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									INFECTION PREVENTION
    AND CONTROL
       AN D
PERSONAL PROTECTIVE
     EQUIPMENT
Infection Prevention and Control – Objectives of this package

After reading this section on Infection Control, you will be able to:
     Apply the concepts of Routine Practice / Standard Precautions in your practice.
     Recognize the importance of proper handwashing technique and compliance to hand
        hygiene.
     Recognize the risks from sharps injuries and list the appropriate interventions, including
        immunization.
     Identify the resources available to aid in solving Infection Control issues.
     Outline when isolation is used and how to determine which patients require isolation



                                      Our Service
1. What is Infection Control?

It is a field involving:
          Infectious Disease
          Microbiology
          Epidemiology & Statistics
          Management & Communications
          Employee Health
          Education
          Disinfection, Sterilization & Sanitation
          Patient Care Practices.

    Our goal is to prevent and control of the spread of nosocomial
    (hospital-acquired) infections from occurring in patients, staff and
    visitors.

2. Who makes up the Infection Prevention and Control Team?

We are a diverse team made up of a Manager certified in Infection Control, 8 Infection Control
Practitioners (ICP) who are Registered Nurses, Registered Medical Lab Technologists or
Respiratory Therapists certified in Infection Control or pursuing it. In addition the team also has a
data analyst and secretary who support the ICPs. We are active members of Community and
Hospital Infection Control Association (CHICA), Hamilton and Neighbouring Districts Infection
Control (HANDIC), Hamilton Prevention and Control committee (HIPCC) and American
Practitioners of Infection Control (APIC).

3. What does the Infection Control team do?

The Infection Control service supports all areas in the hospital. The Infection Prevention and
Control (IP&C) policies and procedures are mandated under the Health and Safety Act and are
found on the Hamilton Health Sciences intranet under the Policy Library. The policies and
procedures are written to ensure there is compliance with legislation, national and provincial
guidelines. The ICPs perform clinical surveillance rounds based on previous statistics and problem
areas. Surveillance by objectives, education & consultation is provided to patients, staff, physicians,
visitors, outside agencies and the community.

                                                  Orientation                          Revised April 2007
4. Who are the members of the Infection Control Team:
     Manager, Infection Prevention & Control (IP&C.) Service, Lee Ramage ext. 42011.
     Medical Director, Dr. Mark Loeb
     Secretary, Infection Prevention & Control, Margaret Renda ext. 42007

      Chedoke and McMaster:
         Mary-Catharine Orvidas, ext. 76310, pager 7517
         Connie Gittens-Webber, ext. 75407, pager 7138
         Simona Dalgleish, ext. 75400, pager 7252
      General:
         Cathy Dixon, ext. 46189, pager 7556
         Shelley Schmidt, ext 46115, pager 7101
         Patricia Perry, ext. 46141, pager 7081
      Henderson:
         Jennifer Blue, ext. 42056, pager 7004
         Cindy O’Neill, ext. 43534, pager 7051

     Or visit the Infection Control Intranet at http://corpweb/infectioncontrol/

     **After 17:00 there is one ICP on call for all sites and they can be contacted through paging .

5. Where can I find the Infection Control Policies and Procedures?

     The Infection Control policies and procedures are on-line. They can be accessed through the
     HHS Intranet by selecting Policy Library >Infection Control > choose specific Policy and
     Procedure. Also any updated information or new standards will be outlined on the Infection
     Control website.

6. Are there differences at the four sites?
     Due to the distinct nature of the patient populations at all four sites, some differences in
     practice may occur. Every effort is made to ensure that the basic principles of Infection Control
     are used in consistent decision-making. Where you see variations in protocol, which are
     difficult to understand, please contact your Infection Control Practitioner for clarification or
     correction.
     Remember ...not all “bacteria” are harmful. In an effort to protect you and our patients,
     remember to please take the time to wash your hands for 15 seconds after all patient contact
     and after handling of contaminated items.

     Waterless handwash products are the best and most efficient method to wash hands.




                                                     Orientation
Handwashing is a #1 priority



                   15 seconds before and after patient contact or
                    touching their environment.
                   Before and after applying gloves.
                   Wear gloves for one task then remove.
                   Use anti-bacterial hand lotion provided in hospital.
                   No artificial nails – direct patient care or food
                    handling.




                          Using Quik-Care™
                Gently pull the tip of the nozzle with the fingers to
               dispense a small amount of Quik-Care™ foam (the size
               of a quarter) into the palm of your cupped hand.

               ****Rub hands together until completely dry before
                         touching anything




                                   Orientation
Infectious Cycle

Organisms are spread by modes of transmission. All isolation and disinfection practices are based
on the 6 modes of transmission.

                                                                                       Modes of Transmission
                                                                 ion
                                                              iss           1.   Contact- Touch, person –to-person spread. Handling contaminated equipment
       Re                                                sm
            se                                      an
               rv                                 Tr                        2.   Droplet- Large droplets sprayed one meter around patient from coughing/sneezing
                  o   ir                   s   of
                                        de
                                   Mo                                       3.   Airborne - Small particles dispersed into the air and remain in the air.
                                                                            4.   Vehicle – Common source e.g. Food contaminated with bacteria.
                                                                            5.   Vector – Spread by vector e.g. West Nile virus spread by mosquito.
                                                                            6.   Parenteral – Needlestick injuries – bloodborne pathogens


                           Susceptible Host




Whether Infection Occurs Depends Upon………

       Length of the exposure
       Nature of the exposure
       Type of exposure (micro-organism)
       Inoculum (how much substance got into patient/you)
       Virulence of the substance
       Mode of transmission
       Your health status, risk factors, immunity or susceptibility


             Type of
                                                                       Potential Pathogens                                                   PPE
            Isolation

            AIRBORNE                                      Tuberculosis, Varicella, Disseminated shingles                        N95 Respirator


                                                                                                                                Surgical facemask or fluid
             DROPLET                                      Neisseria meningiditis disease. Rubella                               resistant procedure mask
                                                                                                                                with eye protection.

