Infection Control for the Safety Monitor

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Infection Control for the Safety Monitor

• Anne Lawrence
• Nov, 2006

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Role of the Safety Monitor as a Team Member

• Objectives
• 1. Understand the concept of quality as it
  relates to health care.
• 2. Understand how each department works together
  to provide quality care.
• 3. Discuss how attitude is important to the work
  environment.
• 4. Discuss the impact of attitude on personal
  health, safety and productivity.

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Quality Care

• Whos Job is it?
• - any and all health care workers.
• Why?
• - it is important to patients and residents.
• - important to families and communities.
• - we promise as an organization.
• - we are the organization / team that provide
  the care.

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Why is your attitude so important?

• Because .
• it affects how you look,
• what you says and
• what you do

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Attitude

• it affects how you feel both
• physically and mentally.
• And
• it largely affects how successful you are
  in achieving your purpose in life.
• WHAT COULD BE
• MORE IMPORTANT?
  

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What About You?

• Is the Glass half full or half empty?

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Attitude

• a POSITIVE Attitude
• makes everyday life
  Better!
• LIFE more meaningful!
• PROBLEMS easier to handle!
• GOALS more attainable!
• MISTAKES less disastrous!
• the FUTURE more exciting!

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Attitude

• SO
• The Quality of your life depend on YOUR attitude
  towards yourself and others
• which only YOU can change.
• Start practicing POSITIVE THINKING
• to create a POSITIVE
  ATTIUDE
• RIGHT NOW.
• 
  

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Infection Control and Employee Health
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Infection Control/Employee Health

• Objectives
• - Have a basic understanding of the role of
  Infection Control/ Staff Health
• - Understand the importance of a healthy
  lifestyle and good personal hygiene.
• - Understand the importance of reporting
  occupational injuries.

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Infection Control

• What does this mean?
• Any Ideas?

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Infection Control

• Preventing illnesses acquired at a
• health care facility.
• Hospital acquired infections are known as
  nosocomial infections.
• examples urinary tract infections, surgical
  infections, respiratory infections, foodbourne
  illness, hepatitis and AIDS.

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Why is Infection Control Important

• It is vital to the patients well being, and
  yours, too.
• Infections can lengthen the hospital stay,
  cause inconvenience, loss of income, pain and
  even death.

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Who Is Responsible?

• Who do you think?
• - the Infection Control department?
• - doctors?
• - nurses?
• - administration?
• - anyone else?

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Infection Control

• Involves consultation teaching staff re
  isolation and care of infected patients.
• Involves monitoring of patients and staff for
  infectious or contagious diseases. Infections may
  be transmitted from employee to patient or
  from patient to employee

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Focus of IC

• Education
• teachings re disease process and prevention.
• policy development.
• Surveillance
• data collection.
• Control measures
• cleanliness of environment.
• waste management
• proper use cleaning of
• equipment.

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Staff Health

• Starts with being healthy.
• Prevention of disease in staff
• On orientation health assessment
• - immunization record
• - blood work for
  immune
• status
• (measles, rubella,
  varicella)
  
  
  
• - Health Record

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Immunization

• Tetanus/Diptheria
• Hepatitis
• Rubella vaccine if not immune
• Varicella vaccine if not immune
• Influenza vaccine
• PPD (Tuberculine Testing)

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Job Related Illnesses

• Infectious Contacts
• Exposure to
• Tuberculosis skin testing/ CXR/ 3 month
  follow up.
• Chicken Pox varicella titre if non
  reactive off work from day 10-21 post
• exposure.

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Job Related Illnesses

• Exposure to Blood and/or Body Fluids
• Hepatitis B - 6 - 30
• Hepatitis C - 0.5 - 10
• HIV - 0.1 - 0.3

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Work Restrictions

• Diarrhea individual assessment
• - may be excluded from pt care
• - food service workers no
  food
• handling until symptoms
  resolve.
• Influenza during communicable period,
• employees may be excluded
  
• from direct patient care.

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Work Restrictions

• Herpes Simplex individual assessment.
• May be excluded
  from
• direct patient
  care.
• Conjunctivitis draining sore eyes. Employee
  maybe excluded from direct pt care.
• Sore hands individual assessment.

