The term Routine Practices is used to describe practices that were previously known as Universal Precautions.

Transcription

1 Health & Safety Manual Health Promotion & Wellness ROUTINE PRACTICES PROCEDURES INTRODUCTION The term Routine Practices is used to describe practices that were previously known as Universal Precautions. They are based on the premise that there is potential for infection transmission even when people are asymptomatic. The same safe standards of practice should be used routinely with all people to prevent exposure to blood, body fluids, secretions, excretions, mucous membranes, non-intact skin or soiled items and to prevent the spread of microorganisms. The consistent and appropriate use of Routine Practices by employees will lessen microbial transmission and reduce the need for any additional precautions. PROCEDURES 1. Hand Hygiene a) Hand hygiene is considered the most important and effective infection prevention and control measure to prevent the spread of infections. b) Hands are the most common vehicle for transmission of infection from person-to-person. c) Hand hygiene refers to killing or removing microorganisms on the hands as well as maintaining good skin and nail integrity. d) The purpose of hand hygiene is to destroy or remove microorganisms that have been picked up from contact with people supported or employees, contaminated equipment, or the environment. e) Appropriate hand hygiene results in a reduction of infections. i) Indications for Hand Hygiene When providing direct care, hand hygiene should be performed according to the following four moments: before initial environment contact (i.e. any physical contact with person); before performing aseptic procedures (i.e. oral care, eye care, wound care, injections); after body fluid exposure (i.e. oral care, cleaning up vomit, urine or feces); after environmental contact (i.e. touching bed rail, leaving persons room). It is also important to perform hand hygiene: after performing personal functions such as using the toilet, coughing or sneezing; before preparing, eating or handling food; before and after removal of PPE; after handling raw meats or unwashed vegetables and fruits; after smoking, eating, or drinking; before and after touching any animal or animal excrement. Page 1 of 6

2 ii) iii) iv) Hand Hygiene with Alcohol-Based Hand Rub (ABHR) 1. Performing hand hygiene with an alcohol-based hand rub (ABHR) is the preferred method for decontaminating hands when they are not visibly soiled. 2. ABHRs provide a rapid kill of most transient microorganisms on the hands. It is preferred that ABHR have a minimum alcohol concentration of 70-90%. 3. Point-of-care is the place where three elements occur together: the person, employee and the care or treatment involving person contact. Hand hygiene products available at point-of-care are easily accessible to employee by being as close as possible (i.e. within arm s reach) to where person contact is taking place. Point-of-care products should be accessible without leaving the zone of care. Hand Hygiene with Soap and Water 1. Washing hands with soap and water is the preferred method for decontaminating hands when they are visibly soiled. 2. The combination of adequate friction, lather (for at least 15 seconds) and rinsing removes germs from the hands. 3. Hand washing for routine care may be done with plain liquid soap and water. 4. Antimicrobial soap is not recommended for routine use. 5. Bar soap must not be used for employees and should be reserved for individual person use only. 6. Hand soap must be dispensed from disposable, single-use containers only. 7. Liquid products must be dispensed in a disposable, pump dispenser that is discarded when empty; they should never be topped-up or refilled. Effectiveness of Hand Hygiene 1. Encouraging/supporting hand hygiene for people supported, visitors, and employees is important. 2. Employees, people supported and visitors have a role to play in preventing the spread of microorganisms. It is important that employees encourage hand hygiene for all individuals. 2. Personal Protective Equipment (PPE) a) PPE is used to prevent transmission of infectious agents from person supported to employee. The same equipment will also prevent transmission from person to person, employee to person and employee to employee. b) PPE is used alone or in combination to prevent exposure by placing a barrier between the infectious source and one s own mucous membranes, airways, skin and clothing. The selection of PPE is based on the nature of the interaction with person supported or the likely mode(s) of transmission of infectious agents. Selection of the appropriate PPE is based on the risk assessment. i) Gloves Gloves must be worn when it is anticipated that the hands will be in contact with mucous membranes, non-intact skin, tissue, blood, body fluids, secretions, Page 2 of 6

3 excretions, or equipment and environmental surfaces contaminated with the above. Appropriate Use of Gloves Wear the correct size of gloves; Gloves should be put on immediately before the activity for which they are indicated; Gloves must be removed and discarded immediately after the activity for which they were used; Hand hygiene must be performed immediately after glove removal; Change or remove gloves if moving from contaminated body site to a clean body site within the same person; Change or remove gloves after touching a contaminated site and before touching a clean site or environment; Do not wash or re-use gloves; The same pair of gloves must not be used for the care of more than one person. To reduce hand irritation related to gloves: Wear gloves for as short a time as possible; Ensure hands are clean and dry before putting on gloves; Ensure gloves are intact and clean and dry inside. ii) Gowns A gown is worn when it is anticipated that a care activity is likely to generate splashes or sprays of blood, body fluids, secretions, or excretions. Long - sleeved cuffed gowns protect the forearms and clothing of staff from splashing and soiling with blood, body fluids and other potentially infectious material. Appropriate Use of Gowns When use of gown is needed, the gown should be put on immediately before the task and must be worn properly; Remove gown immediately after the task for which it has been used in a manner that prevents contamination of clothing or skin and prevents agitation of the gown; Discard used gown immediately after removal into appropriate receptacle. Do not hang gowns for later use; Do not re-use gown; Do not go from person-to-person wearing the same gown. iii) Masks A mask is used by a staff (in addition to eye protection) to protect the mucous membranes of the nose and mouth when it is anticipated that a care activity is likely to generate splashes or sprays of blood, body fluids, secretions or excretions, or within two metres of a coughing person. Appropriate Use of Masks Select a mask appropriate to the activity; Masks should securely cover the nose and mouth; Change mask if it becomes wet; Page 3 of 6

