Transcript contentfiles/Infection Control

Bon Secours Hospital Cork
Infection Prevention and Control and
it’s challenges in the Primary Care
Setting!
• Brenda O Sullivan Connolly.
2016 Presentation
Presentation Outline
• Topics covered in the presentation are based
on requests for information identified on the
closed Practice Nurse Face Book Page
INFLUENZA SEASON
What is influenza (also called
flu)?
• Influenza is an acute contagious respiratory illness
caused by infection with an influenza virus.
Influenza can occur throughout the year but activity
usually peaks in winter.
• Influenza viruses infect the nose, throat and lungs.
They can cause mild to severe illness and at times
can lead to death. The best way to prevent flu is by
getting the flu vaccine each year.
• Influenza is a serious public health problem that
causes severe illnesses and deaths for higher risk
populations.
• Three types; A, B and C ( A and B-human
illness occur more frequently)
• Acute self limiting illness, upper or lower RTI
lasts 2-7 days.
• Sudden/ Acute onset of symptoms.
• Pyrexia >38◦c, cough, headache, severe
malaise, sore throat, sore muscles/joints,
SOB.
• Can be severe in >65yrs, those with
underlying medical conditions
Symptoms
Flu
cold
Fever
>38◦C Lasts 3-4 days
Rare
Headache
Prominent
Rare
General aches and pains Usual, often severe
Slight
Fatigue and weakness
Can last 2-3 weeks
Quite mild
Extreme exhaustion
Early and prominent
Never
Stuffy nose
Sometimes
Common
Sneezing
Sometimes
Usual
Sore throat
Sometimes
Common
Chest discomfort, cough
Common, can become
severe
Mild to moderate,
hacking cough
How is it spread?
• Coughing, sneezing, contaminated hands or
surfaces.
• Anyone with flu can be infectious from 1 day
before to 3-5 days after onset of symptoms.
• Highly infectious and can survive on
worktops/ objects.
• Virus can live on hard surfaces for up
to 24hrs and soft surfaces for 20mins
In the Practice What can you do
???
• Standards precautions- Every patient, Every
time
• Hand hygiene. WHO 5 moments.
• Clean equipment between patients.
• Assess on arrival, Act fast for suspected
patients
• Contact & Droplet.
• ? Diagnostic sample viral swab.
• Review, assess, plan, evaluate
Vaccination
• Encourage vaccination for high risk groups.
• Flu Vaccination- Encourage your
colleagues – including the GP.
• Flu Vaccination is highly recommended for
all Health Care Workers.
• Mandatory in some countries/states.!
Influenza Vaccine Staff Uptake in Hospitals,
2015-2016 (n=50 Hospitals) (HPSC 2016)
•
Participation
• 50 hospitals provided sufficient data for complete analysis
•
Uptake (average)
• Among all HCWs was 22.5%
• highest among ‘medical and dental’ professionals
• lowest among ‘nursing’ staff
• Acute Paediatric Services Hospital group highest uptake: 37.6%
• In general uptake higher in larger (staff numbers) hospitals
• 7 (14.0%) hospitals reported uptake > 40% among all HCWs (HSE
Target)
Influenza Vaccine Staff Uptake in LTCFs,
2015-2016 (n=98 LTCFs
• Participation
• 101 out of 229 (44.1%) of known LTCFs participated
• Uptake (average)
• LTCF HCWs was 26.6%
• highest among ‘medical and dental’ professionals
• lowest among ‘nursing’ staff
• 18 (18.4%) LTCFs exceeded 40% national uptake target
• Range across Community Health Organisations: 15.2-48.1%
• highest in CHO 9 (Dublin North, Dublin North Central, Dublin
North West) at 48.1%
Uptake by Health Care Workers
(HCWs) in Hospitals* by Season
Total
Total
No.
Avg.
Seaso No.
Vaccinat Upta
n
HCW
ed
ke %
s
HCWs
201146329
8275
17.7
2012
201241995
7325
14.6
2013
201350202 12234
21.5
2014
201451324 12006
21.3
2015
201559204 14833
22.5
2016
Avg.
Uptake
% 95%
CIs
14.6820.75
11.5917.52
18.4824.49
17.5725.01
19.3825.62
Median
Uptake
%
15.7
11.0
19.4
20.1
19.8
Range
Uptake
%
4.0039.98
3.4838.79
2.5645.87
1.1247.53
6.8947.04
No.
Hospital
s
42
35
46
45
50
Uptake by Hospital HCW Staff
Category by Season*
Uptake in Hospitals by Hospital
Group & Season*
Waste Management in
healthcare settings
• Department of Health and HSE (2014)
Healthcare Risk Waste Management,
Segregation, packaging and storage
guidelines for Health Care Risk Waste,
5th edition (November 2014)
Definitions
• Healthcare Risk Waste
• Infectious Waste
• Healthcare Non-Risk Waste.
Healthcare Risk Waste
This is categorised as risk waste which
is potentially hazardous to those who
come in contact with it by nature of its
infectious, biological, chemical,
radioactive nature or because it
contains used sharp material which
could cause injury.
