2. Orientation Infection Control/Staff Health

3. Introduction No Scents is Good Sense Please do not wear perfume, scented hairspray, cologne, scented deodorant, aftershave or other scented products. Scented products contain chemicals which cause serious problems for many people, especially those with asthma and allergies.

4. General Orientation Infection Control * Introduction to Infection Control * Chain of Infection * Handwashing * Standard Precautions * Transmission-Based Precautions

5. Chain of Infection Causative Agent Reservoir Portal of Exit Mode of transmission Portal of Entry Susceptible Host

6. Definition Nosocomial Infection: A hospital acquired infection

7. Causative Agent Bacteria-salmonella/campylobacter Viruses-Hepatitis B/influenza Fungi-athlete’s foot/plantars warts Protozae-beaver fever (giardia) Colonized vs Infected

8. Three Common Reservoirs Common reservoirs associated with nosocomial infections : a.Patients b.Health care workers c.Health care equipment and environment

9. Two types of Human Reservoirs Cases Carriers A Reservoir is anywhere an infectious agent can survive

10. Portal of Exit Portal of exit is the path which an infectious agent leaves the reservoir -respiratory tract -Urinary tract -GI tract -Skin/mucous membrane -Mother to fetus -blood

11. Mode of Transmission Mode of transmission is the transfer of an infectious agent from a reservoir to a susceptible host -Contact (direct/ indirect) -Droplet -Airborne -Common Vehicle ie food,water -Vector-borne

12. Portal of Entry Portal of entry is the path by which an infectious agent enters the susceptible host 1.Respiratory tract 2.Urinary tract 3.GI tract 4.Skin/mucous membrane 5.Fetus from mom 6.Blood

13. Susceptible Host A susceptible host is a person or an animal lacking effective resistance to a particular organism. Susceptibility may be influenced by age, underlying diseases, certain treatments, breaks in the first line of defense, immunization status etc.

14. Handwashing Handwashing is the single most important infection control procedure to prevent nosocomial infection.

15. Hand washing * Use plain soap for general hand washing. * Antibacterial soap for resistant bacteria.

16. Happy Birthday The most effective way to prevent the spread of infection is handwashing Do it often -- do it well!

17. Procedure for Handwashing Wet hands Lather (15-30 seconds) Rinse Towel dry Turn off taps with paper towel

18. When to wash Hands should be washed between patients, anytime they are soiled, after removing gloves, prior to performing procedures, and after personal body functions such as using the toilet or blowing one’s nose.

19. Waterless Hand Wash Solutions Waterless Handwash solution is available for use when you are unable to get to a sink. It may be used between patients/residents when you are doing care that deals with intact skin. It is NOT effective for use when you are handling substances that may contain spores such as C- Difficile. The alcohol content must be at least 60% to be effective.

20. Standard Precautions The term Standard Precautions grew out of the need to address the misuse or misunderstanding of various terms used in the past. Standard Precautions are used to prevent the transmission of pathogens from blood, body fluids and moist body substances.

21. Reasons for Standard and Transmission Based Precautions Variation in the interpretation and use of Universal Precautions and Body Substance Isolation Confusion as to which body fluids/substances required precautions Inappropriate use of TB Guidelines Multi-drug resistant microorganisms becoming a new problem (MRSA,VRE)

22. Standard Precautions apply to: Blood All body fluids, secretions and excretions, except sweat Non-intact skin Mucous membranes * They apply to all patients regardless of their diagnosis or presumed infection status

23. Components of Standard Precautions Handwashing Personal Protective Equipment (PPE) Environmental Control Linen Dishes Waste Management

25. Sharps Containers It is a requirement that you dispose of all sharps (needles, blades etc.) in a sharps container. It is also important to adhere to the guidelines for ensuring that these containers are closed and changed when they are at the full line. This is usually 2/3 of the way up the container. If you notice a container is at the full line, close the top and request that it be changed.

