Infection Control Practices

Standard Infection Control Precautions

• Applied Microbiology and Infection Control Practices course, BSN112
• Academic year 2024-2025
• Semester 2, Week 5

Learning Outcomes

• Students will be able to apply principles of infection control precautions
• Students will be able to analyze methods of infection control
• Students will be able to demonstrate proper hand hygiene technique
• Students will be able to explain methods of reducing infection transmission

Topic Outline

• Definition of standard infection control precautions
• Sources of infection
• Elements of standards of infection control precautions
• Patient placement and risk assessment
• Hand hygiene
• Respiratory and cough hygiene
• Safe management of care equipment
• Safe management of the care environment
• Safe management of linen
• Safe management of blood and body spillage
• Safe disposal of waste

Standard Infection Control Precautions (SICPs)

• Basic infection prevention and control measures to reduce the risk of transmitting infectious agents
• Reduce or prevent the transmission of infectious agents
• Maintain objects and healthcare settings free from infectious agents

Standard Infection Control Precautions Application

• SICPs are used by all staff in all care settings at all times
• Used for all patients, regardless of known infection status

Sources of Infection

• Blood and other body fluids
• Secretions or excretions (excluding sweat)
• Non-intact skin or mucous membranes
• Contaminated equipment or items

Sources of Infection (Diagram)

• Infectious agent
• Reservoir
• Susceptible host
• Entry
• Exit
• Transmission method (Contact, Droplet, Airborne)
• Direct/Indirect transmission
• Equipment/environment
• Hands, Injection, Ingestion pathways as points of infection

Application of SICPs

• Application of SICPs determined by;
• Task
• Level of interaction
• Anticipated level of exposure to blood or body fluids (risk assessment and perception)

Elements of SICPs

• 10 elements:
• Patient placement/assessment of infection risk
• Hand hygiene
• Respiratory and cough hygiene
• Personal protective equipment (PPE)
• Safe management of the care environment
• Safe management of care equipment
• Safe management of healthcare linen
• Safe management of blood and body fluids
• Safe disposal of waste (including sharps)
• Occupational safety/managing prevention of exposure (including sharps)

Standard Precautions

• Must be used when caring for all patients, regardless of infection status.
• Includes performing hand hygiene, using personal protective equipment (PPE), routine environmental cleaning, handling and storing waste and linen safely.

Patient Placement & Risk Assessment

• Patients must be assessed for infection risk on arrival and continuously throughout their stay
• Risk assessments inform placement decisions based on clinical/care needs
• Patients with known or suspected infection risk factors (e.g., diarrhea, vomiting, rash, fever, respiratory symptoms, prior multi-drug resistant organism (MDRO) infections like MRSA, or CPE) or prior hospitalization should be considered, and isolation protocols should be addressed

Hand Hygiene

• Hand hygiene is one of the most important ways to reduce the transmission of infectious agents

• Clinical hand-wash basins should be used only for hand washing and not for disposal of liquids

• Basins should have mixer taps, no overflows, and be in good repair, along with liquid soap and paper towel dispensers

• Instructions for hand hygiene should be available

• Before performing hand hygiene, expose forearms (bare below the elbow), remove all hand and wrist jewelry, and ensure fingernails are clean and short

• Wash hands with non-antimicrobial liquid soap and water if visibly soiled or involved in activities with vomiting or diarrhea

• Use alcohol-based hand rubs (ABHRs) in all other circumstances

• Dry hands thoroughly using disposable paper towels

• Use lotions regularly.

Hand Hygiene: Surgical Hand Antisepsis

• Surgical scrubbing/rubbing for invasive procedures
• Remove jewelry
• Use nail picks for visibly dirty nails
• Use soft, non-abrasive, sterile sponges with antimicrobial liquid soap (licensed for surgical use), or licensed ABHR for surgical rubbing
• Use alcohol-based hand rubs (ABHR) between surgical procedures if hands are not visibly soiled

Respiratory and Cough Hygiene

• Cover nose and mouth with a tissue when sneezing, coughing, or blowing nose; use crook of arm if tissue is unavailable
• Dispose used tissues in waste bins
• Wash hands with non-antimicrobial liquid soap and warm water after such activity, using tissues, or contact with respiratory secretions or contaminated objects
• If no running water, use hand wipes with ABHR and wash hands as soon as possible -Keep contaminated hands away from eyes, nose, and mouth

Personal Protective Equipment (PPE)

• Wear PPE that adequately protects against risks associated with the procedure
• PPE must be located close to the point of use
• PPE for healthcare providers providing community and domiciliary care should be transported in clean receptacles
• PPE should be stored in a clean, dry area until required, adhering to expiry dates
• Single-use PPE unless otherwise specified by manufacturer
• Change PPE immediately after each patient and/or after completing each procedure or task
• Dispose of used PPE appropriately in the correct waste stream
• Discard damaged or contaminated PPE

Personal Protective Equipment (PPE) - Gloves

• Wear gloves when exposure to blood and/or other body fluids, non-intact skin, or mucous membranes is anticipated or likely
• Change gloves after each patient and/or after completing a procedure/task even on the same patient
• Change if a perforation or puncture is suspected
• Gloves should be appropriate for use, fit for purpose, and well-fitting
• Never decontaminate with ABHR or soap
• Gloves should pose low risk of causing sensitization
• Gloves should be appropriate for tasks undertaken

Personal Protective Equipment (PPE) - Sterile Gloves

• Sterile gloves should be worn whenever sterility is required during procedures (such as operating theatre, central venous catheter insertion, peripherally inserted central catheter insertion, pulmonary artery catheter insertion, spinal, epidural, and caudal procedures)
• Double gloving is not routinely recommended for clinical care.

