wall mounted in locked clinical rooms and portable
sharps containers are available so that they can be available at the point of
use.
16.2 Management of a Needle Stick Injury.
In the event of a needle stick injury, the staff member should immediately stop what they are
doing and take the following steps:







Encourage the area to bleed freely by washing under warm running water.

Report the incident to the person in charge or senior nurse on duty [or specify
other]

Complete an incident form.
Do not suck the puncture site
Do not scrub the site
Wash the site thoroughly with soap and water
Dry the area thoroughly
Apply waterproof dressing.
Where possible the source should be identified, that is, which resident is the
source.
31 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
REMEMBER
BLEED IT → WASH IT → DRESS IT → REPORT IT
16.2.1
Blood tests may be obtained from the source where possible (only with the
sources consent) and checked for hepatitis B, Hepatitis C, and HIV.
16.2.2
The staff member may need to attend enter name of local] occupational health
department or A&E department for an assessment for any further follow-up
treatment that may be required including having his/her bloods taken. The risk of
infection must be assessed and post-exposure prophylaxis (PEP) treatment
protocols started immediately after the injury if advised.
16.2.3
[The Centre] adopts a no blame culture, and it is important that sharps injuries are
properly investigated to identify systemic failures.
16.2.4
[The Centre] should communicate the importance of follow-up and treatment, and
attending all appointments for blood tests. Staff will be released from work to
attend the follow-up appointments.
16.2.5
Counselling will be available for all staff at risk of sharps injuries if required. The
staff member should speak with the person in charge regarding this.
16.3 Obtaining Blood Sample from Source Resident
16.3.1
Where the source resident is known, and does not lack mental capacity, a
consultation with him/her should be carried out by the person in charge in
association with the resident’s general practitioner.
16.3.2
The person in charge/general practitioner should explain to the source resident in
simple language exactly what has happened and ask the source resident if they
are known to be infected with Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) or
Human Immunodeficiency Virus (HIV).
16.3.3
If the source residents Blood Borne Virus (BBV) status is unknown, the person in
charge /general practitioner can request permission from the source resident to
have a blood sample taken for testing for HBV, HCV and HIV.
16.3.4
Informed consent must be obtained for this testing. All necessary information
must be provided to the source residents by explaining to him/her why the tests
are being done, exactly what tests will be carried out, and the implications for them
if a test result is positive.
16.3.5
The source resident must be informed that they are free to refuse to provide
a sample or to have this testing carried out. An information leaflet should be
provided. If the source resident refuses consent, this fact should be recorded by
the health professional in the nursing and medical records.
16.3.6
The source resident should be told that the blood results will be provided by the
testing laboratory to their general practitioner and the person in charge and that
the staff member who sustained the injury will also be told the blood results. The
confidential nature of the testing process should be emphasized to the source
resident.
16.3.7
If, as a result of the outcome of this testing, follow-up care is necessary for the
source resident (e.g. referral to an infectious diseases consultant), this must be
arranged by his /her general practitioner.
16.3.8
Informed consent: the components of a legally valid consent are that it must be
given by a person with the capacity to consent, it must be given voluntarily and not
under any duress or coercion and the person must be given sufficient information
to allow them to make a decision. Fully informed consent requires a clinician to
32 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
disclose to the person the reason for the test or procedure, the benefits and all of
the material risks associated with the test or procedure together with the
consequences of having or not having the test or procedure and the person
understands the information that has been provided, and has been given an
opportunity to consider and weigh it up in order to make a decision.
16.3.9
If the source resident is unknown or known but refuses testing, the risk should be
assessed based on any available information, including:

The circumstances of the exposure i.e. the type of injury and the type of
material involved e.g.
 Percutaneous injuries
 Human bites which break the skin (not bruising or indentation of the
skin)
 Exposure of broken skin to blood or body fluids.
 Exposure of mucous membranes (including the eye) to blood or
body fluids, e.g. by splashing

The epidemiological likelihood of Blood Borne Virus (BBV) in the source
resident e.g.
 Known to have a BBV
 (History of) Injecting drug user
 (History of) Commercial sex worker (CSW),
 (History of) Men who have sex with men (MSM),
 Born in an endemic country e.g. Sub-Saharan Africa
 Sexual partner with a risk factor.
16.3.10
Consent is required by a clinician who treats, examines, tests or operates on a
person and to do so without that person’s consent would result in that clinician/
nurse committing an unlawful act.
16.3.11
There are exceptions to this principle, usually in exceptional or emergency cases
where the treatment is necessary to save the life of or preserve the health of a
person.
16.3.12
To ensure the greatest level of protection to persons taking samples, where
consent is not forthcoming, an application to Court should be made. Under
Irish law, informed consent to testing should be obtained from the source
prior to carrying out the test. Where this is not available, the permission of
the Court to test should be obtained, save in exceptional circumstances
where the treatment is necessary to save the life of or preserve the health of
a person and there would not be sufficient time in which to make an
application to Court. An application can be made to Court at very short
notice. (Health Protection Surveillance Centre and Health Service Executive,
2012).
17.0 Respiratory Hygiene and Cough Etiquette
17.1 Staff should encourage residents to report any flu like symptoms such as, fever,
headache, tiredness, dry cough, sore throat, nasal congestion and body aches.
17.1.1
To prevent the transmission of all respiratory infections in healthcare settings,
including influenza, respiratory hygiene and cough etiquette the following should
be implemented at the first point of contact with a potentially infected person.
17.1.2
The following measures to contain respiratory secretions are recommended for all
individuals with signs and symptoms of a respiratory infection.
17.1.3
Influenza (flu) and other serious respiratory illnesses are spread by cough,
sneezing, or unclean hands.
17.1.4
To help stop the spread of respiratory infections staff, visitors and residents
should:
33 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016

Cover the mouth and nose with a tissue when they cough or sneeze.

Put any used tissues in the waste basket.

If they don’t have a tissue, cough or sneeze into their upper sleeve or elbow, not their
hands.

Inform people that they may be asked to put on a facemask to protect others.

Encourage people to wash their hands often with soap and warm water for 20
seconds.

If soap and water are not available, use an alcohol-based hand rub.
17.1.5
Staff should ensure the availability of materials e.g. tissues and bins, for adhering
to Respiratory Hygiene/Cough Etiquette for residents.
17.1.6
Staff should also encourage or assist residents to carry out hand hygiene.
17.1.7
Visitors should be encouraged to use the alcohol rub on entering and leaving [the
Centre].
17.2 Masking and Separation of Persons with Respiratory Symptoms
17.2.1
During periods of increased respiratory infection masks may be offered to persons
who are coughing. This may only be deemed necessary whereby there are a
number of residents and staff with respiratory infections.
17.2.2
Use either procedure masks (i.e. with ear loops) or surgical masks (i.e. with ties).
17.2.3
Residents may be asked to wear a mask when he/she is leaving the bedroom and
going to communal areas.
17.2.4
Encourage coughing persons to sit at least three feet away from others in common
areas such as dining rooms and sitting rooms.
18.0 The Management of Waste
18.1 Healthcare waste is defined as the solid or liquid waste arising from healthcare or
health related facilities (DOHC, 2008).
18.1.1
Categories include
a) Health Care Non-Risk Waste – black or clear [specify colour used in the centre]
b) Health Care Risk Waste – Yellow
18.2 Health care risk waste
18.2.1
Healthcare risk waste includes any waste which by nature of its toxic, infectious or
dangerous content may prove hazardous to those having contact with it. Examples
include: Syringes/needles/sharp instruments e.g. lancets, tips of I.V. sets, stitch cutters,
razors etc.
 Human/animal tissue/leeches/worms.
 Blood and any items visibly soiled with blood e.g. dressings, wound drains,
blood stained disposable clothing etc.
 Sputum containers, suction tubing, suction canisters etc.
 Waste generated in an area of known or suspected infection.
 Incontinence pads from residents with known or suspected enteric pathogens.
 Laboratory and post-mortem room waste
 Pharmaceutical waste.
 Radioactive waste.
34 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
18.3 Healthcare non risk waste
18.3.1
Healthcare non risk waste includes:
 Domestic waste - normal household and catering waste, all non-infectious
waste, non-toxic, non-radioactive waste and non-chemical waste,
 Confidential Material - Includes shredded waste documents of a confidential
nature.
 Medical equipment- Assessed as non-infectious, i.e. not contaminated with
blood or hazardous body fluids, e.g. plastic bottles, plastic packaging, etc.
 Potentially offensive material - Assessed as non-infectious, i.e. not
contaminated with blood or hazardous body fluids, e.g. incontinence wear,
stoma bags, etc.
18.3.2
The Person in Charge and all staff have a duty to ensure that the following
necessary precautions are taken when disposing of health care risk waste:

Waste is carefully labelled, secured and stored safely.

Black or clear bags are used for healthcare non-risk waste, and disposed of to
a landfill site.
 Yellow bags are used for healthcare risk waste, and disposed of in accordance
with national policy and legislation.
18.4 Black, clear and yellow bags
18.4.1
Bags must never be more than 2/3 full as over-filling may cause the bag to split in
transport.
18.4.2
All yellow bags must be tagged prior to final disposal from [the Centre].
18.4.3
Bags must never be dragged or thrown as this may result in the bag splitting.
18.4.4
Waste should be segregated into the appropriate containers outside i.e. green
containers for healthcare non- risk waste, yellow containers for healthcare risk
waste, purple containers for food and red container for items suitable for recycling
 Not accessible to members of the public.

Is free from pests and rodents
Yellow Risk Waste Bags
Yellow Clinical Waste Bags used for:
 Blood stained or contaminated/infectious
items including dressings, swabs,
bandages, personal protective equipment
(gowns, aprons, gloves). Suction catheters
and tubing.
 Incontinence waste from known or
suspected enteric infections.
 Soft Waste Only, no hard objects.
Excluded items:
 Sharps or fluids.
 Disposable forceps (should be placed in
sharps container/yellow rigid bin as they
will tear yellow bag).
 Chemical/cytotoxic/pharmaceutical waste.
 Blood or blood components.
35 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
18.5 Storage of Waste
18.5.1
Waste in stored in a secure designated area at [enter where waste storage / bins
are kept].
18.5.2
Storage areas for waste in [the Centre] conform to the following: Well ventilated, well drained, impervious hard standing
 Enclosed compound with lockable gates
 Secure from interference by unauthorised persons, children or scavenging
animal.
 Storage areas should be easily accessible to collection vehicles.
 Healthcare risk waste must be kept separate from non-risk waste, to minimise
the risk of accidental cross contamination.
18.5.3
Storage areas have:
 Sufficient capacity for the proposed frequency of collection including a margin
for an interruption in the collection/disposal system.
 Empty and full containers must be adequately segregated and must be of
sufficient capacity to adequately contain unanticipated volumes.
 The storage of healthcare waste should be for as short a time as possible.
18.6 Disposal of Clinical Risk Waste
18.6.1
[The Centre] have a contract with [enter details of risk waste disposal company] for
the disposal of clinical risk waste.
18.6.2
The waste is collected on a scheduled basis and upon request. On collection of
the risk waste, a docket is issued and following safe disposal an additional
certificate is sent to [the Centre] – these dockets are stored in [specify where].
18.7 Disposal of Pharmaceutical Products
18.7.1
Unused drugs and other pharmaceutical products must be returned to the
pharmacist; they must not be administered to any resident, other than the resident
for whom they were dispensed.
19.0 The Management of Laundry
19.1 Clothing or bed linen used by residents may be heavily contaminated with microorganisms and therefore be a possible source of infection. All laundering is carried
out on site.
19.1.1
For this reason careful handling, segregation and bagging of linen is essential.

Aprons and gloves must be worn when dealing with used laundry.

Any skin lesions must be covered with a waterproof dressing.

Adequate hand-washing facilities are available and conveniently located.

Protective clothing must be removed and hands washed before returning to other
duties.

Used linen must be removed from a resident’s bed with care, avoiding the
creation of dust, and placed in the appropriate bag at the bedside.

Used linen should never be sorted in the resident’s bedroom.

When handling linen contaminated or soiled with blood, urine or faeces, staff
must wear appropriate protective clothing, remove any solid matter and place
linen in an alginate / water-soluble bag at the bedside immediately as it may be a
source of infection e.g. Norovirus.
36 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016

Infested linen (e.g. with lice or fleas) should be dealt with in the same way. Such
action reduces handling of the linen to a minimum and therefore reduces the risk
of infection.

Linen should not be rolled into a mass for bagging.

Bags should never be overfilled as this may prevent closure, increase the risk of
rupture of the bags in transit and increase the risk of injury to handlers.

