HANDS UP FOR HANDS-ON! Infection Prevention & Control Newsletter The purpose of bringing this quarterly newsletter to you is to provide you with information and updates on contemporary infection prevention and control issues that may be relevant to your workplace. We hope you find the information informative and useful. Introducing our new Team Member... Volume 1, Issue 2 We have welcomed a new member, Yvonne Fletcher, to our team. Yvonne has been employed as October 2009 an Infection Control Nurse and joined the team in May. Yvonne completed her registered nurse training at the WA Institute of Technology in 1994. After completing her midwifery certificate at KEMH in 1988 she moved into day surgery where she has remained for the past 21 years combin- Inside this issue: ing a clinical and management role including staff development, OH&S, quality, accreditation and infection control. Yvonne completed the Graduate Certificate in Infection Control in 2007. Introducing our new 1 Yvonne brings to the team a wealth of experience in the day surgery setting with particular knowl- Team Member edge and skills in the reprocessing of reusable instruments and equipment, and maintenance of the associated environment. Welcome to the Hands-On Team Yvonne. PANVAX® Vaccina- 1 tion Campaign Hepatitis A & B 2 PANVAX® Vaccination Campaign In response to the recent influ- The principles for targeting PRIORITY GROUPS FOR Gastroenteritis Out- 2 break Checklist enza A (H1N1) pandemic, a groups in Australia include: VACCINATION national vaccination program 1. To prevent disease in those ♦ People with underlying Cleaning Re-usable 2 has been initiated by the Com- Equipment 3 people vulnerable to more chronic medical condit- monwealth. The aim of this severe outcomes. ions which may make Personal Protective 3 program is to provide free vac- them more vulnerable to Equipment cine against pandemic (H1N1) 2. To prevent spread of dis- complications from H1N1 2009 influenza for all members ease to the vulnerable by infection. of the community who wish to vaccinating their contacts. be vaccinated. Vaccinations are ♦ Health care and com- 3. To protect those people at scheduled to commence on munity care workers higher risk of exposure Wednesday 30 September 2009. (including volunteers & because of their work i.e. The initial rollout of the health care workers. students). Panvax® H1N1 vaccine will ♦ Indigenous people. 4. To protect health care ser- focus on ensuring that people in vices and reduce healthcare ♦ Pregnant women. the specified priority groups are worker absenteeism. offered the vaccine first. This Vaccinations will take place includes people with existing 5. To mitigate potential eco- either at your workplace, your underlying medical conditions nomic impact on the Aus- GP or a community based who have been identified as tralian pig industry. Mass Vaccination Clinic being at highest risk from pan- (MVC). 6. To provide herd immunity. demic (H1N1) 2009 influenza. REMEMBER... To find out more informa- There will be flexibility to vacci- tion about locations and TAKE TIME TO nate other people, such as fam- opening hours of the MVCs ily members of those at risk, if visit: WASH YOUR they wish to be vaccinated. HANDS WELL! www.public.health.wa.gov.au Page 2 HANDS UP FOR HANDS-ON! MANY OF US MAY BE AT Hepatitis A & B Vaccination - Who Needs It? RISK OF COMING INTO Hepatitis A vaccination is recommended for: CONTACT WITH HEPATITIS ♦ All travellers to, and all expatriates living in, moderately to highly endemic areas (including all developing countries; A OR B... ♦ Those whose occupation may put them at risk of acquiring hepatitis A - child day-care & WHAT ARE YOU DOING preschool staff, carers of people with intellectual disabilities, healthcare workers who regu- larly provide care to Aboriginal & Torres Strait Islander children, plumbers or sewage work- ABOUT IT? ers and sex workers; ♦ Those whose lifestyle may put them at risk of acquiring hepatitis A - men who have sex with men, and injecting drug users; ♦ People with intellectual disabilities; ♦ People chronically infected with either hepatitis B or C viruses; and ♦ Patients with chronic liver disease. Hepatitis B vaccination is recommended for : ♦ Residents and staff of facilities for people with intellectual disabilities; ♦ Healthcare workers, ambulance