HLTIN301C Comply with infection control policies and procedures
Introduction to infection control Health care is delivered in many different ways: ∗ Clinics – medical, dental, allied health [physio, podiatry etc] ∗ Hospitals, aged care facilities ∗ Home environments
∗ Identifying the risks of infection is difficult because ∗ saliva dries clear ∗ contaminated surfaces cannot be seen
The importance of infection control has been highlighted by ∗ The spread of viruses that cause diseases such as hepatitis B, hepatitis C and AIDS ∗ The increasing number of bacteria that are resistant to antibiotics ∗ The need to ensure that instruments that are to be reused are sterile
Infection control principles
∗ A patient cannot be treated differently because of a medical condition ∗ Infection control procedures do not differentiate between patients ∗ Standard precautions are required for all patients ∗ A medical history does not always identify those patients with an infectious disease ∗ All patients must be considered infectious
All health care workers must
∗ Wear appropriate personal protective equipment ∗ Be aware of procedures required to prevent the transmission of infection ∗ Understand why these procedures are necessary ∗ Receive training in up-to-date infection control procedures
Exposure to disease causing microorganisms in blood and saliva
Is an occupational hazard for all health care workers
Disease can be spread in the following ways ∗ Physical contact with infected blood and body fluids • Splatter of blood, saliva or other bodily fluids onto skin (especially if broken) or mucosa
∗ Airborne transfer
Spread of infection in a health care setting
1. A source of infecting microorganisms 2. A path of transmission 3. A susceptible host
Sources of infecting microorganisms Person suffering an acute infection An infectious person not yet showing signs or symptoms of the disease - Incubation stage
An infectious person without signs or symptoms who is a carrier of a disease-causing organism
Who is a disease carrier? Although many carriers of HBV are free of symptoms contact with blood/saliva will spread the virus It is impossible to identify those patients who may be carriers of infectious disease Standard precautions must be implemented Assume that all blood and body fluid substances are potential sources of infection
Path of transmission
∗ Microorganisms must enter the body to cause disease ∗ Entry into the body can occur by Direct contact Aerosols Sharps injuries
Direct contact
If you work without gloves
Contact with blood & saliva will occur
Viral diseases such as hepatitis and herpes are transmitted in this way
Aerosols If you work without a mask and protective glasses
Aerosols can be inhaled and splatter can be swallowed
Diseases such as influenza, measles, mumps, tuberculosis and the common cold are transmitted in this way
Sharps injuries Injuries involving contaminated sharps
Are potentially very serious
Diseases such as hepatitis B & C and the human immunodeficiency virus can be transmitted in this way
A susceptible host ∗ What makes one person a more susceptible host then another? ∗ Immunisation or immunity ∗ Nutrition ∗ Age ∗ The very young and the very old are more susceptible to infection
∗ Diabetes ∗ Immune deficiency ∗ Such as that caused by HIV
Standard precautions Work practices that prevent the spread of infection
Implemented during the treatment and care of all patients
Standard precautions Require staff to assume that all blood and body substances are potential sources of infection
Standard precautions are necessary
because It is not possible to identify all patients who are an infection control risk
Standard precautions consist of ∗ ∗ ∗ ∗ ∗ ∗ ∗ ∗
Personal hygiene practices especially hand hygiene Use of personal protective equipment Techniques to limit contamination Surface cleaning and management of blood and body fluid spills Safe handling and disposal of sharps Safe handling and disposal of waste Appropriate reprocessing of reusable equipment and instruments Practising respiratory hygiene and cough etiquette
Aerosols
Splatter
A fine mist of tiny airborne particles that may contain bacteria, viruses and fungi
Larger particles of blood and saliva contaminated debris
Minimize aerosols and splatter ∗ Protect items from contamination until required for use ∗ Ensure instruments used to penetrate tissue are sterile at time of use ∗ Cover surfaces that are more difficult to decontaminate between patients ∗ Clean all environmental surfaces
Transmission based precautions Work practices required when standard precautions alone may not be sufficient
Transmission based precautions ∗ Work practices required when standard precautions alone may not be sufficient to prevent the transmission of specific infectious diseases ∗ Tuberculosis ∗ Measles ∗ Creutzfeldt-Jacob
Aseptic non-touch technique ∗ Work practices that protect patients during invasive procedures ∗ Significantly reduces the rate of healthcare associated infections ∗ Effective hand hygiene is an essential component of ANTT ∗ Where surgery is to be performed a surgical hand scrub is required
Identify and respond to infection risks
Hazard ∗ A hazard is a potential source of injury, ill health or disease
Risk ∗ A risk is the possibility that the hazard will cause injury or ill health ∗ The degree of risk to health increases ∗ With the severity of the hazard ∗ The exposure to the hazard
∗ Infection risks may include ∗ ∗ ∗ ∗ ∗ ∗
Sharps injury Inhalation of airborne infectious microorganisms Contact with blood or other body substances Contact with infectious materials Contact with infectious clients Waste including general waste, clinical waste and sharps
Risk management ∗ ∗ ∗ ∗ ∗
Establish the context – Hazard identification and risk management Identify the risks Analyse the risks Evaluate the risk Treat the risk
Risk control involves ∗ ∗ ∗ ∗ ∗
