INFECTION CONTROL

AIMS To give an overview of ‘The Chain of Infection.’ To emphasise the importance of handwashing in a healthcare setting. To provide an outline of the personal protective equipment available to prevent and control the spread of infection. To provide an outline of correct waste disposal and management.

LEARNING OUTCOMES At the end of the session, the student should be aware of: The ‘Chain of Infection’ The importance of good infection control. What you can do to prevent and control the spread of organisms. The personal protective equipment available to prevent and control the spread of organisms. Why correct waste disposal and management is necessary to prevent and control infection.

Why do we bother trying to control infections in healthcare settings?

Legal Responsibility Increased morbidity. Increased mortality. ‘Bed blocking’ Public perception/confidence in health care. A reservoir of infection develops. Financial implications. Antibiotics becoming ineffective against routine infection

The Chain of Infection

The Chain of Infection Susceptible Host

What makes somebody a Susceptible Host? Low immunity (low white cell count). Increase/imbalance in the normal flora. Invasive procedures.

The Chain of Infection Causative Micro-organism Susceptible Host

Causative Micro-organisms There is an increased number in hospital. Antibiotic treatments can often enhance the development of resistant pathogenic strains. (Resistance = genetic mutation of the base DNA = changes in amino acids  creates a different protein.)

The Chain of Infection Causative Micro-organism Susceptible Host Reservoir

Reservoir or Source or where the potential spread originates Patients And visitors Staff Fomites

The Chain of Infection Causative Micro-organism Susceptible Host Portal of Entry Reservoir Portal of Exit

Portals of Entry and Exit Respiratory tract. Gastro-intestinal tract. Genito-urinary tract. Broken skin.

The Chain of Infection Causative Micro-organism Susceptible Host Portal of Entry Reservoir Portal of Exit Mode of Transmission (Spread)

Mode of Transmission Direct contact Indirect contact Vector spread Airborne spread ‘Self spread’ Exogenous spread (Cross-infection) Endogenous spread

The Chain of Infection Causative Micro-organism Susceptible Host Portal of Entry Reservoir Portal of Exit Mode of Transmission (Spread)

If you break the chain at ANY point, infections can be prevented and controlled.

HAND DECONTAMINATION

Purpose of Hand Decontamination To remove transient hand flora Staphlococcus aureus Streptococci Viruses To reduce number of resident (commensal) flora Anaerobic cocci Coagulase negative staphlococci e.g. Staphlococcus epidermidis All micro-organisms found on the hands are capable of colonising susceptible sites

WHEN TO DECONTAMINATE YOUR HANDS! Before entering and when leaving a clinical area. Before and after any patient contact. Before and after carrying out any procedures. Before and after removing aprons and gloves. After going to the toilet Before food preparation and eating. However, if your hands become contaminated with blood or any other body fluid, you need to immediately and thoroughly wash them.

Types of Hand Washing Level 1 - Social or routine handwash Level 2 - Hygienic hand antisepsis Level 3 – Surgical handscrub

WHAT TO USE!!! Alcohol Hand Wash / Gel Will destroy most transient organisms, such as MRSA and Staphlococcus. HOWEVER, it is not as effective against Clostridium difficile, Norovirus or if hands are contaminated with organic matter. Antimicrobial Liquid Soap and Water Will remove all transient organisms.

IMPORTANT Hand washing includes the wrists NO jewellery (except for a plain wedding ring) should be worn below the elbows in clinical areas Fingernails should be clean and short If alcohol hand wash / gel used, it should be applied to all surfaces of the hands If soap and water used, hands need to be dried properly with paper towels Use the hand barrier cream or moisturiser provided

Optimum Handwashing Technique Wet hands under running water Apply soap to all areas of your hands Rub hands together vigorously, thoroughly cleansing all the surfaces for 10 – 15 seconds (or approximately 5 strokes backwards and forwards for each area Keep hands lower than elbows and do not touch the taps with skin Rinse hands thoroughly under running water Dry hands thoroughly using paper towels.

‘Bare Below the Elbow’ Policy. Clean Your Hands campaign To encourage hand washing and increase its effectiveness there are local campaigns and national initiatives ‘Bare Below the Elbow’ Policy. Following recommendations from the Department of Health Clean Your Hands campaign Developed by the National Patient Safety Agency.

DISPOSAL OF CLINICAL WASTE

Waste is separated into 2 distinct types Household e.g. paper, plastic bottles/containers. Clinical e.g. sharps, soiled dressings, anything contaminated with blood and/or bodily fluids All clinical waste must be identifiable and traceable back to the source it originated from

If in doubt, treat the item as a sharp. What is a Sharp? A sharp is described as any item that may potentially cut or penetrate the skin. If in doubt, treat the item as a sharp.

Why is it important sharps are disposed of correctly? It prevents direct injuries to staff. It reduces the risk of exposure to blood borne viruses.

Disposal of Sharps Sharps must be disposed of in an appropriately sized sharps bin. NEVER re-sheath a needle. A used sharp MUST be placed immediately and directly in to a sharps bin at the point of use. Sharps bins should always be carried by the handle with the sliding door closed. NEVER empty out the contents of a sharps bin. NEVER try to retrieve an item once discarded into a sharps bin. DO NOT overfill a sharps bin CORRECT USE OF SHARPS BINS Bins must be correctly assembled according to the manufacturer’s instructions Sharps bins must be kept out of the reach of children e.g. not on the floor Sharps bins must always be carried by the handle Used needles, blades and other sharp instruments must be placed immediately and directly into a rigid sharps container at the point of use. Never re-sheath, bend or break needles. NEVER empty out the contents of the bin NEVER try to retrieve an item once discarded in a sharps bin

STANDARD INFECTION CONTROL PRECAUTIONS These precautions should be applied at all times and are applicable to all staff and patients. Gloves and Aprons Broken skin Hand hygiene Sharps Clinical waste and linen

References Department of Health (2007) Uniforms and Workwear. An evidence base for developing local policy. Kerr (1998) Handwashing Nursing Standard, Vol 12, No 51, pp 35 – 42. Mims,C. Dockrell,HM. Goering,RV. Roitt,I. Wakelin,D. Zuckerman,M. (2004). Medical Microbiology (3rd ed) Mosby, Edinburgh.

References Pratt. RJ, Pellowe. C, Loveday. HP, Robinson. N Smith GW (2001) The epic Project: Developing National Evidence-based Guidelines for Preventing Healthcare associated Infections. Part 1 Guidelines for Preventing Hospital acquired Infections. Journal of Hospital Infection 47 (Supplement) S3-S4. Sheffield Teaching Hospitals Trust (2006) Infection Control Guidelines.