Infection Control in the Emergency Room

Where the agent enters the next host (Usually the same way it left the old host ) AGENT SUSCEPTIBLE HOST RESERVOIR PLACE OF ENTRY PLACE OF EXIT METHOD OF TRANSMISSION Person who can become infectedPlace where the agent lives, such as in or on blood, humans, animals, plants, the soil, air or water Where the agent leaves the reservoir (host) Disease producing microorganisms, such as HBV, HIV and Mycobacterium tuberculosis (Tb) How agent travels from place to place (or person to person) DISEASE TRANSMISSION CYCLE Adapted from APIC 1983: WPRO/WHO,1990

Standard Precautions (Body Substance isolation/universal Precautions) Standard precautions represents a system of barrier precautions to be used by all personnel for contact with blood, all body fluids, secretions, non intact skin, and mucous membranes of ALL patients, regardless of the patient’s diagnosis. These precautions are the “standard care”. This system embodies the concepts of “Universal Precautions” & “Body Substance Isolation” (CDC 1996)

The “Standard Precautions” All patients are treated the same, regardless of whether or not they have a serious infection or are friends, co-workers, neighbors, or family. Every patient is treated as if his/her blood and body fluids are infectious. Barriers are worn if contact with a body fluid (e.g., blood, sputum, urine, stool, sweat, etc.) is anticipated.

Standard Precautions: Key Components Hand washing (or using an antiseptic hand rub) After touching blood, body fluids, secretions, excretions and contaminated items immediately after removing gloves Between patient contact Tietjen L, Bossemeyer D, N Mcintosh Infection prevention Guidelines for health care facilities with limited resources. JHPIEGO, USA

Gloves For contact with blood, body fluids, secretions and contaminated items. with mucous membranes and non intact skin Masks, goggles, face masks Protect mucous membranes of eyes, nose and mouth when contact with blood and body fluids is likely Gowns Protect skin from blood or body fluid contact Prevent soiling of clothing during procedures that may involve contact with blood or body fluids

Linen Handle soiled linen to prevent touching skin or mucous membranes Do not pre-rinse soiled linens in patient care areas Patient care equipment Handle soiled equipment in a manner to prevent contact with skin or mucous membranes and to prevent contamination of clothing or the environment Clean reusable equipment prior to reuse

Environmental cleaning Routinely care, clean and disinfect equipment and furnishings in patient care areas Sharps Avoid recapping used needles Avoid removing used needles from disposable syringes Avoid bending, breaking or manipulating used needles by hand Place used sharps in puncture-resistant containers

Process instruments, and other items after use by first decontaminating and thoroughly cleaning them, then either sterilizing or high level disinfecting them using the recommended procedures. Protect workers, through offering relevant immunizations

Patient resuscitation Use mouthpieces, resuscitation bags or other ventilation devices to avoid mouth-to- mouth resuscitation Patient placement Place patients who contaminate the environment or cannot maintain appropriate hygiene in private rooms

Additional Isolation Types 'Droplet Precautions' is used for diseases spread through the air but are only on the moist droplets sprayed out from a person's mouth when they talk, sneeze, or cough. An example of this is the flu or influenza. Copyright © Baptist Healthcare System & Western Baptist HospitalBaptist Healthcare System

‘Airborne’ or ‘Respiratory Isolation’ additional precautions may be used when certain infectious diseases are known or suspected, such as tuberculosis (TB), measles, chickenpox, or mumps. These germs are spread through the air. Persons with these diseases are usually placed in ‘Airborne’ or ‘Respiratory Isolation’. This involves the use of a mask before entering the patient’s room, the door is closed, and a warning sign is placed on the door.

‘Contact Precautions’ ‘Contact Precautions’ is used for diseases spread by hand-to-hand contact such as lice, scabies, or when a patient has a wound infection (where we know a lot of bacteria are present). A sign is placed on the door to warn the person entering to use gloves and good hand washing. Additional covers may be worn over the clothes depending on the procedure being done.

‘Protective Isolation’ ‘Protective Isolation’ is used when we need to protect the patient from our germs (from our hands, nose, and mouth). The patient usually has a very low immunity and has a decreased ability to fight off infection. Commonly this is seen in cancer patients who are receiving chemotherapy. In most cases hand washing is sufficient but masks and gloves may be added. The sign on the door will indicate what precautions need to be used.

The Motto of The Day Stay Safe Stay Healthy And Remember being Safe is better than being Sorry