Principles of Infection Control

Care Homes IPC Study Day Sue Barber Lead Nurse, Infection Prevention & Control AV & Chiltern CCG’s

Why Infection Prevention & Control is important

• A healthcare associated infection (HCAI) is an infection caused by any type of healthcare contact.

• Damage the patient’s quality of life – painful, unpleasant, scary and in severe cases can be fatal

• Cost the NHS approx. £1 billion per year

• Prevention of healthcare associated infections is covered by legislation in The Health & Social Care Act 2008

• Monitored by the Care Quality Commission

• 10 criteria against which health & social care providers must be compliant

• Increasing numbers organisms are becoming resistant to all our standard antibiotics

• Infections and outbreaks can attract high profile media attention and damage the organisations reputation

• Possibility of litigation with Health Care Associated Infections

• Risk of emerging pathogens such as pandemic influenza strains

Responsibilities

• Staff must be appropriately trained in infection

prevention & control practice and knowledge

updated on a regular basis (records must be

kept)

• All staff are required to be familiar with, and

comply with infection control policies

• Don’t put residents or colleagues at risk if you

are unwell e.g. norovirus - do not return to work

until 48 hours without symptoms

• Identify and report IPC related risks

Risk of infection

• Some people will be more at risk of infection than others.

• Elderly

• Young babies

• Immunocompromised

• Those with invasive devices e.g. catheters, PEG tubes

• Malnourished

Chain of infection

Reservoir People,,equipment or

environments

Good hygiene & clean

environments

Portal of Entry Mucous membranes, broken

skin, invasive devices

Aseptic technique, hand

hygiene, management of

invasive devices

Susceptible Host Elderly, neonates,

immunosuppressed

Recognise high risk

patients, strict IPC

precautions &

immunise when able

Portal of Exit Excretions and secretions

Use of PPE, safe

management of clinical

waste and used linen

Mode of transmission Contact, airborne

Hand hygiene, cleaning

environments and

equipment

Infectious agent Eg bacteria, virus

Prompt treatment and

rapid identification of

infection can break

the chain

Take any of these links

out of the chain and

prevent the spread of

infection

How infections can spread

There are 6 modes of spread

• Airborne

• Contact

• Ingested e.g. food poisoning

• Environmental e.g. water

• Vectors e.g. malaria

• Sexual

Different types of Micro-organisms

• Bacteria

• Viruses

• Fungi

• Parasites

• Millions of different species

• Have the ability to cause a variety of diseases

• Pathogen - is the term used for germs that cause disease

Types of illness caused by Bacteria

• Throat infections

• Boils, pimples

• Blood poisoning

• Meningitis & Meningococcal septicaemia

• Wound infections

• Urine infections

• Chest infections

• Clostridium difficile

Types of illness caused by Viruses

• Respiratory infection • Flu • Sore throat • Diarrhoea & Vomiting • Slapped cheek syndrome • Hand foot and mouth • Measles • Chicken pox • Rubella

Note: Antibiotics do not work on

viruses

Types of illness caused by Fungi

• Thrush

• Ring worm

• Athletes foot

Types of illness caused by vectors

• Malaria

• Sleeping sickness

• Leptospirosis

– Weil’s Disease

Types of infection caused by parasites

• Scabies

• Head lice

• Body lice

• Tapeworm

• Many tropical diseases

Standard Precautions

Should be used at all times with all residents – you cannot always

tell if someone has an infection therefore standard precautions

protect both you and the resident.

Effective hand hygiene practices

Maintenance of skin integrity

Protection of open wounds/skin lesions

Use of appropriate personal protective clothing

Avoidance of sharps injury through safe use and disposal of

sharps

Appropriate decontamination of instruments and equipment,

including safe management of blood spillage

Maintaining a clean environment

Safe disposal of waste

Safe handling and laundering of used linen

Standard Precautions

Should be used at all times with all resident – you cannot always tell if

someone has an infection therefore standard precautions protect bot you

and the resident.

