1. Audiology Infection Control Practices Bruce Gamage, BSN CIC Infection Control Consultant BCCDC

2. Outline Basic risk factors in patients Risk of cross-contamination Chain of Infection Spaulding classifications Scope of practice Routine High risk procedures Routine Practices Employee Health BBF exposure

3. Patient Risk Factors All treatment offered should minimize potential disease transmission Patients may have underlying disease May be immunosuppressed Drug related Leads to increase risk of infection from opportunistic organisms

4. Chain of infection

5. Agent Infectiousness Pathogenicity Source Period of infectivity Portal of exit

6. Transmission Contact spread Common vehicle spread Airborne spread Vectorborne spread

7. Host Portal of entry Non specific defense mechanisms Skin, tears, mucous membranes, stomach acid, inflammatory response Specific Immunity Natural immunity, vaccinations Host response

8. Environment Don’t over emphasize! Temperature Humidity Cleanliness

9. Risk of cross-contamination Patients and technicians Variety of contacts with environment and objects Direct or indirect contact with multiple patients

10. Spaulding’s Classifications Critical items Penetrate the skin, contact blood, unintact mucous membranes require sterilization E.g. curettes, wax loops, imittance and autoacoustic emissions probe tips, ear impression syringes and otoscopic specula Many of these items are available as disposables

11. Spaulding's Classifications Semi-critical Contact intact mucous membranes - require high-level disinfection Non-critical Contact intact skin only - sterilization not required Require cleaning and disinfection

12. Cleaning Remove gross contamination Most important step to disinfection or sterilization as soil will inhibit the process Accomplished with brush, wipe or ultrasonic machine

13. Disinfection Kills specific organisms depending on chemical used QAC, Phenolic will kill vegetative bacteria, enveloped viruses (e.g. Hep B, C, HIV) Aldehydes, Concentrated Hydrogen peroxide, chlorine (bleach) will kill fungus, and enveloped viruses dependent on contact time. Not bacterial spores Prolonged contact time can provide sterilization. (must follow manufacturer’s recommendations for concentration and contact time)

14. Disinfection Disinfection is acceptable for non-critical items – items that do not penetrate the skin, touch mucous membranes Noncritical items: Earmolds, “in the ear” hearing aids Supra-aural headphones Otoscope specula Probe tips Electrodes All items should be cleaned and disinfected between patients

15. Disinfecting the Environment Surfaces in work areas should be disinfected regularly Disinfectant wipes/squirt bottle Waiting room toys “Your saliva is my saliva”

16. Sterilization Kills all microbes, including spores Autoclaves Uses moist heat Must be used correctly Must be monitored Cold Sterilization Usually accomplished soaking in a chemical sterilant (e.g. 2% gluteraldehyde, 7.5% hydrogen peroxide) Requires correct contact time and concentration Solutions should be monitored

17. Disposables Many items involved in cross-contamination are available as disposables Otoscope specula, probe tips, earmold impression syringe tips, insert receivers, probe microphone tubes. May be cleaned and reused on same patient Re-use of disposables between patients Don’t go there!

18. Scope of Practice Routine procedures More invasive procedures Exposure to body fluids Interoperative monitoring of cranial nerves Sensory evoked potentials Insertion needle electrodes Vestibular procedures (vomiting) Cerumen

19. Routine Practices Aimed at controlling exposure between people and the environment/objects Varies with the nature of the contact from simple cleaning sterilization Responsibility of Clinician to provide a safe work environment for themselves, their colleagues and their patients Assume that every patient is potentially infectious

20. Routine Practices Handwashing Soap Antibacterial soap Alcohol based hand rubs Equivalent to a handwash as long as hands are not visibly soiled

21. Routine Practices Gloves Should be worn for all procedures where risk of exposure to body fluids ( e.g. cerumen management, draining ear, lesions present, cleaning spills and disinfecting) Single use Task specific Vinyl vs. Latex Utility Gloves for handling chemicals

22. Routine Practices Protective apparel Safety glasses and masks should be worn is risk of splash or spatter of body fluids Cerumen removal Working with grinding or buffing wheel Masks for potential TB patients Disposable headphone covers for mass screenings

23. Waste Disposal Waste that is contaminated with blood, body fluids (ear drainage, cerumen) can go in regular garbage unless “dripping” Saturated materials, tissue, etc. must be placed in biohazardous waste bags Proper sharps disposal GVRD regulations require that biohazardous waste/sharps must be picked up and processed (either sterilization or incineration)

24. Employee Health Vaccinations: Hepatitis B Vaccine MMR Diphtheria/tetanus (every 10 years) Influenza Varicella Hepatitis A? If working with high-risk population

25. BBF exposure Blood or other potentially infectious body fluids Intact skin No risk – wash with warm soapy water Splash to mucous membrane or sharps injury High risk – flush with NS, water Don’t squeeze or soak in bleach Report to nearest emergency department for: Assessment – type of exposure/status of source Baseline blood work Possible ART

26. Summary Cross-contamination Cleaning, disinfection and sterilization Routine practices