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Principles of Infection Control
Care Homes IPC Study Day Sue Barber Lead Nurse, Infection Prevention & Control AV & Chiltern CCG’s
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Why Infection Prevention & Control is important
• A healthcare associated infection (HCAI) is an infection caused by any type of healthcare contact.
• Damage the patient’s quality of life – painful, unpleasant, scary and in severe cases can be fatal
• Cost the NHS approx. £1 billion per year
• Prevention of healthcare associated infections is covered by legislation in The Health & Social Care Act 2008
• Monitored by the Care Quality Commission
• 10 criteria against which health & social care providers must be compliant
• Increasing numbers organisms are becoming resistant to all our standard antibiotics
• Infections and outbreaks can attract high profile media attention and damage the organisations reputation
• Possibility of litigation with Health Care Associated Infections
• Risk of emerging pathogens such as pandemic influenza strains
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Responsibilities
• Staff must be appropriately trained in infection
prevention & control practice and knowledge
updated on a regular basis (records must be
kept)
• All staff are required to be familiar with, and
comply with infection control policies
• Don’t put residents or colleagues at risk if you
are unwell e.g. norovirus - do not return to work
until 48 hours without symptoms
• Identify and report IPC related risks
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Risk of infection
• Some people will be more at risk of infection than others.
• Elderly
• Young babies
• Immunocompromised
• Those with invasive devices e.g. catheters, PEG tubes
• Malnourished
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Chain of infection
Reservoir People,,equipment or
environments
Good hygiene & clean
environments
Portal of Entry Mucous membranes, broken
skin, invasive devices
Aseptic technique, hand
hygiene, management of
invasive devices
Susceptible Host Elderly, neonates,
immunosuppressed
Recognise high risk
patients, strict IPC
precautions &
immunise when able
Portal of Exit Excretions and secretions
Use of PPE, safe
management of clinical
waste and used linen
Mode of transmission Contact, airborne
Hand hygiene, cleaning
environments and
equipment
Infectious agent Eg bacteria, virus
Prompt treatment and
rapid identification of
infection can break
the chain
Take any of these links
out of the chain and
prevent the spread of
infection
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How infections can spread
There are 6 modes of spread
• Airborne
• Contact
• Ingested e.g. food poisoning
• Environmental e.g. water
• Vectors e.g. malaria
• Sexual
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Different types of Micro-organisms
• Bacteria
• Viruses
• Fungi
• Parasites
• Millions of different species
• Have the ability to cause a variety of diseases
• Pathogen - is the term used for germs that cause disease
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Types of illness caused by Bacteria
• Throat infections
• Boils, pimples
• Blood poisoning
• Meningitis & Meningococcal septicaemia
• Wound infections
• Urine infections
• Chest infections
• Clostridium difficile
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Types of illness caused by Viruses
• Respiratory infection • Flu • Sore throat • Diarrhoea & Vomiting • Slapped cheek syndrome • Hand foot and mouth • Measles • Chicken pox • Rubella
Note: Antibiotics do not work on
viruses
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Types of illness caused by Fungi
• Thrush
• Ring worm
• Athletes foot
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Types of illness caused by vectors
• Malaria
• Sleeping sickness
• Leptospirosis
– Weil’s Disease
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Types of infection caused by parasites
• Scabies
• Head lice
• Body lice
• Tapeworm
• Many tropical diseases
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Standard Precautions
Should be used at all times with all residents – you cannot always
tell if someone has an infection therefore standard precautions
protect both you and the resident.
Effective hand hygiene practices
Maintenance of skin integrity
Protection of open wounds/skin lesions
Use of appropriate personal protective clothing
Avoidance of sharps injury through safe use and disposal of
sharps
Appropriate decontamination of instruments and equipment,
including safe management of blood spillage
Maintaining a clean environment
Safe disposal of waste
Safe handling and laundering of used linen
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Standard Precautions
Should be used at all times with all resident – you cannot always tell if
someone has an infection therefore standard precautions protect bot you
and the resident.