Infectious Waste
Infectious substances are defined as
substances containing viable microorganisms or their toxins which are
known to cause disease.
Healthcare Non-Risk Waste.
Non risk waste which is not hazardous
to those who come in contact with it. Its
contents are non-infectious, nonradioactive or residual chemical waste
Non Risk Waste Bag - Domestic
Waste
Not contaminated with blood or
hazardous body fluids- Plastic, gloves,
aprons, gowns, masks – INCLUDING
from isolation cases
Nappies/incontinence wear, stoma bags
– from non-infectious patients.
Non Risk Waste Bag - Domestic
Waste
Oxygen Face Mask and Tubing
Empty Urine Drainage bags and Urinary
Catheters
Enteric feeding Bags
Giving Sets with Tips Removed.
Clear Tubing e.g.- NG etc
Non Risk Waste Bag - Domestic
Waste
Normal commercial and catering waste
Non infectious, non-toxic, nonradioactive
Shredded waste documents of a
confidential nature.
Health Care Risk Waste: Yellow
Bag
Health Care Risk Waste: Yellow
Bag
Yellow Bags
• All soiled bandages, Swabs, gown, gloves,
tissues and soft disposables.
• Gloves, gowns, Aprons, Mask contaminated
with blood or infectious body fluid.
• Incontinence pads and nappies from known
or suspected enteric infections (e.g. Rotavirus
etc)
• Suction Catheters, tubing and wound drains.
Health Care Risk Waste: Yellow
Bag
• No free fluids.
• No sharp items.
• No chemical or pharmaceutical waste
Sharps Bin
• Used for sharps with
the exception of
cytotoxic waste
• Syringes
• Scalpels
• Contaminated slides
• Stitch cutters
• Razors.
Sharps Bin with Purple lid
• All needles, syringes, sharp
instruments, cartridges + broken glass
that have been used in the
administration or production of
cytotoxic/cytostatic medicines or other
toxic pharmaceutical waste.
Yellow Rigid Box with Black Lid
• Recognisable large
anatomical body parts,
placentas.
• Waste containing blood
or tissue that may have
originated from a
patient with known or
suspected TSE/CJD.
• Contaminated large
metal objects.
Yellow Rigid Box with Purple Lid
• NON sharp healthcare
waste contaminated
with cytotoxic/cytostatic
medicines or other toxic
pharmaceutical waste,
discarded chemicals
and medicines.
• Small quantities of
medication left over
after administration to
patient – e.g. glass
antibiotic vials.
Storage and other considerations
• Healthcare risk waste must be treated with
the respect it deserves.
• It contains potentially dangerous material so
therefore
 Must be handled carefully.
 Never dragged along the floor.
 Never thrown!!
 Must be stored separate to non risk waste
How clean is your surgery?
Cleaning of Equipment
↑
• Equipment used in health care may be designated as
single use, single patient use or reusable multi-patient use
– always read the label if you are not sure if an item can
be reused
• Any equipment not designated as a single use item must
be made safe following use to prevent micro-organisms
being transferred from equipment to patients and
potentially resulting in infection.
• Cleaning is the critical element of the process and should
always be undertaken thoroughly regardless of the level of
decontamination required.
Decontamination of Equipment.
• All items that are used between patients
must be cleaned between patients.
• Devise a cleaning list to ensure that all
equipment is also cleaned weekly.
Decontamination of Equipment.
• Most equipment requires cleaning only with detergent
and water.
• Disinfection with a hypo chloride is required in the
following circumstances
• Contaminated with blood or body fluid – e.g.
ACTICHLOR PLUS 1.7g in 100mls of water is the
disinfectant of choice in this circumstance as per
blood /body fluid spillage policy
• After contact with a patient who has a condition known or
suspected of being transmitted by contact. ACTICHLOR
PLUS 1.7g in 1000mls of water
Decontamination of Equipment.
• Decontamination is a process (or combination
of processes), which removes or destroys
contamination and thereby prevents microorganisms or other contaminants reaching a
susceptible site in sufficient quantities to
cause infection or other harmful response.
• It is important to establish the differences
between cleaning, disinfection and
sterilisation, which are used in the process of
decontamination.
Decontamination of Equipment
• Cleaning
The physical removal of contaminants including
dust, soil and organic matter, along with a large proportion of
micro organisms. Thorough drying following cleaning will cause
a further reduction. This is the first and most important step
in any decontamination process.
• Disinfection Utilising heat or chemicals to reduce the number of
viable micro- organisms to a level which is not harmful to health
(but not all viruses and/or bacterial spores)
•
• Sterilisation Renders the object free from viable microorganisms, including bacterial spores and viruses
Process is categorised as one of
3 levels
•
Low Risk: Items in contact with healthy
skin or mucous membranes or not in
contact with patient
•
Medium Risk: Items in contact with intact
skin, particularly after use on infected
patients or prior to use on Immunocompromised patients, or items in contact
with mucous membranes or body fluids
•
High Risk: Items in close
contact with a break in the skin
or mucous membrane or
introduced into a sterile body
area.
.
