infection-control _ standard precautions and transmission based precautions.pptx

Infection control

1. Standerd precausions and transmission based precausions Advanced trauma life support program AND INTERNATIONAL TRAUMA LIFE SUPPORT Infection Control Principles and Practices Prepared by Dr Rasheed Dr Dhyia 2018 MSF-OCA

2. Cough Etiquette

3. Topics Chain of infection Standard precautions Transmission-based precautions MSF-OCA

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

5. Chain of Infection Agent ↓ Reservoir ↓ Portal of exit ↓ Mode of transmission ↓ Portal of entry ↓ Susceptible host MSF-OCA

6. 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. MSF-OCA

7. Standard precautions 1) Work practices 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 MSF-OCA

8. 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 MSF-OCA

9. 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 MSF-OCA

10. Standard precautions hand hygiene infectious waste management sharps safety devices PPE respiratory hygiene/cough etiquette MSF-OCA

11. Standard precautions Hand hygiene sinks, soap, paper towels available in convenient locations alcohol gel in convenient locations for staff MSF-OCA

12. 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 MSF-OCA

13. 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 . MSF-OCA

14. Alcohol-based hand rub at the point of care Before and after any patient contact After glove use In between different body site care The University of Geneva Hospitals, 1995

15. Alcohol-based handrub at point of care A ccess to safe, continuous water supply, soap and towels 2. Training and Education 3. Observation and feedback 4. Reminders in the hospital 5. Hospital safety climate + + + + The 5 core components of the WHO Multimodal Hand Hygiene Improvement Strategy 1. System change

16. Sax H, Allegranzi B, Uçkay I, Larson E, Boyce J, Pittet D. J Hosp Infect 2007;67:9-21 “My 5 Moments for Hand Hygiene”

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

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

19. 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 MSF-OCA

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

21. Standard precautions Personal protective equipment gloves gowns aprons goggles, face shields surgical/procedure masks respirators MSF-OCA

22. 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 MSF-OCA

23. Standard precautions Respiratory hygiene/cough etiquette supplies tissue alcohol gel waste baskets education posters signs MSF-OCA

24. 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 MSF-OCA

25. 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 MSF-OCA

26. Modes of transmission contact droplet airborne common vehicle vector-borne MSF-OCA

27. 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 MSF-OCA

28. Modes of transmission Diseases spread by contact transmission staph skin infections norovirus rotavirus hepatitis A MSF-OCA

29. 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 MSF-OCA

30. Modes of transmission Diseases spread by droplet transmission pertussis influenza mumps Diseases spread by droplet and contact transmission adenovirus SARS (also airborne transmission) MSF-OCA

31. MSF-OCA

32. 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 MSF-OCA

33. Modes of transmission Diseases spread by airborne transmission TB measles Diseases spread by airborne and contact transmission SARS monkeypox smallpox disseminated shingles MSF-OCA

34. 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 MSF-OCA

35. 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 MSF-OCA

36. 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 MSF-OCA

37. Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings

38. PPE Use in Healthcare Settings: Program Goal Improve personnel safety in the healthcare environment through appropriate use of PPE. PPE Use in Healthcare Settings

39. PPE Use in Healthcare Settings: Program Objectives Provide information on the selection and use of PPE in healthcare settings Practice how to safely don and remove PPE PPE Use in Healthcare Settings

40. Personal Protective Equipment Definition “specialized clothing or equipment worn by an employee for protection against infectious materials” (OSHA) PPE Use in Healthcare Settings

41. Regulations and Recommendations for PPE OSHA issues workplace health and safety regulations. Regarding PPE, employers must: Provide appropriate PPE for employees Ensure that PPE is disposed or reusable PPE is cleaned, laundered, repaired and stored after use OSHA also specifies circumstances for which PPE is indicated CDC recommends when, what and how to use PPE PPE Use in Healthcare Settings

42. Hierarchy of Safety and Health Controls Training and administrative controls Engineering controls Work practice controls Personal protective equipment PPE Use in Healthcare Settings

43. Types of PPE Used in Healthcare Settings Gloves – protect hands Gowns/aprons – protect skin and/or clothing Masks and respirators– protect mouth/nose Respirators – protect respiratory tract from airborne infectious agents Goggles – protect eyes Face shields – protect face, mouth, nose, and eyes PPE Use in Healthcare Settings