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Health Record

• Confidential
• All information collected in one file
• Updated
• Copies available

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Staff Health and Safety

• NO SCENTS IS GOOD SENSE
• Please do not wear perfumes or any scented
• products to work. Scented products contain
• chemicals which can cause serious problems
• for many people with lung disease allergies.

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Employee Health

• No clinic available
• report to ext. 5297 if you are at work and
  sick.
• If you have vomiting and/or diarrhea.
• If you have open sores.
• If you have possibly been in contact with a
  communicable disease.

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Reporting Incidents

• All accidents, injuries or near misses should be
  reported ASAP.
• Complete the form.
• Notify your manager.
• Notify staff health if there has been an exposure
  to blood or body fluids.

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The Chain of Infection
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Objectives

• Describe the chain of infection.
• Have a basic knowledge of microbiology.
• Explain the factors that allow microorganisms to
  grow and how to eliminate or control these
  factors.

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The Chain of InfectionDefinitions

• Infection process by which a susceptible host
  (person) is invaded by a pathogenic (or
  infectious) agent that grows and causes harm.
• Types localized, primary, secondary, mixed,
  cross droplet, airbourne, generalized.
• Others waterbourne, foodbourne, terminal and
  septic.

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Definitions cont

• Antibodies a protein that is produced in the
  body in response to invasion by a foreign agent
  (antigen) and that reacts specifically with it.
• Inflammation tissue response to injury or
  destruction of the cells. (Injury or infection)

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Definitions cont

• Bacteria can be harmful or helpful.
• - Comes in a variety of shapes.
• - Reproduce every 20 minutes.
• Virus - smaller than bacteria.
• - parasitic in nature.
• - can remain inactive for long periods of time
• Fungi vegetable organism (classed with
  mushrooms and mold)

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What allows microorganisms to grow and cause
infections?

• The microorganism must enter the body.
• There must be sufficient numbers to cause a
  disease.
• Must be capable of destroying healthy tissue.
• The host must not have immunity to the disease.
• The route of transmission is appropriate.

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Chain of
Infection
Infectious Agent
Reservoir
Susceptible Host
Portal of Entry
Portal of Exit
Mode of Transmission
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Standard Precautions Transmission Based
Precautions
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Objectives

• Understand the importance of isolation
  precautions in the health care setting.
• Understand the importance of wearing PPE.
• Understand how to properly don and remove PPE.

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Hospital-based Infections

• Each year nearly 200,000 patients in Canada get
  an infection while hospitalized.
• Of these patients, about 8,000 will die as a
  result of their infection!
• Estimated cost - 1 billion a year.

Community and Hospital Infection Control
Association of Canada
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Transmission of infection within a hospital
requires three elements

• Source
• Host
• Transmission

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Source

• Patients
• Personnel
• Visitors
• Incubation period of a disease
• Colonized by an infectious agent
• Chronic carriers of an infectious agent

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Other sources

• Patients own endogenous flora
• Inanimate environmental objects (ie., equipment
  and medications)

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Host

• Resistance to pathogenic micro- organisms
• gt age
• gt underlying diseases
• gt certain treatments
• gt breaks in first line of defense

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Standard Precautions

• Prevents the spread of microorganisms.
• Applies to ALL patients.
• Transmission based precautions are added if
  needed.
• Reduces the spread of infection within the
  hospital setting.

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Applies to

• Blood
• All body fluids except perspiration
• Non-intact skin
• Mucous membranes

If it is wet and sticky and not yours DO NOT
touch it without gloves!
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Do it right every time!

• You wont have to question yourself when a
  patient is diagnosed as infectious!

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Transmission Based Precautions

• Designed for patients infected with highly
  transmissible diseases or pathogens.
• Additional precautions beyond Standard
  Precautions are needed to interrupt transmission
  in hospitals.
• Used either singularly or in combination, but
  always with Standard Precautions.

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Transmission

• Five main routes of transmission
• gt Contact
• gt Droplet
• gt Airborne
• gt Common vehicle
• gt Vectorborne
• These routes do not usually play a significant
  role in typical nosocomial infection.

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Mode of Transmission

• In medical care facilities, hands are the major
  instrument for the transmission of most bacteria.

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Hand-washing

• In health care, nurses and doctors wash only 30
  of the required time between patient contacts and
  procedures!

