Infection Prevention and Control Study guide
Infection prevention and control Regulations CQC Outcome 8 Non Clinical Introduction All staff must be aware of the importance of Infection Prevention and Control practices and keep up-to-date in order to prevent and reduce the risk of infection to patients, visitors and themselves. With your help, the following measures and practices will contribute to the prevention and control of infection. Have you washed your hands? Hand washing is the single most important step in reducing the spread of disease. Use the six-step technique before direct contact with patients and after any activity that contaminates the hands. Dry thoroughly afterwards, using disposable towels. Hand gel can be used if hands are not visibly soiled but soap and water MUST be used if you have had contact with a patient, or their surroundings, who have had diarrhoea and/or vomiting. Do you need Personal Protective Equipment (PPE)? Carry out a risk assessment and only use if potential contamination by blood or body fluid is likely or the patient has a known infection, e.g. MRSA or C.difficile. Use disposable gloves, aprons, masks, goggles or visors to protect yourself and your patient from these risks of cross-infection, and when handling these substances or hazardous chemicals and some pharmaceuticals. Pay attention to the Isolation signs on patient s room doors or within the ward environment and ask the nurse in charge for advice. Are you preventing Sharps Injuries? Do NOT handle sharps without appropriate training and PPE. Keep handling to a minimum and never resheath. Dispose of sharps carefully in a special container at the point of use. Please read latest needle stick injury policy on the Intranet and report to Occupational Health. Are you disposing of waste correctly? Ensure that you have been instructed in how to dispose of waste safely, including the colour coding of bags used for different types of waste Please refer to the latest Waste Management policy on the Intranet. Do you deal promptly with spillages? Spillages must be dealt with quickly, using appropriate chemical disinfectants as necessary. Ensure you have a thorough knowledge of chemical disinfectants if you are handling them. Follow instructions for preparation of disinfectants this ensures the appropriate concentration for effective decontamination. Instructions are available within the clinical area (for hypochlorite solutions 1 tablet should be dissolved in 1 litre of cold water for large blood spillages this should be 10 tablets in 1 litre.) 1
Do you decontaminate equipment? Meticulously clean, disinfect and sterilise re-usable equipment, as appropriate, to ensure it is safe for future use. Instructions from the manufacturer MUST be adhered to. If devices are cleaned locally this must be discussed with Infection Prevention and Control team and the Decontamination Lead to get agreement. Items labelled with this symbol are single use. This means they are used once and then MUST be discarded. Pack expiry dates All sterile packs are issued with a Use By Date which is found on the outer wrapping. These dates must be checked on a regular basis and any items found to have expired are to be disposed of without being used. Are you maintaining a clean environment? Ensure your workplace has a regular planned, written and monitored cleaning schedule, which details the items and environments to be cleaned, how often this should happen and who is responsible for cleaning each item. If your clinical area is not being cleaned as per the schedule by the Domestic team you must call the help desk. For further information refer to Facilities Management user guide on the Intranet. Do you know what to do in the event of an accident? Attend the injury, washing it well in cold running water. If bodily fluids have splashed into eyes, irrigate with cold water. If they have splashed in to the mouth, do not swallow and rinse out several times with cold water. Report the incident and seek expert advice. 2
INFECTION PREVENTION AND CONTROL Do you know of your workplace policies and procedures? Ensure you are fit to work do not attend work if you have possible infectious rashes or have symptoms of diarrhoea and or vomiting which could be infectious. Report symptoms to your line manager and Occupational Health. Ensure that you understand and follow your workplace s policies and procedures on all aspects of infection prevention and control. Links to these are available on the Infection Prevention and Control page on the Intranet Policy / Further reading Infection Control policies Contact Infection Prevention and Control Team: Royal London site (covering RLH, SBH, MEH, Dental) Tel: 020 3246 0294 Newham: 020 7363 9405 Whipps Cross: 020 8535 6846 MUST DO s Successfully complete the Infection Prevention and Control quiz Following successful completion your records will be updated automatically 3
Clinical Introduction All staff must be aware of the importance of Infection Prevention and Control practices and keep up-to-date in order to prevent and reduce the risk of infection to patients, visitors and themselves. With your help, the following measures and practices will contribute to the prevention and control of infection. All staff with clinical contact: Must be bare below the elbow (this includes wristwatches and bracelets) to ensure that wrists and hands are decontaminated effectively before and after every patient contact and before and after contact with the patient environment. Preventing Infections Relating To Intravascular Devices Healthcare Associated Infections (HCAI s) are infections that are acquired as a result of being in the healthcare interventions. There are a number of factors that can increase the risk of acquiring an infection, one of which is the presence of intravascular devices. Staff involved in the insertion and care of intravascular