A LITTLE YELLOW INFECTION CONTROL BOOK

Transcription

1 A LITTLE YELLOW INFECTION CONTROL BOOK Essentials of Infection Control in District nursing Grampians Region Infection Control Group 48 1

2 ABOUT THIS BOOK This Little Yellow Infection Control Book for home care is one of a series of booklets designed to fill the need for simple, point-of-first-use infection control information. It is not designed to be a comprehensive infection control manual. Staff seeking detailed information should refer to the agency infection control policies and procedures. This booklet was developed with the assistance of the Royal District Nursing Service - May 2004 Updated September 2010 Production by: Bruce Fowkes Mary Smith Grampians Region Infection Control INFECTION CONTROL RESOURCES: CLINICAL NURSE CONSULTANT - INFECTION CONTROL Phone: Fax: RESOURCES Policies and procedures located: Additions by: Sue Atkins Royal District Nursing Service Melbourne Further publications: Infection_Control/index.aspx DISCLAIMER: Every effort has been taken to confirm the accuracy of the information presented in this guide, however, the authors, are not responsible for errors or omissions or for any consequences from application of the information in the guide and make no warranty, express or implied, with respect to the contents of the publication. In view of ongoing research, changes in government regulations and the flow of other information, the information is provided on the basis that all persons undertake responsibility for assessing the relevance and accuracy of its content. 2 Department of Human Services 47

3 NOTES PAGE: INDEX Protecting Your Clients and Yourself Transmission of Infection 4-5 Important Elements of IC 7 Standard Precautions 9 Additional Precautions 11 Hand Care 13 Glove Use 15 Clinical Waste Disposal 17 Equipment Cleaning & Disinfection 19 Equipment Bag 21 Mobile Computer 23 Storage of Sterile Goods 25 Single Use Items 27 Pathology Specimens 29 Staff Health and Hygiene 31 Staff Immunisation 33 Sharps 35 Food Hygiene 37 When Things Go Wrong Spills 39 Occupational Exposure 41 Should you be at Work? 43 Table of Additional Precautions Infection Control Resources

4 How Microbes Are Transmitted Droplet Precautions Haemophilus influenza meningitis/epiglottis neisseria meningitidis septicaemia/meningitis Ψ Diptheria (Pharyngeal) Mycoplasma (pneumonia) + Pertussis Influenza + Parainfluenza Mumps ** Parvovirus B19 Rubella ** Pneumonic plague Group A Streptococcal infections in infants and young children Group A Streptococcal pneumonia, scarlet fever in all age groups Ψ Yes See Standard Precautions Contact Precautions Resistant Bacteria (MRSA, VRE, others named by Infection Control Committee) + C.difficile + RSV + Herpes simplex (neonatal or mucucutaneous) Highly contagious skin infections (ie scabies, lice, impetigo)+ Infants/young children (<6 years), or any patient incontinent with: Enterovirus Hepatitis A Rotavirus, Shigella, Giardia, other forms of gastroenteritis Yes Yes See Standard Precautions Yes If HCW s clothing will have substantial contact with the patient, environmental surfaces or items in the patient s room See Standard Precautions See Standard Precautions See Standard Precautions See Standard Precautions Single use or disinfect before next patient Regular mask for patient Notify area receiving patient Notify area receiving patient Cohort requires one metre of patient separation Remove gloves and gown, wash hands before leaving patient room From Health Canada, Infection Control Guidelines Refer to specific local policy Ψ Droplet precautions for Haemophilus and meningococcal infections only need to be continued until the patient has had 24 hours of effective antibiotic treatment. The same applies for Group A Streptococcal infections, as far as pharyngeal carriage is concerned. Group A Streptococcal infections may need to be isolated in special circumstances, such as burns units, until there is evidence of clearance of the organism from the burn. 4 45