Effective hand hygiene practices Maintenance of skin integrity
Protection of open wounds/skin lesions
Use of appropriate personal protective clothing
Avoidance of sharps injury through safe use and disposal of sharps
Appropriate decontamination of instruments and equipment, including
safe management of blood spillage
Maintaining a clean environment
Safe disposal of waste
Safe handling and laundering of used linen
We will return to hand hygiene later
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Personal Protective Equipment (PPE)
Choice of protective clothing depends upon the anticipated risk of different activities.
Many pathogenic organisms are present in
body fluids, protective clothing is used to
minimise their transmission onto clothing or
skin Would you like a
cup of tea Mrs
Jones?
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Contact with
blood or body
fluid but HIGH
risk of
splashing
Activity
Contact with
blood or body
fluid but
LOW risk of
splashing
Gloves +/-
apron
Gloves, mask,
eye protection,
water-resistant
gown/apron
No contact
with blood
or body
fluids
No PPE BUT
remember
organisms are
always present
- hand hygiene
Risk assessment and protective clothing
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Types of PPE
Commonly used items • Gloves • Sterile • Non sterile
• Aprons/gowns
Rarely used items – a small stock should be kept for use if required
• Face masks • Surgical
• Eye protection • Goggles • Face visor
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Gloves and Aprons
Gloves are not a substitute for hand hygiene
Hand hygiene after glove removal is essential
Non-latex, powder-free gloves should always be used
Wear aprons if there is a possibility of contamination/
splashing to clothing
Change between residents and between a dirty and clean
task for the same resident
Clean hands after removal
Remember all PPE are single use items
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Decontamination Environments
• The environment needs to be clean to prevent cross contamination
• Detergent is suitable for most cleaning but disinfectants are required in some areas and for outbreaks e.g.. chlorine based
• Higher risk areas should take higher priority i.e. clinical rooms, toilets
• Keep clean & dirty areas separate where possible
• Ensure carpets and soft furnishings can be cleaned effectively (steam cleaning)
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Decontamination Equipment
• All reusable equipment must be decontaminated between each resident’s use
• Cleaning - Dirt always has to be removed first with detergent & water –Detergent wipes are practical
• The item may then also need to be disinfected
• Chlorine-releasing product e.g. Actichlor, Milton
• Alcohol
• If the item needs to be sterile - use single use
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Body Fluid Spillages
Body fluid spillages should be cleaned up immediately and protective clothing worn
Body Fluid Surface Method
Blood/blood stained fluid
Hard surface Treat spill with chlorine releasing agent e.g. Milton, Actichlor. Then clean area with detergent & water
Blood/ blood stained fluid
Carpets or soft furnishings
Clean with detergent & water then steam clean where possible
Non-blood stained body fluids
Any surface Clean with detergent & water
Chlorine products should not be applied directly to urine or vomit spills
Spillages during outbreaks will be discussed later
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Body fluid spill kit
• Have a spill kit or the separate components
• chlorine releasing granules or tablets, gloves, apron, cleaning cloths, disposal bag, detergent wipes
• Know where the spill kit is kept
• Make sure you know how to use it
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Management of waste
• Waste management systems are designed to protect all people who will handle waste from production to final disposal
• There are many regulations regarding waste and these must be complied with, most notably in healthcare - • Safe Management of Healthcare Waste
• Waste must be segregated into the appropriate categories or streams
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Waste Streams (some waste streams you might use)
Domestic waste
Paper, packaging, food, flowers etc.
Disposed of in landfill - so must not contain contaminated items
Clinical waste
For any infectious or potentially infectious items
Dressings, gloves, aprons, body fluids etc.
