leading asia pacific through knowledge and collaboration learning package... · • possible...

1 Nephrology Nursing Board Asia Pacific Version 1, August 2013

Leading Asia Pacific through Knowledge and Collaboration

Infection Prevention and Control Learning Package


Objectives This learning package has been developed to provide basic theoretical knowledge with regards Infection Prevention and Control, to assist in providing a sound foundation in clinical approaches adopted in treatment and care delivery.

Methods of Assessment E-Learning activities are provided to assess the learners understanding of Infection Prevention and Control practices. Activity1. Hand Hygiene Australia Learning Activity. Activity2. Infection Prevention and Control Learning Activity Activity3. Read the accompanying power point presentation

Successful Completion On completion of the online activities please complete the attached competency checklist as evidence of learning and retain copy for evidence of Professional Development

Objectives and Instructions


1. Principles of Infection Control ............................................................................ 4

1.1. Standard Precautions ................................................................................. 4

1.2. Transmission Based Precautions .................................................................... 4

2. Hand Hygiene ................................................................................................ 5

2.1. Indications for Hand Hygiene ....................................................................... 5

2.2. Indications for Hand Hygiene in Dialysis .......................................................... 5

2.3. Learning Activity ...................................................................................... 5

3. Personal Protective Equipment ........................................................................ 6

3.1. Gloves ................................................................................................... 6

3.2. Eye Protection ......................................................................................... 6

3.3. Masks .................................................................................................... 6

3.4. Respirators ............................................................................................. 6

3.5. Gowns ................................................................................................... 7

3.6. Aprons ................................................................................................... 7

3.7. Learning Activity ...................................................................................... 7

4. ......................................................................................................................................................... Cleaning and Disinfection of Devices and Environmental Surfaces ……………………………… 8

4.1. Personnel ............................................................................................... 8

4.2. Cleaning Products and Supplies ..................................................................... 8

4.3. Environmental Cleaning and Suggested Schedule ............................................... 8

5. ......................................................................................................................................................... Transmission Based Precautions .......................................................................... 11

5.1. Identifying Potentially Infectious Patients ...................................................... 11

5.2. Contact Precautions ................................................................................. 11

5.3. Droplet Precautions .................................................................................. 11

5.4. Airborne Precautions ................................................................................ 11

6. Learner Activity………………………………………………………………………………12

References ……………………………………………………………………………………………… 13

Contents


1.1. Standard Precautions Standard precautions are the minimum infection prevention measures applicable to patient care. They are implemented at all times, whether an infection is present or not. These precautions are evidence based and are designed to protect both patient and staff while preventing transmission of infection in any healthcare environment. Standard precautions, more recently termed routine practices in Canada and Europe, replace what was known in the 1970s as ‘Universal Precautions and Body Substance Isolation’ Standard Precautions include:

• Hand Hygiene

• Use of personal protective equipment, depending on level of anticipated exposure

• Respiratory Hygiene or ‘Cough Etiquette’

• Safe Injection Practices

• Safe handling of potentially contaminated equipment or surfaces

1.2. Transmission Based Precautions

Transmission based precautions are additional precautions which augment Standard Precautions in patients with known or suspected colonization or infection of highly transmissible or epidemiologically relevant pathogens. They are used when the route of infection is not adequately interrupted by Standard Precautions. Transmission based precautions include

• Contact precautions

• Droplet precautions

• Airborne precautions

Where infectious disease may have many routes of transmission, a combination of transmission based precautions may be used. Standard precautions are always used in addition to transmission precautions. Please refer to Section 5.for further information

1. Principles of Infection Control


2. Hand Hygiene Hand hygiene procedures include the use of alcohol based rubs of 60-95% alcohol and hand washing with soap and water. The use of alcohol rubs are the preferred method of hand decontamination unless hands are visibly soiled or when caring for a patient with infectious diarrhoea such as C.diff or Norovirus

2.1. Indications for hand hygiene

2.2. Indications for Hand Hygiene in Dialysis Opportunity Category Specific Examples

1. Before to touching patient Entering station, contact with vascular access, adjusting/ removing cannula

2. Before clean/aseptic procedures Prior to accessing vascular access, performing CVC care, medication preparation, administering IV medication/infusions

3. After body fluid exposure risk After exposure to blood/ body fluids, contact with contaminated fluids eg spent dialysate, handling used dialysers & blood lines

4. After touching patient On leaving a station following patient care, , on removing gloves

5. After touching patient surroundings After touching the dialysis machine, any item at the station, using bedside computer, leaving the

2. Hand Hygiene


station, removing gloves

CDC, 2012 (amended to reflect WHO terminology of 2008)

2.3. Activity

Visit the site below, enter the section relevant to your discipline eg nursing /midwifery & complete the activity. Upon successful completion you will receive a personalised certificate. Print and keep for reference http://www.hha.org.au/LearningPackage/olp-home.aspx


