Patient transport by Karen Foulis

Infection Prevention & Control Manual Hospice â&#x20AC;&#x201C; adult

Infection Prevention & Control Manual Policies and Guidelines Patient Transport

Infection Prevention Solutions Gordon House 1-6 Station Road Mill Hill London Nw7 2JU T: 020 8906 2777 F: 020 8906 2233, E: info@infectionpreventionsolutions.co.uk

www.infectionpreventionsolutions.co.uk

i ISO 9001 REGISTERED FIRM

INTERNATIONAL ACCREDITATION BOARD Registration No. 0044/1

Infection Prevention Solutions

INFECTION PREVENTION & CONTROL PATIENT TRANSPORT POLICIES AND SAFE PRACTICE GUIDANCE CONTENTS Title

Section 1

Standard Precautions

Hand hygiene

Personal Protective Equipment (PPE)

Spread of Infection (basic principles)

3 4

Sharps (Safe handling and disposal)

Management of Healthcare Waste

6 7

IPC Good Practice Housekeeping Guidelines

Linen and uniform laundering

Environmental cleaning - vehicles and facilities inc. spills

Principles of Asepsis

Transfer and conveyancing - IPC elements and isolation of service users

Infections with specific alert organisms

Prevention and Management of Occupational Exposure to BBVs

Vaccination Programme Staff ATSL

Decontamination of medical devices

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Contents Infection Prevention Solutions ÂŠ2014

Infection Prevention Solutions

THE SPREAD OF INFECTION INTRODUCTION The spread of infection within health care requires a number of elements:     

A micro-organism e.g. bacteria, virus, fungi etc A reservoir (source) where micro-organisms are found A route of transmission of the organism from the reservoir to a host A means of entry into and exit out of the host A susceptible host

For an infection to occur there has to be a series of events, with each event leading and linking with the next. This process is widely known as the chain of infection. Breaking the chain at any point will help to prevent the spread of infection

Micro-organism

Susceptible host

Portal of entry

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Reservoir

Portal of exit

Route of spread

Infection Prevention Solutions

THE CHAIN OF INFECTION Micro-organisms Infections are caused by micro-organisms. Those that cause the majority of healthcare associated infections are either bacteria or viruses. Other types of micro-organisms include fungi, protozoa and helminthes (worms). Parasites (although not strictly speaking microorganisms) may be another source of infection e.g. the scabies mite.

Reservoir (source) of micro-organisms

Micro-organisms are highly adaptable and can survive and multiply in a wide range of environments. They are found everywhere – in soil, water, air, in and on human beings. Generally speaking they require warmth, moisture and a source of nutrients to survive and multiply. Most of these requirements can be found in human beings or in the healthcare environment. A fundamental element of infection control practice is to deprive microorganisms of their growth requirements in order to stop them from multiplying.

In healthcare, there are a number of possible reservoirs of infecting micro-organisms including service users, staff and family members / visitors; contaminated medical equipment; the healthcare environment; contaminated food or water and insects (vectors).

People may display obvious signs of infection e.g. a rash or they may be asymptomatic and carrying the micro-organism on or in their body e.g. MRSA can be carried on the skin without any obvious signs of infection. Another possible source is the individual’s own normal flora – those micro-organisms that live in a range of different body sites e.g. the gut, the throat etc. and which are non-pathogenic (causing no infection) in their normal site but which may become pathogenic (causing infection) when transferred to another body site. A common example in healthcare is gut bacteria such as E. coli which colonize the human gut in large numbers and play an essential role in the synthesis of food but which, if transferred to the urinary tract during, for example, urethral catheterization may result in a urinary tract infection.

Medical equipment which has been used on a service user may be the source of an organism being transferred to another individual if the equipment is not decontaminated after use. The healthcare environment can harbor micro-organisms in dust or suspended in the air which can become airborne (on air currents) and then settle on skin, in wounds or on equipment and then become a source of potential infection. Food is a common source of micro-organisms e.g. salmonella bacteria in poultry and eggs. If these micro-organisms are not destroyed e.g. by cooking then they can multiply in the gut when food is eaten causing food poisoning. Similarly, water can become contaminated by

sewerage, animal excreta etc. and be ingested by drinking where they may multiply in the gut causing a range of infections.

Route of spread – transmission

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Infection Prevention Solutions

Micro-organisms can be transmitted by a variety of routes and the same micro-organism may be transmitted by more than one route. These routes include:     

Contact – both direct contact or indirect contact Airborne / droplet (respiratory) Faecal / oral Inoculation / absorption Vertical (via the placenta)

Contact spread

This is the most important and most frequent means of transmission in the healthcare environment and can be divided into two main subgroups: (a) Direct Contact

(b) Indirect Contact

This involves direct physical transfer of the micro-organism from one site to another e.g. from one body site to another, or from person to person e.g. sexually transmitted diseases. However, the most common source of direct contact transmission in healthcare is via the hands of healthcare workers.