44. Factors Influencing PPE Selection Type of exposure anticipated Splash/spray versus touch Category of isolation precautions Durability and appropriateness for the task Fit PPE Use in Healthcare Settings

45. Gloves Purpose – patient care, environmental services, other Glove material – vinyl, latex, nitrile, other Sterile or nonsterile One or two pair Single use or reusable PPE Use in Healthcare Settings

46. Gloves Purpose – patient care , environmental services, other Glove material – vinyl, latex, nitrile , other Sterile or non-sterile One or two pair Single use or reusable PPE Use in Healthcare Settings

47. Do’s and Don’ts of Glove Use Work from “clean to dirty” Limit opportunities for “touch contamination” - protect yourself, others, and the environment Don’t touch your face or adjust PPE with contaminated gloves Don’t touch environmental surfaces except as necessary during patient care PPE Use in Healthcare Settings

48. Do’s and Don’ts of Glove Use (cont’d) Change gloves During use if torn and when heavily soiled (even during use on the same patient) After use on each patient Discard in appropriate receptacle Never wash or reuse disposable gloves PPE Use in Healthcare Settings

49. Gowns or Aprons Purpose of use Material – Natural or man-made Reusable or disposable Resistance to fluid penetration Clean or sterile PPE Use in Healthcare Settings

50. Face Protection Masks – protect nose and mouth Should fully cover nose and mouth and prevent fluid penetration Goggles – protect eyes Should fit snuggly over and around eyes Personal glasses not a substitute for goggles Antifog feature improves clarity PPE Use in Healthcare Settings

51. Face Protection Face shields – protect face, nose, mouth, and eyes Should cover forehead, extend below chin and wrap around side of face PPE Use in Healthcare Settings

52. Respiratory Protection Purpose – protect from inhalation of infectious aerosols (e.g., Mycobacterium tuberculosis ) PPE types for respiratory protection Particulate respirators Half- or full-face elastomeric respirators Powered air purifying respirators (PAPR) PPE Use in Healthcare Settings

53. Elements of a Respiratory Protection Program Medical evaluation Fit testing Training Fit checking before use PPE Use in Healthcare Settings

54. PPE Use in Healthcare Settings: How to Safely Don, Use, and Remove PPE

55. Key Points About PPE Don before contact with the patient, generally before entering the room Use carefully – don’t spread contamination Remove and discard carefully, either at the doorway or immediately outside patient room; remove respirator outside room Immediately perform hand hygiene PPE Use in Healthcare Settings

56. Sequence* for Donning PPE Gown first Mask or respirator Goggles or face shield Gloves *Combination of PPE will affect sequence – be practical PPE Use in Healthcare Settings

57. How to Don a Gown Select appropriate type and size Opening is in the back Secure at neck and waist If gown is too small, use two gowns Gown #1 ties in front Gown #2 ties in back PPE Use in Healthcare Settings

58. How to Don a Mask Place over nose, mouth and chin Fit flexible nose piece over nose bridge Secure on head with ties or elastic Adjust to fit PPE Use in Healthcare Settings

59. How to Don a Particulate Respirator Select a fit tested respirator Place over nose, mouth and chin Fit flexible nose piece over nose bridge Secure on head with elastic Adjust to fit Perform a fit check – Inhale – respirator should collapse Exhale – check for leakage around face PPE Use in Healthcare Settings

60. How to Don Eye and Face Protection Position goggles over eyes and secure to the head using the ear pieces or headband Position face shield over face and secure on brow with headband Adjust to fit comfortably PPE Use in Healthcare Settings

61. How to Don Gloves Don gloves last Select correct type and size Insert hands into gloves Extend gloves over isolation gown cuffs PPE Use in Healthcare Settings

62. How to Safely Use PPE Keep gloved hands away from face Avoid touching or adjusting other PPE Remove gloves if they become torn; perform hand hygiene before donning new gloves Limit surfaces and items touched PPE Use in Healthcare Settings

63. PPE Use in Healthcare Settings: How to Safely Remove PPE

64. “Contaminated” and “Clean” Areas of PPE Contaminated – outside front Areas of PPE that have or are likely to have been in contact with body sites, materials, or environmental surfaces where the infectious organism may reside Clean – inside, outside back, ties on head and back Areas of PPE that are not likely to have been in contact with the infectious organism PPE Use in Healthcare Settings

