Infection Control.pdf

WORKSHOP 1: INFECTION CONTROL HNB1102 Foundations in Nursing 1 By Navneet Grewal Victoria University ack...

WORKSHOP 1: INFECTION CONTROL HNB1102 Foundations in Nursing 1 By Navneet Grewal Victoria University acknowledges, recognises and respects the Ancestors, Elders and families of the Boonwurrung, Waddawurrung and Wurundjeri of the Kulin who are the traditional owners of University land in Victoria, and the Gadigal and Guring-gai of the Eora Nation who are the traditional owners of University land in Sydney.  WORKSHOP LEARNING OUTCOMES At the end of this workshop you will be able to: Explain infection and the chain of infection Explain how to prevent transmission of different types of infection Outline the different types of PPE used to prevent transmission of infection Explain the significance of correct hand hygiene technique Outline the Preventing and Controlling Healthcare-Associated Infection Standard 2 WHAT IS AN INFECTION? Infection is a disease state that occurs when micro-organisms invade and grow in the body to cause ill health. Hill et al., (2016) 3 TYPES OF INFECTIONS Virus: Smallest of all microorganisms. Requires a living host to replicate. When it is outside of the cell it is called Virion and is transmitted from person to person, e.g. a common cold, various strains of hepatitis. Bacteria: This is the most common type of infection. Categorized by their shape spherical (cocci), rod shape (bacilli), spiral (spirilla) or corkscrew shape (spirochetes). Fungi: Plant-like organisms (e.g. mould and yeast) present in air, water and soil. Examples include athlete foot, ringworm, Candida. (Hill et al., 2016) 4 FOR AN INFECTION TO OCCUR… The micro-organisms must enter the body The micro-organism must grow and multiply The micro-organism must cause a response, leading to signs and symptoms  The spread of infection from a colonized or infected host or another source depends on a complex chain of events. Infection is result of cyclical process and has the following components in the chain of infection. Hill et al., (2016) NHMRC (2010). 5  CHAIN OF INFECTION https://www.ottawapublic health.ca/en/professionals -and- partners/resources/Docum ents/infection_chain_ccf_e n.pdf 6  BREAK THE CHAIN OF INFECTION Regardless of the infectious agent being virus or bacteria, they spread from person to person through a common series of events which is through the chain of infection. This spread of germs could be prevented by interrupting this chain at various links. Please refer to the following link for further discussion. https://infectionpreventionandyou.org/wp- content/uploads/2016/09/Break-the-Chain-of- Infection.pdf 7 ACTIVITY 1  Please refer to the in-class activity page to complete this activity. IN 2010, THE AUSTRALIAN COMMISSION ON SAFETY AND QUALITY HEALTH CARE (ACSQHC) ISSUED TWO ISOLATION GUIDELINES: Standard Precautions (Tier 1) Transmission Based Precautions (Tier 2) 9  Precautions Transmission Based Precautions: Tier 2 Standard Precautions: Tier 1 Are implemented when standard precautions are not Always used for all the patients in all sufficient to prevent infection transmission and are based the situations upon the mode of transmission of the infectious agent. 1. Contact Precautions E.g., Multi resistant organisms, norovirus, C. difficale, Localised shingles 2. Droplet Precaution E.g., norovirus, pertussis, meningococcus 3. Airborne Precautions E.g., Pulmonary TB, chickenpox, measles, Disseminated shingles STANDARD PRECAUTIONS (TIER 1) Prevention practices assume that every person is potentially infected or colonized with an organism that could be transmitted in the healthcare setting. These precautions apply to blood and all body fluids, non-intact skin and mucous membranes. 11 STANDARD PRECAUTIONS Safe infection practices include: Strategies Hand hygiene Personal protective equipment (PPE) Eye protection, Gloves, Mask, Gown Handling and disposing of sharps, Appropriate waste disposal Patient care equipment : Single use equipment (dispose after use) Care of the patient environment: Rooms are cleaned frequently and disinfected Respiratory hygiene and cough etiquette  HAND HYGIENE  Hand-washing is generally considered the most important hygiene measure in preventing the spread of infection. 5 Moments of Hand Hygiene are: 1. Before touching a patient 2. Before a procedure 3. After body fluid exposure risk 4. After touching a patient 5. After touching patient surroundings (World Health Organization [WHO], 2018) Based on the 'My 5 moments for Hand Hygiene' © World Health Organization 2009. 