Chapter 1. Infection Control
Infection prevention and control (IPAC) practices are evidence-based procedures and practices that can prevent and reduce disease transmission, and eliminate sources of potential infections (PIDAC, 2012). When used consistently, IPAC practices will prevent the transfer of health care associated infections (HAIs) in all health care settings. HAIs, also known as nosocomial infections, are infections that occur in any health care setting as a result of contact with a pathogen that was not present at the time the person infected was admitted (World Health Organization[WHO], 2009a).
Two types of techniques are used to prevent infection in the hospital setting. The first, medical asepsis, or clean technique, has been used in the past to describe measures for reducing and preventing the spread of organisms (Perry, Potter & Ostendorf, 2014). The second, sterile technique, also known as sterile asepsis, is a strict technique to eliminate all microorganisms from an area (Perry et al., 2014). When a patient is suspected of having or is confirmed to have certain pathogens or clinical presentations, additional precautions are implemented by the health care worker, in addition to routine practices (PIDAC, 2012). These additional precautions are based on how an infection is transmitted, such as by contact, droplet, or air. Additional precautions use personal protective equipment (PPE), such as gowns, eyewear, face shields, and masks, along with environmental controls to prevent transmission of infection.
To reduce, and prevent the spread of, HAIs, routine practices, a system of recommended IPAC practices, are to be used consistently with all patients at all times in all health care settings (Public Health Agency of Canada [PHAC], 2012b). The principles of routine practices are based on the premise that all patients are potentially infectious, even when asymptomatic, and IPAC routine practices should be used to prevent exposure to blood, body fluids, secretions, excretions, mucous membranes, non-intact skin, or soiled items (PIDAC, 2012).
To learn the steps for routine practices, see Checklist 1.
|
|
| 1. Complete a risk assessment to determine your need for PPE (gown, clean gloves, mask, face shield, or eyewear). | Consider: Will your face, hands, skin, mucous membranes, or clothing be exposed to blood, excretions, or secretions, either by spray, coughing, or sneezing?
Will you have contact with the patient’s environment/surfaces? Is an infection or communicable disease suspected or confirmed? |
| 2. Perform hand hygiene (hand washing) following hospital policy. | Hand hygiene is considered the most important and effective measure to prevent HAIs.
HAIs are most commonly spread by the hands of health care workers, patients, and visitors. Health care workers, patients, and visitors spread about 80% of all HAIs. Always perform hand hygiene after using the washroom, coughing, or sneezing, and before and after eating. Using an alcohol-based hand rub (ABHR) is the recommended method for hand hygiene if hands are not visibly soiled. |
| 3. Follow proper cleaning or disinfecting procedures of patients and the environment (room etiquette). These environmental controls will control the site or source of microorganism growth. | Dispose of soiled linens and dressings in appropriate receptacle bin.
Avoid contact of soiled item with uniform. Clean contaminated objects and sterilize or disinfect equipment and patient rooms according to agency policy. Discard any item that touches the floor. Control sources of wound drainage and body fluids; change soiled dressings. Avoid shaking bed linen or clothes; dust with a damp cloth as required. Microorganisms can be expelled through the air and inhaled by patients and health care workers. Provide all persons with their own linen and personal items. Place syringes in designated puncture-proof containers. Keep table surfaces dry and clean. Empty and dispose of drainage containers as per agency policy. |
| 4. Follow respiratory etiquette. | Wear a mask if coughing or sneezing.
Wear a mask if suffering from a respiratory condition, and consider staying home. Avoid talking, sneezing, or coughing over open wounds and sterile dressings. Practise coughing or sneezing into your upper arm, not your hands. Follow hospital policies related to creating healthy workplaces. Do not come to work ill or with symptoms of a communicable disease (flu or cold) that puts co-workers or patients at risk. |
| 5. Wear clean gloves for appropriate activities based on a risk assessment. Use clean gloves when handling all blood and body fluids. | Follow recommendations for assessing each situation and the need for clean gloves.
