1. Infection Control

2. Presentation Objectives
To understand the basics of infections
To be aware of routine practices
To know when to implement transmission-based precautions:
Contact precautions
Droplet precautions
Airborne precautions
To identify the importance of cleaning requirements
To be aware of self screening protocols
Explain overview of the presentation
Ensure time is available for questions

3. Infections: The Basics
Causative agent
(What causes the infection)
Susceptible host
(Where the infection survives)
Mode of transmission
(How it gets there)
Explain the chain of infection with emphasis on the key components:
Infectious Agent: Biological, chemical, physical agent capable of causing disease
Reservoir:Location where infection can survive
Portal of Exit: Pathway (respiratory, gastric, blood) chosen by organism to leave
Mode of Transmission: Way infection moves to host by person to person or on objects (Kleenex, food, linens)
Portal of Entry: Path used to enter host (broken skin, respiratory openings)
Susceptible Host: Person who lacks sufficient resistance to a specific organism (factors: age, health, meds, lifestyle, occupation, nutrition)
Infection prevention and control aims to ‘break’ the chain of infection!

4. Routine Practices Consists of:
Minimum standards to use for all resident contact
Protect residents, staff and visitors
Protect self if there is a chance of exposure to blood, body fluids, excretions or secretions.
Routine Practices is Health Canada terminology but means the same thing as ‘standard precautions’
Routine Practices is the minimum standard of care and is applied to all body fluids, excretions or secretions.
Can explain the history of the terminology: universal precautions in the 80’s primarily focused on blood and body fluids in light of HIV/AIDS and focused on protection of the health care provider. Routine practices extends that to include all body fluids, secretions, and excretions and aims to protect health care workers and the patients/residents.
Emphasize that it is important to not get ‘hung up’ on the terminology but to keep the principles in mind.

5. Review when to wash hands and also how to wash hands
Review when to wash hands and also how to wash hands. Could consider using a glow germ demonstration as well.
Explain when alcohol based hand sanitizers should and should not be used. Remind staff to use soap and water when hands are visibly soiled.
Power Point note:
For the video clip to work the Hand washing Windows Media hyper-link file must be saved with the power point file.
See tip in manual on how to set up a hyper-link
HANDWASHING is the Single most effective method in Preventing the Spread of Infection

6. HANDWASHING is the Single most effective method in Preventing the Spread of Infection
Review when to wash hands and also how to wash hands. Could consider using a glow germ demonstration as well.
Explain when alcohol based hand sanitizers should and should not be used. Remind staff to use soap and water when hands are visibly soiled.
Power Point note:
For the video clip to work the Hand washing Windows Media hyper-link file must be saved with the power point file.
See tip in manual on how to set up a hyper-link

7. Routine Practices – Hand Washing
The Hand Washing Process:
Friction during hand scrubbing opens pores and loosens germs
Wash for at least 20 seconds (Happy Birthday X 2)
Use warm water to loosen germs better
Wash often
Don’t re-contaminate your hands
Use Alcohol gel when hand washing is not possible

8. Hand Washing - When? Hand washing should be performed:
At the start and finish of cleaning procedures
After touching any blood, body fluid, excretion or secretion
After removing a pair of gloves and before wearing a pair of new gloves
Before and after contact with residents or their environment
Between tasks/procedures on the same resident

9. Routine Practices - Personal Protection
Use of personal protective equipment is driven by:
Symptoms
Home Procedures
Option:
Watch Dawn of a new day: Video explains how to use personal protective equipment.
Routine practices (as already mentioned) should be used for all residents, all the time regardless of their diagnosis.
In order to reduce confusion regarding the use of PPE, emphasize a common sense approach based on symptoms and procedures.
Regarding symptoms: anyone with gastrointestinal illness (vomiting and/or diarrhea) should be managed with gloves and gown. The organism doesn’t matter at this point as precautions are based on symptoms. Anyone with a febrile respiratory illness should be managed with gloves, gown, mask and eye protection if within a meter of the ill resident. Emphasize that the meter rule is just a guideline and when in doubt PPE should be used.
Regarding Procedures: any procedures likely to generate respiratory droplets or aerosols require the use of mask, eye protection, gloves, and gown such as suctioning.
This slide is also another opportunity to emphasize the importance of hand hygiene.

