Download Section 3 Infection Prevention and Control

Section 3
Infection Prevention
and Control
I N F E C T I O N
P R E V E N T I O N
A N D
C O N T R O L
Routine Practices and Additional Precautions
Routine Practices are intended to prevent and control the spread of infectious agents
(microorganisms) in health care settings and apply to all clients during all aspects of care.
Additional Precautions are used in addition to Routine Practices and are based on the infectious
agent’s mode of transmission. Additional Precautions include: contact precautions, droplet
precautions, droplet/contact precautions and airborne precautions.
Always follow the ESW agency’s specific guidelines, protocols, policies and procedures
for implementing Routine Practices and Additional Precautions.
Routine Practices are comprised of five basic elements; administrative controls, risk assessment, hand
hygiene, personal protective equipment and environmental controls.
• Administrative Controls are put in place by the agency and may include immunization
policies, PPE policies, ensuring that adequate supplies are available (PPE, ABHR, etc.), and
providing employee education regarding infection prevention and control and reporting of
exposures.
• Risk Assessment refers to the brief assessment that should be performed by ESWs prior to all
interactions with clients and the client’s environment in order to:
 Determine if there is potential for exposure to and/or transmission of disease/illness.
 Decide which control measures are required to prevent exposure/transmission.
 Implement appropriate control measures.
In the simplest of terms, an ESW should use Routine Practices with any client where there
is a potential to spread disease/illness, whether the client is symptomatic or not.
• Hand Hygiene refers to the process of removing dirt, debris and most importantly potentially
infectious microorganisms from the hands. Hand hygiene is vital in protecting ESWs from
infection.
• Personal Protective Equipment (PPE) refers to equipment worn to offer protection from
infectious diseases. PPE includes gloves, gowns, masks, protective eyewear and N95
respirators. The type of PPE required depends upon the type of infection, the mode of
transmission and the risk of exposure.
• Environmental Controls include cleaning, disinfection and sterilization of surfaces and
equipment, and the safe handling, storage, transport and disposal of sharps and other
contaminated items (e.g.: uniforms).
The following section will provide greater detail with regard to Hand Hygiene, PPE and Environmental
Controls that can be used in order to help protect ESWs from the spread of infectious diseases that
may be encountered during the line of duty.
I N F E C T I O N
P R E V E N T I O N
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Hand Hygiene
Hand hygiene is the single most effective infection prevention and control measure. It is vital
that all ESWs follow hand hygiene protocols that are appropriate for their specific work setting.
Alcohol-based hand rub (ABHR) containing 70 to 90 percent alcohol is recommended and must be
provided in the health care setting.
There are two methods of killing/removing microorganisms from the hands:
1. ABHR is the preferred method for cleaning hands that are not visibly dirty.
2. Hand washing with soap and warm, running water should be performed when hands are
visibly dirty.*
* If running water is not available, use a moist towelette to remove dirt, and then perform hand
hygiene using ABHR.
Hand hygiene is vital:
• Before eating
• Before/during/after handling and/or preparing food
• After use of the bathroom
• After sneezing, coughing, or blowing your nose
• Before and after touching a wound
• Before and after giving medicine
• After handling animals
• After any contact with blood or body fluids
• After handling potentially contaminated items (equipment, surfaces, etc.)
• Before and after putting on or taking off PPE
I N F E C T I O N
P R E V E N T I O N
A N D
C O N T R O L
Personal Protective Equipment
Personal Protective Equipment (PPE) refers to equipment worn to offer protection from infectious
agents. Best practice recommends the use of appropriate PPE when an ESW comes into contact with
blood, body fluids, non-intact skin, mucous membranes and/or contaminated surfaces. PPE includes
gloves, gowns, masks, protective eyewear and N95 respirators.
PPE is considered to be “single use” and should be removed and discarded after use.