5 Isolation Type Standard Precautions Airborne Precautions Disease Examples All patients All blood, body fluids, secretions (except sweat), excretion and contaminated items TB suspect/confirmed Measles ** Add Contact Precautions as well: Varicella (chickenpox) ** Zoster, disseminated ** Zoster, immunocompromised ** Viral haemorrhagic fever, eg. Ebola *** Many Objects Can Transmit Microbes, But CARER S HANDS Are The Most Common Hand Washing Yes Yes Gloves For body substances See Standard Precautions Gown If soiling likely See Standard Precautions Mask Protect face if splash likely Particulate mask for TB only. All others, regular mask. Goggles/Face Shields Protect face if splash likely See Standard Precautions Special Handling of Equipment No all blood/body substances handled with care **** See Standard Precautions Transport of Patients Cover all patient s open wounds Particulate mask for patient with TB. All others, regular mask for patient. Notify area receiving patient Miscellaneous Avoid contaminating environmental surfaces with gloves Teach patient to cover nose and mouth when coughing or sneezing * Except certain circumstances determined by Infection Control, eg neutropenic/transplant patients ** All personnel should know their varicella, measles, mumps and rubella status (only immune personnel should care for these patients. *** All waste should be treated as Clinical Waste **** Handle needles, syringes and sharps with care. Use rigid containers for disposal. DO NOT recap, break or bend needles. Exposure to blood/body substance immediately wash site, notify supervisor and seek management of exposure. 44 Recommended Infection Control Precautions NSW Health Department Circular 99/87 5

6 SHOULD YOU BE AT WORK? Infectious diseases in staff can be readily transmitted to susceptible clients. Respiratory infections eg. the flu, can be transmitted to clients by respiratory secretions shed by coughing, sneezing, and on your hands. Infections on your skin or eyes can be transmitted to clients by your hands. Diarrhoeal infections can be transmitted to clients by your hands, on articles you have touched, on food you have handled. IF YOU ARE ILL PLEASE CONSULT YOUR MEDICAL PRACTITIONER OR INFECTION CONTROL CONSULTANT 6 43

7 IMPORTANT ELEMENTS OF INFECTION CONTROL Hand hygiene Personal protective clothing Sharps safety Clinical waste disposal Decontamination of equipment Sterile supplies and aseptic techniques Environmental cleanliness Single use supplies Staff immunisation and health Food safety 42 7

8 Complete protection is possible but not practical OCCUPATIONAL EXPOSURE Needle stick injury or splashes with body fluids require: Immediate washing of area with soap and water. If unavailable use an alcohol based hand gel Eye splashes should be rinsed well with water or normal saline Report exposure to person In charge Follow your agency protocol Adequate protection is based on degree of risk Complete and lodge incident report Undertake blood tests, take prophylactic drugs and attend counselling if and when organised by person in charge and/or medical practitioner The type of follow-up will depend on the degree of risk of the exposure. 8 41

9 Your worst nightmare! STANDARD PRECAUTIONS Standard precautions are a set of protective measures designed to prevent contact with body fluids of any other person. This approach is based on the possibility that any person may be infected with a blood-borne infection, which may be transmitted to other persons. Possible Entry Sites for Body-Fluid Borne Viruses: Inoculation into tissue by needle-stick with used sharp. Contact with broken skin Contact with conjunctiva Contact with mucous membrane of mouth or nose Risk Management: Calculate risk of contact with body fluids Wear level of protection necessary, based on risk of exposure Disposable gloves (hand contact) Eye protection (splash potential) Plastic apron (splash potential) Mask (splash potential) Hand washing after inadvertent contact with body fluids Careful disposal of sharps 40 9

10 Sometimes additional precautions are required! BIOLOGICAL SPILL Assess the volume of spill to be removed Don protective apparel Soak up spill with paper towel Dispose of paper towel directly into a plastic waste bag Clean area of spill using neutral detergent/hot water Use of a chlorine compound following cleaning (Bleach diluted as per manufacturers instructions) MAY be necessary for benchtop spills ) - consult your agency policies and procedures Place all used disposable protective apparel into a plastic bag, secure and place directly into general waste receptacle Seek advice from the person in charge or your infection control consultant if you suspect a client requires additional precautions Wash hands 10 39

