Infection Prevention To prevent healthcare associated infections for both patients and healthcare workers

Standard precautions Standard precautions are a set of infection prevention practices healthcare workers use to reduce transmission of microorganisms in healthcare settings for all patients, all the time. Standard Precautions protect healthcare workers, patients and visitors from infectious agents.

Standard Precautions include: Hand Hygiene: handwashing with soap and water or use of alcohol based hand rub (ABHR) as per the 5 moments of hand hygiene Personal Protective Equipment (PPE): when there is a risk of a splash or spray of blood or body fluids ` Gloves ` Mask ` Eyewear` Gowns Safe handling and disposal of sharps Environmental Cleaning Aseptic Non touch technique (ANTT) Management of waste and Linen Processing of Reusable Medical Devices (RMDs) or use of single use items Respiratory and cough etiquette

Why is hand hygiene important? Infections are a serious problem in healthcare facilities. There are around 200,000 healthcare-associated infections in Australian acute healthcare facilities each year. Around half of these are considered preventable. Many infections are transmitted on the hands of healthcare personnel. Hand Hygiene forms part of Standard Precautions. It can reduce the transmission of healthcare-associated infections – to your patients and to you.

Do you use hand hygiene when you should? Immediately before touching a patient Immediately before performing an invasive procedure or manipulating an invasive device Immediately after touching a patient Immediately after removing gloves Immediately after touching contaminated surfaces

What reasons prevent you from practicing hand hygiene regularly? Cleaning hands cause skin irritation and dryness Sink location/accessibility Lack of soap or hand rub Too busy/lack of time Patient needs take priority Don’t think it is important other

SO, I NEED TO IMPROVE. WHEN SHOULD I PRACTICE HAND HYGIENE? Whenever hands are visibly dirty or contaminated. Before: having contact with patients putting on gloves inserting any invasive device manipulating an invasive device After: having contact with a patient’s skin having contact with bodily fluids or excretions, non-intact skin, wound dressings, contaminated items having contact with inanimate objects near a patient removing gloves

BUT I DIDN'T TOUCH THE PATIENT. WHY SHOULD I PRACTICE HAND HYGIENE? Bacteria can survive for DAYS on patient care equipment and other surfaces. Surfaces in the patient care environment – including bed rails, IV pumps, and even computer keyboards – are often contaminated with bacteria. It’s important to practice hand hygiene after you leave the room, even if you only touched patient care equipment or other surfaces.

Why are alcohol-based hand rubs so great? Alcohol-based hand rubs (foam or gel) kill more effectively and more quickly than handwashing with soap and water. They are less damaging to skin than soap and water, resulting in less dryness and irritation. They require less time than handwashing with soap and water. Bottles/dispensers can be placed at the point of care so they are more accessible

WHEN SHOULD I USE ALCOHOL-BASED HAND RUBS? An alcohol-based hand rub is the preferred method for hand hygiene in all situations, except for when your hands are visibly dirty or contaminated.

HOW DO I PRACTICE HAND HYGIENE CORRECTLY? HAND RUB (foam and gel) 1. Apply to palm of one hand (the amount used depends on specific hand rub product). Rub hands together, covering all surfaces, focusing in particular on the fingertips and fingernails, until dry. Use enough rub to require at least 15 seconds to dry. HANDWASHING Wet hands with water. Apply soap. Rub hands together for at least 15 seconds, covering all surfaces, focusing on fingertips and fingernails. Rinse under running water and dry with disposable towel. Use the towel to turn off the faucet.

BE A ROLE MODEL AT YOUR FACILITY. Colleagues, trainees, and other staff watch what you do: Research has shown that the actions of clinicians influence the behaviour of others. Show your colleagues that hand hygiene is an important part of quality care. Your patients watch you too: Your actions send a powerful message. Show your patients that you are serious about their health.

WHAT ABOUT HAND LOTIONS? Hand lotions are important to prevent skin dryness and irritation. You should use only hospital-approved hand lotions at least 3 times per shift. Other lotions may: make hand hygiene less effective cause breakdown of latex gloves become contaminated with bacteria if dispensers are refilled

WHAT ABOUT MY FINGERNAILS and Jewellery ? Organism growth from the back of wrist watch worn by a HCW while on duty Keep your natural fingernails short to about ¼ inch and nail polish free. Do not wear artificial nails when having direct contact with high-risk patients (e.g., ICU, OR). A wedding ring Only. Remembering studies have shown skin underneath jewellery heavily colonized compared to areas of skin without jewellery. Therefore jewellery can hinder effective hand hygiene.

NOW YOU KNOW ABOUT HAND HYGIENE WHAT ADDITIONAL STANDARD PRECAUTIONS SHOULD BE IMPLEMENTED? If there is a RISK of a splash or spray or contact of the blood or bodily fluid, you MUST wear the appropriate PERSONAL PROTECTIVE EQUIPMENT (PPE): Gloves Gowns Masks Eye Protection Face Mask

HOW DO I USE GLOVES CORRECTLY? Hand hygiene prior to glove use is essential Put on new gloves before contact with non-intact skin or mucous membranes Wear gloves during contact with bodily fluids or contaminated items Remove gloves after caring for a patient - do not wear the same gloves for more than one patient Do not reuse or wash gloves Don’t forget hand hygiene after removing gloves. Gloves are not a replacement for hand hygiene

How do I use Gowns correctly? Long sleeve, single use, impervious gowns protect inner clothing/uniform from transient organisms, splashes and sprays of blood and body fluid. Single use gowns are exactly that SINGLE USE. Gowns should not be left hanging in patient areas for reuse. Remove, discard and perform hand hygiene.

