Management of infection prevention and control Antoinette Barton-Gooden 2013

Objectives Discuss the aims of infection control Identify the levels of responsibility for infection prevention and control Discuss the advantages of infection control Explain the regulatory framework at the national and organizational levels. Identify components of infection prevention & control. Discuss organizational control measures to protect both patients and healthcare workers.

Introduction Is infection control necessary? kingston-central-police-lockup-diagnosed- with-tubercolosis kingston-central-police-lockup-diagnosed- with-tubercolosis

Aim of infection control To reduce infection/health care associated infections (HCAIs)/nosocomial infection (Hospital acquired). These infections increase patients’ suffering and can prolong the length of hospital stay. Many of these infected patients suffer permanent disability and a significant number die. Increasing numbers of infections are being caused by microbes resistant to conventional treatments. (WHO Patient Safety Curriculum Guide: Multi-professional Edition, p.210)

HCAIs WHO defines a health care-associated (also called hospital acquired) infection as an infection acquired in hospital by a patient who was admitted for a reason other than that infection and/or an infection Occurring in a patient in a hospital or other health-care facility in whom the infection was not present or incubating at the time of admission. This includes infections that are acquired in the hospital, but appear only after discharge, as well as occupational infections among health-care facility staff. (WHO Patient Safety Curriculum Guide: Multi- professional Edition, p.210)

It is not all about you! Infection control is everyone’s business.

Regulatory process Jamaica: Ministry of Health developed policies about infection control (2000) and immunization policy to guide health care facilities and organizations. – Organizations eg. Hospital, health centres, schools, workplaces. Professional associations: training for their stakeholders eg. Nurses, Doctors, Occupational Safety and Health Administration (OSHA). Quality assurance framework within various institutions. Centre for Disease Control (USA) have guided the development of policies.

Scenario The infection control practitioner educated the patient and staff about the transmission route Clostridium difficile when a case was reported on the ward. While caring for the client, the nurses were observed to be wearing mask, hair cap, gown, gloves and hurriedly performed each task without talking. What devices are necessary to ensure infection control?

Infection prevention & control committee Multidisciplinary membership: Microbiologist, dietary, housekeeping, laundry, medical, nursing, pharmacy, Central Sterilization and Supplies Department, Public health nurses (PHNs)and inspectors

Infection control functions Universal precautions Development of isolation procedures Education of all staff Monitoring and surveillance Reporting as an element of quality assurance to the CEO, SMO, Medical Officer of Health and Nursing Directors. Continuous quality improvement by liaising with all departments to identify problems and solutions to enhance patient care.

Components of infection prevention & control Isolation: Creation of a barrier, mechanical or spatial to prevent the transmission of infectious diseases to or from a patient. – Adequate personnel assigned to area – Appropriate equipment and supplies – Schedule daily routine cleaning and maintenance – Education of HCW, patients and family regarding the illness and precautionary measures to be observed.

Components of infection prevention & control Standard precaution – Hand washing before, after patient contact, immediately after any contact with body fluid, after covering a sneeze, picking the nares, using the toilet, after removing gloves, touching contaminated objects, before preparing food//handling food, when hands are dirty etc. – Wear PPE when there is a risk of splashing eg. Masks, goggles, aprons, closed shoes, gloves, caps

Components of infection prevention & control Transmission based precautions – Droplet – Fecal – blood

Components of infection prevention & control Disinfection & Sterilization: Sterilization is a procedure which achieves complete destruction of all microorganisms including bacteria spores. Disinfection: A procedure which removes or kills most, but not all viable microorganisms. Antiseptic: A non toxic ‘disinfectant’ used on the skin or living tissues. Usually used at a lower dilution; should not be used to disinfect instruments or the environment.

Components of infection prevention & control Soiled instruments and surfaces soiled with body fluid should be disinfected for at least 5 minutes with a fresh 1:10 dilution of a 5% bleach solution or 1:6 dilution of 3% bleach solution that yields a 0.5% solution or other effective disinfectant. Heavy soiled instruments should be disinfected for 5 minutes with a 1:5 dilution of 5% bleach solution or a 1:3% bleach solution that yields a 1% solution.

Components of infection prevention & control Housekeeping – Frequent wiping of floor with bleach – Blood spillage wiped immediately with bleach

Components of infection prevention & control Health care waste management – All soiled linen and clothing must be placed in a clear plastic bag and labelled appropriately before being sent to the laundry. – All body waste must be flushed in toilet – All other infectious waste must be placed in red or yellow bags. – Bags should be tied securely and removed for incineration. – Puncture resistant container for sharps

Components of infection prevention & control Risk management: Infection control team – Surveillance – Outbreak investigations – Communicable disease reporting – Education – Antibiotic utilization and audit – Committee and consultant involvement – Regulatory compliance (Hoffmann, 2009)

Components of infection prevention & control Please read classification of wastes and waste management segregation and packaging (Ministry of Health (2000): Health Facilities Infection Control Policies and Procedures Manual).

Bibliography Hoffmann, K.(2009). Developing an infection control program. Ministry of Health (2000): Health Facilities Infection Control Policies and Procedures Manual). University Hospital of the West Indies (2007): Infection Control Policy and Procedures Manual. WHO (2011) Patient Safety Curriculum Guide: Multi- professional Edition. Image: content/uploads/2010/10/11_bg.jpg&imgrefurl= /mesh_info.php?term=Patient+Isolation&lang=1&h=326&w=500&sz=41&tbnid=R b8pqkM27EXCZM&tbnh=181&tbnw=278&zoom=1&usg=__8htB0NO4WDgIi3gzBU vItGL2K-c=