Infection Prevention and Control: 365 Days a Year; Back to Basics

Presented by: Cynthia Arseneau, RN, BSN, BSHNU

Manager of Clinical Education Programs

Outline• How do diseases spread?• How do we prevent the spread of diseases?

– Routine Practice and Additional Precautions– Cleaning and Disinfection– Vaccination

• Why does all of this matter?

Chain of Transmission

Infectious AgentBacteria

Parasites

Fungus

Reservoirs• Are places where an

infectious agents live and can reproduce in such a manner that can be transmitted– People– Food– Environment – Animals

Portal of Exit

Means of Transmission

Portal of Entry• How the infectious

agent gets into a person• Open skin• Mucous membranes –

eyes, nose, mouth• Gastrointestinal system Do NOT

touch!

Susceptible Host• Characteristics that affect susceptibility:

– Age– Nutritional status– Disease history– Underlying illness– Stress and fatigue– Working shift work– Lack of sleep

ROUTINE PRACTICE

http://www.infectionlandscapes.org/2011/08/gut-infections.html

Routine Practice• Legislated under “Work Safe BC” occupational

health and safety act• Consider all residents including body fluids, blood,

secretions, excretions, and specimens as potentially infectious

• Minimum standards to be used by all healthcare providers to protect the residents and staff from potentially pathogenic (disease causing) organisms

Clean Your Hands• Alcohol based hand rub

is best method• It is fast and simple• Use soap & water if

hands are visibly soiled

How you clean your hands makes a difference!

Effective Hand Hygiene!

wet hands first with warm water

apply 1-2 pumps (3 to 5 ml) of soap to hands

lather and rub hands together for at least 15 seconds, covering all surfaces

of your hands and fingers

weave fingers and thumbs together and slide them back and forth

ensure to get in between fingers and at nails

rinse hands thoroughly with warm water

use a single-use paper towel to blot hands dry

Effective Hand Hygiene!

use paper towel to turn off water faucet

What About Alcohol-Based Hand Rubs?

If hands are not visibly soiled or contaminated with blood or body fluids, use alcohol-based hand rub for routinely cleaning your hands

Alcohol-based hand rubs are more effective in reducing the number of bacteria on hands than plain soap and water

It is fast and simple

Product must contain a minimum of 70% aclohol in order to be effective against noro-like viruses (Norwalk)

Tips on Using Alcohol Based Hand Rub apply 1 pump (loonie size) of the alcohol gel to

the palm of one hand, and rub hands together

cover all surfaces of your hands and fingers, including areas around/under fingernails

continue rubbing hands together until alcohol dries

if you applied a sufficient amount of alcohol hand rub, it should take at least 10 -15 seconds of rubbing before your hands feel dry

Wear Gloves• When performing tasks

that might contaminate your hands

• Remove & discard gloves when task completed

• Clean your hands

When Not to Wear Gloves

Wear a Mask and Eye Protection• For all coughing patients• Especially if within 2 meters

(6 feet) of the client/resident• Use a fluid resistance mask

with a visor or mask and goggles

• Eye glasses do not count as eye protection

Wear a Personal Protective Equipment (PPE) as part of your routine:

• If your clothing MIGHT get contaminated• Add mask & goggles if RISK of facial contamination • Discard disposable gown, gloves, and mask in garbage

Just Clean Your Hands• After removing gloves or body

fluid exposure risk• Before & after directly touching

a client/resident and/or their environment

• Before administering or assisting with medications

• If hands are visibly dirty• After using the washroom or

coughing

What Is the Difference??

Routine Practice vs. Additional Precautions

4 Types of Additional Precautions

1. Contact2. Droplet3. Droplet/Contact4. Airborne

CONTACT PRECAUTIONS• Gown and gloves are suggested for ALL direct

care given to a resident in their living space• Disposable gowns and gloves are to be

removed and discarded in the garbage• Perform hand hygiene before and after PPE

DROPLET PRECAUTIONS• Used when a resident has a non-febrile

respiratory illness• A fluid resistant mask with visor is suggested

whenever you will be within 2 meters of the resident

• Hand hygiene is to be performed before and after using PPE

DROPLET and CONTACT Precautions• Used when resident has a febrile respiratory

illness like Influenza or if resident is vomiting• Fluid resistant mask with visor, gown, and

gloves are suggested for all direct care given to resident

• Hand hygiene MUST be performed before and after using PPE

CLEANING AND DISINFECTIONWhat is the difference between?

Cleaning of Equipment• Cleaning equipment between use is almost as

important as hand hygiene• Clean first then Disinfect• Contact time and friction make the difference• Methods of disinfection

– Cloth with cleaner applied to it– Pre-moistened wipes (OxivirTb® Wipes, Cavi® Wipes)

• Ensure wipes are not expired!

Vaccination• 100 years ago infectious diseases were the

leading cause of death in the world• In Canada now less than 5% of deaths are

related to infectious diseases• Vaccination plays a huge role in decreasing the

number of deaths related to infectious disease

http://www.immunize.cpha.ca/en/default.aspx

Vaccination• Cholera• Diphtheria• Hepatitis A• Hepatitis B• Herpes Zoster (shingles)• Human papillomavirus (HPV)• Influenza (the flu)• Invasive Haemophilus Influenzae Disease• Invasive Meningococcal Disease• Invasive Pneumococcal Disease• Japanese Encephalitis• Measles• Mumps

• Pertussis (whooping cough)• Poliomyelitis (polio)• Rabies• Rotavirus• Rubella (German Measles)• Smallpox• Tetanus• Tick-Borne Encephalitis• Tuberculosis (BCG Vaccine)• Typhoid• Varicella (chickenpox)• Yellow Fever

http://www.phac-aspc.gc.ca/im/vpd-mev/index-eng.php

Breaking the Chain• Interrupting 1 or more links breaks the chain

of transmission• This can be accomplished by:

– the use of routine practice– additional precautions – essential cleaning of equipment between

residents

Breaking the Chain con’t • cleaning high touch surfaces• 2 meter spatial separation • respiratory etiquette • wound care/dressing changes• hand hygiene

VIDEOWhy Don’t We Do It In Our Sleeves?

What do you do when you are sick?• If you have the following you should stay

home:• Fever• Vomiting• Diarrhea

*If you have vomiting and/or diarrhea you should stay home for 48 hours after your last episode of vomiting and/or diarrhea because you are still contagious

Why does all this matter?

What does an outbreak mean for our residents?

• Physical and social isolation to their suites/rooms if they are sick

• Restrictions• All large group activities are usually cancelled

for the duration of outbreaks• With every outbreak a sick resident has in

increased risk of hospitalization and/or death

The End!

Always remember that what you do and how you do it affects our residents lives in many ways!