INFECTION CONTROL

HLTIN301C

Comply with infection control policies and procedures

What are Infectious Diseases?

• disorders caused by organisms – Bacteria– Viruses– Fungi– Parasites

• Can be passed (transmitted) by– Person to person– bites from insects or animals– ingesting contaminated food or water – Needles (sharps) or other exposures in the environment.

• Signs and symptoms vary, but often include fever and chills

Duty of Care

• If you do not adhere to infection control policy and procedure you have the potential to harm patient/clients, staff and customers

• Who is responsible?– Employers– Persons in control of a workplace– Self-employed persons– Employees– Manufacturers, Importers and Suppliers

Duty of Care

• Take all reasonably practicable steps to protect the health, safety and welfare at work of the employer’s employees and third parties

• Provide and maintain– A safe work environment– Safe systems of work

Duty of Care

• Use equipment in accordance with instruction, consistent with its safe and proper use

• Not create or increase risk to another person

• Cooperate to extent necessary to enable one to fulfil duty

Workplace Health & Safety (WHS)

Legislation • depends on State and Territory Legislation and

requirements • common law duties to meet the general duty of

care requirements• requirements for the maintenance and

confidentiality of records of occupational injury and disease

• provision of information, induction and training• regulations and approved codes of practice

relating to hazards present in work area• health and safety representatives and health

and safety committees• prompt resolution of health and safety issues

Standard PrecautionsStandard Precautions

• Aseptic technique– Procedure used to prevent the spread of

infection– Goal is to make the environment free of

harmful micro-organisms– Practices usually set by each healthcare

setting (e.g., clinics, surgery rooms, etc.)

Standard PrecautionsStandard Precautions

• Minimising contamination– Protecting materials, equipment and instruments

from contamination until required for use– Ensuring instruments used for invasive procedures

are sterile at time of use– Cleaning all environmental surfaces

Standard PrecautionsStandard Precautions

• Techniques to minimise contamination– Personal hygiene practices– Personal protective equipment– Routine environmental cleaning– Transmission-based precautions

• Contact precautions• Droplet precautions• Airborne precautions

– Good reference: Clinical educators guide for the prevention and control of infection in healthcare (NHMRC, 2010)

• Surface cleaning and management of blood and body fluid spills

Standard PrecautionsStandard Precautions

• Personal hygiene practices especially washing and drying hands (eg. before and after client contact)– Hand hygiene must be performed before and after

every episode of patient contact. This includes:• before touching a patient;• before a procedure;• after a procedure or body substance exposure risk;• after touching a patient; and• after touching a patient’s surroundings.

– Hand hygiene must also be performed after the removal of gloves.

Standard PrecautionsStandard Precautions

• Use of personal protective equipment– Specialised clothing or equipment worn for

protection against infectious materials• Gloves (most common) that comply with current

Australian/New Zealand standards– Be aware of guidelines for latex allergic clients and staff

• Aprons and gowns that comply with Australian/New Zealand standards

• Face shields• Protective eyewear e.g., goggles, glasses• Masks and respirators• Footwear to protect from dropped sharps and other

contaminated items

Standard PrecautionsStandard Precautions

• Cleaning Procedures– Damp dusting benches, equipment and shelving– Maintaining the interior of drawers and cupboards

in a clean and tidy state– Cleaning floors daily using a mop and water and

detergent– Storing cleaning equipment clean and dry– Managing the removal of a small blood or body

fluid spill

Standard PrecautionsStandard PrecautionsSharps Sharps

• 70% of needlestick / sharps injuries are preventable. – The main reasons recapping needles, manipulation of

needles, or incorrect disposal of needles. • Safe handling of sharps

– Assemble all equipment required for the procedure to be performed.

– Minimise distractions– Use equipment strictly according to protocols and only

for the purpose for which it was designed. – Choose the safest equipment available. T– Practice with new equipment so it can be used safely.

Standard PrecautionsStandard PrecautionsSharps Sharps

• Safe disposal of sharps and other clinical waste– Any used syringe could be contaminated and should be disposed – using a yellow receptacle.– Ensure sufficient sharps’ containers or suitable yellow biohazard bins

are available in all areas where syringes are likely to be used or disposed of.

– Ensure that sharps containers are puncture resistant, moisture-proof, shatterproof, capable of being sealed and able to withstand heavy handling.

– Containers must conform to Australian Standard (AS) 4031 Non-reusable containers for the collection of sharp medical items used in health care areas.

• Appropriate reprocessing and storage of reusable instruments– Reusable sharps must be placed immediately after use in a puncture-

resistant sharps container specially kept for that purpose – When more than one reusable sharp is carried in a container special

care is required during placement and removal of sharps

Standard PrecautionsStandard PrecautionsGeneral WasteGeneral Waste

• Discard general waster via a small bin lined with plastic, mounted on the wall or on a bench

• The usual waste paper bin under the desk can be used for waste not contaminated by blood or body fluids.

Standard PrecautionsStandard PrecautionsMRSAMRSA

• Methicillin-resistant Staphylococcus aureus (MRSA) Infections– bacteria that is resistant to many antibiotics

• In the community, most MRSA infections are skin infections. I

• In medical facilities, MRSA causes life-threatening bloodstream infections, pneumonia and surgical site infections.