                                                                                                                                Surgical facemask or fluid
                                                          Influenza, RSV, pneumonia, patients with fever &                      resistant procedure mask
  DROPLET/CONTACT                                         respiratory illness                                                   with eye protection.
                                                                                                                                Gown and Gloves
                                                          Scabies/lice, draining wound not contained in dressing,
                                                          diarrhea, Antibiotic Resistant Organisms (AROs)
                                                          including Multi-resistant Staphylococcus aureus
             CONTACT                                      (MRSA), Vancomycin Resistant Enterococci (VRE),
                                                          Extended-spectrum Bacterium Lactamase (ESBL),                         Gown and Gloves
                                                          Multi-resistant pseudomonas aureus, Strep pneumoniae
                                                          resistant to Penicillin




                                                                                        Orientation
How to put on Personal Protective Equipment (PPE)

                            Wash Hands




How to remove Personal Protective Equipment (PPE)




                                  Orientation
Isolating Patients

      No Doctor’s order needed to isolate refer to Infection Control policies and
       procedures Communicable Disease Index and Febrile Respiratory Illness (FRI)
       policy on intranet.
            Look up signs and symptoms/ diagnosis/ organism on Communicable
               disease index to determine who should be isolated.
      Follow and wear the appropriate Personal Protective Equipment (PPE) as
       outlined on patient’s door & use the supplies outside door
      Discard apparel appropriately - gown and gloves in room, face masks and eye
       protection at door after handwashing
      Dishes and Linen - no special precautions * Just wash hands after removing PPE
      Waste – infectious waste goes into YELLOW plastic bags
      Airborne isolation requires negative pressure room and/or High Efficiency
       Particulate Air filter (HEPA) – door must be kept CLOSED at all times.

Standard Precautions (Routine Practices)

Treat all blood and body fluids as potentially infectious and apply the appropriate PPE
according to the task you will be performing.

As a healthcare professional, you are responsible to assess what procedures you are
about to perform, then don (apply) the most appropriate PPE. Any procedure where
there is even a remote chance of exposure to blood or body substance spray – a
facemask and eye protection must be worn.

Notifying Infection Control

      CALL your Infection Control Practitioner at your site for Infection Control
       concerns:
      Inform patient name and diagnosis for any patient who has suspect or known
       infection;
            Respiratory symptoms, positive chest x-ray, rashes, post operative
               infected wounds, IV or central line infections, diarrhea
      When isolating patient or discharge isolation
      When consultation is needed

Exposed to Meningitis?

   What type of meningitis did the patient have?
   If Meningococcal - Yes, then ask
            Did I do mouth-to-mouth?
            Did I intubate patient?
            Did I suction patient?
            Was I directly in contact with patient while they were vomiting?
   If the answer is “No”, no further follow-up is required

   Was I wearing a facemask? - If answered “Yes” – No follow-up is required

   In any case, you should report to Occupational Health

                                              Orientation
What Is a Needlestick or Mucosal Injury?

     Puncture, cut or jab - breaking your skin caused by a contaminated sharp object
      eg. needle, scalpel
     Mucosal splash is a spray of blood or contaminated body fluid into eyes, nose or
      mouth

Immediate First Aid following Needlestick/Sharp Injury

     Briefly induce bleeding from wound
     Wash wound 10 minutes with soap and water or antiseptic
        (Do not use chlorine bleach on your skin)
     Remove foreign objects from wound
     Report to Employee Health or when closed, report to ER immediately

Immediate First Aid - Non-intact Skin or Eye Exposure

     Wash area of skin with soap and water or antiseptic soap
     If splash to eye, irrigate copiously with tap water, sterile saline, sterile water for
      10-15 minutes.
     Report to Employee Health or when closed, report to Emergency Room
      immediately

Follow Up

     Need to be assessed for Post Exposure Prophylaxis (PEP). If patient is HIV+,
      need to start Anti-virals as soon as possible after injury no later than 8 hours.
     Your Hepatitis B status- Have you been immunized? Must have Anti-HB > 10
          If source positive HBsAg+ - You need Hepatitis B Immunoglobulin
          If source negative for HBsAg – You need a vaccine
     Need Anti-Hepatitic C Virus checked. If this turns positive within 3-6 months, you
      may need treatment

You are Responsible and A Role Model For

     Following good handwashing practices.
     Wearing proper PPE and removing it carefully as per Isolation signs and
      Standard Routine Precautions.
     Follow the Infection Control policies and procedures, when in doubt ask
     Complying with Infection Control practices
     Reporting your exposures and any infectious illness (i.e. febrile respiratory
      illness) or Communicable Disease to Employee Health
     Maintaining your immunizations and obtaining your
            Annual Flu shot
            Hepatitis B vaccine




                                               Orientation
Orientation
Orientation
Orientation

								
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