Download Infection Control - Bridgepoint Health

Student Guide to
Infection Control
A Primer for Students
Bridgepoint Hospital students are encouraged to use this guide as part of their
general orientation program.
For more information and resources, please contact Sharon O’Grady of Infection
Prevention and Control, Bridgepoint Hospital 416.461.8251 x 2126
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Basic Precautions for Everyday Life
How to Protect Yourself (and Your Family) at Work, Home, and in
the Community
•
Get your flu shot every year – the flu shot will protect you and those around
you from getting the flu.
•
Clean your hands with an alcohol-based hand rub or with soap and water
thoroughly and often – good hand hygiene is the best way to prevent the
spread of all flu viruses.
•
Keep an alcohol-based hand rub (gel or foam) handy at work, home and in
the car. Always clean hands before eating or after using the toilet.
•
Cover your mouth and nose with a tissue when you cough or sneeze –
safely dispose of the tissue immediately.
•
Cough or sneeze into your sleeve or elbow if unable to use a tissue - not
your hands.
•
DO NOT TOUCH YOUR FACE! – unless your hands are clean (Cold
and flu viruses enter your body through the eyes, nose, and/or mouth)
•
Stay home when you are sick and notify your instructor. If this condition
could be due to an exposure at Bridgepoint, then Occupational Health should
also be notified.
•
Keep shared surface areas clean, such as doorknobs, light
switches, telephones, keyboards and other surfaces, which can
become contaminated with all kinds of bacteria and viruses.
Regular cleaning and disinfecting of these surfaces can help.
Talk About Staying Healthy!
•
Encourage others to follow the simple steps shown above.
•
If you have children, be a good role model - teach them to clean
their hands with alcohol-based hand rub or wash their hands properly with
soap and water (count to 20 or sing Happy Birthday or Twinkle, Twinkle Little
Star for an appropriate amount of time); show them how to cover up when
they cough or sneeze.
•
Warn others –”DO NOT TOUCH YOUR FACE!”- unless you have
clean hands
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HEALTH CARE PROVIDER RESPONSIBILITIES FOR ALL STAFF
AT BRIDGEPOINT HOSPITAL
POLICY
Each health care provider has an important role to play in the
prevention and control of health care associated infections.
In understanding the basic principles and practices of infection
prevention and control, health care providers are able to work safely
to protect themselves and their patients.
PROCEDURE
1. The health care provider understands how infections are spread and
may be prevented and uses the Chain of Transmission as a model.
2. The health care provider understands how Routine Practices prevent
spread of micro-organisms and engages in these practices 100% of the
time.
3. The health care provider understands the importance of and always
uses hand hygiene in order to prevent the spread of micro-organisms
4. The health care provider understands the Additional Precautions
required to prevent transmission of epidemiologically important microorganisms and implements them in all appropriate circumstances.
5. The health care provider understands their role in, and the resources
available for infection prevention and control. The health care provider
educates staff, patients and visitors about infection prevention and
control and communicates all relevant information to staff, patients,
visitors related to individual infectious situations.
6. The health care provider understands and applies basic microbiology
concepts; understands and applies the principles and practices of
asepsis and sterile technique
7. The health care provider understands their responsibility and performs
surveillance through assessing and communicating unusual
occurrences and/ or clusters of infections to the appropriate people and
reporting communicable or reportable diseases to the Infection
Prevention and Control Program
8. The health care provider understands their role in maintaining a healthy
work environment by practicing environment and equipment cleaning
and disinfection, by refraining from working when ill and by receiving all
recommended vaccinations.
REFERENCES
Ministry of Health & Long Term Care. Core Competency Statements 2007
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PROCEDURES FOR POINT-OF-CARE STAFF- General Principles of
Infection Control
Break the Chain of Transmission:
Infectious
Agent
Reservoir
Susceptible
Host
Portal of
Entry
Mode of
Transmissio
n
Portal of
Exit
The goal of all Infection prevention and control practice is to break
the chain of transmission – the following actions are targeted at
specific links in the chain.
Infectious agent- swabs taken on patient with acute respiratory symptoms
to identify if caused by a virus.
Reservoirs for pathogens are eliminated by food safety, environmental
sanitation and personal hygiene.
The portals of exit for body fluids are covered.
Hand hygiene, personal protective equipment and environmental hygiene
address modes of transmission.
Patient education regarding hand hygiene and general wellness protect
portals of entry as does aseptic technique.
Susceptibility is diminished by vaccination, nutrition, skin integrity,
exercise and rest.