personnel, dentists, embalmers, tattooists and body – piercers; ♦ Others at risk include Police, emergency services staff, funeral workers, staff of child day-care centres and sex industry workers; and ♦ Household contacts of acute and chronic hepatitis B carriers. OUTBREAK! Gastroenteritis Outbreak Checklist Over the past few weeks, there have been a num- 4. Separate affected & unaffected residents. HAVE I TICKED ber of residential care facilities who have experi- 5. Restrict/discourage/minimise visitors. enced a gastroenteritis outbreak. The following ALL THE BOXES?? is a quick reference checklist to ensure that the 6. Restrict movement of staff, residents & outbreak is being managed correctly: visitors within the facility. 1. Inform staff, residents & visitors of the out- 7. Exclude staff with gastroenteritis until at break. Provide information about gastroen- least 48hrs after resolution of symptoms. teritis & put up advisory notices at appropri- 8. Instruct cleaners on increased/specific clean- ate sites around the facility. ing requirements. 2. Emphasise the importance of frequent & 9. Instruct staff on standard precautions for meticulous hand hygiene for staff, residents linen handling. & visitors. Provide adequate HH supplies (liquid soap, paper towels, alcohol-based 10. Notify the regional Population Health hand rub). Unit. 3. Implement contact precautions including isolation/cohorting and PPE. Effective & Appropriate Cleaning Prevents Cleaning Re-usable Instruments & Equipment Cross Contamination Effective reprocessing of reusable instruments and equipment involves cleaning immediately after use to remove organic residue and either disinfection (heat or chemical) or sterilisation. The proce- dures necessary for the cleaning, disinfection and sterilisation of reusable medical instruments and equipment, and for the maintenance of associated environments in health care facilities, are pro- vided in AS/NZS4187 & AS/NZS4815. Instruments and equipment must be reprocessed to a level appropriate for their intended use. Page 3 Cleaning Re-usable Instruments & Equipment cont. The minimum levels of processing and storage requirements for reusable instruments and equip- ment are based on the following three risk categories of use: 1. Critical site (entry into sterile tissue, cavity or bloodstream) - instruments should be sterile at time of use. Instruments should be single use and either steam sterilised or low-temperature chemi- cal sterilised. 2. Semi-critical site (contact with non intact skin or intact non sterile mucosa) - instruments should be single use or sterilised after each use. If this is not possible, high-level disinfection is the minimum level of reprocessing that is acceptable. 3. Non-critical site (contact with intact skin) - cleaning alone is generally sufficient for all noncriti- cal items after every individual use, although either intermediate or low-level disinfection may be appropriate in specific circumstances. These recommendations apply to all health care facilities including office-based practices. Donning & Removal of PPE Personal Protective Equipment Sequence Order The use of personal protec- ♦ Mask ♦ Slide ungloved finger under PPE ‘ON’ PPE ‘OFF’ tive equipment (PPE) pro- wrist of remaining glove, ♦ Protective eyewear peel off from inside, creat- tects healthcare workers from ing a bag for both gloves ♦ Gloves exposure to blood or body 1. How to don a gown ♦ Discard substances, non-intact skin and mucous membranes. ♦ Opening is in the back 2. Gown removal PPE should comply with ♦ Gown front & sleeves are ♦ Fully cover torso from neck ‘dirty’; handle by inside/ relevant Australian Stan- to knees & wrap around dards. Types of PPE include back back of gown, unfasten ties, peel gown away from disposable examination and ♦ Secure at neck and back neck and shoulders surgical gloves, protective 2. How to don a mask eyewear (glasses, goggles or ♦ Turn contaminated outside face-shields), surgical face ♦ Secure on head with ear surface toward the inside, loops or ties fold or roll into a bundle masks and respirators (P2 particulate respirator), gowns ♦ Place over nose, mouth & ♦ Discard and plastic aprons. Selection chin ♦ Perform Hand Hygiene and utilization of PPE is de- ♦ Fit flexible nose piece over nose bridge 3. Eyewear removal pendant on