Hands should be washed following the removal of protective clothing.
19.2 Categories of Linen
19.2.1
The risk of infection from linen is minimal, if handled properly.
19.2.2
All linen other than residents clothing is laundered off-site.
19.2.3
Linen soiled with blood, body fluids, secretions and excretions should be handled,
transported and processed in a manner that prevents skin and mucous membrane
exposures and contamination of clothing, and that avoids transfer of microorganisms to other residents and environments.
19.2.4
Manual sluicing is not recommended.
19.2.5
Categories of linen are identified by the use of colour coded bags and linen skip
lids. Signage is erected in the soiled linen store area to indicate appropriate use.
19.2.6
It is the responsibility of staff to ensure that the correct bag/skip is used.
19.2.7
Linen should never be transferred from one bag to another bag.
19.2.8
Clean linen should always be kept separate from soiled linen to prevent cross
contamination.
19.2.9
Soiled linen or clothes should never be placed on the floor in the bedroom or
laundry room.
19.2.10
Linen can be divided into the following categories.
 Used/Non-Fouled linen
 Bed linen is placed into a [enter colour] canvas bag with the [enter colour]
lid on the linen skip.
 Resident personal clothing is placed is into a [enter colour] canvas bag
with the [enter colour] lid on the linen skip.
 Infected/Fouled Linen
 Fouled or soiled linen is placed into a water soluble bag which is secured by
using the string attached to the bag. .
 The water soluble bag is then placed into a [red] canvas bag with [red] lid on
linen skip for soiled linen
 Do not overfill the water soluble bag.
 The water soluble bag prevents further handling of the contaminated linen as
the bag is placed directly into the washing machine.
19.2.11
Appropriate use of alginate / water soluble bag
 All linen from known or suspected cases of infection e.g. Clostridium Difficile.
 All blood stained linen from any resident.
 All linen soiled with urine or faeces from any resident.
19.2.12
Pillows
 Pillows should be covered at all times with a heat sealed plastic covering.
 Stained/contaminated pillows and pillows where the plastic has been torn
should be replaced as necessary
37 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
19.2.13
Curtains.
 Routine curtain changes should occur [enter frequency – at least twice yearly]
in [the Centre].
19.2.14
Duvets.
 Duvets: should be washed between resident use and when contaminated.
 Heat sealed and waterproofed duvets can be decontaminated by staff by
wiping down the duvet.
 Fibre filled duvets are washed in [enter arrangements].
20.0 Decontamination of Reusable Medical Equipment
20.1.1
All items/equipment should be visibly clean.
20.1.2
Resident equipment soiled with blood, body fluids, secretions, and excretions
should be handled in a manner that prevents skin and mucous membrane
exposures, contamination of clothing, and transfer of microorganisms to other
residents and environments.
20.1.3
Reusable medical equipment should be cleaned as per the manufacturer’s
instructions. Items may be cleaned using detergent and warm water and dried
thoroughly.
20.1.4
Ensure that another resident does not use the equipment if it is individual use only
or where the equipment is for multi-use, until it has been cleaned appropriately
20.1.5
Ensure that single-use items are discarded properly.
Single Use Only
20.2 Procedure for cleaning nebuliser equipment
20.2.1
Requirements
 Detergent and warm water solution
 Designated bowl
 Sterile water, 500ml bottle. If bottle not fully used, label with date and time of opening
and discard after 24hrs.
 Paper towels
 Non-sterile gloves.
 Cleaning should be carried out in a clean, designated area, e.g. clean utility room.
20.2.2
The Procedure is as Follows:
 Discard as clinical waste nebuliser/face mask/tubing that is visibly dirty, or visibly
contaminated with sputum/blood/body fluids.
 Put on non-sterile gloves
 Separate the mask/mouthpiece and nebuliser reservoir from the oxygen tubing
 Remove moisture from the mask by drying with a paper towel
 Separate the nebuliser reservoir into individual parts, as per manufacturer’s
instructions
38 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
 Wash each part thoroughly including the mouthpiece if used, in warm water and
detergent solution in the designated bowl
 Do not use a brush or sharp instrument to clean the nebuliser jet as this may result in
damage to the nebuliser rendering it unable to mist and perform properly
 Remove all parts from the detergent solution and allow to drain on paper towels
 Empty the bowl. Rinse in hot water and dry carefully using paper towels
 Fill the bowl with the sterile water, taking care not to contaminate the top of the bottle
and the inside of the lid
 Rinse nebuliser and mouthpiece if used by placing the parts in the bowl of sterile
water and agitate gently to remove any residual detergent solution
 Dry using paper towels
 Re-assemble, following the manufacturer’s instructions
 Store dry at the patient’s bedside in a dustproof container labelled with resident’s
details and the date.
 Replace the container if soiled, and discard on completion of the course of nebuliser
therapy.
21.0 Decontamination of the Environment.
21.1.1
The environment can quickly become contaminated with dust, soil and debris,
along with organic matter and potentially infectious germs.
21.1.2
If the environment is not cleaned regularly there is a build-up of dirt, which
supports the growth of germs.
21.1.3
Although it is not possible to achieve a germ-free environment, it is important to
provide a safe environment and reduce the level of pathogenic germs coming in
contact with residents who are susceptible to acquiring infections.
21.1.4
The choice of method of decontamination (i.e. cleaning, disinfection or sterilisation)
depends on many factors, but the initial choice can be based on infection risks to
the resident. These can be classified as high, medium and low risks.
Fig 8: Infection Risks to Residents from Equipment, Materials and the Environment
Infection Risks to Residents from Equipment, Materials and the Environment
Category
High Risk
Indication
Items that
penetrate skin
or
mucous
membrane,
or enter sterile
body areas
Examples
Level of
Contamination
Methods
Surgical
instruments,
needles
Sterilise
Autoclave
Medium Risk
Items that have
contact with
mucous
membranes
Vaginal
speculums,
endoscopes,
bedpans
Disinfect or
sterilize
Autoclave or
chemically
disinfect
Low Risk
Items used on
intact skin
Wash bowls,
matresses
Clean
Wash with
detergent and
warm water,
dry thoroughly
39 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
(Wilson, 2003)
21.2 Cleaning
21.2.1
Cleaning is an essential part of a programme for the control of infection. Thorough
cleaning with detergent and hot water will remove large numbers of germs and
when followed by drying is adequate for those items, which either do not come into
contact with the resident or touch only intact, healthy skin.
21.2.2
Cleaning is also essential prior to disinfection or sterilization processes, as these
are then much more likely to be effective. Dirt and grime can inactivate
disinfectants. Routine cleaning with household detergents and hot water is
considered to be sufficient to maintain the appearance of a building, and to reduce
the number of germs in the environment to a safe level.
21.2.3
The routine use of disinfectants for general environmental cleaning is
unnecessary. Thorough regular use of detergent and hot water is sufficient for
routine purposes, except for items which are contaminated with blood or other
body fluids.
21.3 Disinfection
21.3.1
Disinfection is used to reduce the number of viable germs to a level where they are
unlikely to be a danger to health but which may not necessarily inactivate some
agents, such as certain virus and bacterial spores.
21.4 Sterilisation
21.4.1
Sterilisation is a treatment necessary for all instruments and equipment that enters
body areas, which are normally pathogen free, or which come in contact with
broken mucous membranes.
21.4.2
Sterilisation of equipment or the environment is not required in residential care.
21.4.3
Sterile single-use items must be used once only.
21.5 Routine Environmental Cleaning
21.5.1
Deposits of dust, soil and microbes on environmental surfaces have been
implicated in the transmission of infection and a routine cleaning and maintenance
schedule is necessary to maintain a safe environment.
21.5.2
The following basic principles should be followed:
 Written cleaning protocols should be prepared and available, including methods and
frequency of cleaning.
 The schedule must take into account high, medium and low risk items of equipment,
and areas in [the centre].
 Flexibility must exist in the cleaning schedule to take account of changing cleaning
needs and outbreaks.
 All cleaning staff must understand the basic theory underlying each practice and
product, and be trained to achieve a high standard of cleanliness.
 Standard precautions should be implemented when cleaning surfaces and facilities
 Staff should wear suitable general purpose gloves and other protective clothing
appropriate for the task.
 All staff involved in healthcare hygiene activities must be included in education and
training related to the prevention of healthcare associated infection.
40 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
21.6 Procedure for Routine Surface Cleaning
21.6.1
Work surfaces should be cleaned and dried before and after each session, or
when visibly soiled.
21.6.2
Cleaning is accomplished using warm water and a detergent. Follow dilution on
the container.
21.6.3
Cleaning is not all in the solution but also with the use of “elbow grease”.
21.6.4
Change water frequently, as dirty water is ineffective for cleaning.
21.6.5
Where surface disinfection is required, the manufacturer’s instructions should be
followed.
21.6.6
When the floors are being cleaned, cleaners should not re-dip the mop head into
the bucket of water.
21.6.7
Basins/Buckets should be emptied after use, washed with detergent and warm
water and stored dry.
21.6.8
Toilets, sinks, wash basins, baths, shower areas, and surrounding areas should be
cleaned routinely and as required.
21.6.9
Cleaning of the environment is facilitated by colour coding of cloths as follows:
21.6.10
A flat mop system is in use in [the Centre] for the cleaning of all floors. The mop
head is changed after each use and never re-dipped into the bucket of water or
enter specific arrangements.
21.6.11
Basins/Buckets should be emptied after use, washed with detergent and warm
water and stored dry.
21.6.12
Laundering of mops is carried out in the allocated washing machine.
21.6.1 Toilets, sinks, wash basins, baths, shower areas, and surrounding areas should be
cleaned routinely and as required.
41 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
21.7 Cleaning of Recreational Equipment
21.7.1
Items used for recreational or therapeutic purposes such as jigsaws, recreational
balls, toys/equipment etc. may be used by more than one person.
21.7.2
Equipment can become contaminated with microorganisms from unwashed hands,
body fluids or by people placing equipment in their mouths.
21.7.3
Therefore, to reduce the risk of cross infection, cleaning of these items will be
necessary between uses by different residents and will also need to be included in
a regular cleaning schedule.
21.7.4
Cloth or soft toys are for individual use only and are unsuitable for communal use.
21.7.5
Cloth or soft toys should be machine washable and laundered prior to use by
another individual.
21.7.6
Books/jigsaws/puzzles that cannot be wiped clean are unsuitable where people
may put them in their mouths.
21.7.7
In order to reduce the risk of cross infection the following guidelines should be
followed.
21.7.8
Follow the manufacturer’s instructions for all cleaning.
21.7.9
Choose durable equipment that can be thoroughly cleaned and dried.
21.7.10
Regularly check equipment for damage e.g. breaks or cracks. If these items are
irreparable or cannot be cleaned, they should be discarded.
21.7.11
Store clean equipment in a clean container or clean cupboard.
21.7.12
Do not allow shared books/jigsaws/puzzles/equipment to be taken to the toilet
area.
21.7.13
Always wash your hands after handling contaminated equipment.
21.8 Cleaning of Equipment
21.8.1
All equipment including that not in use should be cleaned on a regular basis i.e.
weekly.
21.8.2
This will remove dust and dirt that can harbour germs.
21.8.3
Equipment that is visibly dirty should be taken out of use for cleaning.
21.8.4
Immediately clean equipment that is contaminated with body fluids (e.g. blood,
nasal/eye discharge, saliva, urine and faeces).
21.9 Cleaning Procedure
21.9.1
Wash the equipment in warm soapy water, using a brush to get into crevices.
21.9.2
Rinse the equipment in clean water.
21.9.3
Thoroughly dry the equipment.
21.9.4
Hard plastic pieces of equipment may be suitable for cleaning in the dishwasher.
21.9.5
Equipment that cannot be immersed in water should be wiped with a damp cloth
and dried.
21.10 Disinfecting of Equipment
21.10.1 In some situations equipment may need to be disinfected following cleaning. For
example:
 Equipment that may be placed in mouths that have been soiled with body fluids.
42 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
 Equipment that have been soiled with blood.
 During an outbreak of infection.
21.10.2 Manufacturer cleaning instructions should be noted with regard to using
disinfectants as some disinfectants may damage the equipment.
21.10.3 Equipment needs to be cleaned routinely i.e. weekly or more frequently if usage is
high.
21.10.4 Ensure people wash their hands after activities.
21.10.5 The use of communal areas may need to be suspended at certain times i.e.
outbreak of infection.
22.0 Cleaning Guidelines Equipment for Resident Care (Adapted from HSE, 2006).
22.1 All sterile equipment should remain in sealed packaging until required.
22.2 All equipment should be cleaned according to manufacturers’ instructions.
Equipment
Airways
Auroscope Ear Pieces
Baths (and shower cubicles)
Bed Frames, bed rails etc.
Bedding
Bedpans
Bins
Residents wash basin
Cleaning guidelines
Single use
Wash speculum with hot water and detergent and dry
thoroughly.
Non infective Situations – Clean bath after use with detergent
and hot water. A non-abrasive cream cleaner may be use to
remove scum.
Infection Situations – Clean bath with disinfectant and rinse
thoroughly.
Wash with detergent and hot water. Clean with disinfectant)
solution if visibly soiled with body fluids or if used by infected
patient.
Heat disinfection: 65ºC for 10 min or 71ºC for 3 min; For heat
sensitive fabrics use low temperature wash at 40ºC and tumble
drying at maximum of 60ºC.
Should be processed in the bedpan washer/disinfector. If
machine out of order, empty contents carefully down sluice or
toilet. Wash carefully in warm water and detergent avoiding
splashing. If used by an infectious resident clean with
disinfectant and rinse thoroughly.
Should be washed with detergent and hot water. If visibly soiled
with blood or body fluids clean with disinfectant.
Clean with detergent and hot water. Rinse and dry thoroughly.
Store inverted. If used on a resident with a known infection,
clean with disinfectant.
Brushes: Lavatory
Regularly wash with detergent and hot water and store dry.
Change every 3 months.
Brushes: Nail
Avoid use. Single resident use.
Vacuum daily and periodically wet clean with specifically
designated equipment e.g. steam cleaners with a vacuum
extraction facility.
Clean with detergent and hot water after each resident. Rinse
and dry thoroughly.
When visibly soiled, wash with detergent and water. If ceiling
tiles become contaminated, replace them.
Carpets
Catheter Bag Holders/stands
Ceilings
Combs
43 | 8 7
Single resident use
NMA Infection Prevention and Control Policy and Procedures 10052016
Clean with detergent and hot water. Rinse and dry thoroughly.
If visibly soiled with body fluids or used by an infected resident,
disinfect.
Commodes
Cutlery and Crockery
Curtains
Dressing Trolleys
Drip Stands
Examination Couch
Face Cloths
Floors
Flower Vases
Furniture and Fittings
Hoists
Linen Skip
Dishwasher.
Should be laundered at least 6 monthly and when visibly soiled.
Wash with detergent and hot water and dry before and after
use.
Clean with hot water and detergent. Rinse and dry thoroughly.
Clean with detergent and hot water in between resident use. If
visibly soiled with body fluids or used by an infected resident,
clean and disinfect.
Resident should use their own face cloths or be given a
disposable type.
Dry Cleaning – Use a vacuum cleaner or dust-attracting mop.
Sweeping brushes must not be used in clinical areas. Vacuum
cleaners should not be used where residents are being
isolated.
Wet Cleaning – wash with appropriate detergent and hot water.
Disinfection is only required if there is visible soiling with body
fluids or during resident isolation.
Wash with hot water and detergent and dry thoroughly. They
should be stored inverted. Flower water must be emptied into
the sluice and not the wash hand basins.
Clean with detergent and hot water. If visibly soiled with body
fluids or used by an infected resident clean with disinfectant.
Clean with detergent and hot water after use. Clean with
disinfectant if visible soiling with body fluids has occurred or if
equipment has been used by an infected resident. Hoist slings
should be processed through the laundry for cleaning.
Clean with hot water and detergent. If contaminated, disinfect.
Clean with detergent and hot water. Rinse and dry thoroughly.
Lockers
These should be checked regularly to ensure the cover is
intact. If damaged it should be discarded. The mattress cover
should be washed with detergent and hot water on resident
discharge/death. If visibly soiled with body fluids or has been
used by an infected resident, it should be cleaned with
disinfectant.
Disposable cups recommended. If for reuse place in
dishwasher for cleaning.
Mattresses
Medicine Cups
Medical Equipment
Refer to manufacturer’s instructions.
Nebulisers
As per Point 18.6
Residents should use their own shaving equipment. Disposable
razors should be used as an alternative. Where electric razors
are used blades should be soaked in 70% alcohol for 5 minutes
after use.
Clean with detergent and hot water. If visibly soiled with body
fluids or has been used by an infected resident, it should be
cleaned with disinfectant.
Clean with detergent and hot water. If visibly soiled with body
fluids or has been used by an infected resident, it should be
cleaned with disinfectant.
Clean with detergent and water. A non-abrasive cream
cleanser may be used to remove stain & scum.
Razors
Scales
Scissors
Sinks/wash hand basins
44 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
Slings (material)
Soap dispenser
Sphygmomanometer
Stethoscopes
Telephones
Thermometers Electronic
Toilets/Sluices
Urine Bags
Urinal
Walking frames
Walls
Wheelchairs
45 | 8 7
Send to laundry.
The outer casing and the nozzle of the soap dispenser should
be cleaned daily with hot water and detergent. It is
recommended that the dispenser has individual replacement
cartridges that are discarded when empty. If non-disposable
reservoirs are used inside containers, they should be cleaned
and dried prior to refilling. Rinse and dry thoroughly using paper
towels. Topping up with liquid soap should be avoided.
Clean with detergent and hot water at regular intervals.
Clean with detergent and water in between each resident use.
If visibly soiled or in contact with an infective resident, clean
with 70% alcohol wipe.
Damp dust with detergent and hot water. Rinse and dry
thoroughly.
Manufacturer’s instructions.
Seats and handles should be cleaned with detergent and hot
water. If visibly soiled with body fluids or after use by a resident
with a gastrointestinal infection, the seat and handle should be
cleaned with disinfectant. After use of a disinfectant, the seat
should be rinsed with water and dried thoroughly. Clean
lavatory bowl with detergent and water. Pouring disinfectant
into lavatory or drains is unlikely to reduce infection risks.
Single use. Dispose of as non-healthcare risk waste.
Should be processed in the bedpan washer/disinfector. If
machine out of order, empty contents carefully down sluice or
toilet. Wash carefully in warm water and detergent avoiding
splashing. If used by an infectious resident clean with
disinfectant and rinse thoroughly.
Clean with detergent and hot water. Rinse and dry thoroughly.
When visibly soiled wash with detergent and water. If visibly
contaminated clean using disinfectant.
Clean with detergent and hot water. Rinse and dry thoroughly.
If contaminated with body fluid or in contact with infectious
resident clean with disinfectant.
NMA Infection Prevention and Control Policy and Procedures 10052016
23.0 Products used in [the Centre]
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
Name / brand of Product
Hand wash
Name / brand of Product
Alcohol Rub
Name / brand of Product
Surface disinfectant
Name / brand of Product
All-purpose detergent
Name / brand of Product
Bathroom cleaner
Name / brand of Product
Toilet and urinal cleaner
Name / brand of Product
Washing-up liquid
Name / brand of Product
Dishwasher detergent
Name / brand of Product
Dishwasher
Name / brand of Product
Detergent and degreaser for oven and
grill.
Name / brand of Product
Stainless Steel items in kitchen
Name / brand of Product
Floor cleaner
Name / brand of Product
Washing machine detergent
Name / brand of Product
Fabric softener
Name / brand of Product
Carpets
Name / brand of Product
Glass and mirrors
Name / brand of Product
Other chemicals
Name / brand of Product
Other chemicals
Name / brand of Product
Other chemicals
46 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
24.0 Aseptic Practice.
24.1 ‘Asepsis’ is defined as freedom from infection or infectious (pathogenic) material
distinct from ‘Sterile’ which means free from microorganisms. Because of the natural
multitude of microorganisms in the atmosphere, it is not possible to achieve a sterile
technique in residential care facilities for older people. For this reason, aseptic
technique is used to prevent pathogenic organisms, in sufficient quantity to cause
infection, being introduced to susceptible sites by hands, surfaces and equipment
(NHMRC, 2012; HSPC, 2011).
24.2 Clean means free of dirt, marks or stains (Rowley and Clare, 2010). Clean technique
involves strategies to reduce the overall number of microorganisms or to reduce the
transmission of microorganisms from one person to another or from one place to
another. It involves meticulous handwashing, maintaining a clean environment by
preparing a clean field, using clean gloves and sterile instruments and preventing
direct contamination of materials and supplies (WOCN, 2012).
24.3 Aseptic Non Touch Technique (ANNT) is a standardized aseptic non touch
technique which is based on a set of 10 principles, the first of which is that the main
infection risk to the resident is the healthcare worker. The non-touch technique
involves identifying key sites and key parts in a procedure (Rowley and Clare, 2011;
Association for Safe Aseptic Practice, 2011).
24.4 Key parts refer to those parts of clinical equipment that come into direct or indirect
contact with any liquid infusion; key sites and any active key parts connected to the
resident (Rowley and Clare, 2011; Association for Safe Aseptic Practice, 2011).
24.5 Clinical procedures in [the Centre] that require an aseptic non-touch technique
include:
24.5.1
Urinary Catheterisation.
24.5.2
Venepuncture.
24.5.3
Some wound care procedures based on a risk assessment (See section 26).
24.5.4
Any invasive clinical procedure which based on infection risk to resident is deemed
as requiring ANNT.
25.0 Urinary Catheterisation
This section should be read in conjunction with [the Centre’s] policy on Continence Care.
25.1.1
Promotion of continence is the preferred method of dealing with incontinence.
25.1.2
Urinary tract infections (UTIs) are more common in old age and in people with
dysfunction of the bladder or urethra. However, the risk of infection is greatly
increased by urinary catheterisation, particularly the use of long term indwelling
catheters or repeated catheterisation.
25.1.3
The highest incidence of healthcare associated infection is associated with
indwelling urethral catheterisation.
25.1.4
Many of these infections are serious and are linked to morbidity and mortality.
UTIs can reach the bloodstream causing septicaemia, which is associated with a
high rate of mortality
25.1.5
The risk of acquiring bacteruria is approximately 5% for each day of
catheterisation, therefore most residents in long-term care are bacteruric after 20
days of catheterisation.
25.1.6
Catheterisation should never be used solely for the management of urinary
incontinence and should only be undertaken following careful assessment.
47 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
25.2 Minimising the Risk of Infection
25.2.1
25.2.2




