Download Alberta Health Services Infection Prevention and Control

Annual Continuing Education (ACE)
(Print version)
Infection Prevention
and Control
Infection Prevention and Control
This module meets the requirement of the Workplace Health and Safety Code
requirement for annual provision of IPC education to all employees and the
Accreditation ‘Required Organizational Practice’ to provide all employees with hand
hygiene education.
This module provides an overview of Routine Practices, disease transmission, hand
hygiene and proper use of Personal Protective Equipment.
Time needed to complete module: 30 minutes
Please retain your completed and self-corrected quiz for your records and to provide to
your manager, if they require you to do so.
* An alternate e-learning version of ACE is available on MyLearningLink.
Prerequisite/Pre-reading
Optional: review information on Insite:
http://insite.albertahealthservices.ca/ipc.asp
See Waste Management Information sheet on page 12.
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Overview
Infection Prevention and Control is an important part of health care practice. There are
things that all AHS staff can do to prevent infection, resulting in a healthier workplace for
staff, patients, residents and clients. Infection Prevention and Control is important at any
time, but particularly so during infectious outbreaks such as the 2009 H1N1 influenza
pandemic.
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Objectives
By the end of this module, you will be able to:
List and describe the elements of Routine Practices.
List four requirements for an infection to spread.
List six ways a microorganism can get into the body.
List three ways that a microorganism can leave the body.
Demonstrate the correct methods for performing hand hygiene.
Demonstrate proper respiratory hygiene.
Describe four kinds of Personal Protective Equipment (PPE)
Describe how to maintain a healthy workplace.
Describe what to do if you are sick.
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Routine Practices
Routine Practices are things you can do to reduce your exposure to disease-causing
microorganisms. Understanding Routine Practices involves understanding the following
things:
1. The process of disease transmission
2. Hand hygiene
3. Respiratory hygiene
4. Proper use of Protective Personal Equipment (PPE)
5. Handling sharps safely (such as needles, scalpels, etc.)
6. Keeping client care equipment clean
7. Keeping your work environment clean
8. Proper laundry procedures
9. Proper waste management and disposal
10. Careful client placement (or patient accommodation)
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1. The Process of Disease Transmission (Or, How To
Become Infected)
There are four things needed to transmit an infection:
An infectious agent
A source for the infection
A way for the microorganism to spread
A way for the microorganism to enter a person who is at risk
for getting sick (susceptible host)
An infectious agent: This is any disease-causing
microorganism, such as a virus or bacterium.
A source for the infection: People normally come in contact with viruses and bacteria
and can pass these microorganisms to another person. Sources include food, water,
insects, animals, objects, and other people.
A way for the microorganism to spread: There are three main ways that a
microorganism can get into a person to make them sick. These are:
Contact transmission: This includes direct and indirect contact.
• Direct contact: Occurs when microorganisms are transferred from direct physical
contact or body surface to body surface contact between an infected person and
a susceptible person.
• Indirect contact: Occurs when microorganisms are transferred to a susceptible
person on an intermediate object such as contaminated equipment, instruments
or objects in the environment.
Droplet transmission: This is a type of indirect contact and happens when
someone talks, coughs, or sneezes, creating large droplets that are propelled up to
2 metres through the air. The droplets can land on environmental surfaces, or in the
mouth, nose or eyes of a susceptible person.
Airborne transmission: This type of infection transmission occurs when
microorganisms are contained in small droplets or in dust particles that remain
suspended in the air for long periods of time. These particles can be inhaled or
deposited a long distance away from the infected person.
A person who is at risk for getting an infection (Susceptible Host): Not everyone will get
sick if they come in contact with a disease-causing microorganism and, if they do, some
people will get sicker than others. Everyone has natural defenses against diseasecausing microorganisms, but some people will have poor defenses because they are
very young or very old, they have another illness, their natural immune systems aren’t
working well, or they are experiencing a lot of stress.
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Disease-causing microorganisms can get into your body when you:
consume food or drinks contaminated with the microorganism
touch your eyes, nose, or mouth
have an open cut or sore on your skin
breathe it in
are exposed to an infected animal or insect or
have contact with contaminated solutions, needles, syringes, or other medical
devices.
