2 Presentation Objectives To understand the basics of infectionsTo be aware of routine practicesTo know when to implement transmission-based precautions:Contact precautionsDroplet precautionsAirborne precautionsTo identify the importance of cleaning requirementsTo be aware of self screening protocolsExplain overview of the presentationEnsure 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 diseaseReservoir:Location where infection can survivePortal of Exit: Pathway (respiratory, gastric, blood) chosen by organism to leaveMode 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 contactProtect residents, staff and visitorsProtect 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-linkHANDWASHING 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 germsWash for at least 20 seconds (Happy Birthday X 2)Use warm water to loosen germs betterWash oftenDon’t re-contaminate your handsUse Alcohol gel when hand washing is not possible
8 Hand Washing - When? Hand washing should be performed: At the start and finish of cleaning proceduresAfter touching any blood, body fluid, excretion or secretionAfter removing a pair of gloves and before wearing a pair of new glovesBefore and after contact with residents or their environmentBetween tasks/procedures on the same resident
9 Routine Practices - Personal Protection Use of personal protective equipment is driven by:SymptomsHome ProceduresOption: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 skinTask specificAvoid contaminating the environmentPerform hand hygiene after removal
11 Routine Practices - Gloves NEVER substitute gloves for hand washingGloves 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 contaminatedGloves need to be worn if the staff has open lesions on their handsReview 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 proceduresThey must be washed and disinfected prior to reuse and after contact with heavily contaminated surfaces or itemsDisposable gloves should be changed:Between cleaning resident roomsIf 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 excretionsWhen caring for coughing/febrile clientsMasks 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 clothesNot 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 residentsCreamsLotionsSoapsRazorsEquipment should be cleaned before use in the care of another residentPersonal 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 transmissionUsed in addition to routine practicesTransmission based precautions are additional to routine practicesTransmission 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 roomResident should be out of the room for essential purposes only and should wear a surgical/procedure maskExamples include: Tuberculosis or Chicken poxExplain the difference in Airborne vs. dropletExplain 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 sizeLarger droplets do not remain suspended in the airSurgical masks use within 1 meter of the residentExamples: Influenza, Pertussis, Mumps
21 Droplet Precautions Limit number of people entering the room Resident should wear a surgical/procedure mask when outside of their roomGloves, mask, eye protection, gown and hand hygieneExamples: Viral respiratory infections, such as InfluenzaApplies to most of the colds and respiratory illnessesClusters or any influenza-like illness are reported by the DOC to Public Health
22 Contact PrecautionsUsed for residents known to have an infection that is transmitted by direct contact with the client or their environmentUsed if there is potential for widespread environmental contamination. Typically:Fecal incontinence (uncontrolled diarrhea)Uncontained wound drainageInfluenza (with droplet precautions) or any uncontrolled respiratory secretionsSkin rash compatible with scabiesContact 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 equipmentCommunication is keyEmphasize the importance of communication for all infection control precautions to other care providers to ensure that gaps do not occur.
24 CleaningIS MANDATORY!Cleaning is the physical removal of dirt and debris using water and detergentDisinfectants kill germsThere 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 restrictedStaff should not come to work if unwellDiarrhea or vomiting: return to work 48 hours after last symptomFever: do not come into work until you are fever freeSore 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 PractitionerHand hygiene is the most important wayto prevent the spread of infection
27 What Is Wrong With This Picture? Personal tooth brush not properly protectedLoose razorDirty bag
28 What Is Wrong With This Picture? Tooth brushes being stored in a urine catch containerUrine catch container being stored in a wash basin