Infection prevention and control

For Nursing

1. Standard Precautions

2. Standard Precautions Standard Precautions are a group of practices that are designed to protect the HCW’s and patients by preventing the transmission of infectious diseases from one person to another . These precautions are to be used, as a minimum, in the care of all patients regardless of their diagnosis or their infectious status. Principle :Standard precautions apply to 1)blood; 2) all body fluids, secretions and excretions except sweat, 3)non-intact skin; and 4) mucous membranes.

3. Hand Hygiene Personal Protective Equipments Respiratory hygiene and cough etiquette Safe injection Practices Linen and laundry Cleaning and Disinfection of devices and Environmental Surfaces Patient Placement Components of Standard Precautions

4. Most common mode of transmission of pathogens is via hands. Hand hygiene is considered the simplest and cheapest method to reduce the spread of health care associated infections. Hand Hygiene

5. 6 steps of hand hygiene

6. 5 moments of hand hygine

7. Rings: Skin underneath rings is heavily colonized with bacteria. Fingernails and artificial nails: artificial nails are not advisable. Barrier to effective hand hygiene

8. Hand washing agents cause irritation and dryness Skins are inconveniently located/ lack of sinks Lack of soap and paper towels Too busy/ insufficient time Understaffing/ overcrowding Patient needs take priority Low risk of acquiring infection from patients. Few factors for poor adherence with hand hygiene

9. Routine/Social Aseptic/Clinical Surgical Three types of hand hygiene techniques: LEVEL-1 SOCIAL/ROUTINE HANDHYGIENE L EVEL-2 ASEPTIC/CLINICAL HANDHYGIENE LEVEL-3 SURGICAL HAND HYGIENE At least 15-20 seconds 1 min(60secs) 3 minutes

10. Keep nails short and pay attention to them when washing your hands – most microbes on hands come from beneath the fingernails. Do not wear artificial nails or nail polish. Remove all jewellery (rings, watches, bracelets) before entering the operating theatre. Key steps

11. Total Duration -3 minutes Step 1: Duration two minutes Preliminary step: Rinse the hands and arms and wash with sufficient antimicrobial soap to 2.5cm above the elbows (20 seconds). This preliminary step ensures adequate skin coverage and contact time during Step. Without rinsing, apply additional antimicrobial solution and wash all surfaces of hands and forearms working from nail beds and between fingers before proceeding to wash the forearms (to the level of the elbows) using circular motions .( 10 strokes of each step) . Apply more antimicrobial soap if necessary. On completion, rinse the hands and forearms Step 2: Duration one minute Hands and forearms are washed again using the same principles and procedures above, but stopping at mid forearm. On completion rinse the hands and forearms. Finally, the hands and forearms are rinsed thoroughly ( 5 strokes of each steps ) . PROCEDURE FOR SCRUBBING WITH ANTIMICROBIAL SOLUTION

12. Thank You  

13. When to wear PPE:These are specialized clothing or equipment worn by an employee for protection against infectious materials. When to use: When you are anticipated to blood and body fluid exposure irrespective of the infectious status. Types of PPE: Gloves protect hands Gown/ aprons protect skin and clothing Masks- Protect mouth/nose Goggles- protect eyes Face shields- protect face, mouth, nose and eyes. Personal Protective Equipments

14. Where to remove PPE : At doorway, before leaving patient room Ensure that hh facilities are available at the point needed, eg sink or alcohol based hand rub.

15. Gloves : Wear gloves when there is potential contact with blood , body fluids, mucous membranes, nonintact skin or contaminated equipment. Sterile gloves are worn when sterile procedures are undertaken Wear gloves that fit appropriately( select gloves according to hand size) Do not wear the same pair of gloves for the care of more than one patient. Do not wash gloves for the purpose of reuse. Perform hand hygiene before and immediately after removing gloves

16. Donning sterile gloves

17. Removing Used gloves

18. Gown: Wear a gown to protect skin and clothing during procedures or activities where contact with blood or body fluids is anticipated. Do not wear the same gown for the care of more than one patient Remove gown and perform hand hygiene before leaving the patient’s environment

19. How to don gown

20. Sequence for donning PPE Gown first Mask or respirator Goggles or face shield Gloves  

21. Removing Isolation gown Unsafe ties Peel gown away from neck and shoyulder Turn contaminated outside toward the inside. Fold or roll into a bundle Discard

22. Face mask Wear a facemask: When there is potential contact with respiratory secretions and sprays of blood or body fluids May be used in combination with goggles or face shield to protect the mouth, nose and eyes. When placing a catheter or injecting material into the spinal canal or subdural space (to protect patients from exposure to infectious agents carried in the mouth or nose of health care personnel) Wear a facemask to perform intrathecal chemotherapy.