Gloves should always be worn when handling catheters.
The following recommendations should be considered to minimise the risk of
infection in those residents that require catheterisation and are divided into four
distinct interventions:
Assessing the need for catheterisation
Selection of catheter drainage options
Catheter insertion technique
Catheter maintenance
25.3 Assessing the Need for Catheterisation
25.3.1
Use indwelling urinary catheters only after alternative methods of management
have been considered.
25.3.2
Document date of catheter insertion, changes and care.
25.3.3
If documentation is incomplete, informed review of treatment is unlikely to take
place.
25.4 Catheter Drainage Options
25.4.1
Following assessment, the best approach to catheterisation that takes account of
clinical need, anticipated duration of catheterisation, resident preference and risk
of infection should be selected.
25.4.2
Intermittent catheterisation should be used in preference to an indwelling catheter
if it is clinically appropriate and a practical option for the resident.
25.5 Catheter Insertion
25.5.1
Urinary catheterisation should be prescribed by the medical practitioner who is
responsible for the resident (HSE, 2006).
25.5.2
Catheterisation requires the use of a standardized aseptic non-touch procedure
(Fig 9) and should only be carried out by a suitably qualified person who can
demonstrate competence.
25.5.3
An antiseptic hand wash should be carried out prior to catheterisation.
25.5.4
Sterile gloves and equipment should only be used.
25.5.5
Wash hands and wear clean, non-sterile gloves before manipulating the catheter
and wash hands after removing gloves.
25.5.6
Obtain urine samples from a sampling port using an aseptic technique and small
bore needle.
25.5.7
Position urinary drainage bags below the level of the bladder on a stand that
supports the bag and prevents contact with the floor.
48 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
Fig 9: Aseptic Non Touch Technique Urinary Catheterisation.
22.6 Documentation
25.6.1 Post insertion of a urinary catheter the following are some details that should be
documented in the resident’s nursing notes.
25.6.2 Date of catheterisation, type, gauge, and length of catheter, brand and batch
number should be recorded. This can be achieved by removing the sticker found
on the catheter packaging and placing it into the residents notes. Also, the
lubricant and cleansing agent used should be recorded.
22.7 Catheter Maintenance
25.7.1
Document all catheter care using a care plan tailored to meet the individual needs
of the resident.
25.7.2 Include a catheter history i.e. the length of catheter life
25.7.3 Catheters should be changed only when clinically necessary or according to the
manufacturers’ recommendations, (usually every 6 -12 weeks).
22.8 Link Drainage System
(Original Poster Can be Downloaded from http://www.hpsc.ie/hpsc/AZ/MicrobiologyAntimicrobialResistance/InfectionControlandHAI/UrinaryCatheters/Posters/File,1291
1,en.pdf)
49 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
25.7.4
For residents who use ‘leg bags’ a larger long bag can be attached to it at night to
facilitate overnight drainage and keep the original system intact.
25.7.5
It is recommended that the night bag be non-sterile, drainable and disposed o’
after single use.
25.7.6
The leg bag should be replaced once a week or if it has been removed from the
catheter for any reason.
25.8 Catheter Associated Infection
25.8.1
Infection may arise
 either at the time of or immediately following catheter insertion or
 subsequently because the colonising flora within the catheterised urinary tract
becomes invasive (this may occur spontaneously or follow catheter manipulation).
25.8.2 The presence of pus cells in the urine (pyuria) of a resident with an indwelling
catheter does not, by itself, signify infection. Distinguishing between bacteriuria
and infection can be difficult making it important to:
 Send catheter specimen only if clinical signs of infection are present and not
routinely.
 Collect a urine sample carefully and transport it rapidly to the laboratory.
 If this is not possible, refrigerate sample until immediately prior to transportation
 Review positive lab report in conjunction with signs and symptoms of infection before
commencing antibiotics.
25.9 Antibiotic Treatment
25.9.1
Clinical signs of infection determine the need for antibiotic therapy; the lab result
will guide the choice of the most appropriate agent.
25.9.2
The routine use of prophylactic antibiotic administration in catheterised residents is
not recommended because of its tendency to encourage the emergence of
resistant organisms.
25.9.3
Antibiotic prophylaxis when changing catheters should only be used for residents
with a history of catheter-associated urinary tract infection following catheter
change, or for residents who have a heart valve, septal defect, patent ductus or
prosthetic valve.
50 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
Fig 10 Principles of Long-Term Catheter Management
Is the catheter necessary?
What type of catheter?
Urethral, Suprapubic, intermittent
Who will provide catheter care:
self/resident, nurse, healthcare
assistant?
Resident education,
information and support
Catheter selection:
Material, size, length, balloon size
Drainage equipment selection:
Bag, valve, support
Planned care
Catheterization
Regular Care
Bag emptying
& Changing
Planned
Catheter
Change
Sterile Procedure
Managing complications
Meatal Care
Tissue Trauma
Infection
Troubleshooting
Blockage
Catheter
expelled
Adapted from HSE - Guidelines for Infection Control in Nursing/Residential Homes ( 2006)
51 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
26.0
Enteral Feeding
This section should be read in conjunction [the Centre’s] Policy on Nutrition and Hydration
26.1.1
Bacteria can gain access to the feed during preparation and mixing of ingredients,
the dilution and/or decanting of feeds and the subsequent assembly of the feed.
26.1.2
The nutrients that the feeds contain along with the fact that feeds are administered
at room temperature can make them an excellent environment for rapid microbial
growth.
26.1.3
Contaminated feeds and systems can cause diarrhoea and can also lead to more
serious infections including pneumonia and septicaemia.
26.1.4
Residents receiving enteral feeding can be a source of infection as gastrointestinal
organisms from the enteral tube hub can colonise the external surfaces of the
administration set.
26.1.5
The administration set may act as a reservoir of organisms that may be carried on
the hands of the healthcare worker to another resident if hand hygiene is poor.
26.2 Hand washing
26.2.1
Hand washing is essential prior to preparing and administering feeds and
subsequent handling of the system.
26.2.2
Hands should be washed under warm running water, using liquid soap, rinsed and
dried thoroughly.
26.3 Protective Clothing
26.3.1
In line with Standard Precautions gloves should be worn if it is anticipated that
there will be contamination of hands with gastric fluids e.g. connecting
administration set to enteral tube hub or when aspirating.
26.4 Selection of Equipment
26.4.1
The design of the system is important in order to minimise handling.
26.4.2
Wherever possible pre-packaged, ready-to-hang feeds should be used in
preference to feeds requiring decanting, reconstitution or dilution.
26.4.3
Do not decant feeds unless no other feeding system is available.
26.4.4
The system selected should require minimal handling to assemble and be
compatible with the residents’ enteral feeding tube
26.4.5
Components of the administration set and food container should not be touched
during assembly.
26.5 Storage of Feeds
26.5.1
Feeds should be stored in a clean environment protected from extremes of
temperature according to manufacturer’s instructions and where applicable
according to food hygiene legislation.
26.5.2
Feeds when opened and not used immediately can be stored in a designated
refrigerator at a temperature not exceeding 4°C for 24 hours.
52 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
26.5.3
The container should be closed and labeled with name of resident, time and date.
26.5.4
The refrigerator should be checked daily and unlabeled feeds and out of date
feeds discarded.
26.5.5
The fridge should be kept clean.
26.6 Assembly of Feeds
26.6.1
Effective hand hygiene must be carried out before starting to assemble a feed.
26.6.2
Check expiry date of feed and feeding system prior to opening.
26.6.3
Do not use equipment that has been damaged or opened.
26.6.4
Ready-to-use feeds should be used in preference to decanting or diluting feeds.
26.6.5
If decanting or diluting feeds is necessary a clean area should be used to prepare
the feed.
26.6.6
Equipment dedicated for enteral feeding should be used.
26.6.7
Ensure the top of the container is clean and dry prior to decanting.
26.6.8
Cool boiled water or freshly opened sterile water should be used to dilute feeds
using a no-touch technique.
26.7 Administration of Feed
26.7.1
Minimal handling and a no-touch technique should be used when connecting the
administration set to the enteral tube.
26.7.2
Avoid touching any inner aspects of the feeding system.
26.7.3
Ready-to-use feeds can be given for a whole administration session up to a
maximum of 24 hours if sterile (this includes a four-hour break from feeding).
26.7.4
Decanted sterile feeds in sterile reservoirs can be given to a maximum of 12
hours.
26.7.5
Do not top up reservoirs.
26.7.6
Ensure the feeding system is labeled with the residents’ name, date and time the
feed was commenced.
26.7.7
The administration set is a single use item and should not be used for more than
24 hours and should be discarded after each feeding session.
26.7.8
If the administration set is to be disconnected for any reason the set should be
capped.
26.7.9
Avoid touching the end of the set or touching it against clothing.
26.8 Care of Insertion Site and Enteral feeding tube
26.8.1
For healed insertion sites, inspect the site daily, clean and dry with warm water.
26.8.2
A dry dressing may be necessary if there is a discharge from the insertion site.
26.8.3
Skin irritation can occur and should be managed by washing the area frequently
with warm water and drying thoroughly.
26.8.4
To prevent blockage of the tube, flush with cooled boiled water or freshly opened
sterile water before and after feeding and /or administration of medication.
53 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
26.9 Identification of Infection Associated with Enteral Feeding and Appropriate
Action
26.9.1
It is important for staff to be alert to the signs of infection associated with enteral
feeding.
26.9.2
Early recognition is important to permit early treatment.
26.9.3
Local infection at the stoma site can occur indicated by redness, swelling, pain and
ulceration of the skin.
26.9.4
Bowel infections may present with nausea, abdominal pain, vomiting and /or
diarrhoea.
26.9.5
Systemic infection may present as fever, lethargy or altered consciousness.
26.9.6
All suspected infection should be reported to the doctor and documented in the
care plan.
26.9.7
In addition to the treatment of infection it is important to try and identify why the
infection occurred.
26.9.8
A review and change in procedures may be required to prevent a reoccurrence.
Fig 11: Care of Enteral Feeding Equipment
Item
Connectors – single resident use
Extension sets that are single resident use
Extension sets that are single use
Giving sets
Pumps
Syringes for flushing and medication
54 | 8 7
Method
Thoroughly wash in detergent and warm
water. Rinse and dry. Store in a clean
container with lid.
Follow manufacturer’s instructions
Thoroughly wash in detergent and hot water.
Rinse and dry. Store in a clean container
with a lid. Follow manufacturer’s instructions
Discard after single use
Use a new giving set every 24 hours
Wipe over with a damp cloth to keep dust
free. Clean any spillages immediately.
Syringes, which are designated for single
use should be discarded after each use.
NMA Infection Prevention and Control Policy and Procedures 10052016
27.0 Subcutaneous Infusion
This section should be read in conjunction with [the Centre’s] Guidelines on the use of
Subcutaneous Fluids in the Nutrition and Hydration Policy.
27.1.1
Subcutaneous fluid administration is a safe and reliable method of fluid
replacement in nonemergency situations for treating dehydration and symptoms of
thirst in the elderly and palliative care patients. It is also suitable for the delivery of
Opioid infusions for cancer pain relief.
27.1.2
A standardised approach is needed to reduce the risk of infection associated with
subcutaneous infusion.
27.2 Measures to reduce the risk of Infection
27.2.1
Hands should be washed using soap and water, dried thoroughly and then gloved.
27.2.2
Equipment required includes sterile standard intravenous giving set, sterile 21
gauge butterfly needle, sterile occlusive dressing and fluids as prescribed.
27.2.3
Clean the skin with swab saturated with 70% isopropyl alcohol and allow to dry.
27.2.4
Apply a sterile, transparent occlusive dressing to secure the cannula, to allow
visualization of the insertion site and prevent the introduction of infection.
27.2.5
Immediate and careful disposal of sharp equipment into sharps container should
take place on completion of the procedure.
27.2.6
Site of administration should be checked three times a day for evidence of
inflammation (erythema/reddening) or poor absorption (hard subcutaneous
swelling) and documented.
27.2.7
The cannula should be removed and re-sited if pain, redness, oedema or exudate
is observed and recorded.
27.2.8
Care should be taken when delivering care, as butterfly cannula may easily
become dislodged.
28.0
Wound Care
This section should be read in conjunction with [the Centre’s] Policy on Wound Management
28.1.1
Appropriate wound management underpinned by adopting reliable aseptic and
clean techniques aim to prevent healthcare associated infection.
28.1.2
For healthcare workers, the main concern is to prevent wound contamination from
extrinsic sources e.g. hands, non-sterile/ dirty utensils, contaminating vulnerable
wound sites.
Hand washing
Healthcare workers hands have been implicated in the transmission of infection between
patients in outbreak situations and in high-risk areas. Hand hygiene results in a significant
reduction in the carriage of such pathogens & therefore reduces cross-infection. Hence, it is
critical that hands are washed before and after wound care. Also, if nurses hands become
contaminated during the wound care procedure, then repeated hand hygiene may be necessary.
(HSE, 2006)
28.2 Infection Prevention and Control in Wound Care
All interventions undertaken in relation to wound care should be performed using an either
an aseptic non touch technique or clean technique as appropriate following a risk
assessment.
55 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
28.3 Use of Aseptic Technique Non Touch Technique.
28.3.1
As previously outlined, aseptic technique is a method that prevents microbial
contamination of wounds and other susceptible sites by ensuring that only sterile
objects and fluids touch them. The purpose is to protect the resident from infection.
28.3.2
Aseptic technique reduces the risk of contamination to vulnerable sites thus
helping to reduce healthcare associated infection.
28.3.3
The decision to use aseptic technique for wound care is based on the assessment
of risk of infection to the resident, based on the presence of risk factors.
28.3.4
Risk factors that predispose residents to wound infections include:







