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Infection Control Jodie Burr Infection Control Coordinator Women’s and Children’s Hospital Infection Control Unit 24 Hour Infection Control Service During office hours page 18041* After hours ring 9 for Infectious Disease Consultant on call Infection Control Team meet weekly, concerns, enquiry's, issues can be discussed Primary Role of Infection Control Prevent nosocomial infections Reduce mortality, morbidity, and cost Educate and advise patients their families the community Surveillance of nosocomial infections Policy development, implementation and assessment staff IC Issues specific to Paediatrics Communicable diseases affect a higher % of paediatric patients than adults non-immune - acquire - spread paediatric personnel are at a greater risk for exposure to communicable diseases immune status May lack the mental / physical ability to adhere to IC principles lack of hygiene unable to understand / comply with IC principles IC Issues specific to Paediatrics More likely to have contact with contaminated environmental surfaces and objects Parents and siblings may have the same infectious agent involved in patient care - education about transmission and IC principles Immunization It is important to know your health and immunization history chicken pox measles flu vaccination pertussis For vaccinations contact ICGP or Risk Management IC Link Nurses Educate ward/unit staff Ensure compliance with infection control guidelines Assist with outbreaks or disease exposures Develop patient & staff information brochures Promote infection control initiatives Standard + Additional Precautions Standard Precautions all patients all times Additional Precautions some patients some times Standard Precautions Work practices necessary to fulfil basic infection control requirements For all patients regardless of diagnosis or presumed infectious status Standard Precautions Apply to: Blood All body fluids - excretion and secretions (including sweat) Non-intact skin Mucus membranes Regardless of whether there is visible blood or body fluids Hand Hygiene The single most effective method in the prevention of disease transmission 80 % hospital acquired infections are thought to be transmitted by hands Healthcare workers think they wash their hands more than what they do Hand Hygiene Soap and Water mechanical removal of most transient flora and soil minimal microbial kill no sustained activity 15 seconds Hand Hygiene Antimicrobial Soaps removes soil, removes transient and reduces resident flora may have sustained activity 15 seconds (antiseptic handwash) 60 seconds (clinical handwash) 2 minutes (surgical scrub) Hand Hygiene Alcohol Handrubs / Gels very rapid kill destroys transient and reduces resident flora no residual activity (except with antiseptic) will not remove or denature soiling 15 seconds Areas most frequently missed Personal Protective Equipment Eye and/or facial protection (goggles, face shields) Gloves Gowns Masks Assess the likely hood of contamination and prepare accordingly Equipment Reprocessing If it comes into contact with: intact skin = clean mucous membranes = high level disinfection sterile site = sterilise All items must be cleaned first Single-use items must not be reused Environmental Controls Cleaning detergent and water is adequate ensure patient care areas are cleaned regularly minimize clutter Linen and Laundry no need to mark ‘infectious’ if the skip is wet then place in a plastic bag Waste General Waste (Green Bin) dressings, bandages, nappies, sanitary pads, flowers, kitchen waste, plastic, paper, empty containers of blood, body fluid, IV lines, urinary catheters Medical Waste (Yellow Bin) ALL sharps, bags or tubing of blood, human tissue, lab specimens and cultures, cytoxic waste (sealed in purple cytoxic container or bag first) Blood and Body Spills Small spills wipe up with paper towel detergent and water Large spills (easy to clean surface) wipe up with paper towel detergent and water Large spills (difficult to clean surfaces) wipe up with paper towel detergent and water wipe over with Milton(R) Assessment of Risk Factors Your knowledge or experience with the situation or procedure The likely hood of exposure to blood or body fluids at the time The patients ability to cooperate through out the procedure Additional Precautions Are applied in addition to Standard Precautions Apply with: highly transmissible organisms epidemiologically significant organisms Additional Precautions May include: Single room accommodation (ensuite for some) Special ventilation (negative, positive pressure) Special room cleaning Dedicated patient equipment Rostering of immune staff Extended sterilization (or use of disposable equipment) Cohorting may be considered Bed Management CATEGORY A Very High Risk of Cross Infection or Adverse Outcome Mandatory Negative pressure single room CATEGORY B High Level of Cross Infection Mandatory Single room or cohort same contagious agent CATEGORY C Moderate Risk of Cross Infection Single Room in Selected Circumstances CATEGORY D High Risk to the Newborn CATEGORY E Low risk of Cross Infection Rooming in not allowed No segregation required INFECTION / CONDITION Asthma Barmah Forest virus Bat lyssa virus (see rabies) Bronchiolitis Botulism Brucellosis Chicken pox (varicella zoster virus) Cellulitis Chlamydial infection Conjunctivitis Croup Cystic fibrosis exacerbation Creutzfeldt-Jakob disease Cytomegalovirus disease Dengue Diphtheria Eczema, infected Epiglottitis Epstein-Barr virus (glandular fever) Erythema multiforme Febrile convulsion Gastritis SETTING If trigger thought to be viral (npa to confirm) A B C D E Active disease Susceptible contact (appendix 1 for how to determine) Includes, orbital and preseptal Viral (other than adenovirus), bacterial or chlamydial Suspected or proven adenovirus conjunctivitis in family, or hospital outbreak P. aeruginosa status, proximity to other CF patients see p 8 Patient at risk of having been exposed to agent Congenital, Nursery, Neonatal, Oncology, Renal Pharyngeal or cutaneous Streptococcal non Streptococcal, proximity to burns patients non Streptococcal, all other situations In the absence of respiratory or gastroenteritic symptoms If the cause is infective, which is unlikely all other causes Respiratory Syncitial Virus Highly contagious and nosocomial infection common Causes upper and lower respiratory infection Usually occurs during winter No vaccine at present Can be reinfected during the same season Transmitted by contact or droplet Can survive for several hours in the environment Rotavirus Highly contagious and nosocomial infection is common Usually a winter disease but pattern changing Onset is sudden and lasts for 4 - 6 days Mainly infants and children up to 3 years affected Transmitted usually through contact Can survive in environment for several hours Gastrogard-RTM Hospital Acquired Rotavirus diarrhoea prevention program Eligible if: aged between 0 days and 48 months regardless of whether they already have or develop gastroenteritis Ineligible if: cow’s milk protein intolerant (not lactose intolerant) if on a protein restricted diet fasting breast fed Varicella Zoster Virus Chicken Pox Highly contagious Most cases in children, over 90% of adult population is immune Transmitted by droplet and contact Infectious 2 days prior and 4 - 6 days after rash Now a notifiable disease Vaccination now available Varicella Zoster Virus Chicken Pox BUG WATCH Infection Control Awareness Program for Visitors