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Health Protection in relation to Early Years Linda Churm Health Protection Specialist 0844 225 3557 [email protected] Aims and Objectives The aim of this session is to increase and build on existing knowledge of infection prevention and control in your place of work or when home visiting For attendees to take relevant information back to base and discuss to colleagues on topics such as •Role of HPU •Resources •Hand washing: Max •Outbreaks •Infectious diseases Why Infection Control? •Protect children •Protect Staff •Protect Visitors •Demonstrate good and responsible practice •Reduce Costs involved when events get out of hand Beat the bugs Raising Children’s Awareness Teach the importance of regular hand washing Wiping noses and disposal of tissues Covering mouths when coughing or sneezing Media interest! Role of HPU •Queries (Telephone or email) •Parents •Communicable Disease Control •Outbreaks •Meningitis •Measles/whooping cough etc •Infection Prevention and Control Resources •Spotty Book •Posters •Policies •Leaflets •Web site •www.hpa.org.uk •Nhschoices •A2Z Hand Washing Resources Posters Max Glow Box : Please contact HPU to borrow Bristol study Hand washing Did you know one million bacteria can be created by one person in a school day Who washes hands anyway? Why hand washing is so important Good hand hygiene is one of the single most effective measures for preventing the spread of infection Our hands move micro-organisms (germs) from one place to another By hand washing, we remove germs acquired by recent contact with infections, or with the environment Hand washing protects both children and staff History Semmelweis demonstrated that washing hands saves lives in 1847. Death rate amongst women giving birth looked after by doctors was nearly x3 greater than those tended by midwives. Semmelweis made the connection - Drs did postmortems The death rate fell from 11% to below 1% Factors influencing compliance. Training - constant and creative ! Motivation Availability of conveniently located sinks with mixer taps Availability of paper towels or soap which are not too harsh and detrimental to skin Perception (or reality) of insufficient time Workload, Staff shortages Hand rubs-alcohol gel New staff-Induction What lives on our hands? Transient flora – acquired by contact these germs survive on the skin for less than 24 hours and can be removed by hand washing Resident flora – part of our normal skin flora these microorganism survive and multiply on the skin, they rarely cause infections (other than skin infections) except when introduced into the body through invasive procedures Routine hand washing the aim to remove transient micro-organisms(germs) acquired on the hands before they are transferred to other people or surfaces Hand washing with soap and water Definition of hand washing the vigorous, brief rubbing together of all surfaces of lathered hands, followed by rinsing under running water (Garner and Favero 1985) Rub hands together vigorously for a minimum of 15 to 20 seconds in total Pay particular attention to tips of fingers, thumbs and areas between the fingers Hand drying Micro-organisms transfer most effectively from wet surfaces so always dry hands thoroughly Use good quality paper disposable hand towels Cloth towels can become a source of infection Warm air dryers have the potential to spread airborne pathogens Damp hands spread 1,000 times more germs than dry SIX STAGE HANDWASHING TECHNIQUE 1 2 4 3 5 6 1 palm to palm 4 fingertips 2 backs of hands 5 thumbs and wrists 3 interdigital spaces 6 nails Reproduced with kind permission of the Nursing Standard AREAS MISSED DURING HANDWASHING Reference: Taylor L. (1978) Alcohol hand gel Alcohol-based preparations offer a solution when time and facilities are restricted Ideal for rapid hand decontamination Require no facilities Overall kinder to the skin (due to the use of emollients, but these build up over several applications) Not a cleansing agent, so visible contaminates still need removing with soap and water Skin care For care workers, frequent hand washing can cause long-term changes in the skin Minimise the risk of skin damage by following guidance Report any skin irritation or abnormality immediately to the Occupational Health Advisor Apply hand cream regularly to protect the skin from dryness Use own, pump action not shared tub! Improving compliance For both care workers and children education leads to change Recommend this session to your colleagues Introduce routine observation and feedback, engineering controls, workplace reminders, patient education... Borrow the light box Quiz 1. Name 3 reasons why nursery staff do not wash their hands. 