10. Routine Practices - Gloves
Use for touching blood, body fluids, contaminated items, mucous membranes and non-intact skin
Task specific
Avoid contaminating the environment
Perform hand hygiene after removal

11. Routine Practices - Gloves
NEVER substitute gloves for hand washing
Gloves need to be changed between residents if delivering care (with hand washing in between)
Gloves need to be changed between activities for the same resident if contaminated
Gloves need to be worn if the staff has open lesions on their hands
Review when to use gloves and explain why hand hygiene is so important even after glove removal.
Discuss the importance of using gloves appropriately (task specific) and avoid environmental contamination.
Review how to remove them properly

12. Routine Practices - Gloves
Non-sterile gloves such as household rubber gloves should be worn for all cleaning procedures
They must be washed and disinfected prior to reuse and after contact with heavily contaminated surfaces or items
Disposable gloves should be changed:
Between cleaning resident rooms
If torn, punctured, cut or any evidence of deterioration

13. Routine Practices - Masks & Protective Eye Wear
Use for procedures that may generate splashes or sprays of blood, body fluids, secretions or excretions
When caring for coughing/febrile clients
Masks and eye protection are required whenever there is a risk of a splash or spray of blood, body fluids, excretions or secretions. This includes close contact with residents with respiratory illness.

14. Routine Practices - Gowns
Use to prevent soiling of clothes
Not needed for all care but should be used during procedures and activities likely to generate splashes or sprays of blood, body fluids, excretions or secretions.
Review when gowns are appropriate and how to remove them properly to avoid self contamination and environmental contamination.

15. Routine Practices - Handling Sharps
Sharps: Put them in their place! (razors, broken glass, needles etc)
Never ever re-cap needles

16. Routine Practices - Personal Care Supplies and Equipment
Personal care supplies should not be shared between residents
Creams
Lotions
Soaps
Razors
Equipment should be cleaned before use in the care of another resident
Personal items should remain ‘personal’
Equipment and devices that are not dedicated to residents should be cleaned and appropriately disinfected between use on different residents.
Encourage families to bring in electric razors for their resident as opposed to safety razors.

17. Transmission Based Precautions
Certain pathogens require additional precautions.
Based on mode of transmission
Used in addition to routine practices
Transmission based precautions are additional to routine practices
Transmission based precautions are added when the organism is known.
What is a Pathogens?
An organism that causes disease in another organism

18. Airborne Precaution Single room, negative pressure
N95 mask (fit tested)
Limit number of people entering the room
Resident should be out of the room for essential purposes only and should wear a surgical/procedure mask
Examples include: Tuberculosis or Chicken pox
Explain the difference in Airborne vs. droplet
Explain that very few illnesses are spread by the airborne route and most of the viral respiratory illnesses are droplet spread.
Airborne precautions should be implemented for known or suspected TB (only active TB not latent TB).

19. Routine Precautions - Droplet
Reduce the risk of transmission of large droplets greater than 5 microns in size
Larger droplets do not remain suspended in the air
Surgical masks use within 1 meter of the resident
Examples: Influenza, Pertussis, Mumps

20. Spray Spreads!

21. Droplet Precautions Limit number of people entering the room
Resident should wear a surgical/procedure mask when outside of their room
Gloves, mask, eye protection, gown and hand hygiene
Examples: Viral respiratory infections, such as Influenza
Applies to most of the colds and respiratory illnesses
Clusters or any influenza-like illness are reported by the DOC to Public Health

22. Contact Precautions
Used for residents known to have an infection that is transmitted by direct contact with the client or their environment
Used if there is potential for widespread environmental contamination. Typically:
Fecal incontinence (uncontrolled diarrhea)
Uncontained wound drainage
Influenza (with droplet precautions) or any uncontrolled respiratory secretions
Skin rash compatible with scabies
Contact precautions are used for infections that can be spread by direct contact with the resident or their environment.
Typically used for residents who are contaminating their environment. Examples are provided.
Not required for MRSA colonizers in the long term care environment (in most instances). Routine practices will control the spread of most infections.

23. Contact Precautions Use of gown and gloves Single room (if possible)
Dedicated equipment
Communication is key
Emphasize the importance of communication for all infection control precautions to other care providers to ensure that gaps do not occur.

24. Cleaning
IS MANDATORY!
Cleaning is the physical removal of dirt and debris using water and detergent
Disinfectants kill germs
There are policies that identify routine cleaning schedules as well as special cleaning needs/procedures of specific departments, types of surfaces and types of germ/pathogens

25. Self Screening Everyone SELF SCREENS upon entry to the home
Anyone who fails must be restricted
Staff should not come to work if unwell
Diarrhea or vomiting: return to work 48 hours after last symptom
Fever: do not come into work until you are fever free
Sore throat, sneezing and coughing: see your Infection Control Practitioner for direction. (They may direct you to wear a mask)

26. Summary Routine practices will protect you and your residents
PPE use guided by: symptoms and procedures and mode of transmission (if known)
Use resources available to you: Infection Control Practitioner
Hand hygiene is the most important way
to prevent the spread of infection

27. What Is Wrong With This Picture?
Personal tooth brush not properly protected
Loose razor
Dirty bag

28. What Is Wrong With This Picture?
Tooth brushes being stored in a urine catch container
Urine catch container being stored in a wash basin

29. Questions