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Trivia Time!!!

• How may people stop to wash their hands after
  using the washroom?

1 in 3!!!
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More Trivia!!!

• How many diseases can be spread by not washing
  your hands?

Over 200!!!
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Prevention of Infection

• Hand washing
• Use plain soap and water.
• Alcohol hand wash is 99.9 effective (wash with
  soap and water if hands are visibly soiled).

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Handwashing
Happy Birthday
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Contact Transmission

• Involves skin-to-skin contact and physical
  transfer of microorganisms to a susceptible host
  from an infected or colonized person.
• Indirect contact transmission involves contact
  with a contaminated object i.e., a side-rail or
  light switch in the patients environment.

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Examples of diseases

• Gastrointestinal infections (Norwalk Virus)
• Scabies
• Clostridium difficile
• Multi-resistant organisms (MRSA/VRE)

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Important points

• Bring only the supplies you need into the room.
• Always wear a gown and gloves.
• Remove personal protective equipment immediately
  when finished.
• Wash hands.

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Just because you cant see it, doesnt mean that
it isnt there!
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Droplet Transmission

• Involves contact of the eyes or mucous membranes
  of the nose and mouth of a susceptible person
  from a person who has the disease or who is a
  carrier.
• Droplets are generated primarily during coughing
  or sneezing.
• Requires close contact since droplets travel only
  short distances, 3 feet or less.

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Examples of diseases

• Meningitis
• Influenza

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Meningococcal Disease

• Caused by a bacteria
• Spread by close contact
• Droplet Precautions
• Chemoprophylaxis
• Treatment

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Important Points

• The door can be open.
• Always wear a mask (when working within 3 feet of
  the patient), gown, and gloves.
• Remove personal protective equipment immediately
  when finished.
• Wash hands.

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Airborne Transmission

• Occurs by spread of airborne droplets or dust
  particles containing the infectious agent.
• Organisms can be widely spread and may become
  inhaled by or deposited on a susceptible host in
  the same room.

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Examples of diseases

• Tuberculosis
• Varicella (Chicken Pox)
• SARS

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Did I Mention Hand-washing???
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Hand washing

• Good hand hygiene is still the easiest, cheapest,
  and best way to protect everyones health!

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Questions?
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Guidance for the Selection and Use of Personal
Protective Equipment (PPE) in Healthcare Settings
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PPE Use in Healthcare SettingsProgram Goal

• Improve personnel safety in the healthcare
  environment through appropriate use of PPE.

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

PPE Use in Healthcare Settings
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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
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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
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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
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Dos and Donts of Glove Use

• Work from clean to dirty
• Limit opportunities for touch contamination -
  protect yourself, others, and the environment
• Dont touch your face or adjust PPE with
  contaminated gloves
• Dont touch environmental surfaces except as
  necessary during patient care

PPE Use in Healthcare Settings
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Dos and Donts of Glove Use (contd)

• 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
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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
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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
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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
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PPE Use in Healthcare SettingsHow to Safely
Don, Use, and Remove PPE
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Key Points About PPE

• Don before contact with the patient, generally
  before entering the room
• Use carefully dont 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
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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
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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
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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
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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
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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
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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
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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
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PPE Use in Healthcare SettingsHow to Safely
Remove PPE
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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
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Sequence for Removing PPE

• Gloves
• Face shield or goggles
• Gown
• Mask or respirator

PPE Use in Healthcare Settings
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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
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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
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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
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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
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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
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Removing a Mask

• Untie the bottom, then top, tie
• Remove from face
• Discard

PPE Use in Healthcare Settings
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Removing a Particulate Respirator

• Lift the bottom elastic over your head first
• Then lift off the top elastic
• Discard

PPE Use in Healthcare Settings
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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

Ensure that hand hygiene facilities are
available at the point needed, e.g., sink or
alcohol-based hand rub
PPE Use in Healthcare Settings
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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

Ensure that hand hygiene facilities are
available at the point needed, e.g., sink or
alcohol-based hand rub
PPE Use in Healthcare Settings
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Occupational Exposure

• We will talk about
• What is an exposure?
• What to do if an exposure occurs.

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Occupational Exposure

• We will discuss
• HIV/AIDS
• Hepatitis B C
• What they are.
• How they are spread.

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