Transcript No Slide Title

Back to Basics ….& the
Newest Version of the New
Normal for Office Settings
Suzanne Rhodenizer Rose RN BScN CIC
Patsy Rawding RN BScN CIC
Provincial Infection Control Consultants
NS Department of Health
Objectives
• Review the Chain of Infection.
• Discuss Routine Practices & Additional
Precautions.
• Explore prevention strategies in primary care
settings.
• Review personal protective equipment (PPE).
Chain of Infection
Causative
Agent
Susceptible
Host
Reservoir
Portal of
Entry
Portal of
Exit
Mode of
Transmission
Routine Practices
• The standard of care for ALL people during
ALL care in ALL health care settings.
• Routine Practices are activities that you do to
help reduce your risk of being exposed (or
have potential to deal with):
– Blood and body fluids
– Secretions and excretions (except for sweat)
– Non-intact skin
– Mucous membranes
Routine Practices cont’d
• Various components to Routine Practices
– Hand hygiene.
– Cleaning & disinfection.
• Patient care equipment
• Environment
– Safe sharps handling.
– Use of PPE as indicated.
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Mask
Gloves
Gowns
Eye protection
Routine Practices & Risk Assessment
• Based on the type of interaction you are
going to have rather than the diagnosis or
disease.
• Hand hygiene – need we say more?.......... we
will 
• If you are going to touch blood, body fluids,
mucous membranes or non-intact skin……
• If you are going to come in contact with
potentially contaminated surfaces……
Routine Practices & Risk Assessment
cont’d
• If you are going to be splashed or sprayed….
• If your clothing is likely to become
contaminated…..
• Perform a risk assessment before each
patient interaction.
Hand Hygiene
• Traditional hand washing vs alcohol-based hand sanitizers.
• Proper technique essential!
• When, you ask?
– Before and after patient care
– After handling contaminated
equipment
– After the washroom – really!?
– Before and after eating
– After coughing and sneezing (respiratory hygiene works well too!)
• Jewelry can harbour germs and make hand hygiene
difficult.
Cleaning & Disinfection
• Equipment and surfaces contaminated with
secretions from patients should be cleaned
before use with another patient:
– Stethoscopes
– Examining table
– B/P cuffs
Cleaning & Disinfection
• Ensure multi-use equipment
is not used in the care of another
client until it has been properly
cleaned and re-processed.
• Do not re-use single use items.
• Use clean hands to handle clean equipment.
• Any equipment or device that comes in contact with
mucous membranes, open areas or beneath the skin in
sterile sites must be re-processed correctly.
• Single use items, such as a tourniquet or needle, are
one-client use only and are disposed of properly.
Disinfection of
Patient Care Equipment
• Spaulding system: devices categorized based on
contact with patient & risk of infection.
• Non-critical- touches only intact skin or does not
directly contact the pt ie. Stethoscopes.
• Semi-critical- contact with non-intact skin and/or
mucous membranes I.e. laryngoscope blades.
• Critical- enter sterile body cavities, including the
vascular system i.e. surgical instruments.
Disinfection of Equipment
• Non-critical items
low level
i.e. stethoscopes, B/P cuffs, examining tables.
• Semi-critical items
high level
i.e. vag speculums, respiratory therapy equipment.
• Critical items
sterilization
i.e. surgical instruments, prostate biopsy guides.
• Chemical products or processors are classed as low level, high
level, or chemosterilant /sterilizers.
Disinfection of Equipment
• All reusable equipment requires cleaning i.e. stethoscopes.
• Cleaning vs disinfection.
 Cleaning removes organic debris
 Disinfection has microbial kill
• Items requiring disinfection must be thoroughly cleaned prior to
disinfection.
• Single Use Only items should be discarded.
• Monitor reusable equipment for integrity i.e pillows, mattresses.
• Use routine precautions.
Disinfection of Equipment
• Low Level
 3% hydrogen peroxide
 Quaternary
ammoniums (ultraquat)
 Phenolics
 Disinfectant wipes
• High Level
 Pasteurization
 Glutaraldehydes &
OPAs (Cidex)
 Peracetic acid
 6% hydrogen peroxide
Disinfection of Equipment
• Sterilization
Ethylene oxide
Autoclaving
Steam sterilizer
2% glutaraldehydes
Peracetic acid
Remember: All disinfectants are not
created equal!!
Environmental Surfaces
• Be aware of how you inadvertently
contaminate the environment.
– exam tables
– exam lamps
– door knobs
• Regular housekeeping practices.
• Need to clean before disinfection occurs
– True for equipment & environmental surfaces
Hierarchy of
Precautions
Routine Practices
Additional Precautions
Contact
Droplet
Droplet/
Airborne/
Airborne
Contact
Contact
ARO (MRSA)
Contact
Contact
Droplet
Less than 2 metres
Direct
Indirect
Airborne
Greater than 1 metre
Vehicle
Contact Precautions
• Refers to both direct and indirect contact.
• Patient care equipment/surfaces in direct
contact with patient or infective materials
require cleaning between patients.
• Handled equipment can become indirectly
contaminated.