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Infection prevention and control is integrated into all aspects of
excellent patient care.
At Bridgepoint Hospital, like all Canadian health care facilities, we use a system
of infection prevention known as “Routine Practices and Additional Precautions” for
the prevention of healthcare associated infection (HAI). This system involves six
important areas and is considered the minimum acceptable standard of care
1. Critical assessment of the patient and each patient interaction to determine
infection transmission risk
2. Use of “four moments of hand hygiene” before patient (or the patient’s
environment) contact, before aseptic procedure, after body fluid contact, after
care is complete.
3. Use of appropriate personal protective equipment (PPE)
4. Cleaning and disinfection of patient care equipment and the patient
environment as well as general environmental hygiene.
5. Proper patient placement considering risk factors for transmission. This may
require the use of “Additional Precautions” – contact, droplet, airborne or
enhanced droplet precautions.
6. Patient and visitor education to ensure they are doing their part to prevent
infection transmission.
For further information on Routine Practices:
Public Health Agency of Canada, Routine Practices And Additional Precautions For
Preventing The Transmission Of Infection In Healthcare Settings, 2013
Provincial Infectious Diseases Advisory Committee (PIDAC), Routine Practices and
Additional Precautions In All Health Care Settings, 3rd edition, November 2012
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Clean Hands – The #1 Way To Protect Yourself And Others!
Hand Hygiene involves more than just hand washing!
Smooth, supple skin is more important than just feeling great – smooth skin makes it harder for
transient microorganisms to adhere: dry, cracked, calloused skin can provide hiding places for
germs that soap and water can’t access. This is why it is very important that you use skin creams
and conditioners that keep your hands soft and smooth. These are provided by the hospital so the
product is compatible with the gloves we use.
Alcohol-Based Hand Rub
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Is the preferred way to keep hands free of pathogens
- Provides rapid bacterial action against a broad spectrum of microorganisms
- Widely available throughout the hospital, and much quicker to use than soap and water
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NOTE: If hands are
visibly soiled, use
soap and water
Soap and Water
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DO NOT TOUCH YOUR FACE - with dirty hands!
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The illustration shows the areas most often
missed in handwashing
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Personal Protective Equipment (PPE) Putting On and Taking
Off
- The protective equipment provided by Bridgepoint Hospital is available to protect you and our
patients from exposure to infectious agents. This equipment is to be used any time your critical
assessment of the patient interaction indicates potential infection transmission risk.
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PROTECT YOURSELF AND OUR PATIENTS!
Supplies:
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Mask
Face Shield
Gown
Gloves
Personal Protection Equipment – How to Put On
There are a variety of ways to put on protective equipment; however, always adhere to the
principles of infection control.
Sanitize hands with available alcohol-based hand rub or wash hands thoroughly with soap and
water for 15 seconds before applying barrier equipment.
DO NOT TOUCH YOUR FACE! - with dirty hands
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STEP 1: PUTTING ON FACE PROTECTION
Fig. 1 Mask with Face Shield:
1. Masks are used to protect the mucous membranes of the eyes, nose and mouth from splashes.
2. Separate mask to fully open
- 3. Place first headband at neck and pull elastic loops around each ear
- 4. Form nosepiece tightly across bridge of nose and face. Adjust mask to achieve facial seal.
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Fig. 1
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N95 respirators protect against the inhalation of a range of particle sizes: nasopharyngeal,
tracheobronchial and alveolar-sized particles. They are reserved for known or suspected airborne
organisms. Respirators must be individually fit-tested to your face. This should be done at your
college. It is up to you to remember which respirator-type fits you best.
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STEP 2: PUTTING ON GOWN
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1. Hold gown by neck, allowing
it to unfold.
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2. Place arms in sleeves and slide
gown up to shoulders.
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3. Tie gown at neck.
4. Tie gown at waist, covering clothing.
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STEP 3: PUTTING ON GLOVES
1. Select the right size glove – too tight and they may split or tear, too loose, and they may catch.
2. Gloves must be changed between patients, and also between procedures on the same patient,
e.g. DO NOT PERFORM PATIENT’S PERI CARE, THEN ORAL CARE, WITH
THE SAME PAIR OF GLOVES.
3. Pull gloves over gown cuffs.
REMINDERS:
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DO NOT TOUCH YOUR FACE! – Unless you have just cleaned your hands
Avoid touching or adjusting other personal protective equipment.
Remove gloves if they become torn.
Limit surfaces and items touched.
ALWAYS CLEAN YOUR HANDS BEFORE PUTTING ON A NEW PAIR OF
GLOVES.