13 HAND WASHING  The most powerful defence against infection A routine hand wash should be 40-60 seconds. Prior to performing an aseptic procedure, hand washing should be 1 minute. For a surgical wash, hand washing is 5 minutes. Alcohol-based hand gel (60% ethanol) can be used as an adjunct to routine hand washing.  (Sax et al., 2007) 14 HAND WASHING 15 HAND WASHING: SANITIZER VS HAND WASH  When your hands are visibly clean, alcohol-based hand sanitizer can be used instead of hand washing.  The reasons are: It is the most efficacious agent for reducing bacterial count on hands of healthcare workers Requires less time than handwashing Is more accessible than sinks Is self-drying and acts fast Is less likely to cause Allergic dermatitis as a side effect, since all hand rubs contain skin emollient (moisturizers).  (WHO, 2018) 16 STANDARD PRECAUTIONS PPE: GLOVES AND GOWNS Gloves are worn to protect the patient and healthcare worker from infectious agents that may be carried on our hands. Sterile gloves are utilized for aseptic procedures and contact with sterile sites. Gowns are to be worn to protect the skin and prevent soiling or contamination of clothing during procedures and patient care activities when contact with bodily fluids, blood, excretions or secretions is expected. STANDARD PRECAUTION PPE: FACE/EYE PROTECTION AND MASK The mucus membrane of the nose, eyes and mouth are entry points for infection. Protective eyewear and surgical mask must be worn during procedures to prevent splashes or sprays of body substances, Blood, Secretions or excretion entering the body (emptying IDC, drain tubes, nasopharyngeal aspiration, dental procedures). A mask is worn only once and should never be lowered around the neck and then brought back over the mouth and nose for reuse. It should certainly be changed before it becomes damp from the wearer’s exhalations. (Centre of Disease Control and Prevention, n.d) SEQUENCE OF PUTTING ON AND REMOVING PPE https://www.cdc.gov/hai/pdfs/ppe/ppe-sequence.pdf TRANSMISSION BASED PRECAUTIONS (TIER 2) Are used when the route of transmission is not completely controlled using the Standard Precautions. There are three categories of Transmission-based Precautions based on the infection transmission method: Contact Precautions Droplet Precautions Airborne Precautions 20  TBP CONTACT TRANSMISSION They are used when microorganism can spread by direct or indirect contact. Strategies in addition to maintaining standard precautions: Place the person in a single room. Cohorting can be done if same microorganism is involved. Appropriate signage needs to be visible on the patient’s door. Gown and gloves are required when suspected infectious agents that spread by direct or indirect contact with the patient or the patient’s environment. Limit movement of the person out of the room. Dedicate care equipment to that room/person (Eg., Methicillin Resistant Staphylococus (MRSA), Vancomycin Resistant Enterococci (VRE), Open wounds, Gastroenteritis, Localized Shingles/Herpes Zoster (Varicella Zoster Virus) (Centre of Disease Control and Prevention, n.d)  TBP DROPLET TRANSMISSION Droplet infections are transmitted either via large particle aerosols within 1m of patient surroundings or in small particulate nuclei and can travel longer distances. Droplets can be generated by a patient sneeze, talking or coughing. Additional Strategies to prevent droplet transmission Single room for patient Wear surgical mask but N95 mask when working within 1 m of the person Appropriate signage needs to be visible on the patient’s door. When transferring patient within the organization or transferring to external organization ensure they are wearing a surgical mask. All visitors wear the mask and stay 1m away from patient Minimize the movement in and out of the room. Eg., influenza, rubella, mumps, diphtheria and the adenovirus infection (Centre of Disease Control and Prevention, n.d)  TBP AIRBORNE TRANSMISSION Established for patients who have infections that spread through the air, such as tuberculosis, varicella zoster virus (chickenpox), (disseminated shingles/herpes zoster) and measles Place them in single room that has monitored negative air pressure. Keep door closed and person in room. Appropriate signage on the door. Use respiratory protection (N95 mask) when entering room of a person with known or suspected tuberculosis. Transport the person out of the room only when necessary and place an N95 mask on them (Centre of Disease Control and Prevention, n.d) COMBINED PRECAUTIONS – STANDARD, CONTACT AND DROPLET E.g. of situations where this combination of precautions is required include for patients with acute respiratory tract