65. Sequence for Removing PPE Gloves Face shield or goggles Gown Mask or respirator PPE Use in Healthcare Settings

66. Where to Remove PPE At doorway, before leaving patient room or in anteroom* Remove respirator outside room, after door has been closed* * Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub PPE Use in Healthcare Settings

67. How to Remove Gloves (1) Grasp outside edge near wrist Peel away from hand, turning glove inside-out Hold in opposite gloved hand PPE Use in Healthcare Settings

68. How to Remove Gloves (2) Slide ungloved finger under the wrist of the remaining glove Peel off from inside, creating a bag for both gloves Discard PPE Use in Healthcare Settings

69. Remove Goggles or Face Shield Grasp ear or head pieces with ungloved hands Lift away from face Place in designated receptacle for reprocessing or disposal PPE Use in Healthcare Settings

70. Removing Isolation Gown Unfasten ties Peel gown away from neck and shoulder Turn contaminated outside toward the inside Fold or roll into a bundle Discard PPE Use in Healthcare Settings

71. Removing a Mask Untie the bottom, then top, tie Remove from face Discard PPE Use in Healthcare Settings

72. Removing a Particulate Respirator Lift the bottom elastic over your head first Then lift off the top elastic Discard PPE Use in Healthcare Settings

73. Hand Hygiene Perform hand hygiene immediately after removing PPE. If hands become visibly contaminated during PPE removal, wash hands before continuing to remove PPE Wash hands with soap and water or use an alcohol-based hand rub PPE Use in Healthcare Settings * Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub

74. PPE Use in Healthcare Settings: When to Use PPE

75. Standard and Expanded Isolation Precautions

76. Standard Precautions Previously called Universal Precautions Assumes blood and body fluid of ANY patient could be infectious Recommends PPE and other infection control practices to prevent transmission in any healthcare setting Decisions about PPE use determined by type of clinical interaction with patient PPE Use in Healthcare Settings

77. PPE for Standard Precautions (1) Gloves – Use when touching blood, body fluids, secretions, excretions, contaminated items; for touching mucus membranes and nonintact skin Gowns – Use during procedures and patient care activities when contact of clothing/ exposed skin with blood/body fluids, secretions, or excretions is anticipated PPE Use in Healthcare Settings

78. PPE for Standard Precautions (2) Mask and goggles or a face shield – Use during patient care activities likely to generate splashes or sprays of blood, body fluids, secretions, or excretions PPE Use in Healthcare Settings

79. What Type of PPE Would You Wear? Giving a bed bath? Suctioning oral secretions? Transporting a patient in a wheel chair? Responding to an emergency where blood is spurting? Drawing blood from a vein? Cleaning an incontinent patient with diarrhea? Irrigating a wound? Taking vital signs? PPE Use in Healthcare Settings

80. What Type of PPE Would You Wear? Giving a bed bath? Generally none Suctioning oral secretions? Gloves and mask/goggles or a face shield – sometimes gown Transporting a patient in a wheel chair? Generally none required Responding to an emergency where blood is spurting? Gloves, fluid-resistant gown, mask/goggles or a face shield Drawing blood from a vein? Gloves Cleaning an incontinent patient with diarrhea? Gloves w/wo gown Irrigating a wound? Gloves, gown, mask/goggles or a face shield Taking vital signs? Generally none PPE Use in Healthcare Settings

81. PPE for Expanded Precautions Expanded Precautions include Contact Precautions Droplet Precautions Airborne Infection Isolation PPE Use in Healthcare Settings

82. Use of PPE for Expanded Precautions Contact Precautions – Gown and gloves for contact with patient or environment of care (e.g., medical equipment, environmental surfaces) In some instances these are required for entering patient’s environment Droplet Precautions – Surgical masks within 3 feet of patient Airborne Infection Isolation – Particulate respirator * *Negative pressure isolation room also required PPE Use in Healthcare Settings

83. Hand Hygiene Required for Standard and Expanded Precautions Perform… Immediately after removing PPE Between patient contacts Wash hands thoroughly with soap and water or use alcohol-based hand rub PPE Use in Healthcare Settings

84. PPE Use in Healthcare Settings: Final Thoughts PPE is available to protect you from exposure to infectious agents in the healthcare workplace Know what type of PPE is necessary for the duties you perform and use it correctly