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Removal of Personal Protective Equipment (PPE)
After making sure that all tasks with the patient are complete and that the patient is comfortable and
safe:
•
Place needed personal items and the call bell within the patient’s reach.
•
Proceed to remove protective equipment.
•
Removal of personal protective equipment is carried out entirely inside the patient’s room, in the
area next to the sink.
Personal Protective Equipment – Removal Order from MOST CONTAMINATED to LEAST
CONTAMINATED to prevent spreading of microorganisms:
STEP 1:
Take Off Gloves
STEP 2:
Take Off Gown
Clean Your Hands
STEP 3:
Take Off Face Protection
Clean Your Hands
DO NOT FORGET TO CLEAN YOUR HANDS BEFORE MOVING YOUR HANDS
UP TO YOUR FACE!
REMEMBER - If hands are visibly soiled, use soap and water
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Directions for Taking off Personal Protective Equipment
STEP 1: TAKING OFF GLOVES
OUTSIDE OF GLOVE IS CONTAMINATED!
DO NOT TOUCH FACE!
1. Grasp outside edge of
glove near wrist
2. Peel away from hand,
turning glove insideout
3. Hold removed glove
in opposite gloved
hand
5. Peel off from inside,
creating a bag for
both gloves
4. Slide ungloved finger
under the wrist of the
remaining glove
6. Discard gloves in
waste container
7. Wash/sanitize hands
WITHOUT EXCEPTION:
GLOVES ARE TO BE REMOVED INSIDE THE PATIENT’S ROOM
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STEP 2: TAKING OFF GOWN
1. Untie the ties of the
gown and loosen the
gown at the
shoulders.
2. Slip the fingers of one
hand under the cuff of the
gown on the opposite
arm. Do not touch the
outside of the gown. Pull
it down over your hand.
4. Fold and roll the gown
away from your body, with
the contaminated side
facing in.
5. Dispose of the gown in the
3. With your hand inside the
gown, pull the gown off
the other arm.
blue plastic bag in the
linen hamper.
YELLOW GOWNS ARE NEVER TO BE WORN IN HALLS!
DO NOT TOUCH YOUR FACE!
CLEAN YOUR HANDS
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STEP 3: TAKE OFF FACE PROTECTION
1. Grasp ear or head pieces with ungloved clean hands
2. Lift away from face
3. Discard in regular garbage
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CLEAN YOUR HANDS
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Additional Precautions
The signs below are placed outside patients’ rooms when someone in that room needs to have
additional precautions observed. It is important that those working with patients take responsibility
for informing themselves regarding the exact nature of the condition and the person who has it.
CONTACT PRECAUTIONS
CONTACT PRECAUTIONS are designed to reduce
the risk of transmission of microorganisms by direct or
indirect contact.
Direct contact involves skin-to-skin contact and
physical transfer of microorganisms to a susceptible
host from an infected or colonized person (i.e. bathing
pt, turning the pt, and other activities that require
physical contact) and can also occur between two
patients - the patient as the source of infectious
microorganism and the other as a susceptible host.
In indirect contact, the susceptible host comes into
contact with contaminated intermediate objects (such
as; table, side rails, etc.)
Is it possible that the environment could be soiled with infective material?
Then use CONTACT PRECAUTIONS
Examples of conditions that require CONTACT PRECAUTIONS
• MRSA
• Acute diarrhea
• Wound discharge not contained by dressing
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Antibiotic Resistant Organisms
•
Methicillin Resistant Staphylococcus aureus (MRSA)
These are bacteria that have developed resistance to first line antibiotics. In the hospital we
have patients with MRSA
MRSA = The Staphylococcus aureus is RESISTANT to many antibiotics
• Staphylococcus aureus is a very common bacteria that normally
lives on the skin
• 30 to 80 % of adults carry S. aureus. In Canada more than 6% of S.
aureus can be multi-resistant.
• Can cause infections; boils, impetigo, cellulites in the immunocompromised
• Has been isolated in wound and bloodstream (and rarely in urine)
infections
•
•
•
is a strain of Staphylococcus aureus that has developed a resistance to the antibiotic
Methicillin
Some strains of MRSA also resistant to cloxacillin and cephalosporins.
Frequently resistant to some or all of erythromycin, clindamycin, ciprofloxacin, and
trimethoprim/sulfamethoxazole.