This involves contact via an intermediate source that is contaminated e.g. bed linen, surgical instruments, medical equipment. Airborne / droplet spread (respiratory)

Some micro-organisms are readily transmitted by air. Many of them are associated with respiratory infections originating in the respiratory tract (lungs, throat, nose etc.). Such infections include TB, colds and influenza. However, transmission depends on the size of the micro-organism.

(a) Airborne spread

This is caused by the dispersal of smaller micro-organisms e.g. respiratory viruses or airborne dust particles containing the micro-organism. These are widely dispersed by air currents before being inhaled into the respiratory tract. In the case of dust particles they may contaminate horizontal surfaces e.g. the floor, furniture etc. or may settle on equipment. Airborne micro-organisms (being small) can stay suspended in the air for long periods of time (hours in some cases). (b) Droplet spread

This is caused by large droplets of micro-organisms being propelled from the respiratory tract during coughing, sneezing, talking and during procedures that may generate droplets e.g. suctioning. As these droplets are large (and heavy) they are propelled only a short distance through the air before either being inhaled or landing on surfaces. Faecal / oral spread Micro-organisms can spread via the gastro-intestinal tract as a result of, for example food poisoning or during an outbreak of diarrhoea and vomiting (gastro-enteritis). In such cases

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Infection Prevention Solutions

HAND HYGIENE Hand hygiene is the single, most important measure for preventing transmission of infection. The aim is to render hands socially clean and to reduce resident and remove transient micro-organisms. This guideline covers the appropriate use of alcohol hand rub and hand washing technique. Microbiology of the Skin

There are two populations of micro-organisms found on the skin:-

Resident micro-organisms are those that live in the deeper skin layers and provide a protective function. In the vast majority of instances these flora do not cause cross-infection and it is unnecessary to eradicate them from hands during most healthcare activities. However, in certain circumstances resident flora can pose a risk to susceptible individuals. They are a particular risk during surgery and the insertion of some invasive devices such as central venous cannulae etc. Resident flora are not easily removed by mechanical methods and require the application of skin antiseptics e.g. chlorhexidine or povidone iodine to reduce their numbers to acceptable levels. Thus the use of skin antiseptics is standard practice prior to surgical procedures and the insertion of some invasive devices

Transient micro-organisms are those that are not resident on the skin but are acquired by day-to-day activities including direct contact with service users, contaminated equipment and environmental surfaces. It is these micro-organisms that are responsible for the majority of episodes of cross infection. Transient flora includes the vast majority of bacteria, viruses and other pathogenic micro-organisms that our hands come into contact with during the course of daily living. This includes organisms such as Staphylococcus aureus, Clostridium difficile, gram negative bacilli and noroviruses. Transient flora are readily removed by the mechanical action of washing, rinsing and drying hands using soap and water. Most may also be destroyed by the application of alcohol gel / rub etc

Decontamination of the Skin

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Hand Hygiene Infection Prevention Solutions ÂŠ2014 Page 1 of 8

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The 5 Moments apply to any setting where health care involving direct contact with patients takes place

Applying the “5 moments for hand hygiene” in pre-hospital care

The need for hand hygiene is closely connected with the activities of healthcare workers (HCWs) within the geographical area surrounding the patient. This can be divided into two areas – the patient zone and the health-care area.

The patient zone includes the patient and his / her immediate surroundings e.g. all surfaces that are touched by or in direct physical contact with the patient e.g. chair arms, stretcher mattress, linen, tubing etc. It also includes all surfaces frequently touched by HCWs whilst caring for the patient e.g. monitors, knobs and buttons, grab rails, chair handles, slides, boards etc. The patient zone is not static – it changes as the patient is moved from place to place and the zone accompanies the patient where-ever he / she goes e.g. from their bed at home >chair / stretcher -> ambulance -> A/E trolley.

The health-care area corresponds to all surfaces in the health-care setting outside the patient zone i.e. other patients and their zones and the wider health-care environment. This environment still poses a risk – particularly from staff who may acquire micro-organisms within the wider health-care environment that are then transferred to patients when the HCW enters the patient zone to provide direct care. In the pre-hospital environment there are a

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Infection Prevention Solutions

environments, then use an alcohol-based product after using linen / cotton towels. Basic hand care To keep hands in good condition and to perform effective hand hygiene, staff should perform some basic hand care: Use an emollient hand-cream twice a day. Use before and after shifts to help replace the skin’s oils that can be lost through frequent hand hygiene.

