Download Additional Precautions

Additional Precautions
A Guide for
Health Care Workers
MRSA
„
„
Staphylococcus aureus (or staph) are bacteria
that are found on the skin and in the nose of
people. Staph are usually harmless, but they
can sometimes cause infection and serious
illness.
Some strains of staph have become resistant
to the antibiotic methicillin and to other
antibiotics. Infections caused by methicillinresistant Staphylococcus aureus (MRSA) are
hard to treat, as most antibiotics will not kill
the bacteria.
Methicillin Resistant Staph aureus
„
„
„
„
„
Amplified by the use of broad-spectrum antibiotics
Currently more common in hospitals than in the
wider community – is increasing in community
May colonise patients and sometimes HCWs
Do not appear to be more virulent than antibioticsensitive strains
More difficult to treat if infection occurs
Colonisation verses Infection
„
Colonisation – the presence of
microorganisms without sign of infection
„
The deposition and harmful multiplication
of m/o in tissues or on the surfaces of the
body, followed by signs and symptoms of
clinical illness
Increased Morbidity and Mortality
MRSA
„ Surgical site infections
„ Infected vascular and orthopaedic
prostheses
„ Septicaemia
„ Pneumonia
Risk Factors for MRSA
„
Patients most at risk of getting MRSA
are those who have:
„
„
„
„
„
„
presence of vascular access devices
health problems such as diabetes
low immunity
broken skin from wounds
recent surgery; and
dermatitis
Occurrence of MRSA
„
Colonisation precedes infection, colonisation
depends on:„
„
„
„
„
„
Length of stay
Nutritional status
Severity of underlying disease
Presence of invasive devices
Recurrent or recent AB treatment
Presence of wounds
Transmission of MRSA
„
Patient to patient VIA hands of HCWs
„
„
„
Direct patient care
Handling contaminated materials/equipment
INADEQUATE HAND HYGIENE
Basic Infection Control
„
In 1996, the National Health and Medical
Research Council (NHMRC) adopted the terms
‘standard precautions’ and ‘additional
precautions’.
„
These precautions are based on the modes of
transmission of infectious agents, to define
appropriate work practices.
„
This two tiered approach should provide a high
level of protection to patients, HCWs and others.
Use of Standard Precautions –
For ALL Patients
Minimises the risk of cross-infection from:
„
„
„
„
HCW to patient.
Patient to HCW.
Patient to patient.
To be used for all patients regardless
of infectious status or perceived risk.
Standard Precautions
„
Work practices required for a basic
level of infection control
„
„
„
„
„
„
Hand hygiene
Personal protective equipment
Appropriate handling of sharps and waste
Appropriate reprocessing of reusable items
Use of aseptic technique
Use of environmental controls
Additional Precautions
„
Additional precautions are based on
method of transmission
„
„
Necessary for infections spread via airborne
or droplet transmission AND
May be indicated for patients with certain
highly transmissible or epidemiological
important microorganisms transmitted by
direct or indirect contact – e.g. MRSA, VRE
MRSA Transmission
MRSA can be transmitted via:
„ Contact
„ Droplet
– direct/indirect
Direct Contact
„
Transfer of microorganisms as a
result of direct physical contact
between an infected or colonised
individual and a susceptible host.
(Body surface to body surface)
Indirect Contact
„
Involves passive transfer of
microorganisms to a susceptible
host via an intermediate object,
such as contaminated hands that
are not washed between patients,
or contaminated instruments or
other inanimate objects.
Droplet Transmission
A form of contact transmission
„ Droplet transmission refers to large
droplets, > 5 um, generated from the
respiratory tract or the source patient
coughing or sneezing, or during
procedures such as suctioning or
bronchoscopy
„
(Large droplets do not remain suspended in the air)
MRSA - Additional Precautions
„
Contact precautions or
„
Contact + Droplet precautions
Extent of Precautions
„
„
Depends on:
1. Vulnerability of the patient population
2. Endemicity of MRSA in health care
facility
Where MRSA rates are relatively low
there may be more stringent precautions
used than when MRSA is endemic in an
organisation
MRSA Precautions
„
CONTACT
„
„
„
„
„
„
MRSA colonised site (HCFs with low MRSA rates)
Excessive wound drainage
Large infected burns
Infected exfoliative dermatitis
Incontinence or poor hygiene practices
CONTACT + DROPLET
„
„
MRSA +ve sputum – copious uncontrolled sputum
MRSA pneumonia
Additional Precautions
(Contact Precautions)
Single room if possible, with ensuite
„ Cohort with like condition if necessary
„ Clean, non sterile gown and gloves when
entering the room
„ Remove gloves and gown (mask), wash
hands before leaving patient room
„
Additional Precautions
Use dedicated patient equipment – clean
and disinfect before reuse
„ Use disposable equipment wherever
possible
„ Instruments and equipment used for
dressing changes should not be
transferred from patient to patient but
should remain by the patients bedside –
tapes, non sterile scissors etc.
