Transcript Infection Control - women's and children's hospital adelaide

Infection Control
Jodie Burr
Infection Control Coordinator
Women’s and Children’s Hospital
Infection Control Unit
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24 Hour Infection Control Service
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During office hours page 18041*
After hours ring 9 for Infectious Disease
Consultant on call
Infection Control Team
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meet weekly, concerns, enquiry's, issues
can be discussed
Primary Role of Infection
Control
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Prevent nosocomial infections
Reduce mortality, morbidity, and cost
Educate and advise
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patients
 their families
 the community
Surveillance of nosocomial infections
Policy development, implementation
and assessment
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staff
IC Issues specific to
Paediatrics
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Communicable diseases affect a
higher % of paediatric patients than
adults
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non-immune - acquire - spread
paediatric personnel are at a greater risk
for exposure to communicable diseases immune status
May lack the mental / physical ability
to adhere to IC principles
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lack of hygiene
unable to understand / comply with IC
principles
IC Issues specific to
Paediatrics
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More likely to have contact with
contaminated environmental surfaces
and objects
Parents and siblings
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have the same infectious agent
 involved in patient care - education about
transmission and IC principles
Immunization
It is important to know your health and
immunization history
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chicken pox
measles
flu vaccination
pertussis
For vaccinations contact ICGP or Risk
Management
IC Link Nurses
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Educate ward/unit staff
Ensure compliance with infection
control guidelines
Assist with outbreaks or disease
exposures
Develop patient & staff information
brochures
Promote infection control initiatives
Standard + Additional
Precautions
Standard Precautions
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all patients
all times
Additional Precautions
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some patients
some times
Standard Precautions
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Work practices necessary to fulfil
basic infection control requirements
For all patients regardless of
diagnosis or presumed infectious
status
Standard Precautions
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Apply to:
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Blood
All body fluids - excretion and secretions
(including sweat)
Non-intact skin
Mucus membranes
Regardless of whether there is visible
blood or body fluids
Hand Hygiene
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The single most effective method in
the prevention of disease transmission
80 % hospital acquired infections are
thought to be transmitted by hands
Healthcare workers think they wash
their hands more than what they do
Hand Hygiene
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Soap and Water
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mechanical removal of most transient flora
and soil
minimal microbial kill
no sustained activity
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15 seconds
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Hand Hygiene
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Antimicrobial Soaps
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removes soil, removes transient and reduces
resident flora
may have sustained activity
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15 seconds (antiseptic handwash)
60 seconds (clinical handwash)
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2 minutes (surgical scrub)
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Hand Hygiene
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Alcohol Handrubs / Gels
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very rapid kill
destroys transient and reduces resident
flora
no residual activity (except with antiseptic)
will not remove or denature soiling
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15 seconds
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Areas most frequently
missed
Personal Protective
Equipment
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Eye and/or facial protection (goggles,
face shields)
Gloves
Gowns
Masks
Assess the likely hood of contamination
and prepare accordingly
Equipment Reprocessing
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If it comes into contact with:
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intact skin = clean
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mucous membranes = high level disinfection
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sterile site = sterilise
All items must be cleaned first
Single-use items must not be reused
Environmental Controls
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Cleaning
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detergent and water is adequate
ensure patient care areas are cleaned
regularly
minimize clutter
Linen and Laundry
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no need to mark ‘infectious’
if the skip is wet then place in a plastic bag
Waste
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General Waste (Green Bin)
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dressings, bandages, nappies, sanitary
pads, flowers, kitchen waste, plastic,
paper, empty containers of blood, body
fluid, IV lines, urinary catheters
Medical Waste (Yellow Bin)
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ALL sharps, bags or tubing of blood,
human tissue, lab specimens and cultures,
cytoxic waste (sealed in purple cytoxic
container or bag first)
Blood and Body Spills
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Small spills
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up with paper towel
 detergent and water
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Large spills (easy to clean surface)
 wipe
up with paper towel
 detergent and water
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Large spills (difficult to clean
surfaces)
 wipe
up with paper towel
 detergent and water
 wipe over with Milton(R)
Assessment of Risk Factors
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Your knowledge or experience with the
situation or procedure
The likely hood of exposure to blood or
body fluids at the time
The patients ability to cooperate
through out the procedure
Additional Precautions
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Are applied in addition to Standard
Precautions
Apply with:
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highly transmissible organisms
epidemiologically significant organisms
Additional Precautions
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May include:
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Single room accommodation (ensuite for
some)
Special ventilation (negative, positive
pressure)
Special room cleaning
Dedicated patient equipment
Rostering of immune staff
Extended sterilization (or use of
disposable equipment)
Cohorting may be considered
Bed Management
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CATEGORY A
Very High Risk of Cross Infection or Adverse Outcome
Mandatory Negative pressure single room
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CATEGORY B
High Level of Cross Infection
Mandatory Single room or cohort same contagious agent
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CATEGORY C
Moderate Risk of Cross Infection
Single Room in Selected Circumstances
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CATEGORY D
High Risk to the Newborn
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CATEGORY E
Low risk of Cross Infection
Rooming in not allowed
No segregation required
INFECTION / CONDITION
Asthma
Barmah Forest virus
Bat lyssa virus (see rabies)
Bronchiolitis
Botulism
Brucellosis
Chicken pox (varicella zoster virus) 
Cellulitis
Chlamydial infection
Conjunctivitis
Croup
Cystic fibrosis exacerbation
Creutzfeldt-Jakob disease
Cytomegalovirus disease
Dengue
Diphtheria
Eczema, infected
Epiglottitis
Epstein-Barr virus (glandular fever)
Erythema multiforme
Febrile convulsion
Gastritis
SETTING
If trigger thought to be viral (npa to confirm)
A
B
C
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D
E
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Active disease
Susceptible contact (appendix 1 for how to determine)
Includes, orbital and preseptal
Viral (other than adenovirus), bacterial or chlamydial
Suspected or proven adenovirus conjunctivitis in family,
or hospital outbreak
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P. aeruginosa status, proximity to other CF patients see p 8
Patient at risk of having been exposed to agent
Congenital, Nursery, Neonatal, Oncology, Renal
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Pharyngeal or cutaneous
Streptococcal
non Streptococcal, proximity to burns patients
non Streptococcal, all other situations
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In the absence of respiratory or gastroenteritic symptoms
If the cause is infective, which is unlikely
all other causes
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Respiratory Syncitial Virus
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Highly contagious and nosocomial
infection common
Causes upper and lower respiratory
infection
Usually occurs during winter
No vaccine at present
Can be reinfected during the same
season
Transmitted by contact or droplet
Can survive for several hours in the
environment
Rotavirus
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Highly contagious and nosocomial
infection is common
Usually a winter disease but pattern
changing
Onset is sudden and lasts for 4 - 6 days
Mainly infants and children up to 3 years
affected
Transmitted usually through contact
Can survive in environment for several
hours
Gastrogard-RTM
Hospital Acquired Rotavirus diarrhoea
prevention program
 Eligible if:
 aged
between 0 days and 48 months
 regardless of whether they already
have or develop gastroenteritis
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Ineligible if:
 cow’s
milk protein intolerant (not
lactose intolerant)
 if on a protein restricted diet
 fasting
 breast fed
Varicella Zoster Virus
Chicken Pox
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Highly contagious
Most cases in children, over 90% of
adult population is immune
Transmitted by droplet and contact
Infectious 2 days prior and 4 - 6
days after rash
Now a notifiable disease
Vaccination now available
Varicella Zoster Virus
Chicken Pox
BUG WATCH
Infection Control Awareness
Program for Visitors