Principles of Infection Prevention and Control Liz Van Horne Manager, Core Competencies Senior Infection Prevention & Control Professional OAHPP Outbreak Management Workshop September 15, 2010
Objectives To describe the principles of infection prevention and control for: Routine Practices Additional Precautions Rationale for use
How do we implement the principles? Framework for all infection prevention and control programs is built around consistent use of Routine Practices and Additional Precautions Implementation will vary depending on the health care setting Principles remain the same
Principles and Rationale of Routine Practices All patients are potentially infectious, therefore: Same principles of practice should be used ALL the time With ALL patients ALL contact with blood, body fluid, secretions, excretions, mucous membranes, non-intact skin or soiled items could potentially transmit infectious organisms
Routine Practices prevent transmission of organisms from: Resident/Patient to resident/patient Resident/Patient to staff Staff to resident/patient Staff to staff
Elements of Routine Practices Risk assessment Environmental controls Administrative controls Sufficient and accessible barrier equipment, i.e. PPE
Risk Assessment Dynamic process based on continuing changes in information as care progresses, thus must be done before each interaction with a client/patient/resident (PIDAC)
Assessing Risk Risk of transmission involves factors related to: Client/patient/resident infection status Client/patient/resident characteristics Type of care activities being performed Resources available for control Health care provider immune status
Risk Assessment Do I need protection because of a risk of exposure to blood, secretions/excretions or body fluids? Do I need protection because of the patient s symptoms? What are the organizational requirements for a patient with an identified infection?
Will hands be exposed to blood/body fluid or contaminated items? Will face be exposed to splash, spray, cough or sneeze? If yes, If yes, Wear gloves and perform hand hygiene Wear facial protection Will clothing or skin be exposed to splashes? If yes, Wear a gown
Hand Hygiene Elements of a hand hygiene program for all health care SETTINGS Multifaceted and multidisciplinary Point of care hand hygiene products Education on where, when, and how to clean hands Skin integrity Elements for health care FACILITIES Management support Environmental and system supports Observational audits and feedback
Alcohol-Based Hand Rub (ABHR) Preferred method of cleaning hands Can be performed without leaving the resident/patient Use when hands are not visibly soiled 70-90% alcohol Non-alcohol products are not to be used
Personal Protective Equipment PPE used alone or in combination to prevent exposure of health care provider Selection based on the risk assessment PPE should be put on just prior to the interaction and removed immediately after the interaction is done Staff must have quick, easy access to sufficient supplies of PPE
Personal Protective Equipment (PPE) Putting On PPE Gown Mask or respirator Goggles or face shield Gloves Taking Off PPE Gloves Gown Hand hygiene Goggles or face shield Mask or respirator Hand hygiene
Gloves Medical grade gloves must be used for contact with mucous membranes, non-intact skin, blood and body fluids Gloves are NOT required for routine health care activities that are limited to intact skin Eg. taking blood pressure, bathing, dressing Compliance with hand hygiene
Appropriate Glove Use Task specific and single-use for the task Size must be correct Clean hands before putting on gloves Remove gloves immediately after the activity Clean hands after removing gloves Change gloves when moving from contaminated body site to a clean body site on the same patient Do not wash or re-use gloves Gloves must be changed in between patients or when moving from a dirty to clean procedure on the same patient
Types of Gloves Good quality vinyl gloves are suitable for most tasks Latex/synthetic gloves (nitrile or neoprene) are prefereable for clinical procedures where manual dexterity or prolonged contact are expected Powdered latex gloves have been associated with latex allergy Gloves that fit snugly around the wrist are preferred for use with gowns
Gowns Only wear when providing care for patients Put on immediately before task Removed immediately after task
Masks and Respirators Masks To protect the mucous membranes of the health care provider when anticipated splashes of blood or body fluids are anticipated Used in operating theatres and for performing aseptic procedures Place on coughing patient to limit dissemination of respiratory secretions Respirators To prevent inhalation of small particles that may contain infectious agents transmitted via airborne route Must be fit-tested Used for aerosol-generating procedures Sputum induction, diagnostic bronchoscopy
Eye Protection Used to protect the mucous membranes when splashing is anticipated Safety glasses Safety goggles Face shields Visors attached to masks (does not include prescription eye glasses) Disposable or reusable Central processing area or assigned staff member to clean reusable eye protection between uses is recommended
Environmental Controls Accommodation and Placement Environment and equipment cleaning Dishware and eating utensils Linen and waste Laundry Waste management Handling of sharps
Accommodation and Placement Single rooms with dedicated bathroom and sink are preferred for all patients Decision making considerations for placement: Is patient soiling environment due to poor hygiene or incontinence? Does patient have an infection that might be transmitted to others? What is the condition of others in the unit? Does the patient have an indwelling device or non-intact skin? What is the susceptibility level of the patient or potential roommates? Can they follow directions on hygiene?
Environment and Equipment Cleaning Cleaning and disinfection of non-critical equipment between patients High-level disinfection of semi-critical and sterilization of critical medical equipment Daily and terminal cleaning of rooms Cleaning requirements for rooms with C. difficile or VRE positive patients
Dishes, Linen and Waste Dishware and utensils do not need special processing Regular dishwashing processes are effective Laundry soiled with blood/body fluids -- handle ROUTINELY Bag/contain at the site of collection Use leak-proof bags/containers if contaminated with blood/body substances Waste Protective apparel (gloves, footwear) Sharps disposal
Administrative Controls Policies and procedures Education Healthy workplace policies Respiratory etiquette Immunization Monitoring of compliance and feedback Staffing
Additional Precautions
Principles and Rationale of Additional Precautions Additional Precautions are used in addition to Routine Practices when a patient has a certain microorganism Includes suspect cases eg. diarrhea with no identified cause Includes colonization eg. MRSA Application of Additional Precautions may differ depending on the health setting and the needs eg. long term care and community
Elements of Additional Precautions Specialized accommodation and signage Barrier equipment Dedicated equipment Additional cleaning Limited transport procedures Communication
Additional Precautions Interventions used in ADDITION to Routine Practices Protect staff and patients from transmission of known or suspected infectious agents Based on mode of transmission: Contact Droplet Airborne May be combined for some agents e.g. Droplet + Contact
What does this mean to Public Health? Remember... Infection prevention and control involves applying principles to the situation There are few black and white rules only a variety of gray shades
Questions?