26. Transmission-Based Precautions Purpose: Designed for patients documented or suspected to be infected with highly infectious pathogens for which additional precautions are needed to interrupt transmission in hospital. Always used in conjunction with Standard Precautions

27. Five main routes of Transmission- Based Precautions Airborne Droplet Contact *Common vehicle *Vectorborne * these routes do not usually play a significant role in typical nosocomial infections

28. Contact Transmission The most important/frequent mode of transmission >Direct Contact >Indirect Contact

29. Antibiotic Resistant Organisms (AROs) VRE, MRSA, Clostridium difficile

30. Droplet Transmission Transmission occurs when droplets are generated from the source person, primarily during coughing,sneezing and talking and during the performance of certain procedures such as suctioning and bronchoscopy. * Not to be confused with Airborne

31. Most respiratory tract conditions requiring precautions e.g. Mycoplasma, Meningococcal disease, Pertussis, Influenza, Rubella

32. Airborne Transmission Occurs by dissemination of small airborne nuclei containing microorganisms that remain suspended in the air for long periods of time. These microorganisms may be widely dispersed by air currents and may become inhaled over a longer distance from the host.

33. Airborne Transmission Examples: >Mycobacterium tuberculosis (TB) >Rubeola (red measles) >Varicella viruses (chicken pox)

34. Very few conditions require Tuberculosis, Varicella - zoster, Measles

35. PPE Use in Healthcare Settings: How to Safely Don, Use, and Remove PPE

36. Key Points About PPE Don before contact with the patient, generally before entering the room Use carefully – don’t spread contamination Remove and discard carefully, either at the doorway or immediately outside patient room; remove respirator outside room Immediately perform hand hygiene

37. Sequence* for Donning PPE Gown first Mask or respirator Goggles or face shield Gloves *Combination of PPE will affect sequence – be practical

38. How to Don a Gown Select appropriate type and size Opening is in the back Secure at neck and waist If gown is too small, use two gowns Gown #1 ties in front Gown #2 ties in back

39. How to Don a Mask Place over nose, mouth and chin Fit flexible nose piece over nose bridge Secure on head with ties or elastic Adjust to fit

40. How to Don Eye and Face Protection Position goggles over eyes and secure to the head using the ear pieces or headband Position face shield over face and secure on brow with headband Adjust to fit comfortably

41. How to Don a Particulate Respirator Select a fit tested respirator Place over nose, mouth and chin Fit flexible nose piece over nose bridge Secure on head with elastic Adjust to fit Perform a fit check –  Inhale – respirator should collapse  Exhale – check for leakage around face

42. How to Don Gloves Don gloves last Select correct type and size Insert hands into gloves Extend gloves over isolation gown cuffs

43. How to Safely Use PPE Keep gloved hands away from face Avoid touching or adjusting other PPE Remove gloves if they become torn; perform hand hygiene before donning new gloves Limit surfaces and items touched

44. PPE Use in Healthcare Settings: How to Safely Remove PPE

45. “Contaminated” and “Clean” Areas of PPE Contaminated – outside front Areas of PPE that have or are likely to have been in contact with body sites, materials, or environmental surfaces where the infectious organism may reside Clean – inside, outside back, ties on head and back Areas of PPE that are not likely to have been in contact with the infectious organism

46. Where to Remove PPE At doorway, before leaving patient room or in anteroom* Remove respirator outside room, after door has been closed* *Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub

47. Sequence for Removing PPE Gloves Face shield or goggles Gown Mask or respirator

48. How to Remove Gloves (1) Grasp outside edge near wrist Peel away from hand, turning glove inside-out Hold in opposite gloved hand

49. How to Remove Gloves (2) Slide ungloved finger under the wrist of the remaining glove Peel off from inside, creating a bag for both gloves Discard

50. Remove Goggles or Face Shield Grasp ear or head pieces with ungloved hands Lift away from face Place in designated receptacle for reprocessing or disposal

51. Removing Isolation Gown Unfasten ties Peel gown away from neck and shoulder Turn contaminated outside toward the inside Fold or roll into a bundle Discard

52. Removing a Mask Untie the bottom, then top, tie Remove from face Discard

53. Removing a Particulate Respirator Lift the bottom elastic over your head first Then lift off the top elastic Discard

54. FIT TESTING Western Health has a program in place to ensure employees who are required to wear high filtration masks (N95) are FIT tested. Example: Caring for a patient on Airborne Precautions

55. FIT TESTING (cont’d) Employees in any department who are required to wear an N95 mask must be FIT tested. FIT testing is in compliance with the Occupational Health & Safety Regulations. The specific regulations are outlined in the OH & S Guidelines.