3. Personal Protective Equipment

The use of Personal Protective equipment involves special equipment worn by staff to protect against infectious materials. Choice of PPE is based on the nature of the patient interaction as well as the risk of exposure to blood, body fluids or contaminated/ infectious materials

3.1. Gloves Gloves use is required in

• Direct contact with blood, body fluids, mucous membranes, non -intact skin

• Direct contact with people colonized or infected with pathogens transmitted by the contact route

• Handling possibly contaminated or visibly soiled equipment or surfaces Glove selection for nonsurgical/ non aseptic use depends on

• The task to be performed

• Possible exposure to chemicals including Puristeril, Sporotol and chemotherapy medications

• Staff sensitivity to material composition

• Quality of available gloves

3.2. Eye Protection Eye protection is needed where the potential for splash or spray of blood, respiratory secretions or other body fluids exists

• Personal eye glasses / contact lenses do not provide adequate protection

• Visors protect the face from chin to crown, as well as eyes

• Goggles can be modified to vision prescription needs

• Mask must be worn with goggles to afford adequate protection

3.3. Masks Mask use is required to

• Protect persons from infectious materials

• Protect patients during invasive procedures

• Protect persons in contact with those with respiratory infections

3.4. Respirators This type of protection prevents inhalation of infectious or toxic materials. It requires use of a respirator of N95 or higher filtration. It is used in M. tuberculosis, SARS, Avian Flu and pandemic influenza. A seal check is performed at each use to ensure minimal leakage around the face piece.

3.5. Gowns Isolation or surgical gowns protect arms and exposed body areas and prevent contamination of clothing.

3. Personal Protective Equipment


• Requirement is assessed on nature of patient interaction

• Gloves and eye protection are always worn if gowns are required

• Lab coats & cloth gowns do not offer adequate PPE

3.6. Aprons Disposable, single use plastic aprons

• Prevent cross contamination & transmission of microorganisms from patient to patient

• Protect uniforms and prevent skin contamination

• Are cheap and easy to wear

• Should be worn when delivering direct patient care or clothing at risk of contamination

• Should be colour coded according to use, and available in roll dispensers for easy access

TASK Gloves Disposable Apron Disposable Gown VISOR

Set up √ √ Ø √

Cannulation/ de-cannulation √ √ Ø √

CVC connect/ disconnect √ √ Ø √

CVC Insertion/ removal √ Ø √ √

ISOLATION BBV √ Ø √ √

ISOLATION Aerosol/ Droplet √ Ø √ √ + Mask Reprocessing Dialysers √ Ø √ √

Pouring/ transporting chemicals

√ √ Ø √ +/- Mask

Providing/ handling food √ √ Ø Ø Diagrammatic representation of CHRISP 2011 and APIC 2010 recommendations

3.7. Activity

Watch the video and review the information at the site below (Module 7). Then undertake a peer review of your safe practice in PPE http://infectionprevention.e3learning.com.au/

Log in Here – Registration is FREE Complete the activity Principles of Infection Prevention and Control (Module 7) to obtain your certificate. Print and retain in your Professional Development File


1.1. Personnel

• Responsibilities for cleaning and disinfection of environmental surfaces and medical devices must be assigned

• It is the responsibility of all staff to ensure a clean and disinfected clinical environment

1.2. Cleaning Products and Supplies

• Must be replenished as necessary ( gloves, aprons, soaps, hand rubs, disposable towel)

• Manufacturer instructions for cleaning surfaces must be followed, ensuring cleaning product is compatible with the surface/ device being cleaned

• Of appropriate germicidal claim for the infective agent at the correct volume, dilution, contact time, storage & disposal must be used

• Disposable colour coded mops, buckets, cloths appropriate to the functional area must be used

1.3. Environmental Cleaning Dialysis station

• Between each use

• PPE worn

• Clean before disinfecting unless a one -step detergent disinfectant is used( eg Clearsurf)

• Clean high touch surfaces such as front of dialysis machine, dialysis chair, cushions, base & armrests, tables, call bells , media boards waste containers between use

• Non critical equipment cleaned as per manufacturer instruction ( stethoscope, BP cuff) and dedicated to a single patient

Bathrooms

• Wear PPE

• Clean toilet, area surround, sink, faucet handles, door knobs and walls

• Use bleach based disinfectant Medication Area

• Wear PPE

• Clean countertops and surfaces daily & when soiled

• Refrigerators for medication storage cleaned as instructed by manufacturer and when soiled

• Clean & disinfect medication trays between use Cleaning Blood & Body Fluid spills

• Wear PPE

• Use forceps to pick up sharps and discard in sharps container

• Decontaminate area using registered disinfectant with specific label for blood borne pathogens or a freshly prepared bleach product

• Discard in appropriate biohazard waste container Handling of Linen

• Handle all used linen with minimal agitation to avoid contaminating air

• Place soiled linen in lidded skips & store separate from clean areas & items

• Use leak resistant containment for linen contaminated with blood/ body fluids

• Hot wash >70oC for 25mins/ low temperature with approved chemicals Waste Disposal

• Puncture resistant , leak proof sharps containers at each station & point of care

• Regular and medical waste disposed of in designated containers

• PPE worn and waste handled, transported and disposed of in accordance with local regulations

Modified from: CDC 2012, CHRISP 2011, APIC 2010, Siegal 2009.

