Presentation on theme: "Infection Prevention & Control General Practice"— Presentation transcript:
1 Infection Prevention & Control General Practice 2018-19 Phone: | @ipcnursePhone: | This presentation has been designed to be used by WHCCG Primary care IC leads to carry out mandatory training for staff. It is based on the IC policy which was agreed by the IC leads September 2018
2 4,100,000 patients acquire a HCAI in the EU each year 37,000 HCAI deaths (direct consequence)110,000 additional deaths (contributory)101 people per day dying as a direct result301 people indirect deathsData ECDC accessed 2015
3 Standard precautions and the chain of infection Infection PreventionStandard precautions and the chain of infection
4 Chain of Infection Infectious Microbe Susceptible Host Reservoir Bacteria, Fungi, Virus, Prion, ProtazoaReservoirPlace where the microbe lives and replicatesSuch as people, equipment, water, food, animalsPortal of ExitPlace where the microbe leaves reservoirSuch as coughing, sneezing, bleeding, faecesModes of TransmissionContact (hands, sharps injury), Airborne, vehicle (equipment), Droplet, Insect vectorPortal of EntryEntry point such as wound/opening in the skin or mucosa of the mouthVia sutures, catheters, IV linesSusceptible HostNon-immune person, immune deficiency, babies, elderlyHand hygiene, equipment cleaning, isolation, waterVaccinationChain of InfectionAsepsis, sharps safety, hand hygiene, equipment cleaning, PPEThe chain of infection illustrates that infection transmission can be prevented when transmission precautions are used.Transmission precautions include: PPE, Hand Hygiene, cleaning and decontamination, cough etiquette, sharps safety and isolation precautionsHand hygiene, equipment cleaning, cough etiquette, PPE
5 Standard Infection Control Precautions Hand hygienePPERespiratory etiquetteMedical devicesEnvironmentBlood & Body Fluid spillagesDisposal of waste and sharpsOccupational SafetyAsepsisBasic IPC measures to reduce the risk of transmission from both recognised and unrecognised sources of infectionFor use by all staff, in all care settings, at all times and for all patients
7 Your 5 moments for hand hygiene WHO developed the 5 key moments for hand hygiene to help health care staff to remember when they must do hand hygieneThere are other times that staff should also carry out hand hygieneAfter the toiletBefore handling food/medicineBefore starting workWhen leaving workWhen hands are visibly soiled (use soap and water)
8 Ensure you use soap and water if: your hands are visibly dirty or where you have had contact with a patient who has potentially/confirmed infectious diarrhoea and/or vomiting.
9 Caring for your handsDo not work clinically if you have lesions or cuts (not covered with a waterproof dressing) on you hands or lower arms.Seek advice for skin lesions on your hands/lower armsRegularly use moisturiser to prevent/reduce skin damage from hand hygieneDo not over wear gloves and remove them as soon as possibleAlcohol gel is less damaging to the skin than soap and water (in most cases)There is no maximum amount of times that you can use alcohol gel before you need to use soap and water, however when you hands start to feel sticky and grimy from the gel wash your hands with soap and water to remove the excess.Gloves can cause the skin to become moist, which can lead to skin damage
10 Click here to start video Hand hygiene videoClick here to start videoRight Click on link – open hyperlink – will open in you tube.
11 Personal Protective Equipment Infection PreventionPersonal Protective Equipment
12 Personal Protective Equipment Uniform is not part of PPENo nail varnishFootwear – fully enclosed, non-slip, fittedWash your uniform at 60CWash separately to non-uniform itemsNo necklaces (choke/scratch risk)Uniform above elbowsNICE Infection Guidance Bare Bellow Elbows for hands on consultations (see hand hygiene presentation for more details)No watches, bracelets, stoned rings
13 Personal Protective Equipment PPE is not a substitute for hand hygieneSingle use – single patient useDependant on the mode of transmission and the riskRemember ‘nothing below the elbow’Carry out hand hygiene following removal of PPEPPE should be worn to protect yourself from contamination with blood/body fluid.
14 When to wear PPE Assess the risk No blood or body fluid / wounds No known infectionNo PPEBlood or body fluids / wounds butlow risk of splashingNon sterile gloves & apronsBlood or body fluid / wounds withhigh risk of splashingNon sterile gloves & apron or gown & eye and face protection
15 Routes of transmission Aerosol precautions – Unlikely to be required within a general practice setting.Chicken pox or measles (no immunity)FFP3 mask, apron and glovesDroplet precautions – i.e. productive cough, suctioningFace and eye protection, gloves and apron/gown (within 1 metre)Contact and Faecal - Oral precautionsWounds, urine, faeces, blood, sharps equipmentGloves and apron/gownNo PPE precautions required.No risk of blood/body fluid contaminationARI – close contact through droplet transmission from coughing and sneezing, direct human to human contact, contaminated surfaces or breathing aerosols – usually generated by medical proceduresAs you can see the majority of tasks do not require PPE
16 Most health care facilities have reduced the use of latex products.
22 General Cleaning Equipment must be cleaned between use Record that the equipment has been cleaned– if there’s no record, or you were not the last person to use it, clean it againDetergent Cleaning wipes – general cleaningChlorine – infection cleaning
23 Environment General everyday cleaning requires detergent and effort. All rooms and corridors must be cleaned with a suitable detergent and vacuumed regularly (if appropriate)All rooms and corridors should be clutter free to allow effective cleaningAll fixtures, fittings and furniture should be maintained in a good condition to allow effective cleaningClinical areas must be cleaned daily and specific areas cleaned as required i.e. counter tops, examination couchesEnhanced cleaning must be undertaken following recognised infection risk or contamination with blood or body fluidsRecords of cleaning and related audits should be maintained locally.