11 ADDITIONAL PRECAUTIONS Air-borne transmission dissemination of microorganisms by aerosolisation; fine airborne particles suspended in air for long periods of time and widely dispersed by air currents e.g. Pulmonary Tb, Measles, Varicella (Chickenpox) Air-borne Precautions: High efficiency mask Gloves, gown, goggles as required Ensure immunity to varicella, measles Droplet transmission large respiratory particles that travel less than 1 metre; generated from the respiratory tract and spread by coughing and sneezing. Large droplets do not stay suspended in air Mumps, Diphtheria, Pertussis Contact transmission organisms present on skin or in bowel; spread by direct client contact or contact with articles client has touched e.g. extensive diarrhoea, scabies, Varicella zoster, antimicrobial-resistant organisms Droplet/Contact Precautions: Gloves, gown and goggles as required, for substantial close contact Droplet surgical mask for close contact of clients (< 1 metre) Educate client and family 38 11

12 FOOD HYGIENE Microbial growth/toxin production in food can cause serious outbreaks of food poisoning. Risk Management: Hand washing/disposable glove use in food preparation/serving Regular cleaning of food preparation/ serving areas and food storage units Prepared food stored in refrigerators covered with glad wrap and dated Temperature of food maintained within a range which inhibits microbial growth to point of consumption Hot food > 60ºC Cold food < 5ºC (includes salads and pre-made sandwiches) Food/liquids used by their use-by-date Do not reheat food more than once Do not refreeze food once defrosted Educate client and family about safe food handling

13 HAND CARE Staff hands are the most common vehicle for infection transmission. Staff hands can transmit organisms from the following sources: Resident hand flora (own skin micro-organisms) Transient hand flora (micro-organisms picked up from contact with persons and articles) Infectious hand conditions (organisms from actual hand infections eg. paronychia) Risk Management: Routine hand washing between clients contacts (or application of alcohol gel) Hand washing following contact with body fluids, soiled linen, after glove removal, prior to clean procedures Use of disposable gloves to prevent gross level contamination in body fluid contact situations Routine (Hygienic) Hand Wash: 15 seconds with neutral hand wash Cover all hand surfaces Rinse and dry well Application of Alcohol Hand rub: Alcoholic hand rub may be used when hands are not readily soiled Apply sufficient rub to cover hands rub until dry Keep Hands in Good Condition: Apply appropriate water-based moisturiser often 36 13

14 SHARPS A sharp is any item capable of penetrating human tissue. All sharps used on people have the potential to transmit blood-borne infections. Used sharps must be: Immediately placed in a Sharps container after use Not handed to other staff or client/carers Used injection needles not removed from syringe and not recapped (except by singlehandled system) Sharps bins securely locked when 2/3 full, and safely transported to secure storage area Butterfly needles are ONLY handled by both wings Protective devices such as needleless injection systems and IV safety cannulas must be used when supplied by your agency See Clinical Waste Disposal Page

15 GLOVE USE Disposable gloves should be used when contact with body fluids is anticipated Gloves frequently have minute holes so hands must be washed after glove removal Powderless gloves may produce less skin sensitivity than powdered Gloves can carry micro-organisms from one client to another, so must be changed between clients If you have a known allergy/sensitivity, or suspect you may have an allergy/ sensitivity to latex gloves please contact your infection control consultant and the appropriate management will be investigated and commenced 34 15

16 STAFF IMMUNISATION ARE YOU GETTING ENOUGH? The National Health and Medical Research Council recommends specific immunisations for health care workers who have significant client contact. These are: Diphtheria/ Tetanus A full course of three staged injections Polio A full course of three staged injections Measles/Mumps/Rubella Two doses, if born after 1966 Chicken pox (Varicella Zoster virus) Immunisation if no definite history of the disease Hepatitis B A full course of three staged injections, followed by a blood test to check antibody production. It is absolutely essential to know that you have developed antibodies as a result of the immunisation! Influenza Annual injection of the current viral strains TB Skin Test (possibly at induction and exit) Not an immunisation, but useful to know your status. From Infection Control in the Health Care Setting, April

17 Immunisation - Your extra protective umbrella CLINICAL WASTE DISPOSAL Waste generated during direct client care can cause injury and infection transmission if improperly handled. When at all possible, bodily secretions/ excretions should be placed directly into the sewer system (flushed down the toilet) Any other waste potentially contaminated with blood or body fluids should be placed at point of generation into a plastic bag and secured (double bagged to prevent leakage if required) then placed directly into a general waste receptacle Sharps are NOT to be placed into the general waste. Ensure appropriate disposal of sharps directly into a sharps container Cytotoxic waste is NOT to be placed into the general waste. Cytotoxic containers are to be used Persons handling waste to wear personal protective equipment e.g. gloves See agency specific policies and procedures for clinical and related waste management