Effective hand hygiene practices Maintenance of skin integrity

Protection of open wounds/skin lesions

Use of appropriate personal protective clothing

Avoidance of sharps injury through safe use and disposal of sharps

Appropriate decontamination of instruments and equipment, including

safe management of blood spillage

Maintaining a clean environment

Safe disposal of waste

Safe handling and laundering of used linen

We will return to hand hygiene later

Personal Protective Equipment (PPE)

Choice of protective clothing depends upon the anticipated risk of different activities.

Many pathogenic organisms are present in

body fluids, protective clothing is used to

minimise their transmission onto clothing or

skin Would you like a

cup of tea Mrs

Jones?

Contact with

blood or body

fluid but HIGH

risk of

splashing

Activity

Contact with

blood or body

fluid but

LOW risk of

splashing

Gloves +/-

apron

Gloves, mask,

eye protection,

water-resistant

gown/apron

No contact

with blood

or body

fluids

No PPE BUT

remember

organisms are

always present

- hand hygiene

Risk assessment and protective clothing

Types of PPE

Commonly used items • Gloves • Sterile • Non sterile

• Aprons/gowns

Rarely used items – a small stock should be kept for use if required

• Face masks • Surgical

• Eye protection • Goggles • Face visor

Gloves and Aprons

Gloves are not a substitute for hand hygiene

Hand hygiene after glove removal is essential

Non-latex, powder-free gloves should always be used

Wear aprons if there is a possibility of contamination/

splashing to clothing

Change between residents and between a dirty and clean

task for the same resident

Clean hands after removal

Remember all PPE are single use items

Decontamination Environments

• The environment needs to be clean to prevent cross contamination

• Detergent is suitable for most cleaning but disinfectants are required in some areas and for outbreaks e.g.. chlorine based

• Higher risk areas should take higher priority i.e. clinical rooms, toilets

• Keep clean & dirty areas separate where possible

• Ensure carpets and soft furnishings can be cleaned effectively (steam cleaning)

Decontamination Equipment

• All reusable equipment must be decontaminated between each resident’s use

• Cleaning - Dirt always has to be removed first with detergent & water –Detergent wipes are practical

• The item may then also need to be disinfected

• Chlorine-releasing product e.g. Actichlor, Milton

• Alcohol

• If the item needs to be sterile - use single use

Body Fluid Spillages

Body fluid spillages should be cleaned up immediately and protective clothing worn

Body Fluid Surface Method

Blood/blood stained fluid

Hard surface Treat spill with chlorine releasing agent e.g. Milton, Actichlor. Then clean area with detergent & water

Blood/ blood stained fluid

Carpets or soft furnishings

Clean with detergent & water then steam clean where possible

Non-blood stained body fluids

Any surface Clean with detergent & water

Chlorine products should not be applied directly to urine or vomit spills

Spillages during outbreaks will be discussed later

Body fluid spill kit

• Have a spill kit or the separate components

• chlorine releasing granules or tablets, gloves, apron, cleaning cloths, disposal bag, detergent wipes

• Know where the spill kit is kept

• Make sure you know how to use it

Management of waste

• Waste management systems are designed to protect all people who will handle waste from production to final disposal

• There are many regulations regarding waste and these must be complied with, most notably in healthcare - • Safe Management of Healthcare Waste

• Waste must be segregated into the appropriate categories or streams

Waste Streams (some waste streams you might use)

Domestic waste

Paper, packaging, food, flowers etc.

Disposed of in landfill - so must not contain contaminated items

Clinical waste

For any infectious or potentially infectious items

Dressings, gloves, aprons, body fluids etc.