24 The Importance of Cleaning 3 months -2 yearsClostridium difficile1-4 weeksStrep pneumoniae1-2 daysInfluenza6 hoursRSVHow long do pathogens live in the environment. Some pathogens such as C diff can live in the environment for a very long time because they are spore formers which can lay dormant for long periods. Think how many patients you see in 6 hours and how many may at risk if you do not clean equipment after use.
25 Cleaning & Decontamination DisinfectionHighCleaningSterilizationBioburdenAll equipment should be cleaned following use. Cleaning is required prior to higher level processes such as disinfection and sterilisation in order to remove debris from the equipment. Reusable items which require disinfection or sterilisation should be avoided where possible - can you use a disposable alternative? Please contact the CCG of you would like advice on cleaning and decontamination of equipment.ZeroExposure Time
26 Single use itemsIf a medical device or item displays the following symbol on the packaging then it is deemed to be single use only.A single-use device is used on an individual patient during a single procedure and then discarded. It is not intended to be reprocessed and used again, even on the same patient. Reusing a single use product may result in the transfer of legal liability for the safe performance of the product from the manufacturer to themselves or employer.
27 Cleaning segregation colours Reusable mops should be decontaminated in an industrial washing machine ideally daily but a minimum of weeklyDisposable mops should be changed ideally daily but a minimum of weekly(if daily is not possible request a change every three days)Mop water should be changed between each room – ensure that waste water is not disposed of down a hand hygiene sinkCloths should be changed between rooms (reusable cloths should be decontaminated after every use)Mops should be hung up to drip dry, ensure they are not touching each otherMop buckets should be cleaned following useCorrect sequences of sink cleaning e.g. Clean taps before the rest of the clinical wash-hand basin with the plug hole last;
29 Specimen HandlingThe patient should label their specimen container before defecation with their name, date of birth and date and time of production.The specimen should then be placed inside a specimen bag and sealed by the patientThe patient should be advised to wash their hands thoroughly after defecation before touching the specimen pot and again after inserting the specimen pot into the bagAdministration Staff should not be handling specimens; the surgery should have a drop box which is emptied by the Practice Nurses / HCA.General principlesReception staff accepting samples must ask the patient to place their specimen into the box providedSamples should only be accepted where containers are correct and secure in accordance with the above guidelines. Where not, the sample should be refused and a correct container supplied or the patient should be referred back to the appropriate clinicianAny staff member who handles vaccinations should be trained in safe handling of specimensStaff who handle specimens or who are expected to clean up a blood/body fluid spills should be vaccinated for Hepatitis B
30 Testing urine samples Gloves Hard surfacePaper towelDetergent wipesSealed container disposed of in clinical waste binDo not dispose of urine down the sinkDo not dispose of urine down the sinkSRCL have indicated that they are happy with the disposal of urine in clinical waste bins as long as the lid has been tightly screwed back on
31 Spills Clean up spills immediately using a spills kit Always wear PPE, including eye protection as requiredWhere is your spills kit and PPE stored?Staff cleaning up blood/body fluid spills should have Hep B immunity
33 Sharps SafetyAny incident in which a healthcare worker is stuck by a needle or other sharp instrument which penetrates the skin and which is contaminated with potentially infected bloodNational Audit Office (2003) -sharps injuries second only to back injuries as a cause of harm to staff – 17% of all injuriesContaminated needles can transmit more than 20 dangerous blood-borne pathogens including HIV, Hep B and Hep CLegal framework (Health and Safety at Work Act (1974), Management of Health and Safety at Work Regulations (1991)Control of Substances Hazardous to Health (2002) reinforce risk assessment and preventative strategies
34 Sharps Safety Hierarchy of Controls Most effectiveHierarchy of ControlsElimination or substitution of sharp (eliminate unnecessary injections)Engineering controls (auto disable syringes, safer needle devices)Training on how to use devices safelyAdministrative and work practice controls (standard precautions; no recapping; provision and placement of sharps containers)Personal protective equipment (e.g. gloves)Least effective
35 Sharps SafetySharps must not be passed directly from hand to hand and handling should be kept to minimumNeedles must not be bent or broken prior to use or disposalNeedles/syringes or needles/vacutainers must not be disassembled or recapped prior to disposalUsed sharps must be discarded into an approved sharps container at the point of useThese must not be filled above the mark or placed on the floor and the temporary closure mechanism must be engagedBins must be sealed every 3 monthsTemporary closure mechanism will stop sharps coming out of the bin if knocked over and will also stop small hands getting into a bin (incident in a hospital where a child thought the sharps bins was a Lego box)