When do I use a Face Mask? Surgical Masks should be worn when there is a risk of spraying / splashing / aerosolisation with blood or body fluids. When the risk of airborne infection is high, eg. Bronchoscopy, nebulisation, additional droplet/respiratory precautions all Health Care Workers (HCWs) delivering care for maximum protection should wear an appropriate P2/N95 mask with a filter efficiency of at least 95%, . Ensure a P2 respiratory mask is fit tested to offer maximum protection Ensure face mask are fitted correctly to maximise protection

When do I use Protective Eyewear? Protective Eyewear MUST be worn when there is a RISK of a splash or spray of blood and body fluid Ensure eyewear fits your face minimising any gaps for maximum protection Reading glasses are NOT classified as protective eyewear SVPHM provides a range of protective eyewear for HCWs It is the responsibility of the HCW to wear protective eyewear.

What about Safe Handling and Disposal Of Sharps? A sharp is the responsibility of the HCW who created the sharp Sharps MUST be disposed of at point of use NEVER recap a needle Always utilise an appropriate dish/container/trolley to transfer a sharp Sharps should NEVER be passed directly hand to hand Ensure communication/verbilisation prior to passing a sharp Prior to a procedure a passage for sharp movement SHOULD be identified. Eg sharps caddy

How do I ensure the clinical area is Cleaned? Environmental cleaning and disinfection is ESSENTIONAL is decreasing hospital acquired infections amongst HCW, patients and visitors Ensure ALL shared patient equipment is cleaned from top to bottom in between patients by the HCW utilising the equipment or as designated within your department. Refer to the Cleaning of Shared Patient Equipment Policy Ensure cleaning schedules with specific cleaning frequencies are available for ALL furnishings, fixtures, equipment and environments

What is Aseptic Non Touch Technique (ANTT)? Aseptic Technique defines what action are taken during all invasive clinical procedures to prevent the transfer of microorganisms from the health care worker, procedure equipment or the immediate environment to the patient. Principles of ANTT: Always wash hands effectively Never contaminate key parts Touch non key parts with confidence Take appropriate infection control precautions A ‘key part’ is the part of the equipment that must remain sterile: such as a syringe hub, needle, or IV bung. Key parts relate to equipment A ‘key site’ is the area on the patient such as a wound, or IV insertion site Key sites relate to patients Key parts and sites must be protected at all times. The best way to protect a key part or key site is not to touch it For further information please refer to the ANTT Education Package available on the intranet

How do I manage waste? The main waste streams usually generated in healthcare include: General Waste, Recyclables, Clinical Waste, Sharps, Cytotoxic Waste, Organic Waste, Liquid Waste, Chemical Waste, Pharmaceutical and Radioactive Waste. Healthcare facilities are responsible for the waste they generate throughout its life cycle. Signage at the point of generation / disposal of waste should be available to assist HCWs to dispose of waste correctly. When transporting waste, all HCWs MUST practice Standard Precautions, donning appropriate PPE, eg. Gloves, protective eyewear and gown, and performing effective hand hygiene following procedures.

How do I manage Linen? Thermal or chemical disinfection is required for laundered linen utilised within healthcare facilities. Therefore soiled linen at SVPHM is sent to a commercial laundry Reusable Cleaning equipment MUST be sent to a commercial laundry Laundering of Perioperative attire requires disinfection and special processing, therefore MUST be laundered by a commercial laundry NOT in a domestic washing machine. HCW’s transporting soiled linen must comply with Standard Precautions donning appropriate PPE where necessary.

Processing of RMDs or use of single use items Items labelled by the manufacture as single use, are for single use ONLY then to be appropriately discarded. Single use symbol Some items are labelled by the manufacture as single patient use. It is therefore acceptable to re-use for the same patient in accordance with manufacture instructions. All RMD’s require reprocessing according to the risk associated with the device, reprocessing is to be carried out by HCWs appropriately skilled within the sterilisation department.

Now that you know about Standard Precautions what other precautions may be required? Additional Precautions Additional Precautions - Transmission Based Precautions should be used where additional precautions beyond Standard Precautions are needed to minimise transmission of infection. Transmission Based/Additional Precautions include: 1. Airborne Precautions 2. Droplet Precautions 3. Contact Precautions

Key messages Standard precautions are practiced within healthcare as a basic level of infection prevention. Standard precautions should be implemented for EVERY patients, despite whether or not they have a known or suspected infectious disease. Additional precautions are necessary when dealing with someone with an infectious disease or organism. Whether you need to follow standard or additional precautions depends on the infectious agent/organism and its mode of transmission. Additional precautions will be directed by the Infection Prevention Department. DO NOT forget to call them! 9411 7668 or 0438 309 682

References: http://www.hha.org.au/UserFiles/file/Manual/Generic%20Hand%20Hygiene%20 Guidelines_final%20_4_.pdf hhttp://www.hha.org.au/ http://www.cdc.gov/handhygiene/providers/guideline.html http://harp.hicmr.com.au/manualsmenu.aspx https://www2.health.vic.gov.au/public-health/infectious-diseases/infection- control-guidelines/standard-additional-precautions