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Routine Practices

Routine Practices. What Is It?. A set of infection control precautions & practices used for all patient care regardless of their presumed infection status or diagnosis. What's Its Purpose?.

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Routine Practices

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  1. Routine Practices

  2. What Is It? A set of infection control precautions & practices used for all patient care regardless of their presumed infection status or diagnosis

  3. What's Its Purpose? To prevent the transmission of organisms from contact with blood, body fluids and moist body substances with non-intact skin or mucous membranes

  4. Routine Practices Consists Of... • Hand Hygiene • Personal Protective Equipment (PPE) (gloves, gowns, masks, eye protection, face protection) • Accommodation • Equipment • Environmental Controls • Sharps

  5. Routine Practices Consists Of... • Linen • Waste • Specimen Collection • Visitors Guidelines • Education for Healthcare Workers, Patients/Residents/Clients and Visitors • Post Mortem Care

  6. We Don’t Know Which Person May Be Potentially Infectious So… Routinely treat all patients/residents/clients as if they are infectious Use Routine Practices for everyone!

  7. Infectious Agent Reservoirs Susceptible host Portal of exit Portal of Entry Means of transmission Chain of Infection

  8. Chain of Infection • Infectious Agent: • A microorganism with the ability to cause an infectious disease • Infectious agents are bacteria, viruses, fungi and parasites • Reservoirs: • A place within which microorganisms can thrive and reproduce • Example: Human beings, animals, water

  9. Chain of Infection • Portal of Exit: • A place of exit providing a way for a microorganism to leave the reservoir • Example: Microorganisms may leave the reservoir through the nose or mouth when someone sneezes or coughs

  10. Chain of Infection • Means of Transmission: • Route or method of transfer by which the infectious microorganism moves or is carried from one place to another to reach their new host

  11. Means of Transmission • Contact: • Direct • Indirect • Droplet • Airborne • Common Vehicle • Vector

  12. Chain of Infection • Portal of Entry: • Means by which the infectious microorganism gains entry into the new host • Example: ingestion, breathing, skin puncture • Susceptible Host: • A person who cannot resist a microorganism invading the body, multiplying and resulting in infection

  13. Contact Transmission • Direct physical contact between an infected or colonized individual and susceptible host (e.g., Scabies) • Indirect contact involves passive transfer via intermediate object to susceptible host (e.g., contaminated equipment, hands of HCWs) • Example: C.Difficile

  14. Droplet Transmission • Large droplets > 5 um propelled from respiratory tract, coughing, sneezing suctioning or bronchoscopy, a short distance < 1 meter to nasal or oral mucosa of a new host • Droplets don’t remain suspended in air • Example: N. Meningitidis

  15. Airborne Transmission • Dissemination of microorganisms by aerosolization • Organisms suspended in air in droplet nuclei particles < 5 um • Can be widely dispersed by air currents • Example: Tuberculosis

  16. Means of Transmission • Common Vehicle: • Contaminated vehicle (water/food) • Salmonella • Vector: • Non human that transmits infection • West Nile

  17. The 10 Most Common Ways Of Spreading Disease Are The 10 Fingers Hand hygiene is the single most effective way to prevent infection

  18. Hand Facts • Artificial fingernails, gel nails or extenders should not be worn • Natural nail tips should not be longer than 0.635 cm (1/4 inch) long • Nail polish should be removed when chipped • Avoid wearing hand jewellery

  19. NB Factors in Hand Hygiene • Hand Lotions: • Minimize skin irritation that can occur with frequent hand hygiene • Select lotions compatible with products and gloves used • Dispensers: • Do not “top up” partially empty containers • Hand lotion bottles should not be used

  20. Hand Hygiene When to Perform Hand HygieneBefore:-Direct, hands-on care with a patient, resident, or client-Performing invasive procedures.-Handling dressings or touching open wounds.-Preparing, handling, serving, or eating food.-Feeding a patient.-Shifts and breaks.

  21. Between:-Procedures on the same patient where soiling of hands is likely, to avoid cross contamination.After:-Contact with blood, body fluids, non-intact skin, and/or mucous membranes. -Contact with items known or considered to be contaminated. -Removal of gloves. -Personal use of toilet or wiping nose. -Shifts & breaks.

  22. Alcohol Based Hand Rub • Must contain a minimum of 60% alcohol • Use in all clinical situations, except when hands are visibly soiled • Use as an alternative to plain or antimicrobial soap except when hands are visibly soiled

  23. "How To Use Alcohol Based Hand Rub" • Apply 2-3 mls of product to the palm of one hand • Rub hands together, covering all hand surfaces, including fingernails, web spaces, thumbs & palms. • Ensure hands are dry before performing another task (dries within 15-20 seconds). • NB: Alcohol products are flammable.

  24. Soap & Water • Plain Soap (Non-antimicrobial) • For routine hand washing. • Hands must be washed with soap & water when hands are visibly soiled with blood, body fluids, secretions, excretions, and exudates from wounds.

  25. Soap & Water • Antimicrobial Soap: • Before contact with invasive devices • Before performing any invasive procedure • Before contact with immunosuppressed patients, residents or clients • Before/after contact with patients, residents or clients on infection control precautions/isolation

  26. Hand Washing "How To" • Wet hands under warm running water. • Apply soap and distribute over hands. • Rub hands together vigorously for 10-15 seconds to create a good lather. • Using friction, cover all hand surfaces including fingernails, web spaces, thumbs and palms.

