Infection Control Principles and Practices Session 4 Infection Control for LPHA Train the Trainer Course August 25, 2005

Topics Chain of infection Standard precautions Transmission-based precautions Attachments from PHEP

Objectives Understand the various precautions used to prevent disease transmission Be able to practice the correct precautions for a given disease and task

Chain of Infection Agent ↓ Reservoir Portal of exit Mode of transmission Portal of entry Susceptible host Chain of Infection

Standard Precautions Method of infection control that uses work practices, engineering controls, and personal protective equipment (PPE) to reduce or eliminate exposure to infectious agents.

Standard precautions 1) Work practices 2) Engineering controls hand hygiene no eating, drinking in areas with risk of transmission no re-capping of used needles 2) Engineering controls safety devices on sharp medical devices sharps containers hand washing facilities

Standard precautions PPE used as last resort when exposure has not been eliminated by work practices and engineering controls provides protection to skin, clothing, nose, mouth, eyes examples: gowns, gloves, goggles, masks

Standard precautions considers all person potentially infectious applies to all individuals, regardless of presence/type of symptoms used against exposure to blood, all body fluids, secretions, excretions (except sweat), mucous membranes, non-intact skin

Standard precautions hand hygiene infectious waste management sharps safety devices PPE respiratory hygiene/cough etiquette

Standard precautions Hand hygiene sinks, soap, paper towels available in convenient locations alcohol gel in convenient locations for staff

Standard precautions Wash hands: before and after client contact after removing gloves and other PPE after contact with contaminated surfaces and items, specimens, even when gloves are worn before eating or drinking after using restroom after coughing, sneezing, blowing nose

CDC Hand Hygiene Guidelines Standard precautions CDC Hand Hygiene Guidelines Wash with soap and warm water, using friction for at least15 seconds. Dry with a paper towel. Finally turn off the faucet with a clean paper towel. Use of alcohol hand sanitizer is the preferred method of hand hygiene in health care settings.

Standard precautions Infectious waste management sharps containers puncture resistant leak-proof, closable labeled with biohazard symbol or red do not overfill

Standard precautions Infectious waste management biohazard bags for disposal of items with blood, body fluids that are pourable dripable squeezable flakable

Standard precautions Infectious waste management LPHA can haul waste without license if weight does not exceed 50 pounds per month keep log of waste disposal date amount and description (e.g. 5 sharps containers) destination transported by

Standard precautions Sharps safety devices Needlestick Safety and Prevention Act mandates use of sharps with engineered safety devices users must evaluate

Standard precautions Personal protective equipment gloves gowns aprons goggles, face shields surgical/procedure masks respirators

Standard precautions Respiratory hygiene/cough etiquette cover mouth and nose with tissue when coughing, sneezing immediately toss tissue wash hands with soap and water or use alcohol gel have client wear mask if possible barriers for front line staff

Standard precautions Respiratory hygiene/cough etiquette supplies tissue alcohol gel waste baskets education posters signs

Standard precautions Additional work practices restriction of eating, drinking, applying makeup in areas of contamination exclusion of sick staff exclusion of ill clients from LPHA when possible

Transmission-based precautions Measures practiced in addition to standard precautions that are based on the confirmed or suspected presence of a specific communicable disease, and the mode(s) of transmission of that disease

Modes of transmission contact droplet airborne common vehicle vector-borne

Modes of transmission Contact transmission direct: person to person by physical contact indirect: person to intermediary object to person hands contaminated items, equipment, surfaces most common mode of transmission

Modes of transmission Diseases spread by contact transmission staph skin infections norovirus rotavirus hepatitis A

Modes of transmission Droplet transmission large particle droplets (5microns or greater) come in contact with mucous membranes (eyes, nose, mouth) occurs during coughing, sneezing, talking, performing suctioning or bronchoscopy droplets travel approx. 3 feet, then fall

Modes of transmission Diseases spread by droplet transmission pertussis influenza mumps Diseases spread by droplet and contact transmission adenovirus SARS (also airborne transmission)

Modes of transmission Airborne transmission droplets evaporate into droplet nuclei (less than 5 microns) that can spread via air currents for up to 25 feet requires special air handling

Modes of transmission Diseases spread by airborne transmission TB measles Diseases spread by airborne and contact transmission SARS monkeypox smallpox disseminated shingles

Transmission-based precautions Contact precautions physical separation of infectious persons (exclusion from work, school, daycare, social settings, crowded areas) use of private rooms/areas cleaning/disinfection of environment/contaminated equipment and surfaces/patient care items hand hygiene use of PPE

Transmission-based precautions Droplet precautions physical separation of infectious persons (exclusion from work, school, daycare, social settings, crowded areas) maintain distance of ≥ 3 feet use of private rooms/areas use of PPE

Transmission-based precautions Airborne precautions no shared air negative pressure rooms: 6-12 air exchanges/hour, exhaust directly to outside or filtered first, or use of portable HEPA filtration units physical separation of infectious person use of PPE

Quiz time (see notes page for answer) List the types of IC precautions used to reduce transmission of SARS and smallpox. ___ plus________ Standard, contact, and airborne, plus eye protection with every patient contact.

References Siegel JD, et al. CDC HICPAC, “Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007.” http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf OSHA Bloodborne Pathogens Standard, 29 CFR 1910.1030 http://www.osha.gov/SLTC/bloodbornepathogens/index.html WI Public Health Emergency Plan

Infection Control Principles and Practices Gwen Borlaug, CIC, MPH Infection Control Epidemiologist Bureau of Communicable Diseases 1 West Wilson Street Room 318 Madison, WI 53701 608-267-7711 gwen.borlaug@wisconsin.gov