Management of infection prevention and control

1. Management of infection prevention and control Antoinette Barton-Gooden 2013

2. Objectives • Discuss the aims of infection control • Identify the levels of responsibility for infection prevention and control • Discuss the advantages of infection control • Explain the regulatory framework at the national and organizational levels. • Identify components of infection prevention & control. • Discuss organizational control measures to protect both patients and healthcare workers.

3. Introduction • Is infection control necessary? • http://rjrnewsonline.com/local/prisoners-at-kingston-central-police-lockup-diagnosed-with-tubercolosis

4. Aim of infection control • To reduce infection/health care associated infections (HCAIs)/nosocomial infection (Hospital acquired). • These infections increase patients’ suffering and can prolong the length of hospital stay. • Many of these infected patients suffer permanent disability and a significant number die. • Increasing numbers of infections are being caused by microbes resistant to conventional treatments. (WHO Patient Safety Curriculum Guide: Multi-professional Edition, p.210)

5. HCAIs • WHO defines a health care-associated (also called hospital acquired) infection as an infection acquired in hospital by a patient who was admitted for a reason other than that infection and/or an infection • Occurring in a patient in a hospital or other health-care facility in whom the infection was not present or incubating at the time of admission. • This includes infections that are acquired in the hospital, but appear only after discharge, as well as occupational infections among health-care facility staff. (WHO Patient Safety Curriculum Guide: Multi-professional Edition, p.210)

6. It is not all about you! • Infection control is everyone’s business.

7. Regulatory process • Jamaica: Ministry of Health developed policies about infection control (2000) and immunization policy to guide health care facilities and organizations. • Organizations eg. Hospital, health centres, schools, workplaces. • Professional associations: training for their stakeholders eg. Nurses, Doctors, Occupational Safety and Health Administration (OSHA). • Quality assurance framework within various institutions. • Centre for Disease Control (USA) have guided the development of policies.

8. Scenario • The infection control practitioner educated the patient and staff about the transmission route Clostridium difficile when a case was reported on the ward. • While caring for the client, the nurses were observed to be wearing mask, hair cap, gown, gloves and hurriedly performed each task without talking. • What devices are necessary to ensure infection control?

9. Infection prevention & control committee • Multidisciplinary membership: Microbiologist, dietary, housekeeping, laundry, medical, nursing, pharmacy, Central Sterilization and Supplies Department, Public health nurses (PHNs)and inspectors

10. Infection control functions • Universal precautions • Development of isolation procedures • Education of all staff • Monitoring and surveillance • Reporting as an element of quality assurance to the CEO, SMO, Medical Officer of Health and Nursing Directors. • Continuous quality improvement by liaising with all departments to identify problems and solutions to enhance patient care.

11. Components of infection prevention & control • Isolation: Creation of a barrier, mechanical or spatial to prevent the transmission of infectious diseases to or from a patient. • Adequate personnel assigned to area • Appropriate equipment and supplies • Schedule daily routine cleaning and maintenance • Education of HCW, patients and family regarding the illness and precautionary measures to be observed.

12. Components of infection prevention & control • Standard precaution • Hand washing before, after patient contact , immediately after any contact with body fluid, after covering a sneeze, picking the nares, using the toilet, after removing gloves, touching contaminated objects, before preparing food//handling food, when hands are dirty etc. • Wear PPE when there is a risk of splashing eg. Masks, goggles, aprons, closed shoes, gloves, caps

13. Components of infection prevention & control • Transmission based precautions • Droplet • Fecal • blood

14. Components of infection prevention & control • Disinfection & Sterilization: Sterilization is a procedure which achieves complete destruction of all microorganisms including bacteria spores. • Disinfection: A procedure which removes or kills most, but not all viable microorganisms. • Antiseptic: A non toxic ‘disinfectant’ used on the skin or living tissues. Usually used at a lower dilution; should not be used to disinfect instruments or the environment.

15. Components of infection prevention & control • Soiled instruments and surfaces soiled with body fluid should be disinfected for at least 5 minutes with a fresh 1:10 dilution of a 5% bleach solution or 1:6 dilution of 3% bleach solution that yields a 0.5% solution or other effective disinfectant. • Heavy soiled instruments should be disinfected for 5 minutes with a 1:5 dilution of 5% bleach solution or a 1:3% bleach solution that yields a 1% solution.

16. Components of infection prevention & control • Housekeeping • Frequent wiping of floor with bleach • Blood spillage wiped immediately with bleach

17. Components of infection prevention & control • Health care waste management • All soiled linen and clothing must be placed in a clear plastic bag and labelled appropriately before being sent to the laundry. • All body waste must be flushed in toilet • All other infectious waste must be placed in red or yellow bags. • Bags should be tied securely and removed for incineration. • Puncture resistant container for sharps

18. Components of infection prevention & control • Risk management: Infection control team • Surveillance • Outbreak investigations • Communicable disease reporting • Education • Antibiotic utilization and audit • Committee and consultant involvement • Regulatory compliance (Hoffmann, 2009)

19. Components of infection prevention & control • Please read classification of wastes and waste management segregation and packaging (Ministry of Health (2000): Health Facilities Infection Control Policies and Procedures Manual).

20. Bibliography • Hoffmann, K.(2009). Developing an infection control program. http://www.infectioncontroltoday.com/ • Ministry of Health (2000): Health Facilities Infection Control Policies and Procedures Manual). • University Hospital of the West Indies (2007): Infection Control Policy and Procedures Manual. • WHO (2011) Patient Safety Curriculum Guide: Multi-professional Edition. • Image:http://www.google.com/imgres?imgurl=http://www.metrolic.com/wp-content/uploads/2010/10/11_bg.jpg&imgrefurl=http://www.lookfordiagnosis.com/mesh_info.php?term=Patient+Isolation&lang=1&h=326&w=500&sz=41&tbnid=Rb8pqkM27EXCZM&tbnh=181&tbnw=278&zoom=1&usg=__8htB0NO4WDgIi3gzBUvItGL2K-c=