4. Cleaning and Disinfection of Devices and Environmental Surfaces


Suggested schedule for Dialysis Units provided below Decontamination Schedule

Adapted from: Rees, J Kanabar D ( 2007) ABC of Asthma, Oxford: Blackwell CDC 2011 Department of health ,Hong Kong (2010) Infection Control Guidelines on Nephrology Services in Hong Kong Australian Commission on Safety and Quality in Health Care (2012) Standard 3 Preventing and Controling hospital acquired Infections safety and Quality Improvement Guide Fresenius Medical Care (2010) Surface Disinfection of Medical Devices, Hygiene Brochure Asia Pacific Society of Infection Control: The ASEAN Guidelines for Disinfection and sterilization of Instruments in Health Care Facilities Seigal et al (2007) Guidelines for Isolation Precautions; preventing transmission of infectious agents in healthcare settings; CDC.gov

Activity 3 Read accompanying power point presentation for further information

Device Process

Ambu-bags Single Use. If not single use , wash in detergent at 72hr intervals if placed on emergency trolley

Bedding , and pillows Detergent clean after each use. Mattress and pillow cover—waterproofed

Bedframes High level disinfect between patients

Blood pressure cuffs Patient dedicated Or disposable Neutral detergent wipe after each use Blood/ body fluid contamination—discard

Lavatories and commodes

Warm water & detergent, High level disinfectant Cream cleaner if required

Mop buckets and wringers

Neutral detergent, rinse and dry. Store inverted Colour coded

Mop heads Colour coded disposable microfiber

Cloths Colour coded disposable, microfiber ( not J Cloths or woven cloth materials)

Curtains

Washed & dried/ dry cleaned / steam cleaned 3 monthly if fabric Clean immediately after C Diff outbreak as part of terminal cleaning

Floors Detergent Spillage—high level disinfect

Trolleys—emergency, transfer, procedure

High level disinfection after use

Examination couches Cover with disposable paper roll and change between patients High level disinfectant if/ wipes after each use

Tables High level disinfectant

Stethoscopes Clean diaphragm and ear piece after each use

Wheelchairs, weighing scales

Clean daily with neutral detergent High level disinfectant if contaminated with body fluids


5.1. Identifying Potentially Infectious Patients

• Screen patients for blood borne virus and multi resistant organisms prior to acceptance to clinic, on return from vacation or hospitalization where dialysis was received

• Monitor response to vaccination for immunity or susceptibility

• Monitor antimicrobial prescription uptake in the facility

• Liaise with multidisciplinary team regarding antimicrobial use in patients recently admitted/ reviewed

• Remain alert for any symptoms of active infection in staff or patients

5.2. Contact Precautions

• Apply to known or suspected cases of C.diff., Norovirus, rotavirus, MRSA, or diarrhoea, draining wounds or ostomies

• Prioritize for Isolation

• Perform Hand hygiene

• Wear gloves if touching patient or immediate environment

• Wear gown if substantial contact/ contamination likely

• Clean and disinfect station and equipment after use

5.3. Droplet Precautions

• Apply to known/ suspected cases of droplet borne pathogens, respiratory infections

• Place in Isolation if possible

• Patient to use mask, and to dialyse separately from other patients

• Wear PPE – mask and gloves/gown/apron depending on risk of respiratory fluid spray

• Hand hygiene before & after contact with patient/ respiratory secretions

• Clean & disinfect station after use

5.4. Airborne Precautions

• Apply to known or suspected cases of airborne pathogens such as TB, measles, chickenpox, active herpes zoster

• Institute a separate access route to clinic for patient if possible

• Place in Airborne Isolation Room/ negative pressure room if possible

• Provide facemask & isolate in non- negative pressure room if not available

• Hand hygiene before & after touching patient or contact with secretions/ contaminated materials and objects

• Ensure a wait time of >1hour before entering the isolation room to permit complete air exchange and ventilation before performing a terminal clean

5. Transmission Based Precautions


Please review the following checklist to ensure completion of this package

ITEM Evidence Required Signature of Completion Hand Hygiene Printed certification from the

Australian website provided

Infection Prevention and Control Printed certification from the Australian Website

PPT Documentary evidence of appropriate decontamination of Medical equipment & environmental surfaces