Reduced perfusion of blood to tissues.
Raised blood glucose levels.
The severity of the wound
Reduced immune status, stress, alcohol, smoking, drug abuse, lack of sleep.
Age
Nutritional status; emaciation or obesity place people at risk.
Medication; immunosuppressive agents, steroids and non-steroid anti-inflammatory
agents.
 Poor wound management (e.g. inadequate wound debridement).
28.3.5
Asepsis can only be achieved if every effort is taken to ensure that;
 Standard precautions are employed.
 Single-use items are only used once.
 Single resident use items are only used for one resident and are decontaminated
appropriately in between use.
 Re-usable items are decontaminated.
 Sterile equipment is stored in a clean, dry area, free from dust and off the floor to
protect the integrity of the packaging and the equipment.
Fig 12: Practicalities of Asepsis
The aim of hand washing is to remove dirt and reduce the skin bacterial load.
Hand
Antiseptic hand washing is required prior to an aseptic technique. This aims to
Washing
remove transient bacteria and therefore prevent them being introduced into the
wound.
Dressing should only be carried out in rooms with adequate hand washing
Environment
facilities and separate facilities for washing reusable equipment e.g. bowls for
soaking leg ulcers.
Wounds should only be exposed for the minimum amount of time, Use single
use medication and dressings per resident. Foot stools/couch should be
washed with neutral detergent & water and dried in between each use.
The purpose of wearing gloves is to protect the hands from becoming
Glove
contaminated with dirt and micro- organisms and prevent the transfer of
Wearing
organisms already present on the skin of hands and to therefore minimise
cross-infection.
Sterile gloves are worn for aseptic procedures.
56 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
28.4 Clean Technique
28.4.1
This method is a modified aseptic technique and aims to avoid introducing microorganisms to a susceptible site and also to prevent cross-infection to residents and
staff.
28.4.2
A clean technique adopts the same control of infection principles but clean (rather
than sterile) single use gloves and/or tap water that is safe to drink may be used.
28.4.3
It differs from aseptic technique as the use of sterile equipment and the
environment are not as crucial as would be required for asepsis.
28.4.4
A risk assessment must first be undertaken by the nurse to ensure the appropriate
technique is employed.
28.4.5
The process also includes a no or non-touch technique being employed i.e. not
handling the ends of sterile items that will come in contact with the site being cared
for, and clean single use rather than sterile gloves are advocated.
28.4.6
If there is a risk that sterile items may have to be handled, sterile gloves are
recommended as in aseptic procedures.
28.4.7
Dressing of wounds healing by secondary intention usually requires a clean
technique. E.g. Wounds over 6 weeks old, pressure sores, leg ulcers, dehisced
wounds and simple grazes, removing drains or sutures, endotracheal suction. NB
if these wounds enter deeper sterile body areas, then an aseptic non-touch
technique must be used.
28.4.8
Clean technique is considered most appropriate for long term care for residents
who are not at high risk of infection; wounds such as venous ulcers, or wounds
healing by secondary intention with granulating tissue.
28.5 Wound Cleansing
28.5.1
Consider:
 When to clean?
 How to clean?
 What do I use to clean?
28.5.2
When to Clean?
 It is not necessary to cleanse wounds at each dressing change and the rationale for
doing so should be carefully considered.
 If the wound is clean and has minimal exudate, little benefit is derived from routine
cleansing which may traumatise delicate new tissue.
 Exudate is required on the wound surface to maintain phagocyte levels as well as
other wound healing hormones and chemical stimuli. Irrigation would remove these
and is therefore best avoided.
 It may be necessary to cleanse the surrounding skin to prevent excoriation from
excess exudate. This may be achieved by irrigation or wiping around the wound.
28.5.3
What do I use to clean?
 The use of antiseptics on wounds has been questioned following evidence that they
are largely ineffective and have a toxic effect on the micro-circulation that provides
oxygen and nutrients to the wound bed.
 Saline and chlorhexidine show the least toxicity to healthy cells.
 Use sodium chloride 0.9% sterile solution for aseptic wound cleansing.
 Use sodium chloride 0.9% sterile solution for aseptic wound cleansing.
 Potable/drinking/tap water can be used for clean wound dressing techniques.
57 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
28.5.4
How to Clean?
 Saline should be warmed and applied to the wound with a 20ml syringe.
 Cotton wool balls are not recommended as fibres may be left in the wound, act as a
foreign body and can delay healing.
 Bathing/showering is a very effective way of cleansing wounds, i.e. perineal wounds,
abdominal wounds, etc.
 It is very important to ensure that the bath is clean and dry before and after use. It is
recommended that the appropriate disinfectant be used following cleaning e.g.
hypochlorite solution is an effective disinfectant in all circumstances, provided that a
high standard of physical cleaning of the bath is implemented.
 Some residents may present with more complex wound management needs
including those who are specifically vulnerable e.g. resident with diabetes. In such
circumstances, it is advisable to seek advice from nurse specialists or relevant
medical staff.
28.5.5
Iodine-Containing Product:
 Iodine remains one of the few recommended topical antiseptics.

It is not recommended for the routine treatment of chronic wounds or for those
residents who are allergic to iodine.
 It may be appropriate to use in selected clinically infected wounds for a limited period
- usually maximum of 5 days.
 The recommended method of application is the use of already impregnated gauze
which is a slow release iodine product that may be used for longer than 5 days apply according to manufacturer’s’ instructions.
 An infected wound should be changed at least daily or according to the
manufacturer’s instructions of the product used.
 Iodine dressings should be kept to a minimum.
 Ensure to read manufacturer’s instructions prior to use.
 As iodine can be absorbed through the tissues, it should not be applied if the
resident has a thyroid disorder.
 Document any pain or adverse reactions when used and reconsider its use.
28.6 Procedure for Wound Dressing.
28.6.1
Explain the procedure to the resident and obtain their permission to proceed.
28.6.2
With clean hands, clean trolley with detergent wipes or warm water and detergent
and then dry thoroughly with disposable paper towels.
28.6.3
Collect equipment and place on the bottom shelf of the clean trolley.
28.6.4
Take the trolley to the resident’s room and bed area.
28.6.5
If required, screen the resident’s bed area using curtains, disturbing the curtains as
little as possible to avoid the risk of airborne contamination.
28.6.6
Put on a plastic apron and decontaminate hands with soap and water or alcohol
gel if hands are physically clean. Ensure hands are thoroughly dried.
28.6.7
Open pack and position waste bag.
58 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
28.6.8
Open the other sterile equipment e.g. dressing and drop onto the aseptic field
taking care not to touch it. Open the relevant cleaning fluid and pour into gallipot
using non touch technique.
28.6.9
Apply non sterile gloves (sterile if you need to touch the wound).
28.6.10
Place paper towel or drape under the wound.
28.6.11
Remove and dispose of dressing using a non-touch technique.
28.6.12
Decontaminate hands with soap and water or alcohol gel.
28.6.13
Apply gloves (sterile for aseptic technique/non sterile for clean technique).
28.6.14
Clean the wound using non touch technique (sterile water/saline for aseptic
technique or potable/drinking/tap water for clean technique).
28.6.15
Dress the wound.
28.6.16
Dispose of equipment, remove gloves and apron and dispose of same.
28.6.17
Ensure the resident is comfortable.
28.6.18
Clean trolley.
28.6.19
Decontaminate hands.
28.6.20
Complete documentation.
(NHMRC, 2012; NHS, 2011)
28.7 Wound Infection
28.7.1
Every wound has the potential to become contaminated or infected. Therefore, it is
necessary to be aware and to observe for the signs and symptoms of infection,
both local and systemic:
Signs and Symptoms of Infection
Local
Inflammation and/or redness
Cellulitis or heat
Presence of pus or exudate
Pyrexia
Unexplained/change in pain
Friable granulation tissue that easily bleeds
Malodour, pocketing or bridging
Systemic
Pyrexia
Tachypnoea
Tachycardia
Confusion
Hypoxia
28.8 Wound Swabbing
Diagnosis of wound sepsis is based on clinical criteria. In the absence of clinical signs of
Infection, there is no requirement for routine microbiology.
28.8.1
How to take a wound swab?
 Moisten swab in sterile normal saline if swabbing dry site.
 Use a zig-zag motion across the wound rotating the swab between the fingers.
 Place the swab straight into sterile transport media.

Ideally samples should be collected before the commencement of antibiotic therapy.
 When it is necessary to test during a course of antibiotic treatment, the specimen
should be collected just before the dose is given. This should be noted on the
request form.
59 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
 Ensure that every specimen is clearly identified by a label giving the name and
location of the resident and the date.
28.8.2
Specimen Transport (Swabs):
 The sooner specimens reach the laboratory after collection the better, as surviving
organisms will be identified.
 Swabs, which cannot be sent to the laboratory within a short time, i.e. 4-6 hrs, should
be placed in a specimen refrigerator at 4 degrees centigrade.
29.0 Procedure for Collection and Labeling of Specimens.
29.1.1
Standard precautions must be used when handling all bloods and body fluids.
29.1.2
Staff may also need to wear appropriate personal protective equipment.
29.1.3
Specimens should have the resident's relevant details on both the container and
request form.
29.1.4
Obtain a fresh and appropriate specimen.
29.1.5
Collect specimen with as little contamination as possible to ensure that the sample
will be representative of the infective site.
29.1.6
Collect an adequate amount of specimen. Inadequate amounts of specimen may
yield false-negative results
29.1.7
Use sterile equipment and aseptic technique to collect specimens to prevent
introduction of microorganisms during invasive procedures
29.1.8
Collect the specimen before beginning any treatment e.g. antibiotics, where
possible.
29.1.9
Use a vacutainer / monovette or other similar product for the collection of blood
samples.
29.1.10
Collect specimen in a sterile container with a close-fitting lid.
29.1.11
Do not overfill containers, especially urine and faeces samples.
29.1.12
Do not remove swab from sterile container until ready to take sample.
29.1.13
If possible, obtain specimen of pus, exudate / tissue specimen from wound
instead of reserving a swab.
29.1.14
Ensure lid is closed firmly and has sealed correctly.
29.2 Procedure for labelling specimens
29.2.1
Place the following information on the request form and container / swab /
specimen:

Resident's first name and last name.

Date of birth include on specimen / swab.

Date and time of collection.
29.2.2
Also include on form:

Site of swab or specimen type i.e. whether MSU or CSU

History of recent antibiotic treatment if applicable - always for Microbiology
requests.

