Topic 8: Infection Control And Prevention PDF

MICROBIOLOGY RND 11502 TOPIC 8: INFECTION CONTROL AND PREVENTION Prepared by Kogi LEARNING OUTCOME After completing this lesson, student should be able to  explain healthcare worker’s role in preventing spread of infections INTRODUCTI...

MICROBIOLOGY RND 11502 TOPIC 8: INFECTION CONTROL AND PREVENTION Prepared by Kogi LEARNING OUTCOME After completing this lesson, student should be able to  explain healthcare worker’s role in preventing spread of infections INTRODUCTION  Many infectious agent are present in the health care setting.  Patientmay become infected while they are receiving health care and health care workers are at risk while they are doing their work  Other people visiting and working in the health care establishment may also be at risk  Insome cases, health care setting associated infections are extremely serious or even life threatening INTRODUCTION (CONT)  Every year, many lives are loss because of the spread of infection in hospital.  Every health care worker plays a vital part in helping to minimize the risk of cross infection, e.g. by:  making certain that hands are properly washed,  making clinical environment as clean as possible,  ensuring knowledge and skills are continually updated  educating patients and visitors INTRODUCTION (CONT)  Properhand washing is the most effective way of preventing the spread of infection in the hospital  Ensuring the use of safe, effective and ethical infection prevention and control measures is an important component of nursing care  INFECTION CONTROL What is infection control? The set of methods used to control and prevent the spread of disease (Department of Health and Hospital Louisiana, 2009) PRINCIPLES OF BASIC INFECTION CONTROL  Microorganisms are transferred from one surface to another whenever objects touch. A clean item touching a less clean item becomes “dirty” Therefore :  keep hands away from face  keep linens away from uniforms  an item dropped on the floor is considered dirty. PRINCIPLES OF BASIC INFECTION CONTROL  Microorganisms are transferred by gravity when one item is held above another: Therefore:  avoid passing dirty items over clean items  clean items on upper shelves – dirty items on lower shelves. PRINCIPLES OF BASIC INFECTION CONTROL  Microorganisms are released into the air on droplet nuclei whenever a person breathes or speaks: Therefore:  avoid breathing directly in someone’s face  when someone coughs/sneezes, cover mouth with tissue towel, discard  wash hands. PRINCIPLES OF BASIC INFECTION CONTROL  Microorganisms move slowly on dry surfaces, but very quickly through moisture : Therefore:  Don’t wet sterile trolley PRINCIPLES OF BASIC INFECTION CONTROL  Properhand washing removes many of the microorganisms that would be transferred by the hands from one item to another  always wash hands between patients INFECTION CONTROL GUIDELINES- STANDARD PRECAUTION INFECTION CONTROL GUIDELINES- STANDARD PRECAUTION  Designed to reduce transmission of microorganism from recognized and unrecognized sources of infection  Appliedto all patients receiving care regardless of their diagnosis or presume infectious status INFECTION CONTROL GUIDELINES- STANDARD PRECAUTION  Standard precaution applies to:  blood,  all body fluids and secretion (except sweat) regardless of whether it contain visible blood,  mucous membrane,  non-intact skin  Consider every person (patient or staff) as potentially infectious and susceptible to infection STANDARD PRECAUTION By applying standard precautions at all times and to all patients, best practice becomes second nature and the risks of infection are minimized. They include: 1. Hand washing 2. Personal protective equipment [PPE] 3. Preventing/managing sharps injuries 4. Aseptic technique 5. Appropriate reprocessing of instrument and equipment STANDARD PRECAUTION 6. Isolation 7. Staff health 8. Linen handling and disposal 9. Waste disposal 10. Spillages of body fluids 11. Environmental cleaning 12. Good communication – with other health care workers, patients and visitors 13. Training/education 1. HAND WASHING  Handcontamination is a major cause of transmission of infection in healthcare facilities  Isthe single most important procedure for preventing the transfer of microorganisms & therefore preventing the spread of nosocomial infections HAND WASHING (CONT’D)  Required for both standard and expanded precautions.  immediately after removing PPE  between patient contacts.  Wash thoroughly with soap and warm water or, use alcohol-based hand rub. SPECIFIC INDICATION FOR HAND WASHING Before:  Patient contact,  Donning gloves when inserting a central venous catheter (CVC), and  Inserting urinary catheters, peripheral vascular catheters, or other invasive devices that don’t require surgery. After:  Contact with a patient’s non-intact skin,  Contact with body fluids or excretions, non-intact skin, or wound dressings  After removing gloves. 