Gloves:
• To be worn when there is a risk of contact with blood, body fluids, non-intact skin, mucous
membranes and/or contaminated surfaces
• Hand hygiene must be performed before and after glove use
Gown:
• To be worn when there is a risk of splattering or spraying of blood and/or body fluids
• Does not include uniforms, lab coats and/or jackets
Protective Eyewear:
• To be worn when there is a risk of splattering or spraying of blood and/or body fluids
• Does not include personal eyeglasses
Mask:
• To be worn when providing direct care to clients with respiratory infections spread through
droplet transmission (e.g.: influenza)
• If tolerated, should also be worn by clients with respiratory symptoms during transfer/transport
N95 Respirator:
• To be worn when in contact with or caring for clients with airborne infections (e.g.: TB, SARS)
• Must be fit tested at least every two years to ensure proper fit for full protection
*Step-by-step procedures for donning and doffing PPE are located in the Valuable Resources Section *
I N F E C T I O N
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•
•
•
•
•
Skin rash (without fever)*
Acute diarrhea
Draining abscess (sore)*
Bleeding wound*
Antibiotic Resistant Organisms
(ARO)
 MRSA, VRE, ESBL, CRE
 C. difficile
If skin or
clothing
will come
into direct
contact with
the client or
the client’s
environment
• Suspect or known bacterial
meningitis
• Meningococcal disease
• Group A Strep* (iGAS)
• Pertussis
• Unknown febrile respiratory
infection
• Influenza
Within 2 metres
of the client
• Suspect or known TB
• Measles, or rash suggestive of
(if ESW is not immune)
• Chickenpox, or rash suggestive
of (if ESW is not immune)*
* When a combination of symptoms is present, utilize all applicable PPE
N95 RESPIRATOR
MASK
PROTECTIVE EYEWEAR
GOWN
GLOVES
SYMPTOMS
OR
INFECTIOUS DISEASE
HAND HYGIENE
PPE Recommendations Based on
Symptoms or Known Infection
I N F E C T I O N
P R E V E N T I O N
A N D
C O N T R O L
Cleaning, Disinfection and Sterilization
Cleaning
Cleaning refers to the physical removal of organic matter or debris from objects. Cleaning usually
involves the use of soap, water, detergent and/or enzymatic cleaners.
• Always start with the least contaminated (“cleanest”) area and end with the most
contaminated (“dirtiest”) area to prevent the spread of infectious organisms
• Cleaning must always occur prior to disinfection
Disinfection
Disinfection refers to a process that kills or destroys most disease-producing microorganisms. There
are three levels of disinfection:
• High level disinfection destroys all microorganisms, with the exception of high numbers of
bacterial spores. Hydrogen peroxide is a high level disinfectant.
• Intermediate level disinfection kills Mycobacterium tuberculosis, vegetative bacteria,
viruses and fungi, but not spores. Alcohols (ethyl or isopropyl) are intermediate level
disinfectants.
• Low level disinfection kills most bacteria, some viruses and some fungi, but not
Mycobacteria or spores. Low levels disinfectants are typically used to clean environmental
surfaces. Quaternary ammonium based products (“QUATS”) are low level disinfectants.
Sterilization
Sterilization destroys all microorganisms including bacteria, viruses, fungi, spores and prions. Items
must be thoroughly cleaned before effective sterilization can take place. Effective sterilization requires
specialized equipment, close monitoring and staff training.
• Steam sterilization is the preferred method for decontaminating heat-resistant, reusable
medical equipment/devices.
• Chemical sterilants can be used for equipment/devices that cannot withstand heat
sterilization.
Due to the complexity of the sterilization process, most ESW agencies prefer
to utilize single use, disposable equipment.
I N F E C T I O N
P R E V E N T I O N
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Process for Cleaning, Disinfection and Sterilization
Clean
Use detergent, clean water and a clean brush to loosen dirt and debris on surface
Rinse
To remove soap/detergent residue, loosened dirt and debris from surfaces
Non- or
semicritical items
Critical
items
Disinfect
Using an appropriate product based
on the use of equipment/surface
Sterilize
Using an appropiate and
approved sterilizer
Noncritical
Semicritical
Low Level
(e.g. phenols, QUATS)
Intermediate
(e.g. alcohol, hypochlorites,
iodine/iodophor)
OR
High Level
(e.g. hydrogen peroxide,
paracetic acid)
Non-critical items: Items that come in contact with only intact skin, but not mucous membranes
require low level disinfection. (E.g.: stethoscopes, stretchers and cardiac
monitors)
Semi-critical items: Items that come into contact with non-intact skin or mucous membranes, but
do not ordinarily penetrate them require intermediate or high level
disinfection. (E.g.: respiratory equipment and MacGill forceps)
Critical items:
Reusable instruments and devices that enter sterile tissues, including the
vascular system require sterilization. Most critical items used by ESWs are
“single-use” and therefore, disposable. (E.g.: catheters and needles)
I N F E C T I O N
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Disinfecting Environmental Surfaces
Things to consider prior to using surface disinfectants:
• Is the product appropriate for the surface you are cleaning?
• Will the product kill the right microorganisms?
• Is PPE required when using the product, and if so, what type?
• What contact time is required for the product to be effective?
• Are there any special requirements for safe disposal of the product?