  27. Hand Washing "How To" • Rinse under warm running water. • Dry hands gently and thoroughly with a disposable towel. • Turn off faucet using a clean disposable towel. • NB: Faucets are dirty!

  28. Personal Protective Equipment Assessment of Risk • The selection of gowns, gloves, masks and/or face protection should include consideration of the following: • Probability of exposure to blood and/or body fluids • Amount of blood and/or body fluids likely to be encountered • Probable route of transmission

  29. Personal Protective Equipment Gloves • Additional measure to, not a substitute for hand hygiene • Clean, non-sterile gloves of appropriate size should be worn • Single-use disposable gloves should never be reused or washed

  30. Personal Protective Equipment Gloves • Worn for contact with blood, body fluids, secretions and excretions, mucous membranes, draining wounds, or non-intact skin • Worn for handling items visibly soiled with blood, body fluids, secretions or excretions • Worn when the HCW has open sores of his/her hands

  31. Personal Protective Equipment Gloves • Put on directly before contact with patient, resident or client or just before task/procedure requiring gloves • Change gloves between: • Care activities/procedures with the same patient, resident or client • After contact with materials that may contain high concentrations of microorganisms

  32. Personal Protective Equipment Gloves • Gloves should be long enough to fit over the cuff of a gown • Should be removed prior to leaving the patient’s or resident’s room • Hand hygiene must be performed following glove removal

  33. Personal Protective Equipment Gowns • Routine gown use is not recommended • Used to protect uncovered skin and prevent soiling of clothing during procedures/ care activities likely to generate splashes or sprays of blood, body fluids, secretions or excretions

  34. Personal Protective Equipment Gowns • Remove gown when task complete, when leaving the room or when gown is heavily soiled/wet • Gowns are single-use: • Disposable gowns are discarded • Cloth gowns are laundered after use • Perform hand hygiene after removing gown

  35. Personal Protective Equipment Masks • Surgical/procedure masks protect the mucous membranes of the nose and mouth during procedures likely to generate splashes/sprays of blood, body fluids, secretions or excretions • Should be worn within 1 meter (3 ft) of a coughing patient, resident or client

  36. Personal Protective Equipment Masks • Discard masks which are crushed, wet, have dangled around the neck or have become contaminated with patient secretions • Perform hand hygiene following mask removal

  37. Personal Protective Equipment Eye Protection • Used to protect mucous membranes of eyes during procedures/ care activities that are likely to generate splashes, sprays or aerosols of blood, body fluids, secretions or excretions • Eye protection must fit over prescription glasses • Reusable eye protection must be cleaned • Perform hand hygiene following removal

  38. Personal Protective Equipment Face Protection • Used to protect the mucous membranes of the eyes, nose and mouth during procedures/care activities that are likely to generate splashes, sprays or aerosols of blood, body fluids, secretions or excretions • Face protection must fit over prescription glasses • Face protection shall be of appropriate size-large enough to protect mucous membranes of the face

  39. Personal Protective Equipment Respiratory Etiquette • Simple measures individuals can utilize to minimize the spread of respiratory organisms • Cover your cough • Cover your mouth and nose with a tissue when you cough or sneeze OR cough or sneeze into your upper sleeve, not your hands

  40. Personal Protective Equipment Respiratory Etiquette • Put your used tissue in the waste basket • You may be asked to put on a surgical mask to protect others • Clean your hands after coughing or sneezing • Wash with soap and water OR clean with alcohol-based hand rub

  41. Eye/Face Protection

  42. PPE • Donning: • Perform Hand Hygiene • Put on long sleeve gown with opening of gown at back • Tie neck and waist ties • Apply mask/respirator, seal check (if N95) to ensure correct fit, reapply glasses • Apply protective eyewear if appropriate • Apply gloves, pulling gloves up over cuff of gown

  43. PPE • Removing: • Prior to Exiting Room or Area • Remove gloves using “glove to glove, skin to skin” technique, Discard • Perform Hand Hygiene • Untie neck ties first, then waist ties on the gown • Place fingers of one hand under the opposite cuff and pull cuff over hand

  44. PPE • Removing: • Prior to Exiting Room or Area • Using the gown covered hand, pull the gown down over the other hand • Pull the gown down off the arms, being careful that the hands do not touch the outside of the gown

  45. PPE • Removing: • Prior to Exiting Room or Area • Hold the gown away from your uniform and roll it up with the contaminated side inside in a away that minimizes air disturbance. Dispose into garbage or laundry hamper • Perform Hand Hygiene/Use paper towel to open door

  46. PPE • Removing: • Immediately After Exiting Room or Area • Remove eye protection/face shield if worn • Remove mask/respirator according to manufacturer’s instructions • Take care to prevent self contamination • Discard into garbage • Perform hand hygiene

  47. Patient Acommodation • Single rooms not required for routine care • Single rooms with dedicated bathroom facilities for acute care when: • Patients soil their environment • Patients have inadequate hygiene

  48. Equipment • Dedicate equipment for individuals on infection precautions or isolation • Establish and monitor regular cleaning schedules with assignment of responsibility and accountability

  49. Equipment • Clean and reprocess reusable equipment between patients/residents/clients • Reprocessing of a specific item depends upon: • Intended use of an item • Risk of infection to the patient, resident or client • Amount of soil present

  50. Equipment • Visibly soiled equipment must be cleaned immediately • Handle soiled items in a manner that prevents exposure of skin, mucous membranes and contamination of clothing and environment

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