Not for uncontaminated paper or packaging
Offensive waste (tiger stripe)
Waste contaminated with body fluids but is not infectious
Sharps waste
Yellow lidded sharps containers are for all clinical sharps including those containing partially discharged medicine, but not for cytotoxic waste
Cytotoxic sharps waste
For any sharps waste contaminated with cytotoxic waste
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Waste bins
• Have bins in the right place
• Black bags next to hand wash sinks
• Orange bags in sluice or treatment rooms
• Waste must be stored securely and safely.
• Yellow bins must be locked
• Remember to keep
external bin areas
clean
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Management of sharps
• Safe management of sharps protects the user and also others working in that environment
• If a needle free version can be used then do so
• Use safety devices wherever possible
• Do not re-cap needles
• Take sharps bin with you to the resident where possible
• Dispose of sharps as soon as finished
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• Only use approved sharps containers
• Must be assembled correctly and labelled with date and service
• Keep off the floor when in use
• Must not be overfilled
• Temporary closure mechanism should be used in between use
• Must be kept in a secure area for collection
• Must be closed when ¾ full or after a maximum of 3 months use
• Must never be placed inside a clinical waste bag
Sharps waste containers
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Accidents and Inoculation injury Sharps, bites, scratches, Blood splashes to eyes, mouth, broken skin
Encourage bleeding from site (Sharps)
Wash with soap/water Irrigate eye with saline or tap water.
Cover injury with waterproof dressing
Record the incident - including reflection
Notify OHD, A&E or GP promptly
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Hand Hygiene
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Hand Decontamination
Hand hygiene remains the single most effective
means of preventing the spread of infection.
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Your 5 moments for hand hygiene
at the point of care*
*Adapted from the WHO Alliance for Patient Safety 2006
When to clean your hands
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Why to clean year hands?
Resident Micro-Organisms
Deep seated
Don’t generally cause infections and not easily removed
Part of the
body’s natural
defence mechanism
Have been associated with infection following surgery
Transient Micro-organisms
Superficial
Easily picked up and passed on
An important
cause of
cross-infection.
Easily removed by good hand hygiene.
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Before hand decontamination
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After good hand
decontamination
After poor hand
decontamination
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Areas most frequently missed
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1 2 3
4 5 6
Palm to palm Backs of hands Between fingers
Finger tips Thumbs and wrists Nails
How – Hand Hygiene Technique
Applies whether using alcohol foam/gel or soap & water
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Hand hygiene facilities
• An accessible hand hygiene sink compliant with HTM 64 i.e. • Elbow/wrist operated mixer taps
• No plug or overflow
• Water outlet not directly above drainage aperture
• Hand hygiene sinks must be designated for this use only
• Any new service, refurbishment or new build must ensure sinks are compliant and IPC principles are taken into consideration
• If you have problems with hand hygiene facilities this must be flagged up as a risk
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Soap vs Alcohol
Soap
• Cleans
• Lather lifts dirt off the hands
• Dirt and germs are mechanically flushed away
Alcohol
• Disinfects
• Kills germs immediately on contact
• Doesn’t remove dirt and the dirt can protect germs from the alcohol
Both are equally effective at decontaminating hands but they work in different ways
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Alcohol hand gel/foam
• Just as effective as soap & water
• Can be carried with you to use when you can’t get to a sink
• Can be applied as often as required until hands feel sticky.
Remember
• It does not remove dirt - hands require washing if physically dirty
• Less effective against C.difficile and Norovirus so soap & water must be used
• Must be sited and stored safely
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‘Bare below the elbows’
• Uniform and Dress Code guidance (DH) state that ‘bare below the elbows’ principles should be followed when carrying out clinical procedures and hand hygiene
• No ornate jewellery – plain wedding band only
• Remove wrist watch
• Short sleeves, or rolled up
• Nails should be short, no false nails or nail varnish
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Hand hygiene for residents
• Remember that residents/service users also need to clean their hands, especially before meals and after
using the toilet
• Ensure hand hygiene facilities
are made available in toilets
• Ensure relatives & visitors know where they can clean their hands – clearly signpost hand hygiene facilities Hand hygiene
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Now let’s practice