Include relevant clinical details.

State clearly the test required.
60 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016

Resident's first name and last name.

Date of birth include on specimen / swab.

Address of Nursing Home

Requesting Medical/General Practitioners name.
29.3 Safe Handling of Specimens
 To avoid presenting a hazard to anyone in contact with the specimens, it is vital to
avoid contamination of the outside of specimen containers and to ensure that they
are securely closed and safely handled.
 The container with specimen should be placed in an individual transparent plastic
transport bag, as soon as it has been labelled.
 The transport bag must be sealed.
 Leaking specimens are a serious biohazard risk to both [the Centre’s] staff and
laboratory staff.
 Blood stained forms should never be sent to [specify laboratory where samples are
sent].
 If a specimen leaks, contaminating organisms may get into the container and a false
result ensue.
29.3.1
To Ensure Safety:
 Adhere to Standard Precautions for taking and processing of all specimens
regardless of the residents’ infectious status, known or unknown.
 Specimen containers must be placed in plastic bags with a self-sealing seal.
 The request form is kept separate from the specimen in side pocket.
 This system provides protection for all staff from any accidental spillage and prevents
contamination of the accompanying request form.
29.3.2
Whilst Awaiting Transport, specimens should be
 Stored appropriately and securely in the specimen fridge [specify where fridge is
located], away from resident and visitor areas, and from food and medicines.
 Check the individual specimen requirements to determine if refrigeration is advisable
as some organisms are temperature sensitive
 Telephone the laboratory if the proper procedure is in doubt.
29.4 Specimen Rejection
29.4.1
Unacceptable specimens may result in test cancellation or delay.
29.4.2
Common causes to reject a specimen include:
 The samples are received in a hazardous condition.
 The sample identification on either the request form or the sample bottle is
incomplete.
 The sample is unlabelled or incorrectly labelled.
 The sample is received with incorrect resident preparation.

The sample has been collected under inappropriate conditions.
61 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
30.0 Pets
This section does not apply to guide dogs as “Under Equality and Environmental Health
Regulations bona fide Guide Dogs (including assistance dogs and puppies in training) are
entitled to access all public places including restaurants and other food premises”.
30.1.1
Pets can often enhance the quality of life for older people in residential care
settings. However, there may be worries that a resident may catch an infection
from a pet, especially if the resident’s immunity is reduced through age, illness or
therapy.
30.1.2
No pets should be allowed in any food room, staff room or clinical area.
30.1.3
Where animals are in the building e.g. pet therapy, residents own pet, a competent
person must accompany the animal to ensure that there is no risk of contravening
the relevant safety legislation.
30.1.4
There should be a written agreement within [the Centre] to ensure full
understanding of:
 The types of animals allowed for the purposes of “pet therapy”- only mature
house trained pets are acceptable.
 The specific areas they are allowed into in the home and their exclusion from
areas where food is stored, prepared, cooked or served.
30.1.5
Domestic cats, dogs and other types of pets, although apparently healthy, can act
as carriers of enteric pathogens such as Salmonella and Campylobacter.
30.1.6
Pets such as cats and dogs may also bring pathogens into [the Centre] on their
paws and contaminate kitchen food preparation surfaces as well as floor surfaces.
30.1.7
Hands should be washed after handling pets, pet cages, pet feeding utensils or
other pet objects.
30.1.8
Spills from pets such as faeces, urine and vomit should be cleaned immediately
and any contaminated surfaces cleaned and disinfected.
30.1.9
Floor surfaces used by pets and pet feeding areas should be regularly cleaned.
30.1.10
Pet feeding utensils should be designated for pet’s sole use.
30.1.11
Pets such as dogs or cats should be appropriately immunised from disease. The
resident dog will receive annual vaccinations as recommended by the vet.
30.1.12
Pets shall not be housed or fed in the kitchen/staff/dining/or clinical area. The
cleaning of pet cages and tanks shall not be carried out in these areas. Ideally they
should be cleaned outside.
30.1.13
Pet living quarters, and items such as cat litter boxes, should be cleaned on a daily
basis.
30.1.14
Faecal material should be removed from the surface of the litter tray using gloved
hands and paper towels, then flushed down the toilet and hands washed.
30.1.15
All animals should be regularly groomed and checked for signs of infection or other
illness.
30.1.16
If pets become ill, diagnosis and treatment by a vet should be sought. All animals
should have received relevant inoculations.
30.1.17
Dogs should be wormed every three months.
30.1.18
Pets should be exercised regularly.
62 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
31.0 MRSA
31.1 MRSA stands for Methicillin-Resistant Staphylococcus Aureus.
31.1.1
The majority of people diagnosed with MRSA are colonised rather than infected
i.e. MRSA is present on the skin / wound with no evidence of clinical infection.
31.1.2
Colonisation with MRSA is NOT the same as infection with MRSA
31.1.3
Colonisation occurs when a patient has MRSA in or on a body site but has no
clinical signs or symptoms of disease. A person colonised with MRSA may be a
temporary or a longer term carrier of MRSA.
31.1.4
Infection occurs when MRSA enters a body site and multiplies in tissue causing
clinical manifestations of disease. This is usually evident by fever, rising white cell
count, or purulent drainage from a wound or body cavity.
31.1.5
There is no indication for a general hospital or other facility to carry out routine
screening prior to transfer to [the Centre]. However, the staff of [the Centre] should
be informed before transfer of a resident who is MRSA positive.
31.1.6
Carriage of MRSA is not a contraindication to the transfer of a resident to [the
Centre].
31.1.7
Whilst in [the Centre] the resident with colonised MRSA should be encouraged to
practice good hygiene and be assisted with this if their physical or mental condition
makes this difficult.
31.1.8
Isolation for colonised MRSA residents is not required as this may adversely affect
the resident.
31.1.9
However, if there is a reason to think that the resident is shedding large numbers
of bacteria (e.g. large wounds not contained by dressings, a tracheotomy with
frequent coughing), or has been implicated in the development of infection in other
residents, segregation may be necessary.
31.1.10
In addition, residents colonized or infected with MRSA should not be placed in
rooms with debilitated, non-ambulatory residents at greater risk of becoming
colonized or infected.
31.1.11
Residents colonised with MRSA should not be restricted from participation in
social or therapeutic group facilities within [the Centre], however wounds must be
covered.
31.2 Screening
31.2.1
[The Centre] does not carry out screening for MRSA on admission/readmission of
a resident from hospital as residents carrying MRSA do not require special
treatment after discharge from hospital.
31.2.2
A colonised resident may join other residents for social activities in the sitting
room, dining room and other communal areas providing their sores or wounds are
kept covered with an appropriate dressing, preferably impermeable.
31.2.3
Equipment with which the MRSA colonised resident has been in contact, such as a
commode, should be cleaned with detergent and hot water. Chemical disinfection
is not required.
31.2.4
Cutlery, crockery, and healthcare-risk waste should be dealt with as per normal
routine. No additional measures are required..
63 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
31.3 Care of deceased residents
31.3.1
All lesions in deceased residents should be covered with impermeable dressings.
31.3.2
There is no risk to relatives, mortuary staff, or undertakers as long as standard
infection control precautions are followed.
32.0 Clostridium Difficile
32.1.1
Clostridium Difficile is a spore-forming anaerobic bacillus, commonly found in soil
and the intestinal tracts of animals.
32.1.2
The spectrum of C. Difficile human disease ranges from asymptomatic
colonisation to potentially fatal colitis.
32.1.3
Residents can present with diarrhoea, abdominal cramps, fever, occurring several
days to up to 10 weeks after antibiotic therapy.
32.1.4
Pseudo Membranous Colitis (PMC) is the most severe manifestation of the
disease. PMC can present as right sided colitis, fever, pain, decreased gut motility,
mild diarrhoea. Severely ill residents may have little or no diarrhoea due to
dilatation of the colon.
32.1.5
Risk factors include exposure to antibiotic therapy, advanced age and
hospitalisation. Other risk factors include gastrointestinal surgery and
immunosuppressive therapy, and exposure to Proton Pump Inhibitor therapy.
32.1.6
An outbreak is defined as the occurrence of two or more C. Difficile associated
disease cases.
32.1.7
Spread may be direct or indirect via the hands of Healthcare staff, contaminated
equipment, and the environment.
32.1.8
As C. Difficile spores can survive in the environment, effective environmental
cleaning and disinfection is paramount in prevention of spread.
32.1.9
The nurse should request C. Difficile toxin assay test on all symptomatic residents
of diarrhoea (3 episodes in a 24 hour period) where no other cause for symptoms
has been confirmed.
32.1.10
Once diagnosis of C. Difficile is confirmed the resident should not be retested for
C. Difficile.
32.1.11
However if recurrence of diarrhoea after a symptom free interval occurs, a repeat
specimen should be retested for C Difficile toxin and other potential causes of
diarrhoea excluded.
32.1.12
Isolation and contact precautions can be discontinued when the resident is at least
48hrs without diarrhoea and has a formed or normal stool for that resident.
32.1.13
Residents usually present with explosive watery/mucousy foul-smelling diarrhoea
&/or abdominal pain. The resident may also present with a fever
32.1.14
Recurrence of diarrhoea is common (in up to 20% of people)
64 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
32.2 Contact and Standard Precautions
SIGHT Mnemonic protocol (Clostridium Difficle Infection in Ireland. A National Guideline,
2014).
S
Suspect that a case may be infective where there is no clear alternative cause for
diarrhoea.
I
Isolate the patient/resident. Consult with the infection prevention and control team
where available while determining the cause of the diarrhoea.
G
Gloves and aprons must be used for all contacts with the patient/resident and their
environment.
H
Hand washing with soap and water should be carried out after each contact with the
patient/ resident and the patient/resident’s environment.
T
Test the stool for Clostridium difficile toxin, by sending a specimen immediately.
 The SIGHT mnemonic protocol is a useful aide memoire and should be applied by
nurses when managing residents with suspected potentially infectious diarrhea.
 Residents with suspected potentially infectious diarrhoea should be monitored daily
for frequency and severity of diarrhoea using the Bristol Stool Chart.
 All medications should be reviewed by the resident’s general practitioner and
pharmacist (if available) – antibiotics that are no longer clinically indicated should be
discontinued. Other medications that may be causing or contributing to diarrhoea
should also be reviewed and stopped if safe to do so.
 Residents’ with Clostridium Difficle Infection should be reviewed on a daily basis by
the medical and nursing team for deterioration, monitoring the frequency and severity
of diarrhoea.
32.2.1
The resident will require a single room with en-suite facilities / separate toilet /
commode.
32.2.2
Residents with similar microorganisms may be cohorted, if necessary.
32.2.3
Maintain adequate hydration to ensure that fluid and electrolyte balance are
maintained.
32.2.4
Anti-diarrhoeal agents should be avoided.
32.2.5
Liaise with microbiologist/G.P. for advice regarding suitable antibiotic use.
32.2.6
Avoid the use of third generation Cephalosporins.
32.2.7
Place appropriate isolation signage outside the closed door.
32.2.8
Perform hand hygiene - wash hands using soap and water and you may use
alcohol gel as per the 5 moments of hand hygiene.
32.2.9
Hand washing with soap (non-antimicrobial or antimicrobial) and water must be
performed before and after all resident and equipment contact and after glove
removal.
32.2.10
It is vital that hands are washed using warm water and soap as alcohol-based
hand rubs are not recommended as the only hand hygiene measure when caring
for confirmed or suspected C. Difficile residents.
65 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
32.2.11
Staff should wear personal protective equipment (PPE) as per standard
precautions - apron / gloves to be worn for direct contact with the resident, the
resident’s environment and equipment.
32.2.12
Remove PPE prior to leaving the room and perform hand hygiene.
32.2.13
Visitors should be educated to perform hand hygiene by washing hands using
soap and water and not to visit other residents in the nursing home after leaving
the isolated residents room.
32.2.14
All linen and waste is considered potentially infectious – treat as healthcare risk
waste.
32.2.15
Decontaminate bedpans / commodes in washer disinfector.
32.2.16
Decontaminate crockery in dishwasher and any feeding equipment e.g. adapted
cutlery, plate guards, with suitable disinfectant.
32.2.17
Wash all equipment and environmental surfaces daily with detergent and water,
followed by disinfection using a hypochlorite disinfectant.
32.2.18
Terminal Cleaning - thoroughly clean and disinfectant the room as above. In
addition replace curtains and document date of cleaning and change.
32.2.19
Educate the resident / family on the need for precautions, if possible provide with
written information about their condition (give leaflets where applicable).
32.2.20
Notify relevant departments in advance of resident transfer if required (GP / PHN /
Nursing home / Hospital / Ambulance service).
33.0
Herpes Zoster (Shingles)
33.1.1
Primary infection with the varicella zoster virus causes Chickenpox. The virus
remains dormant in the dorsal root ganglion for years and its reactivation, often
decade’s later causes Shingles.
33.1.2
The resident is infectious for up to one week following the appearance of vesicles.
33.1.3
Transmission is caused by direct contact with vesicle fluid. Virus shedding
continues until the lesions dry up.
33.1.4
Facial lesions are considered more infectious than body lesions - clothing reduces
virus dispersal.
33.1.5
The resident may feel unwell for 2-3 days - mild chill, fever, nausea, abdominal
cramps or diarrhoea.
33.1.6
Skin lesions appear 4-5 days later as painful red vesicles which progress to
pustules, which scab and then separate (2-4 weeks).
33.1.7
Vesicles appear on a broad streak of reddened skin along sensory nerve routes.
33.1.8
Lesions are commonest on the chest and spread only on one side of the body.
33.1.9
The resident may complain of chest or facial pain, or a burning pain on the
abdominal or chest wall.
33.1.10
Shingles can be diagnosed by the clinical presentation, serology or demonstration
of the virus in vesicle fluid.
33.1.11
Treatment involves treating of the resident’s symptoms treatment and adequate
analgesia.
33.1.12
Antiviral agents such as acyclovir may shorten the duration of acute illness,
prevent dissemination and shorten the duration of pain. The antiviral agent must
be given within 72 hours of onset to be beneficial.
33.1.13
Steroids may prevent post herpetic neuralgia.
33.1.14
Antihistamines can be prescribed to relieve itching.
66 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
33.1.15
The resident will require standard precautions and contact precautions.
33.1.16
The resident will require isolation for one week following appearance of vesicles
and until all exposed vesicles have dried / crusted.
33.1.17
Residents with similar microorganisms may be cohorted, if necessary.
33.1.18
Place appropriate isolation signage outside the closed door.
33.1.19
Staff should perform hand hygiene using alcohol Gel or washing hands using soap
and water as per the 5 moments of hand hygiene.
33.1.20
Staff should wear personal protective equipment (PPE) as per standard
precautions - apron / gloves to be worn for direct contact with the resident, the
resident’s environment and equipment.
33.1.21
Remove PPE prior to leaving the room and perform hand hygiene.
33.1.22
Visitors should be educated to perform hand hygiene by washing hands using
soap and water and not to visit other residents in the nursing home after leaving
the isolated residents room.
33.1.23
All linen and waste is considered potentially infectious – treat as healthcare risk
waste.
33.1.24
Decontaminate bedpans / commodes in washer disinfector.
33.1.25
Decontaminate crockery in dishwasher and any feeding equipment e.g. adapted
cutlery, plate guards, with suitable disinfectant.
33.1.26
Wash all equipment and environmental surfaces daily with detergent and water,
followed by disinfection using a hypochlorite disinfectant.
33.1.27
Terminal Cleaning - thoroughly clean and disinfectant the room as above. In
addition replace curtains and document date of cleaning and change.
33.1.28
Educate the resident / family on the need for precautions, if possible provide with
written information about their condition (give leaflets where applicable).
33.1.29
Notify relevant departments in advance of resident transfer if required (GP / PHN /
Nursing home / Hospital / Ambulance service).
33.1.30
There is a risk to the health of healthcare workers who have not had chickenpox
(particularly pregnant healthcare staff) and these staff should avoid contact if
possible.
67 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
34.0 Influenza
34.1.1
Influenza is a respiratory illness with a relatively specific syndrome caused by
Influenza A, B or C virus. It occurs in winter / spring epidemics with a relatively
high attack rate.
34.1.2
Vaccinations

All residents should be encouraged to receive the influenza vaccine each
year, in late September or early October unless there is a medical
contraindication.