36 Sharps Safety Gloves should be worn as single use items Needle safety devices must be used where there are clear indications that they will provide safer systems of working for health care personnelItems should not be opened in advance of procedures
37 Examples of incorrect sharps bin use Over filling of the binNon sharps itemsSafer sharps equipment used incorrectly (sheath not deployed after use)
39 Immediately attend your nearest A&E department for treatment Inoculation InjuryALLOW TO BLEEDCOVER ITStaff members can be assessed by someone in the practice, however the assessment must be clearly documented and carried out by a qualified member of staff. If there is any doubt regarding the risk, send the person to their nearest EDWASH ITREPORT ITImmediately attend your nearest A&E department for treatment
40 Immediately attend your nearest A&E department for treatment Splash InjuryWASH ITREMOVEIRRIGATE ITREPORT ITImmediately attend your nearest A&E department for treatmentHeales Medical sharps injury hotline: Mon-Fri 9am-5pm
44 Aseptic and clean technique Non touch techniqueAseptic techniqueRoutine handwashing and non-sterile gloves and apronSterile procedure pack, sterile gloves and procedure trolleyIntact skin or mucous membranesSkin preparationHand hygiene with sterile towel or followed by alcohol gele.g. removal of dirty/used wound dressingsUsed for short invasive proceduree.g. blood takinge.g. wound dressingse.g. invasive procedures such as minor surgery and joint injectionsRoom with hard flooring and minimal soft furnishings.Risk assess the task that is being performedProtects patients against transmission of organisms from the environment
45 Isolation of potentially infectious patients Infection PreventionIsolation of potentially infectious patients
46 IsolationDepending on the urgency of consultation, patients with potentially infectious diseases e.g. infectious rashes and vesicles, diarrhoea, vomiting, mumps etc. should be asked to stay at home and telephone triage or home visits used to manage the patient.Where patients do present to the surgery, they should be immediately isolated in Insert practice process, if this is not available in Insert practice process.Environmental cleaning of touch points and surfaces should be undertaken on the patient’s departure.
48 Staff exclusionStaff with diarrhoea or vomiting due to infectious causes must be excluded from work until 48 hours after symptoms have resolved.Staff with influenza may return to work once their fever has subsided.Staff with rashes should seek medical diagnosis but stay off work until vesicles (chicken pox) has crusted over.A risk assessment is required for Shingles as staff may be able to work if the vesicles are not on hands, face or neck and they do not have contact with vulnerable patients.
49 Notification of infectious diseases Infection PreventionNotification of infectious diseases
50 Notification of disease A number of infectious diseases are statutorily notifiable under the Public Health (Control of Disease) Act 1984 and the Health Protection (Notification) Regulations 2010.Registered medical practitioners have a statutory duty to notify the ‘proper officer’ at their local council or local Public Health England HPT) of suspected cases of certain infectious diseases.Complete a notification form immediately on diagnosis of a suspected notifiable disease.Don’t wait for laboratory confirmation of a suspected infection or contamination before notification.Send the form to the proper officer within 3 days, or notify them verbally within 24 hours if the case is urgent, securely:by phone, letter, encrypted s or secure fax machinePublic Health England South East (Wessex Centre)In HoursOOH
52 Water SafetyBiofilms are common & support bacterial growth
53 Water SafetyThe following actions should be carried out to ensure that your staff and patients are protected from water borne infections such as Pseudomonas and LegionellaCold water must be 20C or lessHot water tank must be no less than 60CHot water must be a minimum of 55C at all outlets within 1 minuteAll staff should identify any infrequently used water outletsAny infrequently used outlets should be flushed for 2 minutes at least weekly (full bore)Identify and remove any dead-legs in the water systemHand Hygiene sinks to only be used for hand hygieneRemove and prevent lime scale build upEnsure that water flushing and temperature checks are documentedIn the majority of cases culturing your water is unnecessary – contact CCG for adviceDo not use the hand hygiene sink for disposal of dirty water or decontamination of equipmentMost practices will have relatively simple plumbing systems and will be low riskAn underused water outlet is defined as an outlet that is used less than once a week. Flushing of these outlets should occur weekly with the outlet opened full bore for 2-3 minutes. The flushing regime should be documentedMake sure staff report outlets that are underused (either because the room use or procedures have changed)Make sure you have a schematic (drawing) of your water supplyMeasuring water temperatures at the boiler and return is useful as an indicator of water supply temperatureHot water should leave the boiler at 60°C and return at no less than 50°C. Water should come out of the taps at 55◦C (assuming that there is no thermostatic mixer valve)Identify the sentinel outlet (furthest from the boiler) if the water is above 55oC the rest of the taps should also be above 55oCYour hot water should reach the right temperature within seconds of turning the tap on – if it doesn’t, your water system needs further investigationCold water should be under 20◦C whenever possible