Name Designation/Title Country and Clinic

Please print this checklist for retention in your personal Clinic Education and Training File

6. Learner Checklist


Boyard EA, Tablan OC ( 1998) Guideline for infection control in healthcare personnel: Hospital Infection Control Advisory Committee inf Cont hosp epidemiol 19(6): 407-46 Boyce JM, Potter-Bgnoe et al ( 1997) Environmental contamination due to MRSA: possible infection control implications Inf Cont Hosp Epimidemiol 48(3): 238-241 CDC Biologic and Infectious Waste (2013) http://www.cdc.gov/nceh/ehs/etp/biological.htm CDC Guidelines for Vaccinating Kidney Dialysis Patients and Patients with Chronic Kidney Disease http://www.cdc.gov/vaccines/pubs/downloads/dialysis-guide-2012.pdf CDC (2007) Ethical guidelines in Pandemic Influenza: Ethical Considerations ,WHO Pandemic Preparedness www.cdc.gov.org accessed 2010 Recommendations for Preventing Transmission of Infections Among Chronic Haemodialysis Patients http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5005a1.htm CDC (2012) Guidelines for Vaccinating Kidney dialysis Patients and patients with Chronic Kidney Disease: Recommendations of the Advisory Committee on Immunization practices (ACIP) http://www.cdc.gov.vaccines/recs accessed 1Jan 2013 California Department of Public Health (2012) Transporting refrigerated Vaccines (Guidelines for vaccine transport and short term storage) http://eziz.org/assets/docs/ IMM-983.pdf accessed Feb.2012 CDC (2012) Vaccine Storage and Handling guide (Best practices storage and Handling recommendations) http;//www.cdc.gov/vaccines/recs/storage/guide/vaccine-storage-handling.pdf accessed Jan 3rd 2013 CDC (2012) Vaccine Storage and handling Toolkit November 2012 http://www.cdc.gov/vaccines/recs/storage guide/vaccine-handling.pdf accessed Jan 3rd 2013 Workbook for Designing, Implementing, and evaluating a Sharps Injury Prevention Program (CDC 2008) http://www.cdc.gov/sharpssafety/pdf/sharpsworkbook_2008.pdf CHICA (2008) hand Hygiene Can J Inf Cont. 23(114): 116-117 Dick EC, Jennings LC (1987) Aerosol transmission of Rhinovirus colds J Inf Dis 156(3): 442-448 Duckro AN,, Blom DW et al (2005) .Transfer of vancomycin resistant enterococci via health care worker hands. Arch Intern Med165 (3): 302-307 Grayson L, Russo P et al (2009) Hand Hygiene Australia Manual Australian Commission for Safety and Quality in Healthcare and World Health Organization HavserSP, Bouchillon SK (2009) Emergence of high levels of Extended spectrum βLactamase producing gram negative bacilli in the Asia Pacific Region :data from the Study for Monitoring Antimicrobial Resistance Trends ( SMART) Program 2007 antimicrobial agents & Chemotherapy 53(8): 3280-3284 Hermsen ED, Van Schooneveld TC et al (2012) Implementation of a clinical decision support system for antimicrobial stewardship Inf Cont. Hosp Epidem 33(4): 412-415 Jagger, J Perry J et al (2008) The impact of US policies to protect healthcare workers from blood borne pathogens: the critical role of safety engineered devices J Infect Public health 1(2):62-71 Norman D, Aikins M (2011) the medico legal pre-requisite for initiating quarantine and isolation practices in public health emergency management in hospitals in Ghana Ghana Med Journ 45(4): 167-173 http://www.dcmcompliance.com/documents/PDFs/Healthcare/DOHCGuidelinesNovember2010.pdf Perry C, Marshall R et al (2001) Bacterial contamination of uniforms J Hosp Inf 48(3):238-241 PIDAC (2008) Best Practices For Hand hygiene in all Healthcare Settings Provincial Infectious Diseases Advisory Committee,

References


Ontario MoH , Toronto Pratt RJ, Pellowea CM et al (2007) epic 2: National Evidence Based Guidelines for Preventing Healthcare Associated Infections in NHS Hospitals in England J Hosp Infect 65S, S1-S6 Roy CJ, Milton DJ (2004) airborne transmission of communicable infection—the elusive pathway N Eng J Med 350(17): 1710-1712 Siegal JD, RhinehartE et al (2007) Guideline for Isolation precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. http://www,cdcgov/ncidod/dhqp/pdf/isolation 2007.pdf accessed June 2008 Seigeild MJ (2008) Ethics, Tuberculosis and globalization Public Health Ethics 1:10-20 Wong TW, Lee CK et al (2004) Cluster of SARS among medical students exposed to a single patient, Hong Kong Emerg. Inf.Dis. 10(2): 269-276

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