Consent should be sought from the resident prior to administration of the
vaccine. In the event that the resident lacks capacity to provide consent,
this should be discussed with the residents general practitioner and
representative/next of kin.

The immunisation status of all residents should be recorded annually.

All staff should receive annual influenza vaccine.

The immunisation status of all staff should be recorded annually.
34.1.3
The incubation period for influenza is usually 1-3 days and residents are infective
for approximately 3-5 days from clinical onset.
34.1.4
The influenza is transmitted by contact with nasopharyngeal secretions / mucous
membranes of infected person and is spread by infected droplets.
34.1.5
The influenza season tends to from the beginning of October to the end of May.
34.1.6
All staff should be aware of the early signs and symptoms of influenza-like illness,
which are:

Sudden onset of symptoms and

At least one of the following four systemic symptoms:
 Fever or feverishness
 Malaise
 Headache

 Myalgia
And at least one of the following three respiratory symptoms:
 Cough
 Sore throat
 Shortness of breath
34.1.7
Residents will require treatment of symptoms and antiviral agents may also be
required.
34.1.8
Residents with influenza are at risk of developing secondary pneumonia or
dehydration.
34.1.9
Standard, contact & droplet precautions are necessary when caring for a resident
with influenza.
34.1.10
The resident will require a single room with en-suite facilities or cohort infected
residents.
34.1.11
The bedroom door should be kept closed.
34.1.12
Appropriate isolation signage needs to be placed on the on the outside of the
closed door.
68 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
34.1.13
Staff should perform hand hygiene by using alcohol gel or washing hands using
soap and water as per the 5 moments of hand hygiene.
34.1.14
Staff should wear gown / apron and gloves, surgical mask FFP2 masks when in
contact with the resident and environment.
34.1.15
All waste and linen should be managed as healthcare risk waste.
34.1.16
Equipment should be dedicated for resident only use and not used on another
resident unless appropriately decontaminated.
34.1.17
Decontaminate all environmental surfaces / daily with detergent and water and
then disinfectant.
34.1.18
The residents care plan or any other documentation should not be brought into the
residents room. .
34.1.19
Terminal cleaning of room should be carried out using disinfection. Replace
curtains and document change.
34.1.20
Education should be provided to the resident and/or representative on need for
precautions and safe cough etiquette.
34.1.21
An outbreak is defined as three or more cases of influenza-like illness (ILI) or
influenza or serious illness suggestive of influenza arising within the same 72 hour
period (HSE, 2012.)
34.1.22
In the event of an outbreak the Person in Charge should follow the guidelines
outlined in the Interim Guidelines on the Prevention and Management of Influenza
Outbreaks in Residential Care Facilities in Ireland 2011/2012.
http://www.hpsc.ie/hpsc/AZ/Respiratory/Influenza/SeasonalInfluenza/Guidance/ResidentialCareFacilitiesGuidance/File,13195,e
n.pdf
69 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
Fig 13: Algorithm for the Management of ILI/Influenza Outbreak
Assessment of the situation
 Establish/confirm influenza
outbreak.
 First case onset date.
 Numbers affected (residents
and staff).
 Symptoms.
 Results of initial laboratory
tests.
If Influenza
Form an Outbreak Control Team and
commence investigation
 Designate roles and responsibilities.
 Formulate working case definitions.
 Define population at risk.
 Active case finding (staff and resident).
 Immunisation status of staff and residents.
 Discuss further specimen collection and
tests.
 Clarify communications between Public
Health department, laboratory and [the
Centre].
 Decide on who needs to be notified.
 Discuss management strategies including
infection control measures, vaccination
and antiviral therapy/chemoprophylaxis &
communication.
 Discuss need for media release.
Outbreak Management
 Sample collection and transport.
 Implement Droplet in addition to
Standard Precautions.
 Antiviral therapy/chemoprophylaxis and
vaccination.
 Collect appropriate documents.
 Ensure daily communication between
[the Centre], laboratory & Public
Health.
If not Influenza
Manage as appropriate and
agree level of support from
local public health
Monitoring outbreak
 Continuing surveillance for new
cases.
 Update line listing.
 Review laboratory results.
 Need for further laboratory testing.
 Evaluate effectiveness of control
measures.
 Are there any further control
measures necessary?
 Movement of staff and residents
between areas/departments.
 Review communications with
residents, healthcare professionals
and other agencies
 Review the need for media briefing.
 Have criteria to declare outbreak
over been confirmed.
Once outbreak is declared over
 Have relevant agencies been
notified?
 Have restrictions at [the Centre]
been lifted?
 Has an outbreak report been
compiled?
 Has a date been set for review?
35.0 Scabies
Declare outbreak over/Debrief
 No new cases for 8 days after the onset of symptoms of last resident case (one incubation
period, one period of infectivity).
 If staff member is the last case, time until outbreak is declared over can be shortened as the
person would be at home during the period of communicability.
 Notify other relevant individuals/agencies.
 Discuss need for on-going surveillance.
 Formulate outbreak report.
 Review management of outbreak
70 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
36.0 Scabies
36.1.1
Scabies is a parasitic skin infection caused by the scabies mite.
36.1.2
The incubation period for scabies is 2-6 weeks before onset of itching however a
person with previous infestation may develop symptoms within 1-4 days following
re-exposure.
36.1.3
A resident will remain infectious until the mites and eggs are destroyed by
treatment.
36.1.4
Scabies is transmitted through direct prolonged skin to skin contact e.g. holding
hands and sharing beds. Transfer from clothes and bedding only occurs if they
have recently been contaminated by infested persons.
36.1.5
Itching occurs 2-3 weeks following infestation and may continue for some time
following treatment.
36.1.6
The rash is usually found on the hands, finger webs, wrists, elbows, groin, penis,
waist and buttocks and itching is worse at night. Tiny vesicles or linear burrows
may be visible. Norwegian or crusted scabies is a more severe form of scabies
and is highly infectious (CDC, 2008) and is more common in the elderly.
36.1.7
Scabies can be diagnosed by observation of the burrows or rash. Skin scrapings
or lifting a mite out of a burrow with a needle for microscopic examination can
assist in making a diagnosis but is not necessary.
36.1.8
The treatment for scabies is topical insecticides.
36.1.9
Itching may persist for some time following treatment.
36.1.10 Applying Treatment
 The treatment is best applied at night.
 Remove all clothes. Watches and rings should also be removed.
 If it is not possible to remove a ring, move it to one side to treat the skin surface
underneath.
 A hot bath or shower should be avoided before putting on the cream: however, skin
should be clean, dry and cool.
 Cream/lotion should be applied to the whole body below the jaw line, according to
manufacturer's instructions.
 In some cases, the treatment may need to extend to the scalp, neck, face and ears. If
the treatment is to be applied to the head, avoid the eyes. This includes the elderly,
the immunocompromised, and those whose treatment has failed (seek GP advice).
 Take special care to apply the lotion/cream into the skin creases of the body – for
instance, nipples and genitalia.
 Particular attention needs to be paid to the skin under the nails and behind the ears.
 Cream/lotion should be brushed under the nails with a soft nailbrush, as mites can
easily escape treatment, in the thickened skin there.
 The cream/lotion should be allowed dry before getting dressed or it may rub off (this
takes 10-15 minutes).
 After the body treatment has dried, cream/lotion should be applied to the soles of the
feet.
 After the lotion/cream has been on for the appropriate time it should be washed off
initially with plain cool water and no soap.
 Once everything is washed off, a shower or bath with soap may be taken.
 Change clothes and wash as usual.
 An antipruritic may be required for itching.
 Oral administration of a sedating antihistamine at night may also be useful.
 Further anti scabies cream should not be applied as this may aggravate the irritation.
The skin will need time for the rash to settle down.
71 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016

If fresh spots appear, G.P. advice should be sought as further treatment may be
necessary or there may be an alternative diagnosis.
36.1.11
Even with fastidious treatment, the cure rate is not 100%. Most apparent failures
are due to either inadequate application of the cream/lotion or failure to identify a
contact.
36.1.12
It is possible to become re-infected with scabies. The rash may appear from 1-4
days after being re-infected.
Pay special attention to these areas when you put on the lotion or cream
36.1.13
Remove all of the residents clothing and bed linen, place in a water-soluble
alginate bag at the bedside and send for washing. It is advised that all clothes,
bedding, and towels used by the infested resident during the 3 days before
treatment are washed (CDC, 2008).
36.1.14
Outdoor clothes and shoes should be placed in a securely tied plastic bag and
store for more than 72 hours as the eggs cannot survive longer than this time
period. The items should then be dry cleaned or washed, as per fabric instructions.
36.1.15
The resident should be treated from head to feet with insecticidal lotion. If any area
is washed during contact time reapply (e.g. hand washing) Follow manufacturer’s
instructions regarding contact time.
36.1.16
The resident will require standard and contact precautions.
36.1.17
The resident will require a single room with en-suite facilities / separate toilet /
commode or cohort residents with same infection.
36.1.18
Appropriate isolation signage should be placed outside the closed bedroom door.
36.1.19
Staff should perform hand hygiene by using alcohol gel or washing hands using
soap and water as per the 5 moments of hand hygiene.
36.1.20
Staff should wear PPE as per standard precautions - Apron / gloves to be worn for
direct contact with the resident, the resident’s environment and equipment. Staff
should remove PPE prior to leaving the residents room and perform hand hygiene.
72 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
36.1.21
Visitors should be educated to perform hand hygiene and not to visit other
residents in the nursing home after leaving the residents room.
36.1.22
Vacuum any soft furnishing such as chairs and rugs, carpets.
36.1.23
Bedpans / commodes should be decontaminated in the washer.
36.1.24
Decontaminate crockery in dishwasher and any feeding equipment e.g. adapted
cutlery, plate guards, with suitable disinfectant.
36.1.25
Wash all equipment and environmental surfaces daily with detergent and water,
followed by disinfection using a hypochlorite disinfectant.
36.1.26
Terminal Cleaning - thoroughly clean and disinfectant the room as above. In
addition replace curtains and document date of cleaning and change.
36.1.27
Educate the resident / family on the need for precautions, if possible provide with
written information about their condition (give leaflets where applicable).
36.1.28
Notify relevant departments in advance of resident transfer if required (GP / PHN /
Nursing Home / Hospital / Ambulance service).
GP confirms a
single case of
scabies
Resident independent
& minimal contact with
other residents
Treat
Two or more
confirmed cases
of scabies
Resident dependant
on others for
personal care
Inform
PHSMO
Treat case twice.
Consider treating all
contacts once i.e.
Residential contacts,
family and staff working
in the nursing home.
Consider
treating all
staff and
residents
Observe closely for
6-8 weeks
Observe closely for
6-8 weeks
Treat
symptomatic
cases twice
Treat
asymptomatic
cases once
Observe closely for 6-8 weeks
73 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
37.0 Norovirus / Winter Vomiting Disease
37.1.1
Norovirus characteristically starts with the sudden onset of severe and dramatic
vomiting.
37.1.2
This can occur with such force that it is termed “projectile”. The person concerned
can be absolutely fine one minute and then vomiting the next.
37.1.3
Some, but not all people also develop diarrhoea.
37.1.4
The illness is usually lasts 1-3 days.
37.1.5
Norovirus can spread rapidly in nursing homes due to the close contact between
residents and healthcare workers. Therefore, it is essential that cross infection be
minimised.
37.1.6
The incubation period is approximately15-48 hours.
37.1.7
The resident may also experience nausea, abdominal cramps, myalgia, headache,
malaise, low grade fever, or a combination of these symptoms. Gastrointestinal
symptoms typically last 24-48 hours.
37.1.8
Residents are infective during the acute phase and up to 72 hours post cessation
of vomiting and diarrhoea.
37.1.9
The Norovirus is highly infectious. It can be transmitted through air, water, food
and direct contact.

By direct contact with the vomit or diarrhoea of an infected person e.g. when cleaning
it up.

From touching those parts of a symptomatic person that has become contaminated
with the virus e.g. their hands after they have been to the toilet (and not washed
them).

From eating food that has been contaminated by an infected food handler.

From food that was contaminated at source e.g. mussels, clams, oysters from
sewage polluted seawater.

Via inanimate objects including flat surfaces that have been contaminated with the
virus after someone has vomited in the vicinity.