„
Additional Precautions
Patient to leave the room for essential
procedures only
„ Maintain precautions during transport
„ Notify area receiving patient
„ Visitors should talk to nursing staff before
entering the room
„ Keep visitors to a minimum
„
Droplet Precautions
(In addition to contact precautions)
Use surgical mask when entering room if
patient has colonised/infected respiratory
secretions
„ Teach patient to cover nose and mouth
when coughing or sneezing
„ Transport of patients – surgical mask to
be worn by patient
„
Environmental Contamination
„
„
Consider the surfaces and furniture
within the room contaminated as well as
patient
After gown/glove/mask removal and
handwashing, ensure that hands do not
touch potentially contaminated
environmental surfaces or items in the
patient's room to avoid transfer of
microorganisms to other patients or
environments.
Environmental Cleaning:
„
„
„
Wear appropriate PPE – gown, gloves +/- mask
Daily routine cleaning of room using
dedicated equipment and neutral detergent
Pay particular attention to frequently touched
surfaces and horizontal surfaces
„
„
Call bells, door knobs, bed rails, bedside tables and
lockers, sinks, surfaces close to patient
Terminal cleaning after patient discharge
Crockery and Cutlery:
No special precautions are needed for
dishes, glasses, cups, or eating utensils.
„ The combination of hot water and
detergents used in hospital dishwashers
is sufficient to decontaminate dishes,
glasses, cups, and eating utensils.
„
Handling Linen:
„ Handle
with a minimum of agitation
„ All soiled linen should be handled in
the same way for all patients
„ Place soiled linen directly into linen
skip at point of generation — avoid
carrying soiled linen to prevent
contamination of uniform.
Linen Contd:
„
„
„
Roll or fold heavily soiled linen to contain
heaviest soil in centre of bundle – place solid
soil, faeces or blood clots into a bed pan or toilet
for flushing
Linen soiled with blood or body substances
should be bagged, transported and stored in
leakproof bags. Double bagging of linen is not
necessary unless outside of bag is contaminated
The laundering of linen must be consistent with
Australian Standard AS 4146: Laundry Practice.
Waste Disposal:
„
ƒ
ƒ
ƒ
ƒ
ƒ
Place all sharps into a sharps container
Use gloves and protective clothing when
handling clinical and related waste bags and
containers
Do not over fill containers
Never compact by hand
Secure lids during transport
PLACE WASTE HEAVILY CONTAMINATED WITH
WOUND EXUDATE INTO YELLOW INFECTIOUS
WASTE BAGS
Definition – Clinical Waste
„
„
„
„
Discarded sharps
Laboratory and associated waste directly
involved in specimen processing
Human tissue, including materials or solutions
containing or contaminated with blood
(including other body fluids removed during
surgery, birth and autopsy)
Animal tissue or carcasses used in research
(Australian and New Zealand Clinical Waste Management Industry Group (ANZCWMIG), “Code of
Practice for the Management of Clinical and Related Wastes 2004” )
Clinical Waste Contd:
Urine and faeces are not considered
clinical waste unless:„ The
specimen of urine or faeces
is for laboratory testing
„ The urine or faeces is
contaminated with visible blood
Removal of Waste and Linen
„ Call
environmental services to
remove waste and linen as soon
as possible
„ Do not leave piled up outside
door
Refer to
your Infection Control Nurse or
Infection Control Manual
for more details
REFERENCES:
1.
2.
3.
Department of Health and Ageing: Infection Control Guidelines for the
Prevention of Transmission of Infectious Diseases in the Health Care
Setting, 2004
NSW Health Department Circlar 9987: Infection Control Policy
Health Canada. Infection Control Guidelines Supplement: Routine
Practices and Additional Precautions for Preventing the Transmission of
Infection in Health Care