18 STAFF HEALTH AND HYGIENE A high level of personal health, appropriate immunisations and good personal hygiene provides good baseline protection for Health Care Workers. The adherence of staff to good infection control practices provides a further level of protection. Clothing - Clean work clothing Hair - Clean and away from face, avoid touching during client care Jewellery - hand and wrist jewellery has been found to carry pathogenic microorganisms - avoid jewellery use Hand Care: Hands kept moisturised Fingernails short Artificial fingernails and nail polish have been indicted in infection transmission

19 EQUIPMENT CLEANING AND DISINFECITON Reusable items used during client care in the home are to be cleaned with detergent and water and thoroughly dried before reuse, and before return to provider Where possible equipment should be dismantled to allow removal of all biological matter Do not immerse sensitive items in water (e.g. electronic equipment), use a cloth dampened with detergent and water to wipe over A low level disinfectant may be required in limited situations with certain clients with resistant organisms (e.g. Bleach diluted as per manufacturers instructions) Follow your agency policies and procedures for item specific cleaning instructions 30 19

20 PATHOLOGY SPECIMENS Improperly sealed containers can be an infection threat to the persons transporting and the persons processing the specimens. Decontaminate outside of specimen container with alcohol wipe if soiling occurs If soiling of the pathology request form occurs, obtain a new completed form, and dispose of the soiled one Ensure container is sealed Label container clearly with information from pathology request slip Place specimen and request slip in appropriate pockets of Biohazard plastic bag Transport pathology specimens in the containers provided (e.g. Esky) Ensure transport container lid is secure

21 EQUIPMENT BAG The equipment bag/container must be considered as a piece of CLEAN equipment and handled in such a way as to prevent contamination from hands or used items. The bag and contents of bag must be protected from contaminated environments within the home and from the external environment heat, cold, rain. The outside of the bag is cleaned as necessary; when it looks dirty The inside of the bag is considered a clean area and therefore cleaned if it becomes contaminated All reusable items taken into the home must be able to be cleaned and if necessary disinfected All reusable items should be cleaned and where appropriate disinfected before returning to the bag refer to page 19 Single use items are discarded at point of use as soon as possible after use and NOT returned to the bag refer to page 27 Ensure all items required for the clients treatment are removed from the bag prior to commencing treatment do not re-enter the bag after hands have become contaminated unless hands have been washed Avoid overstocking bag minimise amount of equipment stored in bag ensuring essential items only

22 SINGLE USE ITEMS Items labelled Single Use are for single use only Items labelled Single Patient Use are for use more than once on the SAME client as per manufacturers instructions Items labelled require you to read and follow the manufacturers instructions Check the integrity of the packaging before use Once the package is opened it can no longer be considered sterile Items for single use must be discarded at point of use as soon as possible after use e.g. Dressing packs Syringes / needles Irrigation fluids Gloves / aprons DO NOT REUSE SINGLE USE ITEMS See agency specific policy for single use items

23 MOBILE COMPUTER It is important to protect the Mobile Computing Device from contamination with organic matter that may be present in the working environment:! Follow Manufacturers Instructions Always keep the computer in the case provided If the case becomes contaminated with blood or other substances: Remove the computer from case Thoroughly clean the case with a cloth dampened with detergent and water Ensure it is completely dry before returning the computer to the case Always ensure the computer is secured in the car, using the bag provided See equipment cleaning/disinfection Page 19 Single Use Only 26 23

24 STORAGE OF STERILE GOODS Sterile goods must be stored in the following conditions to maintain sterility and prevent contamination of sterile items: Storage area controlled and dedicated for that purpose only Free of dust, insects and vermin All surfaces constructed of non-porous, smooth material, capable of being easily cleaned For open shelving, items stored at least 250 mm above floor level and 440 mm from ceiling fixtures Protected from direct sunlight Storage containers, trolleys and cupboards kept clean, dry and in good condition Do not reuse cardboard boxes for storage containers Packaging not damaged due to overfilling of containers Not stored in contaminated environment Do not store excessive amounts of sterile stock in nursing bag or car essential items only