IPC Non-Clinical 2016

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Chemex│Infection Prevention and Control Distance Learning│IPC Guidance for Non-Clinical Staff

Purpose of This Course • Learn about Healthcare-Associated Infections Often abbreviated to HCAIs

• Understand your role in their prevention • The importance of Infection Prevention and Control (IPC) • The general principles of IPC • The importance of hygiene – especially hand hygiene

Main Topics • It’s the law: Health and Social Care Act 2008 Includes code of practice commonly called the ‘Hygiene Code’

• Hand Hygiene • Use of Personal Protective Equipment (PPE) • Environmental Hygiene Keeping areas clean and free of dirt and dust

• Safe Use and Disposal of Sharps • Practical Aspects of Asepsis Keeping ‘bad’ bugs out - we don’t worry about the good ones

Healthcare-Associated Infections • What are Healthcare-Associated Infections (HCAIs)? An infection a patient gets after receiving care and treatment in any healthcare setting - e.g. clinic, GP surgery, ambulance or hospital

• Why preventing them is important About 8% of patients develop a HCAI At least 1 in 3 is preventable Patients with a HCAI are 7x more likely to die in hospital than uninfected ones HCAIs are directly responsible for 5,000 deaths and are implicated in 15,000 more every year

HCAI Patient and Staff Risks • HCAIs are a risk to both patients and staff • Patient risk factors Age, condition, lifestyle, invasive procedures / devices, poor practice: transfer of micro-organisms during care (hands, environment, equipment)

• Staff risk factors Contact with patients with undiagnosed infection (e.g. chicken pox is infectious for 2-3 days before rash) or patients colonised with antibiotic resistant organisms e.g. MRSA Contact with blood, body fluids, needles (bloodborne viruses such as Hep B, Hep C or HIV) Behaviour: poor practices, lack of equipment, lack of knowledge

Responsibility – Personal and Legal • Infection control is EVERYBODY’S responsibility You need to understand your role in keeping service users – and yourself – protected

• It’s so important it’s the law of the land… • CQC: statutory body that inspects healthcare Independent regulator of health and adult social care Providers need to be registered CQC then monitor / enforce / improve Focus on quality from the user’s perspective

• They WILL inspect and audit you – it’s the law

If You Get It Wrong • People might get a preventable infection Infections are a risk to staff but especially to patients

• Infections are serious enough But they can also make other conditions far worse

• Infections prolong a hospital stay …while blocking a bed someone else needs)

• Serious infections shorten both life expectancy …and quality of life

• In the worst cases infections kill And they kill both directly and indirectly

If You Get It Wrong…

IPC│Hygiene and the Chain of Infection How Infections Spread

Hygiene Basics • Not all bugs are bad; the overwhelming majority are harmless or beneficial 10x more bacterial cells in and on you than there are cells of you Million per cm2 on your scalp! Number on your fingertips double after you use the loo Germs can stay alive on hands and surfaces for hours...

• But some can cause serious illness – even death E. coli, MRSA, flu, norovirus, TB, CRE, VRE.... They can kill directly or indirectly by making other conditions worse

• How do you protect yourself? …and your colleagues and people you are caring for

Chain of Infection

Breaking the Chain of Infection The ‘Chain of Infection has six links: • Infectious Agent

e.g MRSA

• Reservoir

Patient colonised

• Portal of exit

Contact with surfaces / hands

• Mode of TransmissionTransferred on hands / eqpt • Portal of Entry

Break in skin / wound

• Susceptible host

Patient is protected by you breaking the chain

Colonisation vs Infection • Colonisation • Infection • When microorganisms • When microorganisms (germs) exist in the (germs) begin to invade body but don’t invade tissue and cause tissue or cause detectable clinical detectable clinical damage damage

Hygiene and Infection Control • You Can’t Disinfect Dirt Dirt provides food for bacteria to grow It gives them a place to ‘hide’

• Surfaces (and hands) need to be visibly clean before you can disinfect them That’s why hand rubs are useless on dirty hands This is why cleanliness is vital to hygiene!

Hygiene and Infection Control • Hand, Respiratory and Surface Hygiene Many bugs spread by hands and surfaces Coughs and sneezes spread diseases!