infection, with unknown aetiology (i.e. low risk of transmission of COVID-19), seasonal influenza and respiratory syncytial virus (RSV) https://www.safetyandquality.gov.au/our-work/infection- prevention-and-control/standard-and-transmission-based- precautions-and-signage COMBINED PRECAUTIONS – STANDARD, AIRBORNE AND CONTACT Examples of situations where this combination of precautions is required include for patients with confirmed or suspected COVID-19, chickenpox, measles and disseminated shingles. https://www.safetyandquality.gov.au/our-work/infection-prevention- and-control/standard-and-transmission-based-precautions-and-signage MEETING NEEDS OF ISOLATED PATIENTS Patients in isolation are at great chance of suffering from psychological trauma such as feeling unclean and undesirable, loss of self esteem, stress. Strategies Education: Education about transmission-based precautions can ease the fears of the people and their families. Education must inform patient and their families that Precautions are often temporary.. Regularly update the patient regarding their care and procedures to minimize anxiety. Active listening: Listen to the person’s concerns, address their concerns, adjust without compromising precautions. Documentation: Document your teaching and the patient’s concerns about additional precautions in the plan of care. (Hill et al., 2016) DEFINITIONS Key sites are any breaches in skin integrity which could be a portal of entry for microorganisms to colonise the patient. This includes wounds and puncture sites Key parts are any parts of the equipment which come into contact with procedural equipment or the patient. This includes invasive devices connected to the patient and liquid infusions. E.g., IV cannula bungs, Needle tips, Sterile gauze used to clean a wound, If key parts become contaminated, they can transfer microorganisms to the patient. Non-Touch Technique: The safest way to protect a key part or key site from contamination is to use a non-touch technique. This means that the safest way to protect a key part or key site is not to touch it, even if wearing gloves Sterile: Free from microorganisms Asepsis: Free from infection or infectious (pathogenic) material. Aseptic technique aims to prevent pathogenic microorganisms, from being introduced to the patient via hands, surfaces and equipment. Aseptic technique can be Standard or Surgical based on number of key parts and key sites. Clean: Free from dirt, marks or stains. NHMRC, 2010 ASEPTIC NON-TOUCH TECHNIQUE (ANTT) Aseptic Non-Touch Technique or ANTT is a tool/framework used to prevent infections in healthcare settings. It enables Healthcare settings to design policies and practice procedures to prevent transmission of preventable healthcare associated infections by minimizing the presence of microorganisms during the procedures. This is in alignment with NSQHS Standard 3 (ACSQHC): Preventing and Controlling Healthcare-Associated Infection Standard. ANTT will be discussed in detail in Workshop 8 ACTIVITY 2 Please refer to the in-class activity page to complete this activity. REFERENCES Centre of Disease Control and Prevention.(2016, January 26). Standard precautions for all patient care. https://www.cdc.gov/infectioncontrol/basics/standard-precautions.html Centre of Disease Control and Prevention. (2020, May 28). Infection Prevention Tools. https://www.cdc.gov/longtermcare/prevention/ Hand Hygiene Australia. (n.d). https://www.hha.org.au/ Hill, R., Hall, H., & Glew, P. J. (2016). Fundamentals of Nursing and Midwifery: A Person-CentredApproach to Care (3rd ed.). Lippincott Williams and Wilkins. National Health and Medical Research Council (NHMRC). (2010). Australian Guidelines for the Prevention and Control of Infection in Healthcare. Commonwealth of Australia. 30 REFERENCES Hill, R., Hall, H. & Glew, P. (2017). Fundamentals of Nursing and Midwifery A person centred approach to care. (7th ed.). Wolters Kluwer. National Health and Medical Research Council (2010). Research Australian guidelines for the prevention and control of infection in healthcare. Commonwealth of Australia. https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-prevention-and-control- infection-healthcare-2010 Sax, H., Allegranzi, B., Uçkay, I., Larson, E., Boyce, J. & Pittet D. (2007). My five moments for hand hygiene: a user-centred design approach to understand, train, monitor and report hand hygiene. The Journal of Hospital Infection. 67(1) 9-21. https://doi.org/10.1016/j.jhin.2007.06.004 World Health Organisation (2018). WHO Guidelines on Hand Hygiene in Health Care. https://www.who.int/publications/i/item/9789241597906 31