Infection Prevention & Control

1. Infection Prevention & Control Annual Compulsory Education

2. Learning Objectives • Be able to define Infection Control • Increase your understanding of “Germ” & “Infection” • Learn why infections occur & how it spreads • Understand the importance of Infection Control • Learn about Preventative Measures • Learn & demonstrate proper hand washing technique • Learn about “Isolation Precaution” to apply this to your work • Understand your role & responsibilities regarding Outbreak Management • Review influenza, Norovirus, & antibiotic resistant organisms

3. What is Infection Prevention & Control? • Policies &procedures used to prevent the spread of infection within health care facilities • A program that keeps people healthy, prevents needless suffering, and saves money in health care & related costs

4. What is a Germ? • Living organisms we cannot see • Live and grow everywhere • Bacteria, viruses, parasites, fungi • Maybe harmful and cause illness • Enter/exit the body through many openings

5. Infections • Under the right conditions – dark, moist, warm environments – germs will multiply & may cause infections • The wrong germ in the wrong place maycause infections i.e. bowel/feces e-coli gets into the bladder or is ingested in food • Infections occur when there are too many germs that even a health immune system cannot destroy • Individuals with weak immune systems and/or those who have chronic conditions are more susceptible to infections Our residents are at high risk for infections

6. How the Body Protects Itself From Infection • Intact Skin • Fever • Immune system • Inflammatory Response • Mucous & cilia • Lymph nodes • Tears • Vomiting • Diarrhea • Blood

7. How Infection Spreads

8. Chain of infection

9. Routes of Transmission Micro-organisms are transmitted by various routes. The same micro-organism may be transmitted by more than one route. There are five main routes of transmission: • Airborne • Droplet • Contact – Direct or Indirect • Vector Borne • Vehicle

10. Routes of Transmission Droplet Transmission: Germs can be in moist particles called droplets from coughing, sneezing, laughing, and/or talking. These droplets are able to travel about one meter in distance. i.e. Cold &Influenza Airborne Transmission: Germs are carried by small particles in the air and move with air currents or dust. These germs maybe carried over long distances. i.e. Tuberculosis

11. Routes of Transmission Contact Transmission: (i.e. Norovirus) Direct Contact:Touching the germs directly  Contact with body fluids &then touching self or others Indirect Contact:Touching an item that has germs on it  Touching soiled linen or equipment & then touching self or others

12. Routes of Transmission Vector Borne Transmission: Germs maybe carried by insects & animals & passed to people i.e. West Nile virus (Mosquitoes), Hanta virus (Mice) Vehicle Transmission: Germs that are carried by some other transport such as via flood, bodily fluids, food, or water i.e. HIV in blood, e-coli in food

13. Why is Infection Prevention so Important? Our residents are more likely to become seriously ill & die from an infection due to: • Fragile skin • Poor bladder emptying • Indwelling catheters • Decreased coughing ability • Slower/weaker immune system • Chronic illness • Infections may present differently

14. Infections Are Not Easily Detected Residents are less likely to have an elevated temperature The inflammatory response is reduced such that commonsigns & symptoms are not always evident Residents do not always feel pain as readily and may not comment about same

15. Prevention Tips • Hand Washing • Cleanliness of environment & equipment • Good personal hygiene • Clean from clean to dirty • Do not shake linens • Dispose of single use items • Do not put items on the floor • Promptly report any illness • Monitor & track infections • Follow outbreak procedures

16. Respiratory Etiquette • Cover nose & mouth when coughing or sneezing • Cough into sleeve if tissue not available • Dispose of tissue after wiping nose, sneezing, and/or coughing • Wash hands after coughing, sneezing, and/or using a tissue • Keep fingers away from eyes, nose, and/or mouth

17. Hand Hygiene • Beginning & end of shift • In between resident care • Before & after glove use • Before eating or serving food • After taking a break • After going to the bathroom • After sneezing, coughing, or wiping your nose • After touching your face, nose, and hair • After contact with organic material • After touching raw meat, fish, or poultry • After handling dirty equipment and/or utensils

18. Hand Washing Technique

19. Alcohol Base Hand Rub Attention: Alcohol based hand hygiene products containing 60% or greater ethanol concentration and used in healthcare facilities are highly flammable and are a safety concern under the requirements of various safety codes.

20. Serving Food Aprons must be worn while serving food Never lick fingers, touch hair/face/clothes, or chew gum while serving food Never wipe plates with your hands Never blow on plates/utensils to remove dust and/or crumbs Handle plates with fingers underneath &thumbs on the edge of the rim

21. Serving Food Pick up cups & cutlery by handles only.  Cups with no handles are to be handled at the middle section Fallen dishes, cutlery, and/or food fallen on the floor must be placed in the wash or discarded. Never handle food if you are experiencing vomiting, diarrhea, and/or you have an infection.