Improper glove use has been linked to the transmission of microorganisms. Do not wear gloves for activities that do not pose a risk, such as feeding or taking blood pressure. Clean gloves are task specific and for single use only. Handle all blood, body fluids, and laboratory specimens as if infectious. Always perform hand hygiene after taking off clean gloves to reduce the potential of contamination from pathogens on gloves. |
| 6. Use additional precautions guidelines for suspected or known infections or communicable diseases. Use PPEs based on mode of infection transmission (contact, droplet, or airborne). | Follow agency guidelines essential to prevent and reduce transmission of infections.
Single rooms, cohorting (placing patients with the same infections in the same room if a private room is not available), restricting visitors, and implementing additional environmental controls may be required. Provide instruction/signage for appropriate use and disposal of PPE for visitors, patients, and all health care workers. Remove PPE immediately after single use and perform hand hygiene. |
| 7. Do not eat or drink in the patient/client or resident areas. | Eating and drinking increases the risk of transmission of infection between health care providers and patients. |
| 8. Use avoidance procedures/actions to minimize the risk of infection transmission. | If a patient has uncontrolled diarrhea, wear a gown when changing linen to prevent contamination of clothing and hands.
If a patient is coughing, sit next to, rather than in front of, the patient when talking to that patient. |
| Data source: CDC, 2007, 2014; Perry et al., 2014; PIDAC, 2012; PHAC, 2012b, 2013 |
- Name four environmental procedures that can break the chain of infection.
- What types of patents are at an increased risk for an HAI?
- How can health care providers reduce patient susceptibility to infection?
For people living in care homes, infections can be serious, and in some cases, life-threatening.
They can also make existing medical conditions worse. Regular contact with staff, other residents, family and friends and the shared living space all mean infection can easily be passed around. It is therefore vital to take the steps that can help prevent infection occurring.
Delivering clean, safe care is essential to preventing infection.
Having clean hands is the most effective way of preventing infection from spreading. There are 5 important moments when you should clean your hands:
- just before you provide care to a resident
- as soon as you have finished providing care to a resident
- straight after you have been exposed to any body fluids
- straight after touching the person's surroundings (such as chair, door handle) if this may have contaminated your hands
- as soon as you take off protective gloves.
Adapted from 'My 5 Moments for Hand Hygiene' - World Health Organisation.
To make it easier to wash your hands regularly, you should:
- keep your arms bare below the elbow
- remove wrist and hand jewellery before starting work
- have short, clean fingernails without nail polish or false nails
- cover cuts or grazes with a waterproof dressing.
Decontaminate your hands with a handrub, except in the following situations when liquid soap and water should be used:
- when your hands are clearly dirty or may be contaminated with body fluids
- when you have been providing care to residents with vomiting or diarrhoea, even if you have been wearing gloves.
The World Health Organization provides an example diagram showing how to effectively wash your hands or use handrub.
This includes the use of gloves and aprons to protect you and reduce the risk of infection while providing care. Selecting which protective equipment to use will require an assessment of the task and the risk to both yourself and the resident.
- wear each item only once
- if gloves are needed, put them on just before providing care and take them off straight afterwards
- change gloves between different care tasks for one person, for example, personal care and care that involves non-intact skin
- change gloves between care tasks for different people
- dispose of all used items correctly.
This refers mainly to the use of needles for which staff will need to have the right training and skills. To help prevent infection:
- handle sharps as little as possible and don't pass them from hand to hand
- do not bend, break or recap a used needle
- put used sharps in the right container straight away
- don't use sharps containers for anything else
- dispose of sharps containers when the fill line is reached, or every 3 months - whichever occurs first.
Healthcare waste, such as dressings and disposable clothing, can spread infection. To reduce the risk of this:
- put waste immediately into the right colour storage, bag or container
- make sure you know how healthcare waste must be labelled and stored
- make sure residents and their friends and family understand how waste must be handled, stored and disposed of.
Residents and their friends and family can play a part in helping to prevent infection. Make sure they know about:
- the importance of clean hands
- how, when and where to clean their hands
- when to use handrub or soap and water
- what they can do to make sure care staff maintain clean hands.
This content has been co-produced by NICE and the Social Care Institute for Excellence (SCIE). It is based on NICE’s guideline on healthcare associated infections: prevention and control in primary and community care and quality standard on infection prevention and control.