By breathing in and then swallowing the virus that is floating in the air around
someone who has just vomited.
37.1.10
On surfaces (door handles, worktops) the viruses can survive in the environment
for some time.
37.1.11
Stool specimens should be sent to the Virus Reference Laboratory (VRL) in Dublin
for diagnosis (do not send vomitus samples).
37.1.12
The treatment for Norovirus is to ensure the resident is kept comfortable and to
prevent dehydration.
37.1.13
Antibiotic treatment has no effect on viruses and should be avoided.
37.1.14
If cross infection is suspected (i.e. 2 or more suspected cases), standard
precautions and isolation should be initiated immediately.
37.1.15
In an outbreak of Norovirus the unit should not be re-opened until 72 hours
following cessation of vomiting and / or diarrhoea.
74 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
37.1.16
The resident will require a single room with en-suite facilities / separate toilet /
commode or cohort residents with same infection.
37.1.17
Appropriate isolation signage should be placed outside the closed bedroom door.
37.1.18
Staff should perform hand hygiene by using alcohol gel or washing hands using
soap and water as per the 5 moments of hand hygiene.
37.1.19
Staff should wear PPE as per standard precautions - Apron / gloves to be worn for
direct contact with the resident, the resident’s environment and equipment. Staff
should remove PPE prior to leaving the residents room and perform hand hygiene.
37.1.20
Visitors should be educated to perform hand hygiene and not to visit other
residents in the nursing home after leaving the residents room.
37.1.21
Remove any exposed fruit/food in the area.
37.1.22
All linen and waste is considered potentially infectious and should be managed as
healthcare risk waste.
37.1.23
Bedpans / commodes should be decontaminated in the washer.
37.1.24
Decontaminate crockery in dishwasher and any feeding equipment e.g. adapted
cutlery, plate guards, with suitable disinfectant.
37.1.25
Wash all equipment and environmental surfaces daily with detergent and water,
followed by disinfection using a hypochlorite disinfectant.
37.1.26
Terminal Cleaning - thoroughly clean and disinfectant the room as above. In
addition replace curtains and document date of cleaning and change.
37.1.27
Educate the resident / family on the need for precautions, if possible provide with
written information about their condition (give leaflets where applicable).
37.1.28
Notify relevant departments in advance of resident transfer if required (GP / PHN /
Nursing home / Hospital / Ambulance services.
38.0 Legionnaires’ disease
38.1 Infection with legionella bacteria can cause 2 distinct clinical syndromes,
grouped together under the name legionellosis.
38.1.1
The first is Pontiac fever, a self-limiting influenza-like illness. It usually occurs in
explosive outbreaks. Incubation period is usually 24-48 hours. The person
recovers spontaneously in 2-5 days.
38.1.2
The second is a severe and potentially fatal form of pneumonia. Symptoms include
a flu-like illness, followed by a dry cough which frequently progresses to
pneumonia.
38.1.3
Approximately 30% of people infected may also present with diarrhoea and
vomiting and around 50% may show signs of mental confusion.
38.1.4
Legionnaires’ disease is a notifiable disease.
38.1.5
Legionnaires’ disease is normally acquired through the respiratory tract, by
inhalation of an aerosol.
38.1.6
Aspiration of water contaminated with legionella is also a route of transmission.
This may occur predominantly in persons with swallowing disorders or in
conjunction with nasogastric feeding.
38.1.7
Person to person transmission has never been documented.
38.1.8
Those identified as being at greater risk include being of an older people, male,
cigarette smoker, and having a chronic underlying disease with or without an
associated immunodeficiency.
38.1.9
The incubation period is usually between 2 days and 10 days although longer
periods have been reported.
75 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
38.1.10
Residents with Legionnaires disease will require transfer to a general hospital.
38.2 Recognised and Potential Sources of Legionella Infection
38.2.1
The following are all sources or potential sources of Legionnaires’ disease:

Hot and cold water systems

Cooling towers and evaporative condensers

Respiratory and other therapy equipment

Spa pools/natural pools/thermal springs

Fountains/sprinklers

Humidifiers for food display cabinets

Water cooling machine tools

Potting compost/soil in warmer climates
38.3 Procedure for Flushing of Taps, Showers, Toilets and Sluices.
38.4.1
Daily flushing of outlets (taps, showers, toilets etc.) is recommended for the
prevention of Legionnaires’ disease (National Disease Surveillance Centre, 2002)
38.4.2
Usage of each outlet (taps, showers, toilets, sluices etc) must be documented
each week.
38.4.3
If an outlet has not been flushed in the previous week, then the outlet must be
flushed.
38.4.4
Records must be kept of
 Outlets not requiring flushing because of usage in the previous week.
 outlets that required flushing because they had not been used in the previous
week.
38.4.5
[Specify person] has responsibility for ensuring that no outlet is unflushed for more
than one week.
38.4.6
Flushing for 2-3 minutes is advised.
38.4.7
Showers should be flushed at the maximum hot setting.
38.4.8
Doors to bathroom/ensuite facilities should remain closed during the flushing
period and should display a notice indicating that cleaning is in progress and that
the facility is out of use.
38.4.9
Flushing to be recorded on log sheets
38.5 Procedure for the Cleaning of Showerheads
38.5.1
Showerheads should be cleaned regularly i.e. quarterly or more frequently if
indicated.
38.5.2
Requirements:
 PFR95 mask (CDC approved mask to protect against airborne pathogens)
 Plastic apron
 Non-sterile gloves
 Bucket
 Household detergent
 Descaling agent
 Measuring jug
 New soft toothbrush.
76 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
38.5.3
Procedure for Cleaning of Showerheads:
 All those involved in the process to wear PFR95 masks, plastic aprons and nonsterile gloves.
 Open the window and close the door of the shower room/bathroom while
showerhead is being dismantled.
 Remove showerhead and discard, if it shows signs of deterioration.
 Place showerhead in a bucket of warm water and detergent with descaling agent to
soak as per manufacturer’s instruction.
 Clean with the soft toothbrush to remove surface dirt.
 Rinse under running water.
 The shower should be run for five minutes and the shower room/bathroom door
should remain closed during the flushing period and should display a notice
indicating that cleaning is in progress and the facility is out of use.
 The facility should remain closed for half an hour, following running of the water to
allow aerosols to settle.
 Refit the showerhead.
 Showerheads should be replaced on a rotational basis
 Cleaning and replacement should be recorded.
 It is advised that a showerhead replacement rota be drawn up.
 This will allow for replacement of all showerheads over a specified period of time, on
a rotational basis.
39.0 Salmonellosis
39.1.1
Salmonellosis is an infection with bacteria called Salmonella.
39.1.2
Most persons infected with Salmonella develop diarrhea, fever, and abdominal
cramps 12 to 72 hours after infection.
39.1.3
The illness usually lasts 4 to 7 days, and most persons recover without treatment.
However, in some persons, the diarrhea may be so severe that the resident needs
to be hospitalized. In these residents, the Salmonella infection may spread from
the intestines to the blood stream, and then to other body sites and can cause
death unless the person is treated promptly with antibiotics. The elderly and those
with impaired immune systems are more likely to have a severe illness.
39.1.4
Persons with diarrhea usually recover completely, although it may be several
months before their bowel habits are entirely normal. A small number of persons
with Salmonella develop pain in their joints, irritation of the eyes, and painful
urination. This is called reactive arthritis. It can last for months or years, and can
lead to chronic arthritis which is difficult to treat. Antibiotic treatment does not make
a difference in whether or not the person develops arthritis.
39.1.5
Salmonella bacteria can survive several weeks in a dry environment and several
months in water
39.1.6
Sources of Infection include:

Infected food, often gaining an unusual look or smell, then is introduced into the
stream of commerce;

Poor kitchen hygiene, especially problematic in institutional kitchens and restaurants
because this can lead to a significant outbreak;

Excretions from either sick or infected but apparently clinically healthy people and
animals (especially endangered are caregivers and animals);

Polluted surface water and standing water (such as in shower hoses or unused water
dispensers);

Unhygienically thawed fowl (the meltwater contains many bacteria);
39.1.7
Salmonella are usually transmitted to humans by eating foods contaminated with
animal feces. Contaminated foods usually look and smell normal. Contaminated
foods are often of animal origin, such as beef, poultry, milk, or eggs, but any food,
77 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
including vegetables, may become contaminated. Thorough cooking kills
Salmonella. Food may also become contaminated by the hands of an infected
food handler who did not wash hands with soap after using the bathroom.
39.1.8
Determining that Salmonella is the cause of the illness depends on laboratory tests
that identify Salmonella in the stool of an infected person. Once Salmonella has
been identified, further testing can determine its specific type.
39.1.9
The resident will require a single room with en-suite facilities / separate toilet /
commode or cohort residents with same infection.
39.1.10
Residents with similar microorganisms may be cohorted, if necessary.
39.1.11
Maintain adequate hydration to ensure that fluid and electrolyte balance are
maintained.
39.1.12
Liaise with microbiologist/G.P. for advice regarding suitable antibiotic use.
Antibiotics, such as ampicillin, trimethoprim-sulfamethoxazole, or ciprofloxacin, are
not usually necessary unless the infection spreads from the intestines.
39.1.13
Salmonella infections usually resolve in 5-7 days and often do not require
treatment other than oral fluids.
39.1.14
Place appropriate isolation signage outside the closed door.
39.1.15
Perform hand hygiene - wash hands using soap and water and you may use
alcohol gel as per the 5 moments of hand hygiene.
39.1.16
Hand washing with soap (non-antimicrobial or antimicrobial) and water or hand
gel must be performed before and after all resident and equipment contact and
after glove removal.
39.1.17
Staff should wear personal protective equipment (PPE) as per standard
precautions - apron / gloves to be worn for direct contact with the resident, the
resident’s environment and equipment.
39.1.18
Remove PPE prior to leaving the room and perform hand hygiene.
39.1.19
Visitors should be educated to perform hand hygiene by washing hands using
soap and water or hand gel and not to visit other residents in the nursing home
after leaving the isolated residents room.
39.1.20
All linen and waste is considered potentially infectious – treat as healthcare risk
waste.
39.1.21
Decontaminate bedpans / commodes in washer disinfector.
39.1.22
Decontaminate crockery in dishwasher and any feeding equipment e.g. adapted
cutlery, plate guards, with suitable disinfectant.
39.1.23
Wash all equipment and environmental surfaces daily with detergent and water,
followed by disinfection using a hypochlorite disinfectant.
39.1.24
Terminal Cleaning - thoroughly clean and disinfectant the room as above. In
addition replace curtains and document date of cleaning and change.
39.1.25
Educate the resident / family on the need for precautions, if possible provide with
written information about their condition (give leaflets where applicable).
39.1.26
Notify relevant departments in advance of resident transfer if required (GP / PHN /
Nursing home / Hospital / Ambulance service).
78 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
40.0 Guidelines for the Prevention and Control of Multi-Drug Resistant
Organisms (MDRO) excluding MRSA.
40.1.1
Residents colonised with a Multi-Drug Resistant Organism (MDRO) should not be
declined admission to [the Centre] or have their admission delayed on the basis of
colonisation status. However, strategies should be in place to control the spread
of such organisms.
40.1.2
In general, residents of long term care facilities would have a lower risk of
developing invasive infections than hospitalised patients.
40.1.3
The management of residents of long term care facilities who are colonised with
an MDRO is quite different to that in the hospital setting. The implementation of
infection control precautions at a level required in the hospital setting may have
adverse psychological consequences for the nursing home resident, where the
facility is also their home. (Royal College of Physicians clinical advisory group on
Healthcare Associated Infections in association with HSE Quality and Patient
Safety, 2012).
40.1.4
Standard Precautions should be implemented by all healthcare workers when
dealing with all residents in [the Centre] regardless of whether they are infected or
colonised with an MDRO.
40.1.5
The decision to isolate a resident must be considered carefully and should take
into account the infection risks to other residents, the presence of risk factors that
increase the likelihood of transmission, and the psychological effects of isolation
on the colonised or infected resident. Before isolating a resident, a plan to review
the need for ongoing Contact Precautions must be in place. The following
scenarios may arise:
40.1.6

Relatively healthy independent residents colonised with an MDRO: Standard
Precautions should be sufficient, ensuring that single-use disposable gloves
and aprons are used when dealing with uncontrolled secretions, draining
wounds, stool, ostomy bags or tubes and pressure ulcers.

Ill dependent residents OR residents with uncontrolled secretions /
excretions OR residents suffering from an infection caused by an MDRO:
Contact Precautions are recommended in this situation. Single room
accommodation is preferable, if available. If single rooms are not available,
cohorting of residents known to be colonised or infected with the same
MDRO is acceptable. If cohorting is not possible, then those residents
colonised/infected with an MDRO should be placed in a room with a resident
considered to be at low risk for acquisition of an MDRO (i.e. not
immunocompromised, not on antimicrobials, without open wounds, drains or
urinary catheters) or those who have an anticipated short duration of stay.

The mobile resident who is incontinent, confused and perhaps wandering,
poses a particular infection control problem when colonised with an MDRO.
Decisions regarding the best precautions to use for a patient with an MDRO
may need to be made on a case-by case basis.
Other aspects of control of MDRO in long term care facilities include:
79 | 8 7

Maintaining a list of residents infected/colonised with an MDRO (to be
carried out by the clinical nurse manager as part of the monthly key quality
indicators data).

Monitoring microbiology culture results of specimens sent to the local
microbiology laboratory

Communication of information relating to the status of an MDRO colonised
resident to other receiving or transmitting facilities where indicated, such as
upon referral to hospital or other healthcare facilities