2. USING PERSONAL PROTECTIVE EQUIPMENT (PPE)  PPE is used to protect both yourself and your patient from the risks of cross-infection.  Itmay also be required for contact with hazardous chemicals and some pharmaceuticals.  PPEincludes items like gloves, aprons, masks, goggles or face shield.  In certain situations such as theatre, it may also include cap and footwear  2. USING PPE (CONT..) I. Gloves  Use when touching:  blood,  body fluids,  secretions,  excretions,  contaminated items;  for touching mucus membranes and non intact skin  Performing venipuncture It may be necessary to change gloves during the care of a single patient to prevent cross-contamination of body sites 2. USING PPE (CONT..) II. Gowns/aprons  Use during procedures and patient care activities that are expected to generate splashes or sprays of blood, body fluid, secretions and excretion  Protect skin and prevent soiling of clothing during patient care 2. USING PPE (CONT..) III. Mask and goggles or a face shield  Use during patient care activities likely to generate splashes or sprays of blood, body fluids, secretions, or excretions  When engaging in procedures requiring sterile technique  Mask use for coughing patients to limit potential dissemination of infectious respiratory secretions  What to do if blood or body fluid Splashes into the eyes, mouth or other mucous membranes?  Irrigate with copious amounts of clean water  Ifcontact lenses are worn, eye irrigation should take place before and after removing the lenses  Inform Manager/Supervisor/sister of your clinical team  Complete a STAFF INCIDENT FORM 3. SAFE HANDLING AND DISPOSABLE OF SHARP  Injuries due to needles and other sharps have been associated with transmission of HBV, HCV and HIV to healthcare personnel.  Theprevention of sharps injuries has always been an essential element of Universal and now Standard Precautions  HBV- hepatitis B virus  HIV- human immunodeficiency virus  HCV- hepatitis C virus 3. SAFE HANDLING AND DISPOSABLE OF SHARP Prevention of needle sticks and other sharps- related injuries(cont’d) 1. Pass sharp 2. Avoid recapping instruments in metal used needles tray during operative procedures. 3. SAFE HANDLING AND DISPOSABLE OF SHARP Prevention of needle sticks and other sharps-related injuries(cont’d) 3. Avoid removing used 4. Avoid bending, needles from disposable breaking or syringes manipulating used needles by hand 3. SAFE HANDLING AND DISPOSABLE OF SHARP Prevention of needle sticks and other sharps- related injuries(cont’d) 5. Place used sharps in 6. Dispose sharps at puncture-resistant the point of use containers that is either yellow in color or labeled with a biohazard label 3. SAFE HANDLING AND DISPOSABLE OF SHARP Prevention of needle sticks and other sharps- related injuries(cont’d) 7. Do not overfill sharps containers. Discard after 2/3 full or when contents are at the “full” line indicated on the containers MANAGING A NEEDLESTICK INJURY  Stay calm.  Wash the area under running with soap and water at least five minutes  Encourage the wound to bleed  Apply an antiseptic and a band-aid.  Inform the Line Manager/Supervisor of your clinical team  Complete a STAFF INCIDENT FORM. 4. ASEPTIC TECHNIQUE Definition  Is the infection control practice used to prevent the transmission of pathogens (DeLaune & Ladner, 2011, p.697)  Should be used during any invasive procedure that bypasses the body’s natural defences, e.g. the skin or mucous membranes  Sepsis - harmful infection by bacteria  Asepsis - freedom from infection. - the practice of making the environment and objects free of microorganisms. 4. ASEPTIC TECHNIQUE (CONT...)  Asepsis must be maintained when handling equipment prior to carrying out invasive procedures e.g. sterile equipment for wound suturing or wound care dressings, intravenous cannula, and urinary catheters 2 Types  Medical Asepsis – Clean technique; procedures used to reduce & prevent spread of microorganisms e.g. Handwashing  SurgicalAsepsis – Sterile technique; refers to the way sterile materials are handled in order to keep them free of living microorganisms 5. APPROPRIATEREPROCESSING OF INSTRUMENT AND EQUIPMENT There are two steps to processing items that are used during clinical and surgical procedures.  Cleaning is the first and the most important step.  Followedby either sterilization or disinfection and by immediate use or proper storage of the item. 5. APPROPRIATE REPROCESSING OF INSTRUMENT AND EQUIPMENT (CONT..) Risks of Infection from Equipment  Can be classified into three categories I. Low risk (noncritical items)  Items that come into contact with normal and intact skin such as stethoscopes or with the inanimate environment (e.g. walls, floors, ceilings, furniture, sinks, etc.).  Cleaning with a detergent and drying is usually adequate. 