Infection Control in health care facilities

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Infection Prevention and Control for Epidemic-
and Pandemic-Prone Acute Respiratory Diseases

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Learning Objectives

• Describe basic infection-control principles.
• Discuss core infection-control measures in
  health-care settings.

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Presentation Overview

• Basic infection control principles
• Core infection control measures used in health
  care settings

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Basic Infection Control Principles
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Aim of Infection Control

• Basic infection control measures reduce risk of
  transmission of pathogens from a known or unknown
  source

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Chain of Infection

Susceptible host
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Routes of Transmission

• Contact Infections spread by direct or indirect
  contact with patients or the patient-care
  environment (e.g., shigellosis, viral
  hemorrhagic fevers)
• Droplet Infections spread by large droplets
  generated by coughs, sneezes, etc. (e.g.,
  Neisseria meningitidis, pertussis)
• Airborne (droplet nuclei) Infections spread by
  particles that remain infectious while suspended
  in the air (TB, measles, varicella, and variola)

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Breaking the Chain of Infection

• Source control measures
• -Cough etiquette, cleaning, disinfection
• Modes of transmission
• -Contact hand hygiene
• -Droplet distance from source gt1 m
• -Airborne ventilation
• -Vector bednets
• Portal of entry into the host
• -Adding barriers, e.g., PPE
• Host
• -Strengthen host defences, e.g., vaccination

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Transmission of Epidemic- and Pandemic-Prone
Acute Respiratory Diseases
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Core Infection Control Measures in Health Care
Settings
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Core Infection Control Measures in Health Care
Settings (1)

• Early recognition and reporting
• Infection control precautions
• Hand hygiene alcohol-based hand rub, hand
  washing
• PPE gloves, gowns, masks/respirators, eye
  protection

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Core Infection Control Measures in Health Care
Settings (2)

• Patient accommodation
• Environmental cleaning and waste disposal
• Occupational health management

WHO
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Prevention is Primary
CDC
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Early Recognition in Health Care Facilities
Health care facility staff must quickly identify
and separate potential sources of infection from
susceptible hosts
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How to identify rapidly

• Rapid identification of Patients with Epidemic-
  or Pandemic-Prone Acute Respiratory Diseases
• Clinical indications
• Severe acute febrile respiratory illness (e.g.,
  fever gt 38C, cough, shortness of breath)
• Exposure history consistent with ARD of potential
  concern
• Epidemiological indications
• History of travel to area affected by ARDs
• Possible occupational exposure
• Unprotected contact with ARDs patient(s)

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Infection Control Precautions

• Standard precautions
• Should be applied for ALL patients
• Transmission-based precautions
• Contact
• Droplet
• Airborne

Transmission-based precautions are often used
empirically, according to the clinical syndrome
and the likely etiological agent
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Standard Precautions

• Hand hygiene
• Respiratory hygiene/cough etiquette
• Use of personal protective equipment (PPE)
• Prevention of needle sticks/sharps injuries
• Cleaning and disinfection of the environment
• and equipment

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Droplet Precautions

• Protection against respiratory pathogens
  transmitted by large droplets
• In addition to Standard Precautions
• Use a medical mask when lt 1 m of patient
• Maintain a distance 1 meter between infectious
  patient and others
• Place patient in a single room or cohort with
  similar patients
• Limit patient movement

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Contact Precautions

• Protection against contact with large droplets
• In addition to Standard Precautions
• Use non-sterile, clean, disposable gloves, gown,
  apron (only if gown is not impermeable)
• Use disposable or dedicated reusable equipment
  (which must be cleaned and disinfected before use
  on other patients)
• Limit patient contact with non-infected persons
• Place patient in a single room or cohort with
  similar patients

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Airborne Precautions

• Protection against inhalation of tiny infectious
  droplet nuclei
• In addition to Standard Precautions
• Use particulate respirator
• Place the patient in adequately ventilated room
  ( 12 air changes per hour)
• Limit patient movement
• Use airborne precautions for performance of any
  aerosol-generating procedures associated with
  pathogen transmission

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Hand Hygiene

• Hand hygiene should be performed
• before and after any direct contact with a
  patient
• after contact with blood, body fluids, secretions
  and excretions
• after contact with items contaminated with blood,
  body fluids, secretions and excretions, including
  respiratory secretions
• Use alcohol-based hand rub or wash hands with
  soap and water
• Wash hands if visibly soiled

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Respiratory Hygiene and Cough Etiquette

• Part of standard precautions
• Education of health care workers, patients and
  visitors
• Source control measures (e.g., cover cough to
  prevent dissemination of infectious droplets)
• Hand hygiene
• Spatial separation (gt 1 meter) of persons with
  acute febrile respiratory symptoms

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Personal Protective Equipment
Courtesy of K. Harriman
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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

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PPE for Standard Precautions Based on Risk
Assessment

• IF direct contact with blood body fluids,
  secretions, excretions, mucous membranes,
  non-intact skin
• Gloves
• Gown
• IF there is the risk of spills onto the body
  and/or face
• Gloves
• Gown
• Face protection (mask plus eye protection goggle
  or visor face shield)