4 Do not touch mask while wearing it; Remove mask correctly immediately after completion of task and discard into an appropriate waste receptacle; Do not allow mask to hang or dangle around the neck; Clean hands after removing the masks; Do not re-use disposable masks; Do not fold the mask or put it in a pocket for later use. iv) N95 Respirators An N95 respirator is used to prevent inhalation of small particles that may contain infectious agents transmitted via the airborne route. N95 respirators need to be fit tested prior to use. Seal check should be performed prior to every use. v) Eye Protection Eye protection is used by employees to protect the mucous membranes of the eyes when it is anticipated that a care activity is likely to generate splashes or sprays of blood, body fluids, secretions or excretions, or within two metres of a coughing person. Appropriate Use of Eye Protection Eye protection should be used whenever there is a potential for splashes or sprays to the eyes; Eye protection must be removed immediately after the task for which it was used and disinfected immediately. Note: Prescription eye glasses are not acceptable as eye protection. 3. Environment and Equipment Cleaning The role of environmental cleaning is important because it reduces the number and amount of infectious agents that may be present and may also eliminate routes of transfer of microorganisms from one person/object to another, thereby reducing the risk of infection. 4. High Touch Surfaces High-touch surfaces are those that have frequent contact with hands. Examples include doorknobs, telephones, bedrails, light switches, computer keyboards, equipment, and wall areas around the toilet. Cleaning of high-touch surfaces require more frequent cleaning and disinfecting than minimal contact surfaces. These areas should be cleaned and disinfected daily. 5. Low Touch Surfaces Low-touch surfaces require cleaning on a regular (but not necessarily daily) basis. Low touch surfaces must be cleaned if visibly soiled. Examples include floors, walls, ceilings, mirrors and window sills. Page 4 of 6

5 6. Soiled Bedding Remove gross soil (i.e. feces) with gloved hand and dispose into toilet. Appropriate PPE, such as gloves and gowns should be used. Bedding should be handled with minimum of agitation and shaking; Heavy soiled bedding should be rolled or folded to contain the heaviest soil in the centre of the bundle; Pre-soak bedding; Put bedding in laundry and wash with hot water and detergent immediately after soiling. 7. Laundering Routine laundering practices are adequate for laundering regardless of source. Additional precautions are not required. a) PPE for Laundering Wear gloves if laundry is soiled; Gowns may be required if laundry is extremely soiled; Ensure Hand Hygiene with Alcohol-Based Hand Rub (ABHR) is readily available in laundry area; Use hand hygiene whenever gloves are removed. 8. Cleaning Products All homes are to use Lysol disinfectant cleaner for regular cleaning. When additional precautions are required, Virex is available at the main office for all homes. If Virex is required after hours, contact manager or for weekends and holidays contact the manager on-call. 9. Cleaning of Blood and Body Substances Assemble materials required for dealing with the spill prior to putting on PPE; Inspect the area around the spill thoroughly for splatters or splashes; Restrict activity around the spill until the area has been cleaned and disinfected and is completely dry; Put on gloves; if there is a possibility of splashing, wear a gown and facial protection; Confine and contain the spill; wipe up any blood or body fluid spills immediately using paper towels. Dispose materials by placing them into regular waste receptacle Disinfect the entire spill area; Wipe up the area again using paper towels and discard into regular waste; Remove gloves and perform hand hygiene; Waste should be removed from inside the home. 10. Additional Precautions (See Infection Control Policy) Additional precautions are used in addition to Routine Practices for people supported known or suspected to be infected or colonized with certain microorganism to interrupt Page 5 of 6

6 transmission. The Manager, Health and Wellness will provide employees with instructions on additional precautions when required if person supported is diagnosed with an infectious disease by a health professional. Employees must follow reporting instructions when person supported is diagnosed. 11. Risk Assessment Employees must assess the risk of exposure to blood, body fluids and non-intact skin and identify the strategies that will decrease exposure risk and prevent the transmission of microorganisms. The following Risk Assessment Tool should be incorporated into daily practices of each employee. Following the employee s assessment of any potential risk, routine practices are to be implemented. RISK ASSESSMENT TOOL STEP 1. EVALUATE THE LIKELIHOOD OF EXPOSURE. Person Supported Related Exposure What risk does the person pose? Continent or incontinent? Uncontrolled drainage? Rash or fever? Coughing, sneezing, vomiting? Can the person supported follow directions? What is the hygiene status of the person you are supporting? Task Related Exposure What task am I about to do? Do I have the equipment I need to do this task? How skilled am I at this task? Will the task involve the use of sharp items or will there be a risk of exposure to a sharp? Will the task involve contact with the contaminated environment? Is there a risk of splash or exposure to blood, body fluids, mucous membranes or non-intact skin? Will the task involve contact with blood or body fluids? Engineering Controls Are engineering controls in place? Alcohol-based Hand Rub (ABHR) available? Sharps containers available? STEP 2. CHOOSE THE APPROPRIATE ACTION OR PERSONAL PROTECTIVE EQUIPMENT (PPE) TO MINIMIZE YOUR EXPOSURE. Page 6 of 6