5. APPROPRIATEREPROCESSING OF INSTRUMENT AND EQUIPMENT (CONT…) II. Intermediate risk (semi-critical items)  Items that are in close contact with mucous membranes or with non-intact skin.  Examples, include respiratory equipment, flexible endoscopes, laryngoscopes, endotracheal tubes, thermometers, and other similar instruments.  Cleaning followed by high level disinfectant is usually adequate. 5. APPROPRIATE REPROCESSING OF INSTRUMENT AND EQUIPMENT (CONT…) III. High risk (critical items)  Items that enters body tissues and the vascular system.  High risk of infection if such an item is contaminated with any microorganism  Cleaning followed by sterilization is required.  High-level disinfection using solution may sometimes be appropriate if sterilization is not possible, e.g., Flexible endoscopes.  Examples of high-risk items include surgical instruments, intra-uterine devices, vascular catheters, implants, etc. ORTHO-PTHALDEHYDE (OPA) 5. APPROPRIATEREPROCESSING OF INSTRUMENT AND EQUIPMENT (CONT..) 1. Cleaning  Cleaning is the removal of all foreign material (dirt and organic matter) from the object being reprocessed  Accomplished by the use of water, detergents and mechanical actions.  Cleaning before disinfection and sterilization is of greatest importance. 5. APPROPRIATEREPROCESSING OF INSTRUMENT AND EQUIPMENT (CONT..) Disinfection and sterilization  Disinfection  Reducing the number of bacteria to a level low enough that disease is unlikely to occur.  Some organisms and bacterial spores may survive.  Using chemical or disinfectant such as formaldehyde, glutaraldehyde, ortho-pthaldehyde (OPA). 5. APPROPRIATEREPROCESSING OF INSTRUMENT AND EQUIPMENT (CONT..) Types of sterilization  Autoclaving  Delivers steam under pressure with heat ranging from 121º C to 132º C  Use to sterilized instruments that will not be harmed by heat and water under pressure.  Boiling  Boilinginstrument and supplies in water kills non- spores-forming organism.  Does not kill spores and hepatitis B. 5. APPROPRIATEREPROCESSING OF INSTRUMENT AND EQUIPMENT (CONT..) Types of Sterilization….cont..  Ionizing radiation  Kills pathogen in sutures, some plastics and biological material that cannot be boiled or autoclaved.  Chemical disinfectant  Used to kill pathogen on equipment and supplies that cannot be heated such as glutaraldehyde (cidex), ortho-pthaldehyde (OPA).  Gaseous disinfectant  Kills pathogen on supplies and equipment that are heat sensitive and must remain dry. E.g. ethylene oxide, hydrogen peroxide gas plasma. THE INSTRUMENT PROCESSING (DECONTAMINATION STEPS) Decontamination process 6. ISOLATION PRACTICES Definition isolation  The state of being in a place or situation that is separate from others. Purpose of isolating patients is to;  prevent the transmission of micro- organisms from infected or colonized patients to other patients, hospital visitors, and health care workers. TYPES OF ISOLATION  1. Airborne precaution  2. Droplets precaution  3. Contact precaution 6. ISOLATION PRACTICES 1. Airborne precautions Indication:  To prevent transmission of pathogen small enough to be suspended in the air and spread through air current.  Droplet nuclei (particles 5 μm)  Used for client with pathogens transmitted by respiratory droplets generated through coughing, sneezing or talking during some procedures (e.g., suctioning and bronchoscopy).  E.g.of disease Haemophilus influenzae, multidrug-resistant strain, meningitis, rubella, diphtheria, pertussis (whooping cough). 6. ISOLATION (CONT..) II. Droplet precautions-…cont.. Requirement in addition to standard precaution:  No special air handling or ventilation required  Private room with door closed at all time  Surgical mask upon entry for staffs and visitors  Surgical mask on patient before transportation  Movement or transport when necessary  Maintain spatial separation, >3 feet from other client or visitors  Transport only if necessary  Place mask on patient when outside 6. ISOLATION (CONT..) III. Contact precautions Indication:  To prevent transmission of pathogens spread by direct or indirect contact.  Serious infection easily transmitted through direct contact such as diphtheria, shigella, impetigo, herpes simplex, scabies, hepatitis A and multidrug–resistant strain others such as methicillin-resistance staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Clostridium difficile.  6. ISOLATION (CONT..) III. Contact precautions Requirement in addition to standard precaution;  Private room  Can be placed in room of patient with the same microorganism  Wear gloves when entering room  Change gloves after contact with infective material such as wound drainage or fecal material  Wash hand immediately after removing gloves 6. ISOLATION (CONT..) III. Contact precautions (cont..) Requirement in addition to standard precaution;  Put on gloves and gowns when entering the room  Wear gloves when touching client’s skin or surfaces and articles in close proximity with client  Remove gloves and gown before leaving the room and perform hand hygiene  Ensure that infected or colonized area of client’s body are covered or contained III. Contact precautions (cont..)  