Disease-causing microorganisms can leave your body in:
secretions or droplets that are released when you cough or sneeze
blood or other body fluids such as diarrhea, vomit or drainage from a sore or wound
or
the air that you breathe out
2. Hand Hygiene
This is the single most important thing you can do to prevent spreading
disease-causing microorganisms, and fortunately it’s also the easiest!
It is important to perform hand hygiene at the following times:
before contact with a patient or patient’s environment. This
includes but is not limited to:
• putting on (donning) Personal Protective Equipment (PPE)*;
• entering a patient’s room; and
• providing patient care,
before a clean or aseptic procedure. This includes but is not limited to:
• wound care;
• handling intravenous devices;
• handling food or
• preparing medications,
after exposure (or risk of exposure) to blood and/or body fluids. This includes
but is not limited to:
• when hands are visibly soiled;
• following removal of gloves
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after contact with a patient or patient’s environment. This includes but is not
limited to: removing (doffing) PPE;
• leaving a patient’s environment; and
• after handling patient care equipment.
*Make sure you clean your hands before removing gloves from the box in which they
are stored. If you do not, your unclean hands will contaminate the entire box of gloves.
How do you perform hand hygiene?
You can do this in two ways:
use an alcohol-based hand rub, or
use soap and water.
When your hands look clean, use an alcohol-based hand rub. The hand rub should
have between 60 and 90% concentration of ethyl or isopropyl alcohol. Here’s how:
ensure that your hands are not visibly soiled and are dry before use;
apply enough product to the palm of one hand to cover all hand surfaces (e.g. 2 to 3
pumps);
vigorously rub product over all the surfaces of the hands and wrists, including:
palms, spaces between fingers, back of hands and wrists, fingers, fingertips and
thumbs;
your hands must remain wet with the product for a minimum of 15 seconds;
continue rubbing product over hands until hands are completely dry; and
periodically apply Alberta Health Services approved hand lotion to assist in
maintaining skin integrity.
When you can see soil on your hands, wash them using soap and water. Here’s
how:
make sure the sink you are using is for hand hygiene and not for other purposes
such as cleaning soiled equipment or discarding body fluids or specimens;
wet hands with warm water, apply enough soap to ensure all hand surfaces are
lathered thoroughly (e.g. 2 to 3 pumps);
vigorously rub soap product over all the surfaces of the hands and wrists, including:
palms, spaces between fingers, back of hands and wrists, fingers, fingertips and
thumbs for a minimum of 15 seconds;
rinse hands under warm running water;
pat hands dry with disposable paper towels;
use paper towels to turn off faucets and to open door;
discard towels; and
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periodically apply an Alberta Health Services approved hand lotion to assist in
maintaining skin integrity.
Fingernails, Hand Jewelry and Ability to Perform Hand Hygiene:
If you provide direct patient care or if you reprocess medical devices or surgical linens,
prepare pharmaceuticals or medications or handle food:
artificial nails, nail enhancements (including gel and acrylic nails), or chipped nail
polish must not be worn,
your fingernails should be natural and short, and
rings worn on your hands should be limited to plain bands.
If you work or provide service in one of the above areas and must wear casts, splints or
dressings that interfere with proper hand hygiene, contact your manager or supervisor.
They will contact Workplace Health and Safety for direction.
3. Respiratory Hygiene
Respiratory hygiene includes covering your mouth and nose when
you cough or sneeze, and performing hand hygiene afterward.
The best way to do this is to cough or sneeze into your upper arm
or sleeve, or into a tissue. If using a tissue, dispose of the tissue
right away. Do not save or reuse the tissue; perform hand
hygiene.
4. Proper Use of Protective Personal Equipment (PPE)
PPE protects you from blood and body fluids and disease-causing microorganisms by
putting an extra barrier in front of clothing, skin and mucous membranes. The most
common PPE worn by healthcare workers are:
Gloves: Vinyl, latex, or nitrile disposable gloves protect hands from exposure to
body fluids, blood, or chemicals. You’ll wear gloves when there is any risk of
touching or being splashed by these hazards. For example, when changing a
dressing or diaper, cleaning up an incontinent client, inserting an IV, obtaining blood
specimens or performing mouth care you should wear gloves. Don’t use gloves
when feeding a client, touching somebody in a social manner, pushing a wheelchair,
delivering meals, mail or clean supplies, or providing care to clients with intact skin.