devices must follow the relevant policies and guidelines set out by the Trust and in doing so will help to prevent infections in such patients. Key components of this include: Insert only if clinically indicated. Ensure the site is cleaned on insertion with the appropriate skin preparation (two percent chlorhexidine in 70 percent isopropyl alcohol solution) for 30 seconds and allowing to dry for 30 seconds. Ensure entry site of vascular device is covered with a sterile, transparent, semi-permeable dressing which allows observation of the insertion site. The insertion site must be clearly visible and dated. Ensure lines do not remain in situ if not clinically required. Peripheral lines should not be in situ for longer than 72 hours without a risk assessment and clear documentation. Care of ports/hubs/taps lines should only be accessed by competent staff using the Aseptic Non-Touch Technique (ANTT) Please watch the ANTT video on the Intranet, which is located on the Infection Prevention and Control page. Correct use and replacement of IV-giving sets. Disconnected lines should not be re-connected. Recording of Visual Infusion Phlebitis (VIP) score. Documentation of insertion and removal of all devices must be recorded on the appropriate patient chart. 4
INFECTION PREVENTION AND CONTROL Blood cultures Blood cultures should be taken when there is a clinical need to do so and not as routine. Blood cultures must be taken using the correct technique in order to prevent contamination of the sample and minimise risks to patients. If a patient presents with sepsis a full septic screen should be performed in addition to the blood culture. Please refer to the Blood Culture Policy on the Intranet and watch the Blood Culture video. Patients with Pyrexia of unknown origin should be isolated and discussed with the Infection Prevention and Control Team or the on-call Microbiologist. Management and control of tuberculosis (TB) TB is an infection caused by mycobacterium tuberculosis, which most frequently infects the lungs or lymph nodes, but can affect any part of the body. Pulmonary TB is acquired by the inhalation of infected airborne droplets and usually requires prolonged close contact for person to person transmission to occur. A diagnosis of pulmonary TB should be suspected in any patient with a persistent cough with or without haemoptysis, or other symptoms compatible with tuberculosis, such as weight loss, anorexia, night sweats, or fever. All patients suspected or confirmed of having pulmonary TB must be isolated with respiratory precautions in a single side room on admission to hospital, until the respiratory team say it is safe to deisolate them. All Multi-Drug Resistant TB patients (MDRTB) or those with risk factors for having MDRTB must be isolated in a negative pressure room until de-isolation is advised by the respiratory team. Tuberculosis is a statutory notifiable disease. The Infection Prevention and Control Team, as well as the TB Team, must be informed of all in-patients with suspected or identified cases of tuberculosis that are inpatients. The TB Team at the Trust will notify the appropriate external contacts. For further information regarding management of patients with TB refer to the Trust policy on the Intranet. Carbapenem resistant organisms (CRO) such as Enterobacter spp, Klebsiella pneumonia and Escherichia coli present a serious threat to public health and the treatment of patients with infections. These organisms have become prevalent in many countries such as Bangladesh, China, Cyprus, Greece, India, Israel, Italy, North Africa (all), Malta, the Middle East (all), Pakistan, Taiwan, Turkey and the USA and outbreaks have been reported across the UK, especially in the North West of England. All patients should be risk-assessed on admission. Patients transferred from other countries especially those with a high incidence and from other hospitals within the UK, where CRO is prevalent are at an increased risk. The Trust has in place a plan for the management and control of CRO and further guidance is available in the MDRGNB policy on the Intranet. All confirmed or at-risk cases must be isolated in a side room with en-suite facilities and the Infection Prevention and Control team informed. Strict adherence to Infection Prevention and Control practice such as hand-hygiene, use of PPE, decontamination of equipment and prudent use of antibiotics is essential. MRSA prevention and control Emergency admissions: all patients admitted via the Emergency Department as an emergency are now screened for MRSA (except for maternity and paediatrics where screening is performed on a risk assessment basis). If MRSA positive, patients are isolated and started on decolonisation protocol. Elective surgical admissions:-most patients are screened for MRSA in pre-admission clinic. Patients are offered decolonisation protocol prior to surgery if MRSA positive. Community patients do not usually require protocol unless risk factors such as wounds are present and if this is the case they will be assessed on a case by case basis by their GP. 5