•
Cleaning
•
Disinfection
•
Disinfection or sterilisation
Sterilisation
• For Sterilisation using bench top steam
sterilisers
• Wear appropriate PPE
• Items must be physically clean before being
exposed to any sterilisation process
Additional general good
practice points
•
The decontamination process chosen must be effective for the
device being reprocessed
•
Cleaning can be undertaken by either manual or automated
methods
•
Ensure decontamination agents used are compatible with the
devices and the reprocessing equipment
•
Decontaminate devices in accordance with the manufacturer’s
instructions
•
Ensure appropriate decontamination facilities are available for the
process to be undertaken
Additional general good
practice points
• Ensure any decontamination equipment used is fit for
purpose, regularly maintained, validated and tested
•
Staff undertaking decontamination activities should be trained for
the tasks they undertake
•
Standard infection control precautions should be adhered to at all
times
•
Workflow should proceed from dirty to clean
•
Sterile and sterilised devices must be segregated and stored in
clean dry conditions, out of the decontamination area.
MRSA
• MRSA- identify high risk patients and
encourage screening if scheduled for
surgical procedure- may need to be
decolonised pre-op.
Patients deemed high risk for MRSA should be
considered for preadmission screening &
decolonisation particularly if for planned surgery
• BSH offers a preadmission screening clinic for all patients
undergoing orthopaedic implants & other surgeries
• It is available to all high risk patients
• Cost of €120: covers initial screening, decolonisation
treatment and follow up screening
• Please contact the IPCN's at 021 4801619 if your patients
would like to avail of this service
• Patients from Kerry can be facilitated in BSH Tralee by
contacting the IPCN's in Cork
MRSA Screening
• Both nostrils (1 swab)
• Perineum
• Wounds, sites of damaged or abnormal skin (leg ulcers)
and sputum if expectorating
• Medical device sites e.g. insertion sites of intravenous
catheters, drains, peg tubes, catheter urine samples.
• Throat, both axilla and groins in KNOWN MRSA
colonised patients and those who give a history of MRSA
• All previously positive sites if still existent.
WHO 5 Moments of Hand Hygiene
Hand Decontamination Technique
Use of Personal Protective
Equipment (PPE)
PPE: Gloves
• Gloves for invasive procedures, contact with sterile
sites and non-intact skin or mucous membranes, and
all activities that have been assessed as carrying a risk
of exposure to blood, body fluids, secretions or
excretions, or to sharp or contaminated instruments.
• Gloves must be worn as single-use items.
• Gloves must be changed between caring for different
patients, and between different care or treatment
activities for the same patient.
PPE: Plastic Aprons & Gowns
• Wear a disposable plastic apron if there is a risk that
clothing may be exposed to blood, body fluids, secretions
or excretions
or
• Wear a long-sleeved fluid-repellent gown if there is a risk
of extensive splashing of blood, body fluids, secretions or
excretions onto skin or clothing. (NICE 2012)
• Use them as single-use items, for one procedure or one
episode of direct patient care
• Ensure they are disposed of correctly (NICE 2012)
PPE: Face Masks & Eye Protection
• Face masks and eye protection must be
worn where there is a risk of blood, body
fluids, secretions or excretions splashing
into the face and eyes.
• Respiratory protective equipment, for
example a particulate filter mask, must be
used when clinically indicated
PPE: Face Masks & Eye Protection
Standard Surgical Mask
(Flu, Neisseria Meningitis)
FFP3 or High Filtration Mask (Pul TB:
Measles & Chicken Pox (non immune
staff)
Stay Informed
www.hpsc.ie Health Protection
Surveillance Centre.
Produce weekly reports on
notifications of infectious diseases
in Ireland.
Is helpful to know what is
circulating in the community.
Week 1-35 2016
Example of Notifications
Mumps – 387 ( ↓1186)
Norovirus – 1,254 (↑ 213)
MTB
–248 (↑55)
CDI-
-1286 (↓ 16)
Zika Virus Infection 9
Summary
• Vaccination- encourage patients and HCWs
Standard Precautions- all patients at all times.
• Hand Hygiene- WHO 5 Moments.
• MRSA- identify high risk patients and encourage
pre-op screening
• Equipment and environmental cleaning- consider
a sign of sheet for weekly cleaning.
Questions???
References
•
•
•
•
CDC (2002) Guideline for Hand Hygiene in Health-Care Settings
European Antibiotic Awareness Day (EAAD)-(2014) Key Messages- Public Health
England
National Institute for Health and Clinical Excellence (2012)Infection Prevention
and control of healthcare –associated infections in primary and community care:
NICE clinical guideline 139 (March 2012) guidance.nice.org.uk/cg139
Royal College of Nursing (2012) Essential practice for infection prevention and
control Guidance for nursing staff
• WHO (2005) Guidelines on Hand Hygiene in Health Care (Advanced draft)
• WHO (2006)
www.who.int/gpsc/tools/Five_moments/en/
• SARI (2005) Guidelines for Hand hygiene in Irish Health Care Settings
• HPSC- (2014)Guidelines for the Prevention and Control of Multi-drug
resistant organisms (MDRO) xcluding MRSA in the healthcare setting