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Observe the hands for any signs of damage to the skin as this can provide a portal for micro-organisms to enter the body. Cover with a waterproof plaster or dressing before the shift begins and replace if necessary. If cracks or breaks do not heal, then occupational health advice should be sought. Dermatitis can be caused by sensitivity to ingredients in hand cleansers. Always seek guidance from Occupational Health if skin problems on hands do not clear.

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Hand and wrist jewellery (including wrist watches) should not be worn by staff undertaking clinical care. Rings containing stones or mounts should not be worn by clinical staff as micro-organisms are known to readily colonize such items providing an on-going source of potential pathogenic micro-organisms. Plain wedding bands are acceptable. Wrist watches are easily contaminated and can prevent thorough hand washing of wrists.

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Fob watches should be worn by patient-facing staff to remove the requirement for a wrist-watch. If a wrist-watch is worn it must be removed for hand washing or the application of alcohol gel.

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Nails should be kept short at all times to reduce the accumulation of microorganisms. False nails and nail extensions / nail jewellery should NOT be worn by patient-facing staff as they too are recognized sources of potential pathogenic microorganisms and discourage staff from thorough hand decontamination.

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Long sleeves should not be worn by staff undertaking clinical care (see section XX uniform and dress code). In the event that long sleeves are worn, they must be rolled up above the elbows prior to hand washing.

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KEY ACTION POINTS 

Skin has 2 different microbial populations – resident and transient micro-organisms

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Transient micro-organisms are acquired by day-to-day activities including patient care

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Infection Prevention Solutions

Risk assessment The choice of PPE selected will depend on the activity and the potential or anticipated risk of exposure to body fluids: Assess risk of activity

Potential contact with body fluid

NO contact with body fluid

LOW risk of Splashing

Gloves and apron

No protective clothing

HIGH risk of splashing

Gloves, mask, apron eye protection

Standardization of PPE

Patient transport vehicles should be equipped with adequate supplies of appropriate PPE relevant to their patient case load and following risk assessment. This may include disposable nitrile gloves, safety spectacles (BS2092) and plastic aprons. Disposable Gloves

Glove use has increased significantly over the last two decades mainly since the emergence of HIV and in response to the implementation of both standard infection control precautions to protect both service users and healthcare workers from the potential transmission of blood-borne viruses and Health and Safety Legislation. However, it must always be remembered that staff have a primary responsibility to protect their service users from risk and a secondary responsibility to protect themselves. Gloves need to be changed between service users and also between tasks on the same service user to ensure that risk of transmission is reduced. The use of latex-containing products inc. disposable gloves is the subject of on-going concern in relation to latex sensitization / allergy. All healthcare providers should undertake a risk assessment relating to the provision of latex-free products to minimize the risk of inadvertent allergic reactions in those service users and staff known to be sensitive to latex and to prevent the acquisition of a sensitivity reaction in at-risk individuals e.g. those with known skin conditions such as eczema, dermatitis etc. Where risk assessment has been undertaken, a decision may be made to remove from use all latex products and to provide a suitable latex-free alternative. In the case of disposable gloves, a variety of latex-free

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Personal Protective Equipment (PPE) Infection Prevention Solutions ÂŠ2014 Page 2 of 4

Infection Prevention Solutions

Do NOT wash disposable gloves or use alcohol gel to decontaminate gloves. Use a new pair for each individual care activity and between patients

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Never write on gloves as this will impair the protective barrier of the glove fabric

Disposable plastic aprons

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Disposable plastic aprons should be worn to protect staff uniform / clothing when contamination with body fluids is possible during care procedures. In addition, a plastic apron should be worn during the following activities to minimize microbial contamination of clothing: during environmental cleaning of vehicles and clinical areas of stations decontaminating clinical equipment when handling used / soiled linen and / or clinical waste

  

Always remove the apron at the end of each care-giving procedure and discard into a clinical waste bag. Wash and dry hands to reduce the likelihood of transferring organisms to another site. Eye protection and face masks Goggles, safety glasses or shield masks should be available and worn when there is a possibility of splashing of blood / body fluids or chemicals / detergents into the eyes and / or mucous membranes. Surgical face masks are of limited protection in pre-hospital environments as they are not fluid repellent. If these products are disposable they should be discarded as clinical waste. If re-usable they should be cleaned as recommended in the decontamination of clinical equipment policy usually with detergent and warm water.

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