08/09/ elements required for Infection to occur. Chain of Infection. Evolution of Standard & Transmission Based Precautions

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1 Helen Murphy, Infection Prevention & Control Nurse Manager, Health Protection Surveillance Centre HPSC/RCPI 2017 Safe Patient Care Course Chain of Infection Evolution of Standard & Transmission Based Precautions Elements of Standard Precautions Transmission based Precautions Introduction to Breaking the Chain of Infection 6 elements required for Infection to occur Infectious Agent Means of Transmission 1

2 3.5 Outbreak May sample sent to Number of patients S&S 2 new cases V & D V only D only per. Mov. Avg. (Number of patients S&S) Sun Date Ward closed 08/05/2015 samples Norovirus Contact 2

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4 In order to interrupt the spread of infection we need to break the chain of infection How? Apply concept of chain of infection to all pathogens Apply Standard Precautions consistently Risk assess the need for application of Transmission Based Precautions Standard Precautions All residents All of the time Contact precautions Risk assess Droplet precautions Risk Assess Airborne Precautions Risk assess 4

5 olation/isolation2007.pdf Reaffirmed standard precautions & transmission based precautions 3 additional elements Respiratory hygiene and cough etiquette Safe injection practices Mask lumbar puncture procedures Standard Precautions are a set of infection control practices that healthcare personnel use to reduce transmission of microorganisms in healthcare settings. Standard Precautions are intended to protect healthcare personnel and residents from exposure to infectious agents. 5

6 Standard Precautions should by used by all health & social care staff with all residents at all times regardless of the residents known or presumed infectious status 1. Occupational Health Programme 2. Patient Placement 3. Patient Movement and transfer 4. Hand Hygiene 5. Personal Protective Equipment (PPE) for HCWs 6. Patient-Care Equipment/Instruments/Devices 7. Environmental decontamination 8. Management of spillages 9. Management of needle stick injuries and blood and body fluid exposure 10. Management of Healthcare non-risk, risk waste and Sharps 11. Management of Laundry and Linen 12. Respiratory Hygiene and Cough Etiquette 13. Safe Injection Practice 14. Infection Control Practices for Special Lumbar Puncture Procedures 6

7 Pre-employment screening Vaccination Management of sharps injuries Stress management Work exclusion criteria Appropriate resident placement is a core component of standard precautions Perform ongoing risk assessment to determine where residents are placed to minimise the potential risk of cross infection Ensure the safe transfer of patients internally and externally Perform ongoing risk assessment to determine where patients are placed to minimise the potential risk of cross infection. Provide adequate information to transport personnel and receiving department or facility. 7

8 Patient zone Healthcare Area Point of Care PPE Personal Protective Equipment Specialised clothing/equipment worn where there is a risk of contact with blood, body fluids or infectious material. Aim of PPE is to protect the wearer (HSA 2007). Follow manufacturers instructions Single patient use Single use only Reusable Cleaning Schedules RIMD 8

9 Neutral detergent e.g. washing up liquid Liquid or wipes depending on size of area to be cleaned Chlorine based disinfectants e.g. Liquid hypochlorite or NADCC tablets or granules Cleaning Disinfection For spillages of body fluid (e.g. urine, faeces or vomit) soak up visible material with disposable paper towels dispose of the soiled paper towels clean the area using warm water and neutral detergent disinfect using a chlorine-releasing solution of 1000ppm, or equivalent discard PPE, decontaminate hands For blood spillages decontaminate all blood spills with a chlorine based disinfectant (10,000ppm available chlorine) or suitable alternative wipe up the spillage with disposable paper towels and discard into a yellow healthcare risk bag or rigid container Wash the area with a general purpose neutral detergent and water discard gloves and apron into healthcare risk bag decontaminate hands 9

10 General Domestic waste Confidential material Medical equipment Potentially offensive material Healthcare non-risk waste Blood &items visibly soiled with blood Contaminated waste from patients with transmissible infectious diseases Incontinence wear/nappies from patients with known or suspected enteric pathogens Items contaminated with body fluids other than faeces, urine or breast milk Other healthcare infectious waste Sharps Any object which has been used in the diagnosis, treatment or prevention of disease that is likely to cause a puncture wound or cut to the skin Healthcare Risk Waste Correct handling & transport prevents transmission of microorganisms to laundry workers, HCWs and the environment. Involves: Store clean linen separate from used linen. Bring laundry skip to the bedside to avoid staff carrying soiled and used linen. Wear protective equipment such as gloves and an apron when required. Avoid manually sluicing of infected/ soiled linen or clothing. 10