23. Place over nose, mouth and chin Fit flexible node piece over nose bridge Secure on head with ties or elastic Adjust to fit How to don a mask

24. Respirators If available, wear N95 – or higher respirators foe potential exposure t infectious agents transmitd via airborne route ( eg . Tuberculosis). All healthcare personnel that use N 95 or higher respirator are fit tested at least annualy and according the requirement.

25. 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 Removing a mask Untie the bottom, then top, tie Remove from face Discard

26. Goggles, face shields Wear eye protection for potential splash or spray of blood , respiratory secretions, or other body fluids Personal eye glasses and contact lenses are not considered adequate eye protection May use goggles with face mask, or face shield alone to protect the mouth, nose and eyes Googles should fit snuggly over and around eyes Face shields protect face, nose, mouth, and eyes. It should cover forehead, extend below chin and wrap around side of face

27. 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.

28. Respiratory hygiene and cough etiquette

29. Cough etiquette

30. Respiratory etiquettes are meant to prevent the transmission of respiratory infections in the facility, infection prevention measures are implemented for all potentially infected persons at the point of entry and continuing throughout the duration of the visit. This applies to any person( eg . Patients and accompanying family members, caregivers, and visitors) with signs and symptoms of repiratory illness including cough, congestion or increased production of respiratory secretions. Identifying persons with potential respiratory infection: Facility staff remain alert for any persons arriving with symptoms of a respiratory infection

31. All persons with signs and symptoms of a respiratory infection(including facility staff) are instructed to: Cover mouth and nose with a tissue when coughing or sneezing; Dispose of the used tissue in the nearest waste receptacle Perform hand hygiene after contact with respiratory secretions and contaminated objects/ materials. Place the coughing patient in an exam room with a closed door as soon as possible(if suspicious for airborne transmission, refer to airborne precautions )if an exam room is not available, the patient should sit as far from other patients as possible in the waiting room Accompanying persons who have symptoms of a respiratory infection should not enter patient care areas and are encourages to wait outside the facility Respiratory hygiene and cough Etiquette

32. Safe injection Practices

33. General safe injection Practices Maintain HH before preparing injections. The cleaning of injection site should be circular- from inward to outwards Always use separate fresh spirit swab to clan the injection site before giving injection. Ensure one needle, one syringe and one patient Take all precautions to avoid NSI Do not attempt to recap or bend needles If using MDV, do not keep the needle inserted in the rubber septum/stopper.

34. Safe injection Practicesrefers to the proper use and handling of supplies for administering injections and infusions(e.g. syringes, needles, fingerstick devices, intravenous tubing, medication vial and parenteral solutions). These practices are intended to prevent transmission of infectious diseases between one patient and another, or between a patient and health care personnel during preperation and administration of parenteral medication. General safe injection Practices Use aseptic technique to avoid contamination of sterile injection equipment. Do not administer medications from a syringe to multiple patients, even if the needle or cannula on the syringe is changed. Needles, cannula and syringes are sterile, single-use items; they should neither be reused for another patient nor to access a medication or solution that might be used for a subsequent patient. Use fluid infusion and administration sets (i.e., intravenous bags, tubings and connectors) for one patient only and dispose appropriately after use. Consider a syringe or needle/ cannula contaminated once it has been used to enter or connect to a patient’s intravenous infusion bag or administration set. Safe injection Practices

35. Use single dose vials for parenteral medication whenever possible. Do not administer medications from single dose vials or ampules to multiple patients or combine leftover contents for later use. If multidose vials must be used, both the needles or cannula and syringe used to access the multidose vial must be sterile. Do not keep multidose vials in the immediate patient treatment area and store in accordance with the manufacturer’s recommendations; discard if sterility is compromised or questionable. Cleanse the access diaphragms of medication vials with 70% alcohol and allow the alcohol to dry before inserting a device into the vial.