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PPE for Transmission-Based Precautions

• Used in addition to Standard Precautions
• Contact Precautions
• Gloves
• Gown
• Droplet Precautions
• Medical mask
• Airborne Precautions
• Particulate respirator

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Masks and Respirators Barriers and Filtration

• Surgical masks
• Protect against body fluids and large particles
• Particulate respirators (e.g., N95)
• Protect against small particles and other
  airborne particles
• Alternative materials (barriers)
• Tissues, cloth

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PPE for Persons Providing Care for Patients with
Acute Febrile Respiratory Illness, Including
Patients with Suspected or Confirmed AI
Infection

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PPE for Interviewing Exposed Persons and
Contacts of ARDs Patients

• Asymptomatic exposed persons and contacts
  (low-risk)
• Routine use of PPE not recommended
• Maintain 1 meter distance between interviewer and
  interviewee
• Use proper hand hygiene
• Symptomatic exposed persons (higher-risk)
• PPE recommended in community and health care
  facility Contact and Droplet Precautions
• In health care facility, person should be placed
  in adequately ventilated room ( 12 air changes
  per hour), if possible
• Maintain a distance of gt 1 meter, if possible

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PPE for Specimen Collection Exposed Persons

• Collecting respiratory specimens is a high-risk,
  aerosol-generating procedure
• PPE recommended
• Gloves
• Gown
• Goggles or face shield
• N95 or higher level respirator

CDC
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Patient Accommodation

• Isolate patients with droplet or airborne spread
  diseases from other patients
• Separate wards, areas, or establish rooms for
  infectious patients where isolation facilities do
  not exist
• Only those patients with epidemiological and
  clinical information suggestive of a similar
  diagnosis should share rooms
• Separate patients by at least 1 meter

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Patient accommodation Natural Ventilation Room
1 meter
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Duration of IC measures for Avian and Pandemic
Influenza

• Adults and adolescents gt 12 years of age from
  time of admission until 7 days after symptoms
  resolved
• Infants and children 12 years of age from
  time of admission until 21 days after symptoms
  resolved
• For immunocompromised patients, pathogen shedding
  may be protracted

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Environmental Cleaning and Waste Disposal

• Environmental cleaning
• Use appropriate procedures for the routine
  cleaning and disinfection of environmental and
  other frequently touched surfaces
• Waste disposal
• Treat waste contaminated with blood, bodily
  fluids, secretions and excretions as clinical
  waste, in accordance with local regulations

WHO
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Waste Disposal

• Use Standard Precautions
• Gloves and hand washing
• Gown Eye protection
• Avoid aerosolization
• Prevent spills and leaks
• Double bag if outside of bag is contaminated
• Incineration is usually the preferred method

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Autopsy Precautions for Influenza A (H5N1)

• Follow standard PPE procedures for autopsies
• Anyone handling a corpse should follow standard
  precautions for blood and body fluids

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Occupational Health Management During an Outbreak

• Monitor staff who work with patients with an
  infectious disease of potential concern for
  symptoms
• Screen for symptoms of influenza-like illness
  among staff reporting for duty (fever, cough)

WHO
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Implementation of Core Infection Control Measures
During Rapid Containment

• Early recognition and reporting
• Infection control precautions
• Hand hygiene
• PPE gloves, gowns, masks/respirators, eye
  protection
• Patient accommodation
• Environmental cleaning and waste disposal
• Occupational health management

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Hospital Preparedness Key Points

• Apply standard precautions routinely in all
  health-care settings
• Place all patients (suspected or confirmed with
  an infectious ARD) in a room or area separate
  from other patients
• Practice both standard and droplet precautions
  when caring for patients with infectious ARD

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Important Components for HC Facility Infection
Prevention and Control Program

• Available supplies and equipment (PPE,
  disinfectants)
• Policies and guidelines for procedures
• Ongoing educational programs for healthcare
  facility staff
• Process for monitoring staff health to identify
  and to prevent staff-to-patient and
  patient-to-staff spread of infection

Jamaica IC Guidelines
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Infection Control for ARD in Heath Care Settings
Infection control precautions
Patient
Standard and droplet precautions
Symptoms acute ILI
Risk Factor
Investigation for ARD of potential concern
Single room adequately ventilated, if possible
Report to Public Health Authorities
Reassess precautions
Different diagnosis
Confirmed ARD of potential concern
Single room adequately ventilated ( 12 air
changes per hour), if possible
WHO
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Environmental Decontamination

• Cleaning MUST precede decontamination
• Disinfectant ineffective if organic matter is
  present
• Use mechanical force
• Scrubbing
• Brushing
• Flush with water

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Environmental Decontamination Disinfecting

• Household bleach (diluted)
• Quaternary ammonia compounds
• Chlorine compounds (Chloramin B, Presept)
• Alcohol
• Isopropyl 70 or ethyl alcohol 60

• Peroxygen compounds
• Phenolic disinfectants
• Germicides with a tuberculocidal claim on label
• Others

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Using Bleach Solutions

• First clean organic material from surfaces or
  items
• Wipe nonporous surfaces with sponge or wet cloth
• Allow to dry
• Use fresh diluted bleach daily!