– The Centers for Disease Control and Prevention (USA) has fantastic resources at preventing MRSA infections

• http://www.cdc.gov/mrsa/

Additional PrecautionsAdditional Precautions

• Special ventilation requirements

• Dedicated equipment (eg. to each client or as appropriate to work function)

• Use of a special facility

Clean ZoneClean Zone

• Storage areas for materials, medicaments, equipment

• Sterile storage areas

• Administration areas

Contaminated Zone Contaminated Zone

• Area used for items that have become contaminated during use

• Receiving area for contaminated instruments in the instrument reprocessing centre

WasteWaste• Clinical waste

– discarded sharps; – laboratory and associated waste directly involved in specimen

processing; – human tissues (but excluding hair, teeth, urine and faeces); – materials or solutions containing free flowing or expressible

blood and animal tissues or carcasses used in research

• Related waste– includes cytotoxic waste, pharmaceutical waste, chemical

waste and radioactive waste

• General waste– includes all waste materials that do not fall into the clinical or

related waste categories.

Disposal of Waste RequirementsDisposal of Waste Requirements

• Disposal in accordance with: Environment Protection (Waste Management) Policy Environment Protection (Waste Management)

Regulations Australian and New Zealand standards Organisation policies and procedures

Clean zoneClean zone

• Storage areas for materials, medicaments, equipment

• Sterile storage areas

• Administration areas

Contaminated Zone Contaminated Zone

• Area used for items that have become contaminated during use

• Receiving area for contaminated instruments in the instrument reprocessing centre

WasteWaste• Clinical waste

– discarded sharps; – laboratory and associated waste directly involved in specimen

processing; – human tissues (but excluding hair, teeth, urine and faeces); – materials or solutions containing free flowing or expressible

blood and animal tissues or carcasses used in research

• Related waste– includes cytotoxic waste, pharmaceutical waste, chemical

waste and radioactive waste

• General waste– includes all waste materials that do not fall into the clinical or

related waste categories.

Disposal of Waste RequirementsDisposal of Waste Requirements

• Disposal in accordance with: Environment Protection (Waste Management) Policy Environment Protection (Waste Management)

Regulations Australian and New Zealand standards Organisation policies and procedures

Infection RisksInfection Risks

• Contact with waste materials• Inhalation of aerosols• Contact with blood and other body

substances• Personal contact with infectious materials,

substances and/or clients• Stock including food which has passed

'use-by' dates• Animals, insects and vermin

Procedures for Risk ControlProcedures for Risk Control

• Eliminating a hazardous process• Using personal protective equipment

appropriately• Changing a system of work to reduce a hazard.• Isolating the hazard• Using protective devices to decrease exposure• Using safe handling techniques• Following infection control policies and

procedures• Procedures to minimise the risk of exposure to

blood and body fluids

Protocols for care following Protocols for care following exposure to blood / body fluidsexposure to blood / body fluids• Immediate care following:

– A sharps injury– A splash of blood or other body fluids– Post exposure care– Record keeping and notification– Legal requirements for the notification of all

work related occurrences of injury, disease or illness

Hand Hygiene Procedures(refer to Hand Hygiene Australia http://www.hha.org.au)

• Routine handwash

• Surgical handwash

• Use of antiseptic wipes and alcohol based preparations in specific situations where waterless hand hygiene is acceptable

Routine Hand Wash• When needed

– Before eating and/or smoking.– After going to the toilet.– Before significant contact with patients (eg physical

examination, emptying a drainage reservoir such as a catheter bag).

– Before injection or venepuncture.– Before and after routine use of gloves.– After handling any instruments or equipment soiled

with blood or body substances.

Reference: http://toolboxes.flexiblelearning.net.au/demosites/series7/702/content/lr_hygiene/006_routine_wash.html

Routine Hand Wash• Washing technique

– Remove jewellery.

– Method 1 - Essential if hands are soiled

• Wet hands thoroughly and lather vigorously using neutral pH liquid handwash.

• Rinse under running water.

• Do not touch taps with clean hands - if elbow or foot controls are not available, use paper towel to turn taps off.

– Method 2 - Permissible only if hands are not soiled

• Apply sufficient alcohol rub or gel into the palm of the hand to enable rubbing for 10 - 15 seconds.

• Rub this over all surfaces of both hands for 10 - 15 seconds.

• Drying– Pat dry using paper towel, clean cloth towel, or a fresh portion of a roller

towel.

Reference: http://toolboxes.flexiblelearning.net.au/demosites/series7/702/content/lr_hygiene/006_routine_wash.html

Surgical Hand Wash• A five minute scrub which includes cleaning of the fingernails is to

be undertaken as the first scrub of the day • Subsequent scrubs of three minutes duration (which omit the

fingernails) are undertaken between cases • Hands are kept higher than the elbows at all times to allow water

to run in one direction only – from clean to dirty (hands to elbows) • The bristles of the nail brush are used to clean the fingernails only • Arms are washed in a circular motion, from the hands to the

elbows without returning to the hands • The antimicrobial soap used for the first scrub of the day should

continue to be used for subsequent scrubs

Reference: http://www.health.qld.gov.au/qhpolicy/docs/gdl/qh-gdl-321-1-1.pdf

Hand Care

• Use suitable water-based hand creams that are registered on the Australian Register of Therapeutic Goods

• Use warm water for handwashing

• Dry hands thoroughly after handwashing

• Wear heavy-duty utility gloves when handling irritant chemicals