Infection Prevention & Control

January 2016

Clinical / Student Orientation

Package

OBJECTIVES

To understand the principles of infection prevention

and control (IPAC), and elements of routine

practices

To review your current infection control practice in

the clinical environment using case scenarios

BASIC PRINCIPLE OF IPAC Chain of Transmission

HOW TO BREAK The Chain of Transmission?

Routine Practices Additional Precautions

For All Patients All The Time, regardless of symptoms &

diagnoses

Used in addition to routine practices;

when a patient has a suspected

or confirmed diagnosis of infection

(Additional precaution signs)

will be posted on the door) Patient Risk Assessment

Personal Protective Equipment

Hand Hygiene

Cleaning equipment

Airborne

Contact

Droplet/Contact

www.ipac-canada.org/pdf/2013_PHAC-RPAP_Tools_eng.pdf

ROUTINE PRACTICE summary

Routine Practice

Risk ASSESSMENT

Low risk for transmission Continent Good hygiene Skin lesions or wounds covered by dressings Able to practice respiratory etiquette Capable of self care Able to comply with infection control precautions

Routine Practice

Risk ASSESSMENT

High risk for transmission

Incontinent of stool Diarrhea Draining skin lesions or wounds Copious uncontrolled respiratory secretions ICU setting (extensive hands on care) Patient has many invasive devices Patient has poor hygienic practices (ie confused)

Routine Practice

Hand HYGIENE

Assess your exposure and choose the most appropriate method:

Soap & Water vs ABHR (Alcohol based hand rub)

Visibly soiled

rinse well

pat dry

moisturize often

Otherwise

alcohol based hand rub

Alcohol based hand rub is the preferred method as it kills 99% of germs in 15 seconds!

Inexpensive

Simple

Effective

Hand HYGIENE

Alcohol Based Hand Rub (ABHR)

4 Moments for Hand Hygiene Hand HYGIENE

Moments of Hand Hygiene

http://www.publichealthontario.ca/en/eRepository/4-

moments-for-hand-hygiene-poster.pdf

4

You enter a ward room, the patient in bed 3 asks for help out of bed and upon leaving the room patient in bed 1 asks you to check her IV site.

Before you enter the ward room After contact with the patient in bed 3 &

before contact with the patient in bed 1 After contact with the patient in bed 1

You enter a room, take the patient’s vital signs, change a dressing on the patient’s foot and then sit the patient up for lunch before exiting the room.

Before you enter the room

Before starting the dressing change

After the dressing change

Upon exiting the room

Hand HYGIENE

Remember…

Hand hygiene sinks located in patient room is intended solely for hand hygiene purposes. Refrain from using the sinks to dispose of bath water, bodily fluids or drainage of IV bags.

Cleaning EQUIPMENT

Multi-use equipment must be cleaned and disinfected between each patient

Remove organic waste matter before disinfection(ie. Feces, blood, vomitus). Dispose waste in proper receptacle (ie. Bath basin water in toilet, drain urine in toilet)

Use Hospital approved disinfectant wipes and allow indicated contact time for disinfection

What do you clean?

ADDITIONAL PRECAUTIONS

Additional Precautions can be started by any TSH Health Care Provider The three main types of additional precautions are Contact Droplet/Contact Airborne

Can only be discontinued by an ICP (Infection Control Practitioner) or IPAC medical director

Additional Precautions

Clostridium Difficile (C. difficile)

Bacteria found in feces

Symptoms: unformed, watery, or bloody stools. May have fever, abdominal pain, lack of appetite

Risks factors are hospitalization, antibiotic use

Spread by soiled hands (fecal oral transmission)

MRSA / VRE / CPE (antibiotic resistant organisms – ARO)

Methicillin resistant Staphylococcus Aureus, Vancomycin resistant Enterobacteria, Carbapenemase Producing Enterobacteriaceae

Spread by contact: direct (hands) and indirect (multi-use equipment)

Colonization vs. Infection

Can cause an infection if passed to another part of the body (wound, blood, urinary tract)

AROs: Admission Screening Swabs

TSH screens patients upon admission for organisms including MRSA, VRE and /or CPE. Screening done according to risk criteria Moisten the swabs with saline or transport medium before swabbing - When collecting rectal / ostomy swab “A Brown swab is a good swab” Sites to be screened include nares, rectum or ostomy sites, G/J tube sites, and open wounds

Name the Route of Transmission

1. Contact via fomite

2. Direct contact

3. Tuberculosis - airborne

4. Cough / sneeze – droplet contact

5. Chickenpox – airborne contact

IPAC TIPS

When to call IPAC… • To reassess isolation status – ICPs

are on the units daily, oncall is available after hours

• Microbiology report that may

change a patient’s isolation status • To report patients with new onset

of symptoms of concern

POST TEST

1. What are the categories of additional precautions?

a. Hand hygiene, cleaning equipment, PPE,

patient risk assessment b. Contact, droplet/contact, airborne c. Gown, glove and mask

2. Which of the following precautions require the use of a fit tested N95 respirator and a negative pressure (hepa filter) accommodations:

a. Contact b. Droplet contact c. Airborne

3. What are the 4 moments for hand hygiene?

a. Before patient, after patient, before body fluid exposure & after sterile procedure

b. After patient, after PPE, before starting work and before going home

c. Before patient contact, before sterile procedure, after body fluid exposure & after patient / patient environment contact

4. Which of the following equipment must be cleaned and disinfected between use with patients?

a. Single Use Equipment

b. Toilets

c. Multi Use Equipment (ie. BP cuffs, glucometer)

5. Your patient has been hospitalized for pneumonia since last week (currently on routine precautions) and starts having diarrhea today. The patient has been on antibiotics and not on any bowel medications, what precaution should you place them in?

a. Contact b. Droplet / Contact c. Routine

6. TRUE OR FALSE

As long as hand hygiene is performed prior and

post patient care, there is no need to perform

hand hygiene during care.

7. TRUE OR FALSE

Your are getting ready to perform an irrigation on

a patient with a stage 4 coccyx ulcer. There is no

precaution signage on the doorway to indicate the

need for Personal Protective Equipment (PPE),

therefore this indicate that there is no need to use

PPE.

8. TRUE OR FALSE

Rectal swabs should be collected in the ostomy of

a patient with an ileostomy or colostomy.

9. TRUE OR FALSE

It is not necessary to wear a face shield / eye protection for care with a patient on droplet contact precautions if you already wear eyeglasses.

10. TRUE OR FALSE

The best place to pour out used bed bath water is in the toilet of the patient’s room.

IPAC Photo Gallery

1. What is the IPAC issue?

2. What is the IPAC issue?

3. What is the IPAC issue?

4. What is the IPAC issue?

5. What is the IPAC issue?

6. What is the IPAC issue?