2. What type of product could be best for washing visibly clean, but potentially contaminated hands? 3. Suggest 3 things that you can do which can make the hand washing more effective. Why people don’t wash their hands Many people do not fully understand the risks associated with not washing their hands Low staffing levels, and other practical issues, contribute to poor handwashing inadequate sinks no soap or hand towels poor water temperature control Different people respond to different motivators identify what works best for individuals The Chain of Infection Chain of Infection model Bacteria, viruses, Fungi etc People, animals, food, water, Equipment etc Infectious agent Host susceptibility People at risk Reservoirs Portals of entry Portal of Exit Means of broken skin, respiratory tract, etc. transmission Contact, inhalation or airborne organisms, blisters, ingestion. Droplets, urine, secretions, skin, etc How do we break the chain? Assess susceptibility of host and protect.- cancer, recent illness, poor hand washing in children, pregnancy, not vaccinated etc Identify risk of infectious agent.e.g. Hand Foot and Mouth/cough /colds. chicken pox and pregnancy Identify where it can live - increased cleaning, stop shared play etc Breaking the chain Close the portal of exit- exclude, clean, throw away, no shared play e.g. sand & water Prevent transmission- hand washing, increase cleaning, covering mouth when coughing, exclude from school Reduce risk- Use of gloves apron, hand wash, raise awareness-communication, plasters Break the chain by targeting one or more links can halt the spread of infection by; Preventing the method of spread through Preventing germs from entering the body by Hand washing Wearing protective clothing Personal hygiene Observing the condition of the client Disposal of waste Environmental hygiene Personal Protective Equipment Personal Protective Equipment Gloves Apron Gowns Masks Overshoes etc Assess body fluid risk of task to be undertaken No risk of splashing No protective clothing Blood/blood stained Disposable gloves & Low risk of splashing aprons. Blood/blood stained Gloves, waterproof gown/ Body fluid and high risk apron & eye protection/ Risk of splashing mask Low Risk Body Fluids Urine Faeces Tears Nasal secretions Sweat Saliva USE OF GLOVES Nappy changing Or when likely to be in contact with blood / body fluids, wounds, mucous membranes not a substitute for handwashing hand contamination occurs during removal handwash after removal powder-free gloves should be used must be changed: • between clean and dirty tasks • between children Cleaning Disposable or colour coded equipment Hot soapy water or Detergent wipes Dry thoroughly Include cleaners in training Get rid of clutter How does it get out of control? Poor communication Lack of knowledge and skill Not adhering to proven policies. Taking dangerous “short cuts” Staff “carrying on” when they have symptoms Visitors and children who have symptoms. Inadequate cleaning Consequences of infection Increased & or prolonged illness Disfigurement Financial – loss of earnings, health service costs. Stress parents and staff Effects on staff/children/parents( physical and moral). Litigation Death The management of outbreaks Outbreak control What is an OB? What is Norovirus? How is it spread? What should I do in an Outbreak Common Questions Definition of an Outbreak This is two or more linked cases of the same illness or symptoms, in staff or children •Diarrhoea •Chickenpox •Slapped cheek •Hand foot and mouth •Measles Transmission In one vomit 32 million virus particles are excreted It takes only 10 particles to become infected Common Questions How do we know it is viral? Vomit in communal areas Visitors/ Staff Shared play +/- Gel Cleaning Can we Vacuum? Immunity Cleaning up spills Protective equipment Gloves Apron Paper towels and yellow bag or detergent and water chlorine agent for blood and body fluid or Spillage kit Dispose of as clinical waste granules tablets shovel instructions gloves paper towels bag apron Carpets and soft furnishings Steam clean or Wearing protective clothing mop up with paper towels or disposable cloths Clean surface thoroughly using a solution of detergent and water and paper towels or disposable cloths Rinse the surface and dry thoroughly Dispose of materials as clinical waste Clean the bucket/bowl in fresh hot, soapy water and dry Discard protective clothing Wash hands What then? Be alert to failure of system. Good observations. Good documentation and communication. Constant review of risks. Effect changes as necessary. Reflect on successes or failures. Know were to get information Support others in their learning Don’t take short cuts Any Questions?