Chapter4 Infection Prevention and Control Cholera.pptx

Infection Prevention and Control Cholera

1. Infection Prevention and Control (IPC): In the context of Cholera Yibeyin Mulualem Diredawa , Ethiopia October 2023 1

2. Learning objective At the end of this session, you should be able to: Define standard precautions and transmission-based precautions List elements of standard and transmission based precautions Describe the importance of applying standard and transmission based precaution in cholera outbreak/CTC 2

3. Brain Storming What is infection prevention and control Why do we apply standard and transmission based precautions in health care setting? 3

4. What is Infection Prevention and Control (IPC)? Infection prevention and control is a scientific approach with Practical solutions designed to prevent harm , caused by infections to patients , health care workers , and the community 4

5. What are the benefits of IPC? Protecting yourself Protecting your patients Protecting your family & community 5

6. For infection to spread, all links must be connected. Breaking any link in chain will stop infection transmission How can we break the links? Apply standard and transmission based precautions C hain of T ransmission I n fecti o u s Agent Reservoir Port of Exit Mode of T ra n smiss io n Portal of Entry S u sce p ti bl e Host CHAIN OF INFECTI O N 6

7. Standard precautions 7

8. Group Discussion 8 What is Standard precautions ? When we apply standard precaution? List the elements/components of standard precaution?

9. What are standard precautions? 9 Standard precautions are the basic level of IPC precautions, to be used for ALL patients at ALL times : Apply regardless of suspected or confirmed status of the patient. Risk assessment is critical for all activities, i.e., assess each health care activity and determine PPE that is needed for adequate protection. 9

10. Key Principles of Standard Precautions Consider every client and patient as potentially infectious or susceptible to infection. Apply to all patients and clients attending healthcare facility No one really knows what organisms clients or patients may have Apply to all blood, body fluid, secretion, execration (except sweat), mucous membrane and non intact skin. 10

11. E lements of standard precautions? The 8 core elements of standard precautions are: Hand hygiene Respiratory hygiene (etiquette) PPE according to the risk Safe injection practices, sharps management and injury prevention Safe handling, cleaning and disinfection of patient care equipment Environmental cleaning Safe handling and cleaning of soiled linen Waste management 11

12. 1. Hand Hygiene Purpose : to mechanically remove soil and debris from skin and reduce the number of transient microorganisms. It is THE SINGLE most important measure in reducing the spread of cholera! The easiest ways to help prevent the spread of cholera 12

13. H and hygiene 13 How to perform hand hygiene? Regularly and thoroughly wash with alcohol-based hand rub / 0.05% chlorine for 20-30 seconds Regularly and thoroughly wash with soap and safe water according to the WHO 11 steps for 40-60 seconds 13

14. Hand Hygiene 14

15. Hand Hygiene demonstration Hand Hygiene demonstration Instruction Avail soap, water, washing basin and alcohol based hand-rub Select two volunteers from the participants One volunteer will demonstrate hand hygiene with soap and water, the second one with alcohol based hand-rub The rest participant will observe what they are preforming and reflect their comments at the end of the demonstration 15

16. Hand Hygiene WHO 5 moments: The WHO promotes the 5 moments of hand hygiene in a healthcare setting 16

17. Back of hand 17 Front of hand Areas usually missed during hand hygiene

18. 2. R espiratory H ygiene Good respiratory hygiene/cough etiquette can reduce the spread of microorganisms (germs) that cause respiratory infections ( e.g. C olds , flu). 18

19. PPE is specialized clothing or equipment worn by HCW to protect: Themselves, Patients and Others (Visitors, etc) Always do risk assessment For rational use of PPE 19 3. Personal Protective Equipment (PPE) PPE indicated for use in Standard Precautions includes: Aprons Gloves (non-sterile and sterile, heavy duty) Gowns (long sleeve, fluid repellent or fluid resistant) Protective eyewear (safety glasses/ goggles) Face Masks (surgical ) Face visors/shields Rubber boot

20. P rinciples for using PPE 20 Wear PPE at donning area and take-off at doffing area Perform hand hygiene during donning and doffing PPE. PPE should not be adjusted or touched during patient care Take off PPE immediately following the provision of care to a patient PPE should be appropriately doffed prior to entering another patient’s care area or providing care to a different patient (if cohorted ) Ensure proper disposal of contaminated PPE and disinfection of surfaces and reusable materials accordingly

21. 4 . Safe injection practices, sharps management and injury prevention 21 Clean workspace Hand hygiene Sterile safety-engineered syringe Sterile vial of medication and diluent Skin cleaning and antisepsis Appropriate collection of sharps Appropriate waste management

22. Decontamination The processes to r emove soil and pathogenic microorganisms from objects so they are safe to handle, subject to further processing, use or discard 5 . Safe handling, cleaning and disinfection of patient equipments Disinfection Sterilization Cleaning 22

23. S teps for Instrument R e-processing 23

24. 53 Cle a ning The step required to physically remove contamination by foreign material, e.g. dust, soil. It will also remove organic material, such as blood, secretions, excretions and microorganisms, to prepare a medical device for disinfection or sterilization. Disinfecting Sterilization A process to reduce the number of viable microorganisms to a less harmful level. This process may not inactivate bacterial spores, prions and some viruses. A validated process used to render an object free from viable microorganisms, including viruses and bacterial spores, but not prions Match with its definition: What is cleaning, disinfection and sterilization ?