• Stool, respiratory secretions, drainage from
lesions are common infective materials.
• PPE?
Droplet Precautions
Droplet Precautions
• Generated by the respiratory tract i.e
coughing, sneezing etc.
• Droplets heavier and larger; can only be
propelled a short distance.
• Maintain a minimum distance of 2 meters.
• Croup, Pneumonia, Colds, RSV, influenza,
meningitis.
• PPE?
Airborne Precautions
• Remain suspended in the air for long periods
of time.
• Widely dispersed by air currents & inhaled
by susceptible hosts at a far distance from the
source (such as a different unit!).
• Examples: Chicken pox, TB, Measles,
Smallpox!
Let’s Talk AGMPs!
• Aerosol-generating medical procedures.
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Endotracheal intubation
Bronchoscopy
CPAP/ BIPAP
Mechanical ventilation
Respiratory/ airway suctioning
Tracheostomy care
Aerosolized or nebulized medication administration
• Can produce aerosols and be a risk in respiratory
infected patients i.e. with influenza.
Airborne Precautions
• Negative pressure room or single room with
door closed.
• Fit tested N95 mask.
• Consider immunity or risk of exposure to
airborne diseases, conducting AGMPs.
Get the Gear
Get the Gear!
• Gloves
– Gloves provide an additional protective barrier
between the HCW’s hands and blood, body
fluids, secretions, excretions and mucous
membranes.
– Removed immediately after completion of care,
before touching clean environmental surfaces.
– Turn inside out when removing.
– Hands must be washed immediately after
removing gloves.
– Vinyl, latex, nitrile.
Get the Gear!
• Gowns/Aprons
– put on with the opening at the back, with edges
overlapping.
– tied at the waist and neck.
– Remove wet gowns immediately as this allows
microorganisms to pass through.
• used to protect uncovered skin and prevent
soiling of clothing during procedures and
activities likely to generate splashes or sprays.
• uniforms should be changed if soiled.
Get the Gear!
• Masks & eye protection
– worn if within 2 metres of a patient with a respiratory infection
– Whenever a mask is required, the HCW should also wear eye or face
protection (i.e. goggles, safety glasses or face shield).
• Mask manners!
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worn once and discarded.
changed if mask becomes wet.
always discarded into an appropriate receptacle.
covering both mouth and nose; both straps tied!
avoid touching mask while being worn.
NEVER dangle mask around neck, this practice causes
contamination.
• All PPE should be removed before leaving the room and hand hygiene
performed!
Donning & Removal
• What goes on first?
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Gown
Mask
Goggles
Gloves
• What comes off first?
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Untie gown in back
Remove gloves
Remove eye protection ( if wearing)
Remove mask using ties
Remove gown
Perform hand hygiene!
Precautions for the Flu
• Gloves
– Gloves on room entry of patients/residents suspected or confirmed to
have influenza.
• Gowns
– Not required for the routine care of patients/residents suspected or
confirmed to have influenza.
– Gowns/aprons should only be used to protect uncovered skin and
prevent soiling of clothing during procedures and patient care
activities likely to generate splashes or sprays of blood, body fluids,
secretions or excretions.
• Masks/Eye Protection
– Should be worn if within 2 metres of a resident with ILI
– Whenever a mask is required, the HCW should also wear eye or face
protection (i.e. goggles, safety glasses or face shield).
• All PPE should be removed before leaving the room
Hand Hygiene –wash your hands, wash your hands,
wash your hands!!!
Meticulous hand washing with soap and water or waterless alcohol hand
sanitizers will inactivate the virus.
In the Office…..
• Make Routine Practices truly routine!
• Screening:
– signage posted outside the entrance asking that
any patient with a fever and/ or new cough or
other respiratory symptoms to perform hand
hygiene and put on a surgical mask.
– Can also occur when doing reminder calls.
In the Office…..
• Source control measures
– Having a physical barrier between the
receptionist and the patient.
– Maintaining a 2 metre distance.
– Educating the patient on hand and respiratory
hygiene practices.
– Placing the patient in a separate area of the
office (e.g.: examination room).
– Scheduling the appointment for the ILI patient at
the end of the day, if possible.
Toys
• Soft toys should be removed.
• Hard non-porous toys should be clean and
disinfected at the very least daily.
• To minimize risk associated with toys,
remove and have parents bring in their childs
own.
Ask Yourself These Questions…..
• Do I need protection because there is a risk
of exposure to…..?
• Do I need protection because of the
resident’s symptoms?
• Does my office or clinic have
policies stipulating what I must
do to provide patient care?
Resources
• Infection Prevention and Control Best Practices for Long
Term Care, Home and Community Care including Health
Care Offices and Ambulatory Clinics:
http://www.chica.org/pdf/IPAC_best_practices_CCAR.p
df
• Ontario Best Practice Manual : Cleaning, Disinfection
and Sterilization In All Health Care Settings:
http://www.health.gov.on.ca/english/providers/program/i
nfectious/diseases/ic_cds.html
• Provincial Centre for IP &C:
– [email protected] 722-1244
– [email protected] 424-8254
Any Questions for Us?