11 Sharps :any object or instrument used in specific healthcare activities which are able to cut, prick or cause injury or infection. Sharps should be handled and disposed of in a manner which prevents injury risks. This includes the use of needle safe devices, and disposal of syringes and needles as one single unit. Sharps should be discarded in an approved container at the point of use. Needles must not be re-capped and sharps should not be passed from person to person by hand. 11

12 All injections must be prepared in a clean area. Dispose of used needles and syringes, blood samples or any material contaminated with blood or body fluids in a separate dirty area Eliminate unnecessary use of sharps. Use sharps with safety engineered protection mechanisms if elimination not feasible Needle and syringes are sterile, single-use items and must not be reused. Single-dose vials should be used wherever possible. Single-dose vials must not be used for multiple clients. Residual products must not be combined for later use. Restrict multi-dose vials to a single patient. Do not use bags or bottles of intravenous fluids as a common source of supply for multiple patients. Intravenous fluids and intravenous sets are single use sterile items for use by a single patient. Consider a syringe or needle/cannula as contaminated once it has been used to enter or connect to a patients intravenous infusion bag or administration set Wear a surgical mask when placing a catheter or injecting material into the spinal canal or subdural space. 12

13 Clean area/dirty area Aseptic Non- Touch Technique Standard Precautions Risk Assessment All residents All of the time Contact precautions Droplet precautions Airborne Precautions Risk assess Risk Assess Risk assess Residents with active infection Residents who are incubating an infectious disease Residents who are colonised with MDROs and are at high risk of transmitting to other residents 13

14 Contact precautions: aim to prevent and control infections spread via direct contact with the resident or indirectly from the residents' immediate care environment or care equipment. Examples: MDRO s, RSV,C. difficile Droplet precautions: prevent and control infections spread over short distances (at least 3 feet (1 metre)) via droplets (>5μm) from the respiratory tract of one individual directly onto a mucosal surface or conjunctivae of another individual. Examples : RSV, Influenza, Pertussis, Neisseria meningitides Designed to prevent and control infections spread by aerosols ( 5μm) from the respiratory tract of one individual directly onto a mucosal surface or conjunctivae of another individual. Aerosols penetrate the respiratory system to the alveolar level. Examples: TB, Chicken pox, Measles 14

15 Patient placement :subject to risk assessment Single room or cohort Movement and transfer: restricted PPE: appropriate use of PPE e.g. gloves, apron or gowns, surgical masks Type R11 or FFP 2/3 respirators, and protective eyewear Environmental Hygiene: enhanced, cleaning & disinfection Terminal clean post discharge or transfer Care equipment: dedicated to resident Core Infection Prevention and Control Knowledge and Skills; A Framework Document May 2015 Framework for supporting development, education and training in IPC 15

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19 Vision for this programme is that it will become a mandatory educational tool that will assist all staff in their quest to provide high quality, safe care across all health and social care services Breaking the Chain of Infection Decontamination of RIMD Devices/decontamination/ DOH, 2010, Healthcare Waste Packaging Guidelines HPSC, 2009, Standard Precautions Z/MicrobiologyAntimicrobialResistance/InfectionControlandHAI/StandardPrecautions/File,3600,en.pdf HPSC, Guidelines for the Emergency Management of Injuries and Post-Exposure Prophylaxis (PEP) Z/EMIToolkit/ HSA, 2007, Guide to the Safety, Health and Welfare at Work (General Application) Regulations RCPI, 2015, Guidelines for hand hygiene in Irish healthcare settings Z/Gastroenteric/Handwashing/Publications/File,15060,en.pdf S.I. No. 135/ European Union (Prevention of Sharps Injuries in the Healthcare Sector) Regulations Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee, 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings Ann O Connor, CIPCN, CHO 9 Working group-hseland E-learning Programme Kevin James, Chairperson, Leadership, Education and Training Manager, Dublin NE) Aurion helped design the e-learning programme Gwen Regan, Practice Development Facilitator Sheila Donlon, ADON, Beaumont Hospital Margaret Nadin, Project manager, DNE Marie Leneahan (OH Manager, Mater hospital) Marian Brennan, ADON IPC Rotunda Hospital Teresa O'Callaghan (Quality & Risk Manager, Dublin NE) Joan Balfe (Admin Support) Ann O Connor, CIPCN, CHO 9 19

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