C difficile prevention and control Prompt identification and isolation of patients with diarrhoea Restrictive antibiotic prescribing policy Routine environmental disinfection with chlorine based disinfectant. Hand gel can be used if hands are not visibly soiled but soap and water MUST be used if you have had contact with a patient, or their surroundings, who has had diarrhoea and/or vomiting. Transmission of Infectious Organisms The chain of infection I nf ectious A gent Mode of transmission In order to prevent the spread of infection a link in the chain MUST be broken. The mode of transmission is important in the transfer an infectious agent from a reservoir to a susceptible host these are: Contact:-this can be direct (skin to skin), indirect (transferred on contaminated equipment or hands), faecal-oral (via food) Droplet: are coughed or sneezed out and settle fairly quickly, before they can travel far. These can also contaminate surfaces and be transferred by hands or equipment. Airborne:-small particles carrying microbes are transferred via air currents. Vector-borne:-transfer of microorganisms by insects, flies, rats, or other vermin Have you washed your hands? Hand washing is the single most important step in reducing the spread of disease. Use the six-step technique before direct contact with patients and after any activity that contaminates the hands. Dry thoroughly afterwards, using disposable towels. Do you need Personal Protective Equipment (PPE)? Carry out a risk assessment and only use if potential contamination by blood or body fluid is likely or the patient has a known infection e.g. MRSA or C.difficile. Use disposable gloves, aprons, masks, goggles or visors to protect yourself and your patient from these risks of cross-infection, and when handling these substances or hazardous chemicals and some pharmaceuticals. Pay attention to the Isolation signs on patient s room doors or within the ward environment. Isolation precautions YELLOW signs for contact precautions gloves and aprons for contact with the patient RED signs for enteric precautions-gloves and aprons for contact with patient & environment, dedicated toilet facilities, soap and water for hand hygiene GREEN signs for respiratory precautions masks gloves and aprons for contact with patient, as per the policy, masks MUST be worn for aerosol generating procedures or suspected/confirmed pulmonary TB. If you are required to wear FFP2/FFP3 masks you should be FIT tested for these (this is required every 5 years and a record kept within the local clinical area). Please refer to the isolation policy on the Intranet if you are unsure about the precautions required. 6
INFECTION PREVENTION AND CONTROL Are you preventing Sharps Injuries? Is there an alternative way to conduct your procedure without using sharp devices? Ensure where appropriate you use the safer sharps provided by the Trust, you must be trained in the use of these devices. Do NOT handle sharps without appropriate training and PPE. Keep handling to a minimum and never re-sheath. Dispose of sharps carefully in a special container at the point of use. Please read latest needle stick injury policy on the Intranet and report to Occupational Health. Disinfection reduction in the number of microorganisms to a safer level using heat or chemicals. Sterilisation total destruction or removal of microorganisms eg. for surgical instruments. Instructions from the manufacturer MUST be adhered to. If devices are cleaned locally this must be discussed with Infection Prevention and Control team and the Decontamination Lead to get agreement. Items labelled with this symbol are single use. Are you disposing of waste correctly? Ensure that you have been instructed in how to dispose of waste safely, including the colour coding of bags used for different types of waste Please refer to the latest Waste Management policy on the Intranet. Do you deal promptly with spillages? Spillages must be dealt with quickly, using appropriate chemical disinfectants as necessary. Ensure you have a thorough knowledge of chemical disinfectants if you are handling them. Follow instructions for preparation of disinfectants this ensures the appropriate concentration for effective decontamination. Instructions are available within the clinical area (for hypochlorite solutions 1 tablet should be dissolved in 1 litre of cold water for large blood spillages this should be 10 tablets in 1 litre.) Do you scrupulously decontaminate equipment? Meticulously clean, disinfect and sterilize re-usable equipment, as appropriate, to ensure it is safe for future use. Cleaning physical removal of organic matter This means they are used once and then MUST be discarded. Packs expiry dates: all sterile packs are issued with a Use By Date which is found on the outer wrapping. These dates must be checked on a regular basis and any items found to have expired are to be disposed of without being used. Are you maintaining a clean environment? Ensure your workplace has a regular planned, written and monitored cleaning schedule, which details the items and environments to be cleaned, how often this should happen and who is responsible for cleaning each item. If your clinical area is not being cleaned as per schedule by the Domestic team you must call the help desk. Cleaning removes contaminants, including dust and soil, large numbers of micro-organisms and the organic matter that may shield them, for example, faeces, blood and other body fluids. For further information refer to Facilities Management user guide on the Intranet. 7
Do you know what to do in the event of an accident? Attend the injury, washing it well in cold running water. If bodily fluids have splashed into eyes, irrigate with cold water. If they have splashed in to the mouth, do not swallow and rinse out several times with cold water. Report the incident and seek expert advice. Do you know of your workplace policies and procedures? Ensure you are fit to work do not attend work if you have possible infectious rashes or have symptoms of diarrhoea and or vomiting which could be infectious. Report symptoms to your line manager and Occupational Health. Ensure that you understand and follow your workplace s policies and procedures on all aspects of infection prevention and control. Links to these are available on the Infection Prevention and Control page on the Intranet. MUST DO s Successfully complete the Infection Prevention and Control quiz Following successful completion your records will be updated automatically Contacts Infection Control Teams: Dental, Mile End Hospital, and The Royal London Hospital Tel: 020 3246 0294 St Bartholomew s Hospital Tel: 020 3465 5321 8