Infection Prevention and Control Routine Practice and Additional

Infection Prevention and Control Routine Practice and Additional Precautions 24 November 2020 1

Introduction to the IPC team • We are part of Quality and Patient Safety Department • Provide consultation and education based on IPC best practice guidelines • Prevent and reduce hospital associated infections to patients 24 November 2020 Monday-Friday generally 0800 -1600 • Check site phone list for local or BB # of your site based IPC Practitioner • After Hours / Weekends / Stats: • • Medical Microbiologist on-call 2

New IPC Acute Care Manual 24 November 2020 3

Routine Practices • Includes • Hand hygiene • Use of Personal Protective Equipment (PPE) • Correct disposal of biohazardous waste • Cleaning of shared equipment between EVERY patient use 24 November 2020 4

Routine Practices: Hand Hygiene • Most common mode of transmission of pathogens is via the hands! • Hundreds of years of research has shown that the most effective way to decrease this risk of spread of germs is to clean your hands 24 November 2020 5

What are the two ways to clean your hands in the healthcare setting? • ABHR: • ABHR kills harmful germs on your hands • Point of care accessibility • Extremely effective method to clean hands • Loonie size amount of product to all areas of the hands (including top and wrists) • 15 -20 second rub 24 November 2020 • Soap and Water: • Physical removal of harmful germs • Entire process takes longer time 1 minute • Use soap and water when hands are visibly soiled (blood, feces, urine) • Use soap and water to clean hands when caring for a patient with diarrhea 6

Additional Indications for Hand Hygiene When arriving and leaving the work area • • • Before and after using gloves • Gloves are not a substitute for hand hygiene Immediately, if skin is broken or punctured • When moving from a contaminated body site to a clean body site during direct patient care • Before handling food or drinks • After using the washroom • When hands are visibly soiled • • After blowing your nose After contact with animals WHEN IN DOUBT Perform Hand Hygiene! 24 November 2020 7

The 4 Moments of Hand Hygiene 24 November 2020 8

Routine Practices: PPE GLOVES: CONTACT WITH BLOOD, BODY FLUIDS, SECRETIONS, EXCRETIONS, NON-INTACT SKIN, CONTAMINATED OBJECTS GOWNS: PROTECT CLOTHES FROM SOILING MASK AND EYEWEAR: PROTECT 24 November 2020 MUCOUS MEMBRANES OF EYES, NOSE AND MOUTH FROM DROPLET SPRAY Need for PPE is proceduredriven, not patient-driven 9

A little more on glove use…. • Not 100% effective - failure rate - “greenhouse effect” • Hand hygiene essential BEFORE putting on gloves and AFTER removal • Remember…there are very few indications for wearing gloves outside of a patient’s room!! 24 November 2020 10

Donning PPE § Order of putting PPE can vary: § Donning sequence must ALWAYS include: – Hand hygiene as the first step – Donning gloves is the last step 24 November 2020 11

DOFFING PPE Remove gloves Perform Hand hygiene Remove gown Perform Hand hygiene Remove face protection (outside patient room or 2 metres away) § Hand hygiene § § § 24 November 2020 12

Additional Precautions Specific strategies above Routine Practices indicated by sign on the door and patient bed space. • • Airborne Precautions Contact Precautions Plus Droplet Precautions AGP Enhanced Contact Precautions Strict Precautions 24 November 2020 13

Contact Precautions • Antibiotic Resistant Organisms (MRSA and some MDROs ) • Large open draining wounds • Lice, bed bugs, Scabies 24 November 2020 14

Contact Precautions Plus • New onset of unexplained diarrhea • Clostridium difficile • Norovirus MUST wash hands with soap and water! 24 November 2020 15

Droplet Precautions Commonly used for: • Influenza • Any Flu-like illness • Vomiting • MER-Co. V • SARS • Pertussis • Bacterial Meningitis • Mumps 24 November 2020 16

AGP sign with Droplet Precautions For patients on Droplet Precautions when conducting an AGP • • • 24 November 2020 Non-invasive positive pressure ventilation (BIPAP, CPAP) Respiratory/airway suctioning (open and closed systems) High-frequency oscillatory ventilation Bronchoscopy procedure Endotracheal intubation Tracheostomy care Diagnostic sputum induction Aerosolized or nebulized medication administration Chest physiotherapy 17

Enhanced Contact Precautions • Used specifically for Lab confirmed positive CPO patient • PPE must be worn for all entries by everyone 24 November 2020 18

Airborne Precautions • Pulmonary Tuberculosis • Chicken Pox • Disseminated Shingles • Measles 24 November 2020 19

Additional Precautions: Visitors • Acute Care: Visitors > 12 years of age • Education required re: Hand Hygiene and PPE if necessary • Outbreaks: Further restrictions may apply, for example immunity to influenza • Pet policy: See IC manual 24 November 2020 20