Remove and dispose PPE and perform hand hygiene prior to transporting client.  Don clean PPE to handle client at transport destination.  Clean patient care item and environment daily  Dedicate equipment to single room use i.e. stethoscope, BP set, thermometer  Movement or transport when necessary 6. ISOLATION (CONT..) Protocol for leaving isolation room  Untie gown at waist  Take off gloves  Untie gown at neck  Pull gown off and place in clinical waste  Take off goggles or face shield  Take off mask  Perform hand hygiene  Follow hospital policy 7. LINEN HANDLING AND DISPOSAL  Proper handling of soiled linen:  Avoid sorting soiled linen  Avoid agitation and shaking to prevent contamination of air  Place in appropriate laundry bags  Pack soiled linen properly to prevent leakage  Wear appropriate PPE when handling soiled linen  Transport and stored clean linen separately to prevent recontamination  Follow hospital policy regarding double begging 8. WASTE DISPOSAL/MANAGEMENT  Clinical waste include:  Discarded sharps  Associated waste directly with specimen processing  Human tissue, including material or solutions containing free flowing blood 8. WASTE DISPOSAL/MANAGEMENT Waste segregation:  Domestic waste – Bin lined with black bag.  Clinical waste (non sharp) – Bin lined with yellow bag.  Clinical waste (sharps) – Sharps bin 9. SPILLAGES OF BODY FLUIDS  Small spills - Remove with absorbent material, wipe with Sodium hypochlorite 1:10.  Large spills - Cover spillage with absorbent material, pour Sodium hypochlorite 1:10 and leave for 5-10 min. Wipe up with absorbent material and place in yellow bin. OR  Sprinkle chloride granules leave for 5-10 min. Scoop with brush and dust pan and discard into clinical waste bin (yellow bin). Mop the area with Sodium hypochlorite 1:100. 10. ENVIRONMENTAL CLEANING  Include those relate to preparation of foods and general cleaning procedures  Floors are generally clean with vacuum cleaners to prevent dust being released into the air  All surfaces such as bedside lockers and overbed tables, should be cleaned daily to eliminate dust and food debris  A chemical disinfectant may be used to clean and other items or furniture's  Rubbish containers should be equipped with close-fitting lids and must be emptied frequently and never left with material overflowing from them. 11. TRAINING/EDUCATION  Nurses can do a great deal to allay fears by communicating effectively, without breaking confidentiality. For example, nurses should:  Provide information leaflets for patients, visitors and staff.  Provide notices which describe the precautions needed. Talk to patients about how they can help themselves.  Include support staff in team meetings during outbreaks.  Ensure that other staff understand the actions they need to take: for example, if the community nurse needs to continue care at home. 11. TRAINING/EDUCATION  Allhealth care professionals who have a clinical responsibility for patients must include infection prevention and control as part of their every day.  The training should cover all the general principles of infection prevention and control, to emphasize the key role that health care professionals play in minimizing the spread of infection; to highlight what can happen as a result of bad practice and underline the importance of good communication 12. STAFF HEALTH  Preventing acquiring infection  immunisation  cover lesions with waterproof dressings  restrict non-immune/pregnant staff  Preventtransmitting infection  Seek medical advice when suffering infection  Report accidents/untoward incidents STANDARD PRECAUTION GUIDELINES Guide lines to prevent transmission of infected agents;  Wash hands thoroughly or use alcohol-base antiseptic after removing gloves and before and after all patient contact  Wear gloves when there is direct contact with blood, body fluid, secretions, excretion.  Protect clothing's with gown or plastic apron is there is possibility of splash or in direct contact with contaminated material  Do not break or recap needles; discard them intact into punctured resistance containers  STANDARD PRECAUTION GUIDELINES  Wear mask, goggles or face shield to avoid being splashed; include during suctioning, irrigations and deliveries  Place all contaminated items and trash in leakproof bag  Clean spills with 1:10 sodium hypochlorite solution or according to hospital policy or approved germicide  Place patient at risk of contaminating the environment in a private room with separate bathroom facilities or with another person with the same infection  Transport infected patient using appropriate barriers i.e mask and gowns.