Ensuring adequate environmental cleaning
NMA Infection Prevention and Control Policy and Procedures 10052016
40.1.7
If the spread of an MDRO within [the Centre] is not controlled by the infection
control precautions mentioned above, intensified infection control measures may
be required and expert advice should be sought form the Infection Prevention and
Control Team (IPCT) in [specify name of hospital and contact details].
40.1.8
Single-use patient care equipment should be used where possible. The amount of
re-usable patient care. Where equipment cannot be single patient use e.g. hoist,
they should be cleaned and disinfected before after every use with the resident.
40.2 Vancomycin-Resistant Enterococci (VRE): Vancomycin Resistant Enterococcus
also referred to as Glycopeptide Resistant Enterococcus (GRE). VRE are
enterococci that have become resistant to vancomycin or other antibiotics that may
have usually treated them.
40.2.1
When a resident is colonised with VRE, he/she may carry it in the bowel or other
site such as in urine or a wound without symptoms. When residents have an
infection caused by VRE their signs and symptoms will vary depending on where
the infection is present e.g. there may be redness if there is a wound infection
caused by VRE.
40.2.2
Some residents develop infections with VRE. VRE infections like infections from
other bacteria vary from mild to severe and depend on many other factors such as
the site of infection, age, and other illnesses that the resident may have.
40.2.3
VRE can spread by:
 Direct resident to resident contact.
 Indirectly via transient carriage on hands of healthcare personnel.
 Contaminated environmental surfaces or resident care equipment.
40.3 Isolation of a resident with colonised VRE is generally not required in long
term care facilities and routine screening for VRE is not recommended (HSE
South, 2012).
40.4 Resistant Enterobacteriaceae / Carbapenem Resistant Enterobacteriaceae
(CRE):
40.4.1
CRE stands for Carbapenem Resistant Enterobacteriaceae. CRE are bacteria
that live in the bowel and that cannot be treated by certain antibiotics, known as
carbapenem antibiotics.
40.4.2
In most people, CRE bacteria are carried in the bowel harmlessly (this is called
‘colonisation’) and do not cause infection. However, if a resident is prone to
infection and the infection is caused by CRE, it can be difficult to treat, because
many of the commonly used antibiotics will not work against CRE.
40.4.3
For most residents, colonised with CRE their immune system controls the CRE in
the bowel and prevents it from spreading elsewhere in the body. Sometimes
however, CRE can cause infection, for example when extremely ill or
immunocompromised. CRE can cause infections, such as kidney infections,
wound infections or in severe cases, blood infection and respiratory infections.
40.4.4
Routine CRE screening of the following at-risk patient groups is recommended:
 Any patient with known history of CRE colonisation or infection.
80 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
 Any patient with a history of admission for more than 48 hours to a named
Irish healthcare facility reporting an outbreak of CRE in the past 12 months
For latest list of named healthcare facilities see:
http://www.hpsc.ie/hpsc/A-Z/MicrobiologyAntimicrobialResistance/
StrategyforthecontrolofAntimicrobialResistanceinIrelandSARI/
CarbapenemResistantEnterobacteriaceaeCRE/ScreeningforCREinIreland/
 Any patient with a history of admission for more than 48 hours to a foreign
healthcare facility in the past 12 months.
 Any patient transferred/repatriated from a healthcare facility in any foreign
country.
 If the patient has attended an Irish healthcare facility reporting a CRE
outbreak or a foreign healthcare facility for less than 48 hours or as a day
patient, the decision whether to perform CRE screening should be made upon
local risk assessment.
40.4.5
Where a resident is colonised with CRE standard precautions are sufficient in the
management of same. Hand hygiene is a primary part of preventing multidrugresistant organism (MDRO) transmission.
40.4.6
Where a resident presents with an infection of CRE, contact and transmission
based precautions including isolation must be applied.
40.5 ESBL (Extended-Spectrum Beta-Lactamases) and Klebsiella pneumoniae
40.5.1
Enterobacteriaceae are a group of gram negative bacteria that commonly live in
the bowel and include E. Coli and Klebsiella pneumonia.
40.5.2
E. Coli are very common bacteria that normally live harmlessly in the gut and can
cause infections, most commonly urinary tract infections (UTI’s). Most urinary tract
infections get better without treatment, or are easily treated with antibiotics.
However, UTI’s can progress to cause more serious infections such as septicemia
bloodstream infection.
40.5.3
ESBL’s (Extended-Spectrum Beta-Lactamases) are enzymes produced by some
types of bacteria, including some strains of E. Coli, which make these bacteria
resistant to most beta-lactam antibiotics (such as penicillins and cephalosporins).
ESBL-producing E. Coli and other bacteria may also be resistant to other classes
of antibiotics.
40.5.4
The majority of residents colonised with ESBL’s do not have any signs or
symptoms present. When residents have an infection caused by an ESBL
producing organism signs and symptoms will vary depending on where the
infection is present.
40.5.5
The gastrointestinal tract is the most likely site for asymptomatic colonisation with
ESBL producing bacteria and can spread from:

Person to person directly or indirectly via faecal contamination of hands
and objects which are then introduced into the mouth,

The hands of residents, visitors and healthcare workers after contact with
an infected person if the hands aren’t cleaned properly.
40.5.6
Residents colonised with ESBL’s should not be placed adjacent to residents with
devices such as urinary catheters and/or wounds
40.5.7
All residents with diarrhoea should be cared for in a single room with en-suite
facilities where available.
40.5.8
Where a resident is colonised with ESBL, standard precautions are sufficient in the
management of same. Hand hygiene is a primary part of preventing multidrugresistant organism (MDRO) transmission.
81 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
40.5.9
It may be necessary to adhere to Contact Precautions where a resident has
infection which is caused by ESBL. The need for contact precautions should be
advised upon by the Infection Prevention and Control Team [specify where i.e.
local hospital and contact details]
41.0 Notifiable Diseases
41.1.1 A list of the 2012 Nationally Notifiable Diseases and Conditions can be sourced at:
http://www.hpsc.ie/NotifiableDiseases/ListofNotifiableDiseases/File,678,en.pdf
82 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
42.0 Management of an Outbreak
42.1.1
Certain cases of infectious disease, whether confirmed or suspected, must be
notified by the Medical Officer or GP to the Department of Public Health.
42.1.2
It is recommended that cases of other infectious diseases, which are not statutorily
notifiable (e.g. scabies), should also be reported by the GP to the Public Health
Senior Medical Officer (PHSMO), when an outbreak is suspected.
42.1.3
Prompt notification and reporting of cases of infectious disease to the PHSMO is
essential for the monitoring of infection, and allows for early investigation and
prompt control of its spread.
42.1.4
A record should be kept of the following information on residents, with suspected
or confirmed infectious disease.
o
Name, age/date of birth, and sex of resident
o
Resident’s address/ nursing home address
o
General practitioner’s name and address
o
Date of onset of symptoms and cessation of symptoms
o
Type of symptoms
o
Samples sent and results, if known
o
Diagnosis
o
Source of infection if known
o
Contacts- e.g. recent hospital in-patient, family, staff and visitors
o
Whether the case was notified/reported to the Department of Public Health. If so,
the date of notification/reporting.
42.1.5
Similar information should be kept for any staff who develops similar symptoms.
42.1.6
As soon as an outbreak of infectious disease is suspected within [the Centre], the
Person in Charge should contact the Public Health Senior Medical Officer
(PHSMO).
42.1.7
The PHSMO, in consultation with the Consultant in Public Health Medicine
(CPHM), will decide whether there is a true outbreak and will initiate and coordinate any necessary action, including the use of the local outbreak control
plans.
42.1.8
They will advise the nurse in charge of any immediate actions necessary to control
the outbreak including:
1) Case finding. This involves identifying all cases and keeping records. The PHSMO
will work in liaison with the Person in Charge to identify all cases.
2) Sending specimens to the local laboratory. Following discussion with the local
microbiologist, specimens should be sent to the local laboratory and a record kept of
same. In addition to the clinical history on the laboratory form, please make note if
the person is a healthcare worker/food handler.
3) Isolating residents: the PHSMO or Director of Public Health Medicine (PHN) in
consultation with the Consultant in Public Health Medicine (CPHM) will advise on the
necessary steps. It may also be appropriate to stop admissions and transfers for a
period of time.
4) In the case of a food borne outbreak, the Public Environmental Health Officer
(PEHO) may interview residents about the food they consumed and will speak to
food handlers about aspects of food hygiene and check procedures and equipment.
42.1.9
As a general rule, health care staff with symptoms of gastrointestinal infection
(diarrhoea and/or vomiting) should be advised to remain off work until 48 hours
83 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
after clinical recovery and stools have returned to normal (where the causative
pathogen has not been identified.
42.1.10
Any food handler infected with Hepatitis A should be excluded from food handling
duties for seven days after the onset of jaundice and/or symptoms.
42.1.11
Emphasising standard infection control precautions, in particular good hand
hygiene, is imperative in controlling an outbreak.
43.0 Staff Health
43.1.1
Staff have the responsibility of ensuring they do not transmit infection to other staff
or residents of [the Centre]. As a result healthcare staff should report any
infectious condition to the person in charge [or specify person]. These conditions
include the following:
DIARRHOEA
AND VOMITING
If a member of staff develops diarrhoea and/or vomiting they must
inform [the person in charge / clinical nurse manager / senior nurse
on duty - specify] and go off duty immediately. If symptoms persist
for a few hours only the cause is likely to be viral and the individual
should remain away from work for 48 hours after the last symptoms
have
stopped.
However, if the diarrhoea and/or vomiting persists for longer than a
few hours, they should visit their GP and take a stool specimen with
them.
SORE THROATS
Severe sore throats, often accompanied by a fever, may be due to
the Group A streptococcus. The individual should have a throat swab
taken by their GP. Antibiotics should be commenced as indicated and
should be prescribed by the GP.
INFECTIOUS LESIONS
Staff may not be suitable to work with infected cuts, spots, boils or
other infected skin lesions, particularly on the face and hands. The
staff member should attend their GP and discuss same. If allowed to
work, all cuts must be covered with a waterproof plaster.
VARICELLA ZOSTER
VIRUS (VZV)
HAIR LICE
SCABIES
84 | 8 7
VZV can manifest as either chickenpox or shingles. Members of staff
who have had chickenpox are in no danger of contracting or
spreading the virus again. However, staff or residents who have not
had the virus and are exposed to chickenpox or shingles may develop
chickenpox. For this reason staff who have not had chickenpox
should be excluded from caring for a resident with shingles or
chickenpox.
Any member of staff who believes they have a hair lice infestation
should see their GP to confirm this and to prescribe the appropriate
treatment. Once treatment has been applied the staff member can
continue working as normal.
Any member of staff who believes they have a scabies infestation
should see their GP who will prescribe the appropriate treatment.
Staff may return to work 24 hours after treatment. The initial therapy
should be repeated 4-7 days after the first treatment.
NMA Infection Prevention and Control Policy and Procedures 10052016
44.0 Infection Control Issues Regarding Last Rites
This section should be read in conjunction with [the Centre’s] Policy on End of Life
44.1.1
Standard Precautions apply in the care of the deceased.
1. Wash hands and put on protective clothing i.e. gloves and apron.
2. Collect and prepare equipment.
3. Remove all upper bed linen and place in appropriate laundry bag.
4. Remove all tubes and drains unless otherwise instructed.
5. Re-dress all wounds with a waterproof dressing.
6. Where drains or tubes are left in position these should also be covered with a
padded waterproof dressing.
7. Wash the resident.
disposable razor.
A male resident should be shaved carefully using a
8. Put on a suitable incontinence pad and secure properly
9. Ensure that any equipment used is decontaminated appropriately.
10. Following removal of the deceased the area is ready for terminal cleaning.
85 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
45.0 References
1.
Department of Health and Children, (2003) Segregation Packaging and Guidelines for
Healthcare Risk Waste.
2.
Royal College of Physicians Clinical Advisory Group on Healthcare Associated
Infections in association with HSE Quality and Patient Safety (2012). Guidelines for
the Prevention and Control of Multi-drug resistant organisms (MDRO) excluding MRSA
in the healthcare setting.
3.
Health Protection Surveillance Centre and Health Service Executive (2012).
Guidelines for the Emergency Management of Injuries
4.
National Clinical Effectiveness Committee (2014) Clostridium difficile Infection in
Ireland. Surveillance, Diagnosis and Management of Clostridium difficile Infection in
Ireland National Clinical Guideline No. 3
5.
Health Information and Quality Authority (2009) National Standards for the Prevention
and Control of Healthcare Associated Infections
6.
Department of Health and Public Health Laboratory Service Working Group (1994).
The prevention and management of Clostridium difficile Infection London: Department
of Health.
7.
Fendler, E.J., Ali, Y., Hammond, b.s., Lyons, M.k., Kelley, M.B. and Vowell, N.A.
(2002). The impact of alcohol hand sanitizer use on infection rates in an extended care
facility. American Journal of Infection Control; 9(1):95-102
8.
Godfrey, H. and Evans, A. (2000) Management of long-term urethral catheters:
minimising complications. British Journal of Nursing Vol 9, No2
9.
Godfrey H. and Evans A. (2000) Catheterisation and urinary tract infections:
microbiology. British Journal of Nursing Vol. 9, No. 11
10.
Infection Control Nurses Association (2003) Asepsis: Preventing healthcare
Associated. Infection http://www.icna.co.uk/
11.
Health Service Executive, (2006) Guidelines for Infection Control in
Nursing/Residential Homes
12.
Health Service Executive (2011) Infection Prevention & Control Guidelines
13.
Health Service Executive (2013) Infection Prevention and Control for Primary care in
Ireland: A Guide for General Practice accessed at http://www.hpsc.ie/AZ/MicrobiologyAntimicrobialResistance/InfectionControlandHAI/Guidelines/File,14612,
en.pdf
14.
Health Service Executive-Health Protection Surveillance Centre. HALT National
Report, November 2010. Available at:
http://www.hpsc.ie/hpsc/AZ/MicrobiologyAntimicrobialResistance/InfectionControlandH
AI/S rveillance/HCAIinlongtermcarefacilities/HALTproject2010/Results/
15.
Health Service Executive-Health Protection Surveillance Centre (2011). Prevention of
Urinary Catheter-related infections in Ireland.
16.
SARI Prevention of Urinary Catheter-related Infection Sub-Committee. Available at:
http://www.hpsc.ie/hpsc/AZ/MicrobiologyAntimicrobialResistance/InfectionControlandH
AI/Guidelines/
86 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016
17.
Health Service Executive-Health Protection Surveillance Centre (2011) Second
National Prevalence Survey on Healthcare Associated Infections and Antibiotic use in
Irish Long-Term Care Facilities.
18.
Health and Safety Authority (2011) Prevention of Sharps Injuries in Healthcare
Information Sheet.
19.
National Disease Surveillance Centre (2001) A Strategy for the control of Antimicrobial
Resistance in Ireland. Report of the Subgroup of the Scientific Advisory Committee of
the National Disease Surveillance Centre. Dublin: National Disease Surveillance
Centre.
20.
National Disease Surveillance Centre (2003) National guidelines on the Management
of Outbreaks of Norovirus in Healthcare Settings. Viral Gastroenteritis Subcommittee
of the Scientific Advisory Committee of the National Disease Surveillance Centre.
Dublin: National Disease Surveillance Centre
21.
National Disease Surveillance Centre Scientific Advisory Committee, Legionnaires’
subcommittee, 2002. The Management of Legionnaires’ disease in Ireland. National
Disease Surveillance Centre.
22.
National Institute for Clinical Excellence (2003) Infection Control: Prevention of
healthcare-associated infection in primary and community care.
http://www.nice.org.uk/pdf/Infection_control_fullguideline.pdf
23.
National Health and Medical Research Council (Australian Government) Aseptic Non
Touch Technique for Wound Care accessed 24/08/2012 @
http://www.nhmrc.gov.au/book/australian-guidelines-prevention-and-control-infectionhealthcare-2010/b1-7-aseptic-technique
24.
South Staffordshire NHS Primary Care Trust (2011) Aseptic and Clean (Non Touch)
Technique Procedure accessed at
http://www.southstaffordshirepct.nhs.uk/policies/infControl/Clin19_AsepticandClean%2
0_non_touch_%20Procedure.pdf
25.
Strategy for Antimicrobial Resistance in Ireland (2004) Draft Guidelines for Hand
Hygiene in Irish Healthcare Settings
http://www.ndsc.ie/Publications/ConsultationDocuments/d849.PDF
26.
Strategy for Antimicrobial Resistance in Ireland (2004) Draft version for Consultation
The control and prevention of MRSA in hospital and in the
communityhttp://www.ndsc.ie/Publications/ConsultationDocuments/
27.
Rowley, S. and Clare, S (2011) ANTT: a standard approach to aseptic technique.
Nursing Times Vol 107 (36).
28.
Wound, Ostomy and Continence Nurses Society (2011) Clean vs. Sterile Techniques
for Wound Management of Chronic Wounds. A Fact Sheet. Journal of Wound, Ostomy
and Continence Nurses Society. March/April 2012.
87 | 8 7
NMA Infection Prevention and Control Policy and Procedures 10052016