25. Level of Decontamination To determine the level of decontamination , use risk assessment Critical (e.g surgical instruments)-steriilzation required Semi critical (e.g respiratory equipment, endoscopic devices, bedpans/urinals) -high level disinfection preferably sterilization if the device can withstand Non –critical (e.g blood pressure cuffs, items that come in contact with intact skin)- low level disinfection 25

26. Environmental cleaning & disinfection is important because microorganisms may survive: on surfaces (such as floors and tables) on clothing and PPE in body fluids (such as blood, saliva and vomit ) Dry sweeping, mopping and dusting should be avoided: Use Double Bucket Technique : Cleaning solution (0.2%) and water for rinsing. The mop is always rinsed and wrung out before it is dipped into the cleaning solution Need contact time From the least soiled (cleanest) to the most soiled (dirtiest ) areas and from the higher to lower levels   26 6 . Environmental cleaning

27. Cont’d Environmental Disinfection Establish mobile team for house spraying Disinfect cholera patient’s home with 0.2% chlorine Wear proper PPE Distribute HH disinfection kit 27

28. 7. Safe handling and cleaning of soiled linen 28 Use Standard Precautions, including PPE , when collecting used textiles. Do not sort textiles in patient care areas . Use leak-proof containers for all textiles and wash and dry containers routinely before subsequent use. Roll items that are heavily contaminated with blood or body fluids carefully into the center of the item . Handle soiled textile as little as possible. Do not shake soiled textiles Two bags may be indicated for highly soiled and non soiled Transport soiled textiles and clean textiles separately.

29. 7. Safe handling and …. Cont’d Soiled materials and others should be separated and immersed in a 0.2% chlorine solution for 10 minutes. Then should then be washed in water with detergent and air-dried in the sunlight, when possible . The laundry area should be near to areas producing highly contaminated materials Sinks, if not large plastic tubes, can be installed with soak away pit The washing area should be cleaned and disinfected daily with a 0.2% chlorine solution. 29

30. 8 . W aste M anagement 30 Safe treatment of waste generated during care activities is the responsibility of all staff

31. 8. Waste Management… Cont’d N o waste that is generated inside the CTC should leave the premises All waste containers and bags must be clearly labelled, emptied at least daily, and washed and disinfected with a 0.2% chlorine solution. Sharp wastes, soft wastes, organic wastes, vomits and faeces should be separately collected and disposed 31

32. Cont’d … Vomits and faeces should be treated with 2% chlorine solution and disposed at dedicated pit Adequate buckets for vomitus and faeces should be in place Incinerators, waste disposal sites, soak away pit , etc should be prepared and regularly monitored 32

33. Transmission-based precautions 33

34. Discussion 34 When we apply transmission– based precaution ? What is the difference between standard and transmission based precautions Mention the type of transmission based precaution? Which type of precaution can apply for cholera

35. For patients who are symptomatic and suspected or who have a confirmed infection with a highly transmissible pathogen When the pathogen is considered important from an epidemiological point of view When medical interventions increase the risk of transmission of a specific infectious agent When the clinical situation prevents the systematic application of standard precautions. 35 When we apply transmission– based precaution ?

36. What do transmission–based precautions include? The items that should be included in transmission -based precautions are : Standard Precautions + Special accommodations/isolation (i.e. single room, space between beds, separate toilet etc.) Signage Personal Protective Equipment (PPE) Dedicated equipment and additional cleaning Limit transport Communication 36

37. Type of TBPs 37 Types of transmission–based precautions

38. C ontact precautions Consists 38 Single room (If not , >1m distance,…) Hand hygiene A ccording to the “5 Moments”, in particular before and after contact with the patient and after removing PPE; A voiding touching eyes, nose or mouth with contaminated gloved or ungloved hands). PPE : gown + gloves Equipment cleaning, disinfection, and sterilization Environmental cleaning avoiding contaminating surfaces not involved with direct patient care, e.g., doorknobs, light switches, mobile phones) Limit movement: Patient to stay in the room

39. Contact precautions … Signage Put up clear signage for patients (signs, posters, symbols, pictures, text in the local language ): Near the entrance to the CTC If the CTC is within hospital grounds, put up signs giving directions to the CTC so as to avoid cholera patients entering other services . At the entrance of the CTC Put up a Patient Entrance sign. Put up a Staff and Suppliers Entrance sign . Inside the CTC Put up a No Entry sign (staff only) at the entrance to the clean zone, morgue and waste area. Label containers: ORS, potable water, 0.05% chlorine solution for hand-washing. Put up a sign indicating men’s/women’s showers and the latrines. Put up a No Entry sign to excreta pits (they must not be used by patients) 39

40. 40 C hlorine Preparation and Purpose Instruction : Think and d iscuss the following questions with your neighboring trainee for 5 minutes and share your ideas within 5 minutes. Question : Explain different types of chlorine solution concentration used for disinfection Explain how to prepare chlorine solution used for disinfection Activity 1.8 Think-Pair-Share Time: 10 minutes