36. Linen and Laundry

37. If linen is contaminated by blood or body fluids, collect in defined bags with biohazard symbol and label properly with type of contamination( urin , feces, blood) and area of generation. Transport to the laundry by separate covered linen-carrying trolleys. Contaminated/soiled linen should be treated by a bleaching agent(preferably hypochlorite) Linen and Laundry management

38. CLEAN LINEN : This refers to the clean & laundered linen. USED LINEN : Which is coming out for patient, which is not contaminated by blood and body fluids. SOILED LINEN /INFECTED/CONTAMINATED LINEN :This refers to linen contaminated with blood or other body fluids,e.g faeces.It specifically applies to linen that has been used by a patient or client who is known or suspected to be carrying potentially pathogenic microorganisms, linen from infectious(or isolated)patients/clients or those suspected of being infectious.

39. POINTS TO BE REMEMBER All laundry staff shall follow standard precautions &hand washing shall be adhered to strictly.

40. Handle all contaminated linens with minimum agitation to avoid contamination of air, surfaces, and persons Do not sort or rinse soiled linens in patient-care areas Collect in defined bags with biohazard symbol and label properly with types of contamination, area of generation. Transport to the laundry by separate covered linen carrying trolleys Contaminated /soiled linen should be treated by a bleaching agent Linen shall not be placed/dropped on the floor or on other surfaces which may be touched frequently as this could lead to contamination , especially during care delivery e.g : locker/table top. Staff shall avoid shaking linen as this may result in the dispersal of potentially pathogenic microorganisms and/or skin scales into the environment. Hand hygiene shall be performed following handling of linen. Handling and Laundering Soled Linens

41. Appropriate and clean bags e.g:linen hampers shall be made available as close to the point of use as possible. Linen soiled or contaminated with blood or other body fluids, shall be placed directly into a pink polybags . This bag indicates that linen is soiled/foul. Infected/Contaminated linen(Preparations and Staff Protection:

42. PPE shall be worn appropriately to protect those transporting linen,e.g : Gloves Measures shall be in place to ensure that linen for use arrives clean Inspection shall be carried out of those transporting linen e.g. :auditing of trolleys to ensure these are clean and that cages are used for storage of linen in these settings with clear separation of clean and dirty linen. Transport of linen to and from the laundry

43. Laundry staff shall wear PPE as appropriate, e.g : gloves,apron . When sorting other used linen,laundry workers shall ensure that any abrasions or cuts are covered and gloves and other PPE is worn. Inappropriate items found during the sorting of linen,e.g catheter bags,sharps,shall be reported. The vehicle shall be disinfected after carrying dirty laundry. The central laundering of linen

44. Patient placement

45. Determine patient placement based on the following principles: Place patient in a single patient room who: Pose a risk for transmission infection to others. Route(s) of transmission of the known or suspected infectious agent. Availability of single-patient rooms Patient placement

46. Care of environmet

47. Clean and disinfect surfaces :bed rails, over bed table and frequently-touched surfaces in the patient care environment( eg ., door knobs etc). Care of environment:

48. Clean and disinfect surfaces that are likely to be contaminated with pathogens. Including those that are in close proximity to the patient ( eg ., bed rails, over bed tables) and frequently-touched surfaces in the patient care environment( eg ., door knobs, surfaces in and surrounding toilets in patients’ rooms) on a more frequent schedule compared to that for other surfaces. Use hospital approved disinfectants. Use in accordance with manufacturer’s instructions. Care of environment:

49. Designated personnel : responsible for cleaning and disinfection of environmental surfaces and medical equipment are assigned to specific persnnel . All assigned personnel are trained in the appropriate Cleaning /disinfection procedures and the proper use of PPE and cleaning products. Supplies and cleaning products : Use EPA- registered disinfectant with appropriate germicidal claim for the infective agent of concern (may vary depending on situation) and follow the manufacturer’s safety precautions and instructions|(e.g. amound , dilution, safe use, storage and disposal) for cleaning/ disinfection.Products and supplies are reviewed periodically to ensure that the materials used are consistent with the existing guidelines and meet the needs of the staff Surface disinfection

50. Thank you