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

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

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

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

5. 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.

6. 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

7. 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

8. 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

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

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

11. 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

12. 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.

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

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

15. 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

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

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

18. 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

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

20. 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

21. 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

22. Modes of transmission contact droplet airborne common vehicle
vector-borne

23. 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

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

25. 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

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

28. 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

29. Modes of transmission Diseases spread by airborne transmissionTB
measles
Diseases spread by airborne and contact transmission
SARS
monkeypox
smallpox
disseminated shingles

30. 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

31. 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

32. Transmission-based precautions
Airborne precautions
no shared air
negative pressure rooms: 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

33. 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.

34. References
Siegel JD, et al. CDC HICPAC, “Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007.”
OSHA Bloodborne Pathogens Standard, 29 CFR
WI Public Health Emergency Plan

35. 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