Eliminate a hazardous process Use personal protective equipment Change a system of work to reduce a hazard Isolate the hazard Use protective devices to decrease exposure
∗ ∗ ∗ ∗
Use safe handling techniques Use safe collection, storage and disposal of waste Follow infection control policies and procedures Minimize the risk of exposure to blood and body fluids
A sharps injury is most likely to occur During procedures using sharps
During instrument reprocessing
During transfer and disposal of sharps Working in confined spaces
Handling a needle
∗ Uncapped needles are the most frequent cause of needle-stick injuries ∗ An uncapped needle must never be passed between staff ∗ Safely remove and dispose of the sharp immediately after use into the sharps container ∗ Safely removing and disposing of all disposable sharps at the end of each procedure
Minimise the risk of sharps injury
∗ Remove sharps and sharp debris using tweezers ∗ Put all disposable sharps into a purpose made sharps container that complies with AS/NZS Standards ∗ Locate sharps container close to point of use ∗ Wear heavy-duty gloves during instrument clean up ∗ Clean sharp instruments using an ultrasonic cleaner or a washer-disinfector
Exposure to blood/body fluids
∗ A sharps injury or a mucosal splash of blood or saliva is potentially a major health hazard ∗ Requires immediate action
Immediate care following sharps injury Promptly flush the wound under running water
Wash the wound using liquid soap and warm running water
Thoroughly pat-dry the area with paper towel
Cover the wound with a sterile waterproof dressing and apply pressure through the dressing if bleeding is still occurring
Report the injury to your supervisor or employer
Ensure the details of the incident are recorded accurately in the accident book
See doctor for blood tests (this first blood test screens whether you have any pre existing infectious diseases) *It can be requested that the patient also see a doctor for a blood test, however the patient has the right to decline.
Seek counselling if you are feeling anxious or stressed
Go for follow-up blood test in 3 months time (this second test determines whether you have contracted an infectious disease from the sharps injury)
Immediate care following a splash of blood/body fluids
∗ Remove contaminated clothing ∗ Wash the skin affected using liquid soap and warm running water ∗ Thoroughly pat dry the area
∗ Rinse eyes, mouth and nose thoroughly with warm water (no soap) or saline ∗ If contact lenses are worn remove them after rinsing eyes and clean as usual
∗ Thoroughly pat dry the area ∗ Report injury immediately to your supervisor or employer ∗ Complete an accident report form
∗ Biological spills kit ∗ Disposable gloves & waterproof apron ∗ Chlorine releasing absorbent granules ∗ Disposable scoop & spatula for clearing vomit spills or scraping up blood soaked granules ∗ Small healthcare waste bag
Record keeping and notification ∗ WHS legislation requires employers to keep records of all health and safety incidents ∗ The accident report form records ∗ The date and time of the injury ∗ How the injury occurred ∗ The person (if known) whose blood or body fluid was involved in the injury
∗ Risk reports must be completed within 24hrs of risk identification
Personal hygiene A high standard of personal hygiene protects you, other staff and patients from infection
Personal hygiene ∗ ∗ ∗ ∗ ∗
Fingernails kept smooth, short and clean Hair short or tied away from face Clean uniforms Hand and wrist jewellery removed at start of day Hands hygiene is carried out before and after any activity likely to cause contamination
Hand hygiene
∗ Schein Solutions http://www.scheinsolutions.com.au/
Use personal protective equipment Gloves, mask, glasses, gown/apron, when worn correctly, provide a physical barrier between you and the patient’s blood and saliva
PPE ∗ Schein Solutions http://www.scheinsolutions.com.au/
Sequence for putting on PPE ∗ Mask ∗ Protective eyewear Perform hand hygiene ∗ Gloves
Sequence for removing PPE ∗ Gloves Perform hand hygiene ∗ Protective eyewear ∗ Mask Perform hand hygiene
Limit contamination
Limiting contamination
∗ Clearly defining the contaminated and clean zones in the health care setting ∗ Simplifies the cleaning process ∗ Allows for a one way flow of items ∗ Reduces the risk of cross-contamination
During and after treatment contaminated instruments and equipment Should be confined to a well designated contaminated zone
Clean zone ∗ Must never become contaminated with items used during patient treatment ∗ Is for sterilized instruments, equipment, materials and medicaments ∗ Includes the interior of drawers and cupboards These must never become contaminated during any procedures with a client
Contaminated zone ∗ Contaminated zone is for items used during patient treatment ∗ All items in this zone must be considered contaminated from the current patient ∗ All contaminated items must be removed, cleaned and appropriately processed for each client
Retrieve instruments and equipment if needed by one of the following techniques
• Remove gloves and wash hands • Retrieve instruments or dispense materials • Re-glove before returning to assist Use transfer tweezers
Transfer tweezers ∗ Used to transfer instruments from the clean area to the contaminated area ∗ Kept separate to other instruments being used ∗ Must remain in a designated holder in the clean zone the health care facility
Preparing for procedures ∗ Place appropriate protective covers as required ∗ Barrier protect hard to clean areas
∗ When a health care procedure has NOT been determined: ∗ Arrange a basic set of instruments into clean area ∗ Arrange any disposable items that may be necessary
Single use ∗ Single use means that a device can only be used on a patient during one visit and must then be discarded ∗ Single use items should be used where possible and must never be reused.