Contact Precautions for MRSA
•
•
•
•
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MRSA is frequently asymptomatic, so patients with MRSA require education about
precautions
Gowns and gloves, but no masks required (exception is patient with tracheostomy colonized
with MRSA)
Patients are allowed out of rooms: but they MUST be taught and supervised using proper
hand hygiene
MRSA+ patients may attend therapy, pool, patient groups
Objects and equipment MRSA+ patients have touched must be disinfected afterwards
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Clostridium difficile (C. difficile)
Bacterium that causes diarrhea and more serious intestinal conditions
such as colitis or toxic megacolon
• Most common cause of infectious diarrhea in hospitalized
patients in the industrialized world.
• The use of antibiotics increases the chances of developing C.
difficile infection.
Other medications such as antacids, stool softeners and laxatives may
trigger C. difficile infection
Because this organism forms spores which are stable in the
environment for years, excellent cleaning and disinfection is needed to
control spread
NOTE: At Bridgepoint Hospital we do not place VRE or ESBL+ patients on contact precautions as
they may in some acute care facilities but rely on routine practices and excellent hand hygiene for
the patient and caregivers.
Vancomycin Resistant Enterococci (VRE)
•
•
•
•
•
•
Enterococci are bacteria that live in the digestive and genital tracts. They are normally
benign and don't cause any problems in healthy people. However, exposure to multiple
antibiotics has caused some of these enterococci to be come resistant.
Vancomycin is a powerful antibiotic that is generally limited to use against bacteria that are
already resistant to penicillin and other antibiotics
VRE is not dangerous in healthy people with strong immune systems
VRE in compromised patients can be dangerous because it cannot easily be controlled with
antibiotics
VRE can cause life-threatening infections in people with compromised immune systems - the
very young, the very old, and the very ill.
VRE can survive in the environment a long time - up to MANY weeks highlighting the
importance of cleaning equipment shared between patients.
Extended Spectrum Beta-Lactamase Producing Organisms (ESBL)
•
•
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These gram-negative organisms come from the gut and genital area and can be one of a
number of types – i.e. Klebsiella or Enterobacter
These organisms have gained the ability to produce the enzyme beta-lactamase which
destroys certain antibiotics making them hard to treat.
Because they are found in the gut they often cause urinary tract infections but can also be the
cause of wound infections and more.
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DROPLET PRECAUTIONS
DROPLET PRECAUTIONS are designed to reduce the risk of droplet transmission of infectious
agents. This precaution is taken to protect the conjunctivae of the eye, mucus membrane of the
nose and mouth from large-particle droplets containing the microorganisms generated from a
person who has clinical disease or who is a carrier of microorganisms.
Droplets are generated primarily from the source
who’s coughing, sneezing, talking, and when
performing certain procedures (e.g. suctioning,
bronchoscopy).
Examples of organisms requiring DROPLET
PRECAUTIONS
• Influenza
• RSV (Respiratory Syncytial Virus)
Influenza
• Incubation period is 1 to 4 days
• Adults are infectious from the day before symptoms begin usually in 5 days
• Severely immuno-compromised can shed the virus for weeks or months
• Signs & Symptoms:
• Sudden onset of abnormal temperature i.e. > 37.5 or < 35.5
• Chills, headache, muscle aches, physical exhaustion & dry cough
• Subsequent onset of chest congestion, sore throat, stuffy or runny nose, and worsening
cough
• In the vaccinated elderly could present as productive cough and chest congestion only
RSV: Respiratory Syncytial Virus
• Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infections in young
children.
• Also serious threat to community-dwelling elderly and high-risk adult patients, accounting for a
substantial disease burden particularly in the winter
• Has been known to cause outbreaks in healthcare facilities.
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AIRBORNE PRECAUTIONS
AIRBORNE TRANSMISSION occurs either by
dissemination of airborne droplet nuclei (these are
evaporated droplets that may remain suspended in the air
for a long time) or dust particles containing the infectious
agents. Microorganisms carried in this manner can be
dispersed widely by air currents and can be inhaled or
deposited on a susceptible host within the same room or
over a longer distance.
Patients requiring these precautions are accommodated
in a negative pressure room.
Examples of illnesses requiring
AIRBORNE PRECAUTIONS
o TB
o Chicken Pox
Tuberculosis (TB)
•
•
•
•
Caused by an AIRBORNE mycobacterium tubercle bacillus.
The MTB enters your body as you breathe.
Usually settles in your lungs but can spread to other parts: central nervous system, bones, and
joints.
Across the world, TB is considered one of the deadliest infectious diseases, especially in
developing countries
www.medicine.swan.ac.uk/inthealth.html
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