Personal Protective Equipment (PPE) - Aprons

• Worn to prevent contamination to uniform or clothing when exposure to patients is anticipated

Personal Protective Equipment (PPE) - Eye/Face Protection

• Worn when anticipated exposure to or likely body fluid contamination of eyes or face
• Must not be impeded by accessories such as piercings or false eyelashes
• Avoid touching while in use

Personal Protective Equipment (PPE) - Fluid Resistant Surgical Masks

• Required during procedures such as surgery
• Prevent patient exposure from wearer
• Protect wearer from splashing or spraying of blood, body fluids, secretions, or excretions onto the respiratory mucosa
• Used as an element of PPE for droplet precautions

Personal Protective Equipment (PPE) - Headwear

• Required in theatres and clean rooms, such as decontamination units
• Covers hair (full coverage)
• Change between procedures or contamination
• Removed before leaving theatre/clean room

Safe Management of Care Equipment

• Equipment contaminated with blood, body fluids, secretions, excretions, and infectious agents
• Single use items are used once and discarded
• Single use items (e.g., nebulizer masks) may require decontamination before reuse with the same patient
• Reusable invasive equipment (e.g., surgical instruments) are used once and decontaminated
• Reusable non-invasive equipment (e.g., commodes, patient transfer trolleys) are decontaminated between each use

Safe Management of Care Equipment- Sterile Equipment

• Check packaging's integrity for damage or contamination
• Check expiry date for validity
• Check sterility indicators are consistent for successful completion
• Proper management needed for decontaminated re-use

Safe Management of Care Equipment- Decontamination of Reusable Non-invasive Equipment

• Decontamination must be undertaken between each use or between patients, after blood or body fluid contamination, and at predefined intervals as part of an equipment cleaning protocol.
• Decontamination must also be undertaken before equipment goes through service or repair

Safe Management of the Care Environment

• Visibly clean, free of non-essential items and equipment to enable effective cleaning
• Well maintained, in good repair, with adequate ventilation

Safe Management of the Care Environment - Routine Cleaning

• Refer to national/institutional cleaning standards
• Use detergent wipes for frequently touched surfaces
• Use fresh solution of general-purpose neutral detergent in warm water for cleaning schedules
• Follow protocols for environmental decontamination

Safe Management of Linen

• Clean linen should be stored in a designated, enclosed area (e.g., cupboard)
• If not in cupboard, use appropriate trolley/receptacle with impervious covering/door
• Used linen should be placed in a labeled, water-soluble bag or receptacle and should be stored in a designated, safe, lockable area
• Do not shake or sort linen when removed from bed/trolleys
• Do not place soiled linen on surfaces such as floor and/or countertops
• Ensure that laundry bags are not overfilled to 2/3 of capacity
• Place used linen (previously known as soiled/fouled linen) in labeled, impermeable bags and receptacle

Safe Management of Blood and Body Fluid Spillages

• Spillages should be treated promptly by trained staff
• Responsibilities for management of blood and body fluid spills should be clear within each area/care unit

Safe Disposal of Waste (Including Sharps)

• Clinical waste includes healthcare and veterinary waste containing living microorganisms/toxins, or biologically active agents like medicine
• Sharps include sharps, body fluids/human tissue
• Sharps containers should have a handle and temporary closure mechanism
• Sharps containers should be labelled and date stamped
• Organizations using reusable sharps containers should have a protocol for assuring safe use and reprocessing
• Sharps should be discarded at the point of use by the user

Occupational Safety: Prevention of Exposure (Including Sharps Injuries)

• Potential risk of blood-borne viruses from exposure during contact with patients, blood, needles, instruments, and contaminated items

• Legal requirement to report sharps injuries and near misses to line managers/employers

• Significant occupational exposure includes percutaneous injuries (e.g., needles), bone fragments/bites breaking the skin, exposure to broken skin and/or mucous membranes

• Avoid unnecessary use of sharps

• If use of sharps is unavoidable, use safer sharps

• Safe procedures for working with and disposal of sharps must be in place (e.g. sticky mats, sharps bins, safety procedures and training)

• Follow manufacturers' instructions for use and disposal of sharps

• Needles not to be re-sheathed/recapped/disassembled after use

• Sharps not passed between people directly

• Sharps discarded at the point of use by the individual using the sharp

• Needles and syringes disposed of as one unit

• If safety device is used, safety mechanisms deployed before disposing