Items that cannot be cleaned and sterilized after use must be discarded
Handle, package, label, store, transport and dispose of waste
Packaged
Waste must be
Labeled Stored Transported
According to legislative requirements
Clinical waste
Waste that has the potential to cause sharps injury or infection
Clinical waste includes
∗ Discarded sharps ∗ Human tissues including materials or solutions that contain free-flowing or expressible blood ∗ Laboratory and associated waste directly involved in specimen processing
Discarded sharps
∗ Wear personal protective equipment ∗ Discard all sharps into a clearly labeled sharps container that complies with Australian/New Zealand Standards ∗ Locate the sharps container close to where the sharps are generated ∗ Keep the sharps container out of the reach of children ∗ Replace the sharps container when three-quarters full ∗ A licensed medical waste contractor undertakes disposal of the sharps container
The sharps container ∗ Use a clearly labeled yellow rigid sharps container ∗ Must comply with Australian and New Zealand Standards ∗ Is located close to where waste is generated ∗ Can only be collected by a licensed medical waste contractor.
Human tissue waste includes ∗ Tissue, blood, blood products and other body fluids removed during surgery/dental procedure ∗ Does not include extracted teeth
∗ Tissue, blood, blood products and other body fluids removed during post-operative care ∗ Pathological/biopsy specimens ∗ Materials saturated with or containing free-flowing blood and other body fluids
Laboratory and associated waste includes
∗ All specimens used for laboratory testing ∗ Cultures of microorganisms used in biological indicators
Disposal of clinical waste ∗ Yellow leak proof container/bag marked with biological hazard symbol ∗ Located close to where waste is generated ∗ Collected by a licensed medical waste contractor.
During waste disposal Use
Practice
Personal protective equipment
Personal hygiene
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Related waste
Wastes that are contaminated with chemicals or pharmaceuticals
Related wastes include
Radioactive
Chemical and pharmaceutical
Disposal of Related waste
∗ Containers must be labeled with the contents and safety instructions ∗ Processing chemicals are highly corrosive and must not be tipped down the sink
∗ Personal protective equipment must be worn when handling chemicals ∗ Collected and disposed of by an approved recycling company
General waste
Waste that is not classified as being within any of the categories of the clinical and related waste streams
General waste
∗ General waste bag is coloured black, buff, green or white ∗ Collected by the community waste contractor ∗ Includes gloves, mask, rubber dam, single-use cups and protective coverings ∗ Handled using heavy duty gloves.
Clean environmental surfaces
Cleaning
A process that removes soil and reduces the number of microorganisms on a surface by washing using detergent
Regular cleaning of the health care facility
Maintains a safe working environment
Deposits of dust, soil and microorganisms
On working surfaces
Can transmit infection
Routine surface cleaning ∗ Wear personal protective equipment ∗ Remove all physical debris ∗ Spills should be cleaned as soon as possible
∗ Begin with the least contaminated surface and end with the most contaminated surface ∗ Clean all work surfaces with a neutral detergent and warm water solution ∗ Use white, lint free, not coloured, cloths or paper towel ∗ Dry all work surfaces
Maintenance of cleaning equipment ∗ Wash buckets after use in warm water and detergent and store dry and inverted ∗ Wash mops after use in warm water and detergent and store dry and head up ∗ Prepare and use cleaning agents and disinfectants ∗ in accordance with manufacturer’s instructions ∗ in accordance with current infection control guidelines
∗ Store material safety data sheets in a location known and accessible to all staff
Maintaining the health care facility
∗ Monitor all surfaces for cleanliness ∗ Keep the interior of cupboards tidy ∗ Damp dust interior of cupboards weekly with detergent and paper towel or gauze ∗ Keep the storage area for sterile items tidy ∗ Damp dust storage areas weekly with detergent and paper towel or gauze.
What happens to instruments and equipment during changeover Stainless steel and other types of reusable items/equipment
Cleaned and sterilized
Single use items
Discard into general waste bag or sharps container
It is your responsibility to collate and maintain evidence to demonstrate ∗ Evidence of specified essential knowledge and skills ∗ Compliance with the organisation’s infection control policy as it relates to specific job role ∗ Consistent application of handwashing, personal hygiene and personal protection protocols ∗ Consistent application of clean and sterile techniques ∗ Consistent application of protocols to limit contamination