Not for uncontaminated paper or packaging

Offensive waste (tiger stripe)

Waste contaminated with body fluids but is not infectious

Sharps waste

Yellow lidded sharps containers are for all clinical sharps including those containing partially discharged medicine, but not for cytotoxic waste

Cytotoxic sharps waste

For any sharps waste contaminated with cytotoxic waste

Waste bins

• Have bins in the right place

• Black bags next to hand wash sinks

• Orange bags in sluice or treatment rooms

• Waste must be stored securely and safely.

• Yellow bins must be locked

• Remember to keep

external bin areas

clean

Management of sharps

• Safe management of sharps protects the user and also others working in that environment

• If a needle free version can be used then do so

• Use safety devices wherever possible

• Do not re-cap needles

• Take sharps bin with you to the resident where possible

• Dispose of sharps as soon as finished

• Only use approved sharps containers

• Must be assembled correctly and labelled with date and service

• Keep off the floor when in use

• Must not be overfilled

• Temporary closure mechanism should be used in between use

• Must be kept in a secure area for collection

• Must be closed when ¾ full or after a maximum of 3 months use

• Must never be placed inside a clinical waste bag

Sharps waste containers

Accidents and Inoculation injury Sharps, bites, scratches, Blood splashes to eyes, mouth, broken skin

Encourage bleeding from site (Sharps)

Wash with soap/water Irrigate eye with saline or tap water.

Cover injury with waterproof dressing

Record the incident - including reflection

Notify OHD, A&E or GP promptly

Hand Hygiene

Hand Decontamination

Hand hygiene remains the single most effective

means of preventing the spread of infection.

Your 5 moments for hand hygiene

at the point of care*

*Adapted from the WHO Alliance for Patient Safety 2006

When to clean your hands

Why to clean year hands?

Resident Micro-Organisms

Deep seated

Don’t generally cause infections and not easily removed

Part of the

body’s natural

defence mechanism

Have been associated with infection following surgery

Transient Micro-organisms

Superficial

Easily picked up and passed on

An important

cause of

cross-infection.

Easily removed by good hand hygiene.

Before hand decontamination

After good hand

decontamination

After poor hand

decontamination

Areas most frequently missed

1 2 3

4 5 6

Palm to palm Backs of hands Between fingers

Finger tips Thumbs and wrists Nails

How – Hand Hygiene Technique

Applies whether using alcohol foam/gel or soap & water

Hand hygiene facilities

• An accessible hand hygiene sink compliant with HTM 64 i.e. • Elbow/wrist operated mixer taps

• No plug or overflow

• Water outlet not directly above drainage aperture

• Hand hygiene sinks must be designated for this use only

• Any new service, refurbishment or new build must ensure sinks are compliant and IPC principles are taken into consideration

• If you have problems with hand hygiene facilities this must be flagged up as a risk

Soap vs Alcohol

Soap

• Cleans

• Lather lifts dirt off the hands

• Dirt and germs are mechanically flushed away

Alcohol

• Disinfects

• Kills germs immediately on contact

• Doesn’t remove dirt and the dirt can protect germs from the alcohol

Both are equally effective at decontaminating hands but they work in different ways

Alcohol hand gel/foam

• Just as effective as soap & water

• Can be carried with you to use when you can’t get to a sink

• Can be applied as often as required until hands feel sticky.

Remember

• It does not remove dirt - hands require washing if physically dirty

• Less effective against C.difficile and Norovirus so soap & water must be used

• Must be sited and stored safely

‘Bare below the elbows’

• Uniform and Dress Code guidance (DH) state that ‘bare below the elbows’ principles should be followed when carrying out clinical procedures and hand hygiene

• No ornate jewellery – plain wedding band only

• Remove wrist watch

• Short sleeves, or rolled up

• Nails should be short, no false nails or nail varnish

Hand hygiene for residents

• Remember that residents/service users also need to clean their hands, especially before meals and after

using the toilet

• Ensure hand hygiene facilities

are made available in toilets

• Ensure relatives & visitors know where they can clean their hands – clearly signpost hand hygiene facilities Hand hygiene

Now let’s practice