Most
difficult
to kill
Bacteria with spores (C. botulinum, C. difficile)
Bacteria with cysts (Giardia, Cryptosporidium)
Mycobacteria (M. tuberculosis)
Non-enveloped viruses (Noroviruses, Hepatitis A)
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Fungi
Vegetative Bacteria
(Salmonella, Staphylococcus aureus, pseudomonas, coliforms)
Enveloped viruses
(Herpes, chickenpox, measles, mumps, influenza, Hepatitis B, HIV)
Easiest
to kill
H
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Disinfection “In a Pinch”
There may be times when an ESW requires access to a quick and effective intermediate-level
disinfectant. The following table outlines the correct dilution rates required to prepare a household
bleach-based disinfectant.
Product
Intended Use
Dilution
Available
Chlorine
Household Bleach
Clean-up blood spills
• Requires contact time* of
at least 10 minutes
1 part bleach
to
9 parts water
50000 ppm
Surface Disinfection
• Requires contact time of
at least 5 minutes
1 part bleach
to
50 parts water
1000 ppm
Food surfaces
• Requires contact time of
at least 2 minutes
1 part bleach
to
200 parts water
200 ppm
5.25%
Sodium Hypochlorite
* The surface being disinfected must remain wet for the recommended “contact time” in order for
the disinfectant to achieve its maximum effect.
For more detailed information about cleaning and disinfection, please contact
the Health Unit and ask to speak with a Public Health Inspector.
I N F E C T I O N
P R E V E N T I O N
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C O N T R O L
Cleaning Blood/Body Fluid Spills
Each agency should have policies and procedures related to the management of blood and body fluid
spills. Spills of blood and body fluids (e.g.: urine, faeces, vomit) should be contained, cleaned and the
area should be disinfected promptly. Care must be taken to avoid splashing during clean up to
prevent the generation of aerosols.
The following sample procedure* can be used as guidance for the development of agency-specific
policies and procedures:
1. Ensure all necessary supplies are assembled.
2. Inspect the area closely (look for splatters/splashes).
3. Restrict activity around the area until cleaned, disinfected and completely dry.
4. Put on gloves (and gown, mask and eye protection if there is a risk of splashing).
5. Contain and clean the spill:
• Use disposable towels to wipe up spill
• Dispose of materials in regular waste receptacle (or yellow biomedical waste container if
materials are so saturated that the material can be squeezed out).
6. Disinfect the entire spill area with a hospital-grade disinfectant, allowing the appropriate
amount of contact time, as defined by the manufacturer.
7. Wipe the area again with disposable towels and discard in regular waste receptacle.
8. Remove PPE in the proper order and perform hand hygiene.
* Adapted from: PIDAC (2009). Best Practices for Environmental Cleaning for Infection Prevention and Control in All Health Care
Settings.
Contaminated Uniforms
Contaminated uniforms must be handled carefully (e.g.: do not shake or agitate) to avoid further
contamination of the air, surfaces and the ESW. In order to safely clean contaminated uniforms:
• Gloves must be worn whenever handling contaminated uniforms (removing, bagging, placing
into washing machine, etc.)
• Carefully remove any loose particles and dispose of in the waste receptacle
• Remove the contaminated uniform, and place it in a plastic bag
• Keep contaminated uniform separate from other items
• Wash any areas of the skin that may have been exposed with soap and warm water (may
require showering if exposure is extensive)
 Carefully assess for areas of non-intact skin that may have been exposed
• Put on a clean uniform
• Normal washing and drying cycles are sufficient for laundering contaminated uniforms
Uniforms extensively contaminated with blood or body fluids should be placed
in a separate, leak-proof biohazard bag for safe disposal (if required).
I N F E C T I O N
P R E V E N T I O N
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C O N T R O L
ESWs are at a greater risk of coming into contact with used sharps and other contaminated items
due to the complex nature of their work environment. The proper disposal of sharps and other
potentially infectious waste is essential for the safety and well-being of ESWs. Below are some
general guidelines that may be considered by agencies when developing policies and procedures
specific to the disposal of sharps and waste.
Disposal of Sharps:
• Sharps must be handled with the utmost care to ensure the safety and security of ESWs, their
clients and the public.
• ESW agencies should have written policies and procedures regarding the safe storage,
handling, transportation and disposal of sharps.
• In general:
 Used needles should never be recapped
 Used sharps must be safely disposed of in an approved container
 Safety-engineered sharps should be utilized whenever possible
Disposal of Wastes:
• Appropriate PPE should be worn when disposing of wastes.
• Items saturated with blood/body fluids (where fluid can be squeezed out of the material) must
be disposed of in an appropriate biomedical waste receptacle (e.g.: biohazard bag).