Gowns: Gowns protect your exposed skin and clothing from splashes, sprays, or
soiling during procedures and client care activities.
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Masks and facial protection. Wearing eye protection and surgical/procedure masks
or full face shields protects mucous membranes of your eyes, nose, and mouth from
splashes and sprays of blood, body fluids, and respiratory secretions. They should
be worn when you are within 2 metres of a patient with respiratory illness and /or
when performing or assisting with a medical procedure that may produce splashes.
N95 Respirators: These masks are filters that fit the face tightly in order to prevent
breathing in airborne microorganisms such as TB. They should also be worn when
performing or assisting with procedures such as sputum inductions that create small
droplet aerosols. You must be fit tested for these masks and be aware of your
correct size before using them.
If you are required to use any of this equipment, please visit the AHS Infection
Prevention and Control website or speak to your manager.
5. Handling Sharps Safely
Sharps are contaminated medical devices that can pierce the skin.
They most often include needles, scalpels, and sutures. There are
specific ways to handle, clean, and dispose of used sharps. All needles
must be disposed of in an approved sharps container immediately after
use and must not be recapped or left at the patient’s bedside or point of
care. Make sure you do not fill any sharps container more than three
quarters full or past the fill line. If your job involves the use or handling
of sharps, you will learn how at your worksite.
6. Keeping Client Care Equipment Clean
Any item that is labeled single use must not be reused. If a piece of medical equipment
is for multi-use, ensure that it is cleaned and disinfected or sterilized, as appropriate,
following use, each and every time.
7. Keeping Your Work Environment Clean
If you are responsible for cleaning environmental surfaces such as bedside tables or
medication preparation areas, be sure that the surface is free of visible soil prior to
disinfecting. This requires a two-step procedure: first, remove soil with a wipe or cloth
moistened with cleaning solution; then, with a clean, disinfectant moistened wipe or
cloth, re-clean the surface. Make sure that the disinfectant solution has wet contact with
the surface for the time recommended on the product label.
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8. Proper Laundry Procedures
When disposing of contaminated linen, ensure that laundry bags or
receptacles are only filled three quarters full and not overfilled. Do not
double bag unless there is leakage or the bag is torn.
9. Proper Waste Management and Disposal
Make sure that waste is handled and disposed of properly according to its category:
general, biomedical, and pathological waste. Do not overfill waste containers. Please
see the Waste Management Sheet on page 12 for details.
10. Careful Client Placement
This involves arranging clients or patients in such a way as to minimize risk of
transmission. Patients with known communicable diseases or symptoms of
communicable diseases should not be placed near other at-risk patients.
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Safe Injection Practices
If you use needles or needleless cannulas to provide injections to patients, it’s vital to
remember:
New Needle, New Syringe, Every Time!
NEVER administer medications from the same needle/cannula or syringe to more
than one patient.
A new needle/cannula and a new syringe must be used for each entry into a
medication vial
Using a new alcohol or chlorhexidine gluconate (CHG) swab:
• Clean* the stoppers of all medication and solution vials prior to each entry with a
needle.
• Clean* all injection ports of medications, solutions, and delivery systems prior to
each entry.
*Cleaning requires vigorous rubbing for a minimum of 15 seconds with an alcohol or
CHG swab. Remember to “Scrub the hub”.
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Risk Assessment
This involves finding out symptoms of illness or other risk factors as early as possible.
Based on this information, it is important to place clients safely, wear PPE, perform hand
hygiene, and manage equipment in a way to prevent disease transmission. If a patient
has a known illness or disease-causing microorganism, contact Infection Prevention
and Control to see if any additional precautions are required.
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Maintaining a Healthy Workplace
This includes making sure that you:
stay home if you have an infection or if you have been exposed to a communicable
disease that you could spread to others,
have all your immunizations up to date. This includes, but is not limited to annual
influenza immunizations,
protect and cover broken skin,
contact Workplace Health and Safety as soon as possible if you suspect that you
have been exposed to blood and body fluids, have received a needle stick injury, or
are injured at work,
clean your hands frequently and
contact Workplace Health and Safety if you must wear a splint, cast or dressing that
interferes with proper hand hygiene. This applies if you work in an area where you
provide direct patient care or reprocess medical devices or surgical linens, prepare
pharmaceuticals or medications or handle food.