56. FIT Testing (cont’d) The process for FIT testing will be provided for you prior to your appointment or when you start work in your designated area. Your responsibility in use of the respirator will be explained to you by your tester.

57. Infection Control Components of Employee Health Pre-employment and periodic health assessments Occupational health and safety education Immunization program Surveillance and management of job related illness and exposure Maintenance of health records

58. Immunizations Tetanus/Diptheria (every 10 years) Hepatitis B Rubella Vaccine (MMR) Varicella (chicken pox) Influenza Vaccine PPD (TB skin test)

59. Work Restrictions Diarrhea Influenza Herpes Simplex Conjunctivitis Sore Hands

60. Work Restrictions Exposure to : -Tuberculosis (PPD skin test/ chest x-ray done as screening) - Chicken Pox (Varicella titre checked) *If titre non-reactive, employee must not work from tenth to twenty-first day after the exposure.

61. Blood and/or Body Fluid Exposure If a health care worker has a parenteral or mucous membrane exposure to blood or body fluids or a cutaneous exposure involving large amounts of blood (especially if the skin is not intact), the source patient should be informed. Consent for HIV testing should be obtained by the attending physician. The source patient will also be screened for HBV and HCV. If the source for the exposure is unknown, the protocol for this situation is initiated.

62. Cont’d Immediately following the incident the appropriate first aid treatment should be administered. The immediate supervisor or designate is notified, an incident report filled out and the appropriate copy sent to Infection Control The Infection Control Nurse is notified as soon as possible (within 24 hours) on weekdays.

63. Cont’d If the nurse is not available, leave message on voice mail. On weekends and after hours, register in the Emergency Dept. for follow-up PROMPT reporting of the incident is important for follow-up.

64. First Aid Treatment Remove contaminated clothing For parenteral exposure, allow bleeding of the wound, wash with soap and water and apply antiseptic if available For mucous membrane exposure, rinse well with tap water or saline and proceed to the nearest eyewash station if available

65. Cont’d For human bites resulting in blood exposure to either person involved, wash wound and skin with soap, flush mucous membranes with water If blood gets on the skin and there are no cuts or puncture wounds, wash well with soap and water No follow-up is required

66. Bloodwork Should be done on the source patient as soon as possible after the puncture. The required bloodwork is HIV,HBV & HCV. Consent for HIV testing must be obtained by the attending physician. Laboratory must be notified that it is an exposure so that HBV and HIV testing will be done at WMRH site.

67. Blood Borne Pathogens Risk following exposure: Hepatitis B – 6% - 30% Hepatitis C – 0.5% - 10% HIV – 0.1% - 0.3%

68. Protocol for Hepatitis C Virus (HCV) Known Source If the source patient is known, ask the patient to consent for Hepatitis C screening. Source neg for HCV – no further follow-up Source pos for HCV – employee to have screening for Hepatitis C completed. If negative repeat in 6 months. If positive the employee should receive counseling. Results are reported to Public Health. Unknown source: As for Positive

69. HIV Post Exposure Prophylaxis Post exposure assessment Known Source: *Nature of Exposure *Likelihood of HIV Infection in the Source Patient The risk of infection should be weighed against the potential toxicity of antiretroviral agents. Prophylaxis should be started within one to two hours after exposure.

70. Cont’d Unknown Source * Exposure risk to be assessed * HCW counseled re HIV Chemoprophylaxis Drugs. * Consent Post exposure prophylaxis should be decided case by case based on exposure risk and possible source patients.

71. Questions?