the outcome of a risk assessment. This assess- ♦ Adjust fit, snug to face and ♦ Outside of eyepiece is below chin ‘dirty’; handle by earpieces, ment determines the prob- grasp earpieces with un- ability of exposure to blood ♦ Fit test (to check for air es- gloved hands, pull away and body substances, amount cape around edges of mask) from face likely to be encountered, type 3. How to don eye protection ♦ Place is designated recept- of body substance involved acle for cleaning ♦ Position eyewear over eyes & and probable route of trans- secure 4. Mask Removal mission of the infectious 4. How to don gloves ♦ Front of mask is ‘dirty’; agent. To ensure complete handle by ear loops/sides, compliance with PPE, health- ♦ Insert hands into gloves remove from face in a down- care facilities should ensure ward direction, using ear ♦ Extend gloves over gown loops that all necessary items of cuffs (if wearing long sleeve PPE are readily available, ♦ Discard gown) accessible and maintained in 5. Perform hand hygiene Sequence for removing PPE good working order. Appro- immediately after removing priate education on correct ♦ All items must be removed PPE. and discarded carefully use should be provided to all healthcare workers. Always 1. Glove removal perform hand hygiene imme- ♦ Outside of glove is ‘dirty’; Remember… diately before donning and use glove-to-glove/skin-to- PPE is single person, after removing PPE. skin handling method single task use ONLY Sequence for donning PPE ♦ Grasp edge near wrist, peel away from hand, turning ♦ Perform hand hygiene glove inside out, hold in opposite gloved hand ♦ Gown/apron Page 4 Our Education Program Hands-On Infection Control offers a Training Activities for 2009 broad range of education training pro- Infection Prevention & Control - grams in infection prevention, control ♦ Infection Control On-Site Educa- and related areas. Programs can be tion and Training 2009—Schedule The Responsibility Is In Our Hands tailored to suit the specific needs of of Topics individual organisations, specialties, ♦ Infection Prevention Study Day environments and staff/volunteer CONTACT US groups. for Residential Care Staff September 2009 (Adelaide) Phone: 61 8 9227 1132 These programs can be incorporated ♦ Infection Prevention Study Day into existing induction/orientation, for Day Hospital/Procedure Fax: 61 8 9227 1134 inservice, professional development Facilities October 2009 (Perth) and targeted programs for all categories of clinical, support, ancillary and office ♦ Infection Prevention Study Day email@example.com (No. 3) for Residential Care Staff -based staff. November 2009 (Perth) www.handsoninfectioncontrol.com.au Education can be provided on or off All education topics and Study Day infor- site for your organisation using accred- mation is available on our website. ited trainers & assessors. To schedule your education and training Our educational needs please contact our staff. courses have been en- dorsed by APEC No 070523701 as author- ised by Royal College of Nursing, Australia (RCNA) according to approved crite- ria. Attendance attracts RCNA CNE points as part of RCNA’s Life Long Learning Program (3LP). USEFUL WEBSITES & RESOURCES REMEMBER! Government of Western Human Swine Influenza for Health Providers http://www.public.health.wa.gov.au Commonwealth Human Swine Flu for Health Professionals http://www.healthemergency.gov.au Immunise Australia Program http://www.immunise.health.gov.au Gastro-Info & Influ-Info Kits Order from National Mail & Marketing 1800 020 103 or Email NMM@nationalmailing.com.au “Hand Hygiene protects the people Standards Australia we come into contact with, our fami- lies, the environment, our communi- http://www.standards.org ties and US!” SAI-Global WebShop http://www.saiglobal.com Guidance for Selection & Use of PPE in Healthcare Settings “HANDS UP FOR HANDS-ON!” http://www.cdc.gov/ncidod/dhqp/ppe.html This newsletter’s purpose is to provide information only. Every effort has been taken to ensure it contains accurate and up-to-date information at the time of publication. While our advice and information is professionally sourced and provided in good faith and all care has been taken in preparation of this newsletter, we do not accept legal liability or responsibility relating to this newsletter and the information it contains.