22. Outbreak Management All units & departments are notified Enhanced cleaning occurs Frequent hand hygiene Anti-bacterial soap may be used Use PPE as required Symptoms are immediately reported Isolate or cohort individuals Movements of staff & residents are minimized  Activities & Programs are cancelled  Notices posted, Visitors are restricted Illness is tracked for residents & staff  Reported to AHS

23. Personal Protective Equipment (PPE) Gloves Gowns Masks Goggles/Eye Protection Use according to isolation signage Utilized in outbreak management Used when handling different chemicals/cleaning agents Utilized in food preparation/handling Important: When putting on and after taking off any type of PPE such as gloves, always wash your hands! Do not double glove.

24. Types of Outbreaks Gastrointestinal Outbreak (GI) Two (2) or more cases of GI illness within a 48 hour period with a common connection such as location, caregivers, roommates, and/or family. Influenza-like Illness Outbreak (ILI - Respiratory) Two (2) or more cases within a 7 day period with a common link such as location, caregivers, roommates, and/or family. At least one individual is a laboratory/specimen confirmed case

25. Tracking Outbreaks Both Gastrointestinal (GI) Outbreaks &Influenza-like Illness (ILI – Respiratory) Outbreaks must be tracked for both residents &staff. This is to determine outbreak point(s) and whether or not it is being contained. Most importantly this information must be shared with Alberta Health Services (AHS). Forms to track the two types of outbreaks are located on the intranet site under “forms”. Outbreaks are declared over – eight (8) days following onset of symptoms in the last case at the outbreak facility.

26. Pandemic vs. Outbreak Outbreak Definition: A disease outbreak is the occurrence of cases of disease in excess of what would normally be expected in a defined community, geographical area or season. i.e. long-term care facilities. Pandemic Definition: A pandemic is a worldwide epidemic that, according to the World Health Organization (WHO), has to meet three conditions: 1) The microbe infects &causes serious illness in humans. 2) Humans do not have immunity against the virus. 3) The virus spreads easily from person-to-person &survives within humans.

27. Pandemic vs. Outbreak • What does a Pandemic mean specifically to us? • We continue to follow outbreak management protocol but an enhanced level • Increased communication between the facilities &AHS • Increased plans of care over &above regularresident care • i.e. dietary storing 7 days worth of food, maintenance • monitoring/maintaining certain boiler temperatures • Activate enhanced Occupational Health Surveillance • Deploy staff & volunteers as necessary

28. Influenza Pandemic Response Plan Contingency Planning & Responsibilities for the BSF Facilities The continuing care facilities will manage clients within their facility or program without transferring them to an acute care setting (except in the case of an acute episodic illness requiring surgical intervention or other urgent care services). This includes clients with influenza-like-illnesses (ILI). Due to the unpredictable nature of the pandemic influenza disaster, organizational plans must be flexible &responsive to the changing nature of the disease.

29. Signs & Symptoms of Influenza • High fever over 38ºC • Severe fatigue/tiredness (maybe bedridden) • Severe aches & pains • Headache • Cough • Occasionally a sore throat • Note: During a pandemic, avoid admissions if possible; if not • RAI on new admissions is not required. • During a pandemic, all RAI processes are on hold.

30. Outbreak Protocol • Assess ill residents (Collaborative Care Model) &document care (Total Team Record of Clinical Record). • Suspected infected resident(s) are placed under isolation with their roommates • Microbiologic specimen collection on suspected infected resident(s) • Review specimen results, document, & inform physician, & DON • Attempt to rule out non-infectious causes of symptoms. •  i.e. Medication may cause both diarrhea & vomiting

31. Outbreak Protocol Support Departments & Programs (RT, PT, SW, etc.) will be suspended & staff will be deployed to other areas suitable to their skills in the “Staff Deployment Form” (Training with Manuals given) Discourage visits from visitors/volunteers/families  Only those providing essential services are present  Important during community outbreaks Overall movements of staff &residents are minimized to prevent further spread of the illness

32. Outbreak Protocol Ill residents are separated from non-ill residents at all times  When 10% of residents or staff are infected acute care areas of isolation will be established to facilitate care needs &close monitoring  Large common areas will be used for this purpose: Britannia Room (BVM), Marlborough Room (WM), King’s Court (CM) & Shakespeare Room (TM)

33. Outbreak Protocol • Personal Preparation for Everyone: • You can reduce the risk of getting an infection by: • -Washing your hands frequently and/or use alcohol hand gel • -Living a healthy lifestyle to keep your immune system at its best • i.e. adequate rest, good nutrition, & exercise • -Avoid crowds whenever possible

34. Outbreak Protocol • Personal Preparation for Everyone: • Plan ahead in case you and/or your family becomes infected: • -Have enough supplies on hand to last 1-2 weeks such as non- • perishable foods & fluids, pet food, toilet paper, tissues, fever • medication, thermometer, alcohol hand gel, etc. • -Arrange for back up care for loved ones • -Keep important prescriptions filled regularly

35. Outbreak Protocol • Personal Preparation for Everyone: • If you do become infected: • -Stay home for your health to avoid spreading the infection • -Report your illness to your workplace • -Cover your nose &mouth when coughing or sneezing • -Wash hands frequently &/or use alcohol based hand gel • -Drink plenty of fluids • -Take medications for symptoms (follow package directions) • -Contact Health Link at 403-943-5465 for advice

36. References Brenda Strafford Foundation LTD. Policies