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What if I’m sick? Should I still go to work?
If you have a cold, influenza or diarrhea, or if you have been
exposed to a disease or condition that can be easily passed on to
others, it’s best not to come to work until you are better or no
longer communicable. Check with your supervisor by phone and
describe your situation if you’re not sure. Don’t be “tough” and
show up to work when you shouldn’t. If you do, clients, patients,
and co-workers may become sick too.
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Education
Learning about Routine Infection Control Practices ensures that you know how to
protect yourself from being exposed to unnecessary risk. Knowing how to perform hand
hygiene and cover your cough, complete risk assessments, and use PPE correctly are
key elements in preventing the spread of infection. Incorporate infection prevention and
control principles and practices every day and every time.
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Summary
Now that you’ve reached the end of this module, you should be able to:
List and describe the elements of Routine Practices.
List four things needed for infection to spread.
List six ways a microorganism can get into the body.
List three ways that a microorganism can leave the body.
Demonstrate the correct methods for performing hand hygiene.
Demonstrate proper respiratory hygiene.
Describe four kinds of Personal Protective Equipment (PPE)
Describe how to maintain a healthy workplace.
Describe what to do if you are sick.
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Quiz answers on page 16
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Quiz
1. Routine Practices include all of the following except:
a. Hand hygiene
b. Droplet precautions
c. Proper use of Personal Protective Equipment
d. Keeping your work environment clean
2. Which statement is false when using alcohol based hand rub:
a. Make sure hands are not visibly soiled or wet before applying alcohol based
hand rub.
b. Apply alcohol based hand rub to hands, rub together for at least 15 seconds and
c. until the hands are dry.
c. Rub hands together for 15 seconds and then dry with a paper towel.
d. Use enough product to cover all hand surfaces (2-3 pumps or about the size of a
loonie)
3. Microorganisms can be shed through:
a. Secretions released when sneezing or coughing.
b. Diarrhea, vomit or wound drainage.
c. Exhaled air when breathing or talking
d. All of the above
4. Nancy has been working hard lately and is feeling tired and run down. Her coworker
Brian has been fighting a cold for a few days now. Nancy borrows a pen from Brian’s
desk for a moment, and as she is walking away she rubs her eye. Match the
following:
1. Infectious agent
2. Source
3. Way organism is spread
4. Susceptible host
a. Direct contact
b. Nancy
c. Brian’s pen
d. Indirect contact
e. Virus
5. Microorganisms (germs) can get into the body:
a. By consuming contaminated food or fluids
b. Through open areas on the skin
c. By breathing in the germs
d. When providing pre-operative teaching to a patient
e. a,b,d.
f. a,b,c.
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6. Personal Protective Equipment (PPE) protects you from blood and body fluids and
disease-causing germs by providing an extra barrier to the skin, ,mucous
membranes and clothing. The most common PPE worn by health care workers are:
a. Gown, gloves, eye glasses, boot covers.
b. Gloves, gown, face shield, steel toed boot
c. N95 respirator, gown, boot covers and contact lenses
d. Gown, goggles, gloves, mask
7. You wake up one morning with a fever, aching joints, sore throat and a stuffy nose.
You know you should probably stay home, but know that your unit is already short
staffed. What is the best thing to do?
a. Stay in bed.
b. Drink plenty of fluids, take medicine to clear stuffy nose.
c. Call manager/supervisor and let them know you are ill.
d. Go to work- they are short staffed already.
8. Which of the following will prevent you from performing effective hand hygiene:
a. Wearing artificial fingernails
b. Wearing a diamond ring
c. Chipped or peeling nail polish
d. Wearing a splint that covers your hand and forearm
e. All of the above
f. a,b,d
Answers:
1. b) Droplet precautions
2. c) Rub hands together for 15 seconds and then dry with a paper towel.
3. d) All of the above
4. 1) e
2) c 3) d
4)b
5. f) A,b,c.
6. d) Gown, goggles, gloves, mask
7. c) Call manager/supervisor and let them know you are ill.
8. e) All of the above
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