• Some people are more susceptible than others Infants / elderly / infirm, people with immunosuppressive diseases such as AIDS, those on chemo- or radiotherapy are more at risk

• Know when to use gloves... Only if you are likely to come into contact with body fluids Wash your hands before and after using gloves

IPC│The ‘Standard Precautions’ Sometimes called ‘Universal Precautions’

The ‘Standard Precautions’ • • • • • • • •

Hand Hygiene PPE Prevention of occupational exposure Management of blood / body fluid spillages Cleanliness of care equipment / environment Safe handling and disposal of linen Safe handling and disposal of waste Patient placement

Hand Hygiene • The single most important way to prevent transmission of infection Important for you to know when to decontaminate your hands and how to do it properly

• Barriers to Hand Hygiene: Nail varnish / false nails Jewellery (especially rings with stones) Wristbands and wristwatches Long sleeves

The ‘5 Moments’ of Hand Hygiene

Hand Washing 2



Palm to palm.


Backs of fingers to opposing palms with fingers interlocked.

Right palm over left dorsum and left palm over right dorsum.


Palm to palm fingers interlaced.


Rotational rubbing of right thumb clasped in left palm and vice versa.

Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa.

Hand Washing: Where People Miss

Most frequently missed

Frequently missed

Less frequently missed

Hand Gels and Foams • Use only when hand washing facilities are limited For example when away from a care facility

• Use when rapid hand disinfection required • Can only be used on hands that are not visibly soiled – you can’t disinfect dirt! • Alcohol has limitations Ineffective against the noroviruses, Rotavirus Ineffective against spore formers such as C. difficile – Chemex Enduro Foam is sporicidal

PPE Protects You and the Patient • Gloves Should only be worn if there is risk of contact with blood / body fluids / mucous membranes / broken skin / known infection / contaminated equipment or environment Change regularly, observe correct removal and disposal (don’t wear when driving to or from a scene)

• Aprons│Protect the uniform Wear when contact with blood / body fluids, a known infection or when cleaning

• Facial Protection│Masks and goggles Change between patients and clean / dirty procedures

Prevent Occupational Exposure Make sure you… • Adopt safe practice with sharps and needles Use appropriate sharps containers

• Always cover broken skin with a waterproof dressing • Wear gloves as necessary • Get immunised: Hep B, flu vaccine • Report illness e.g. vomiting / diarrhoea

Blood / Body Fluid Spills • • • • •

Deal with as soon as possible Protect yourself: PPE Immobilise the spill with RTY240 Powder Remove and dispose of as clinical waste Clean area with appropriate disinfectant If norovirus, C. diff or an organism of high consequence is suspected use Antibak Otherwise use Bacticlean

Environmental Cleanliness • Vehicles Clean daily, weekly and clean contact surfaces between patients Equipment, fixtures and fittings should be in a good state of repair

• Premises Apply good housekeeping, good hygiene practices, proper storage of food and check fridge temperature regularly Always wear disposable gloves and an apron for cleaning - change these for each area being cleaned Clean toilets / changing rooms last Use disposable cleaning cloths, change for each area

• Store cleaning equipment and chemicals properly

National Colour Codes • ALWAYS comply to prevent cross-contamination Kitchens


Dining and mess areas

Sluice, Showers, Changing Rooms

General Areas Offices, corridors, training rooms, medical device storage area

Vehicle Interiors Other treatment areas

Sharps and Waste • Dispose of clinical waste with every patient Yellow sacks for infected / hazardous waste only Do not allow to accumulate Black / Yellow (‘tiger stripe’) sacks for offensive hygiene waste not contaminated with a known infection Black sacks for all uncontaminated general domestic waste

• Dispose of sharps / metal disposable equipment into sharps bin NOT bags Waste and Sharps must be traceable back to source Label with ward / vehicle registration, station, date etc Do not overfill sharps bins/clinical waste and replace used sharps bins weekly or when 2/3rds full

Patient Placement / Transmission • Patients with some infections may require additional (transmission based) precautions If someone is known / suspected to be infected or colonised with an infection where transmission will not be prevented by standard precautions alone This could be – for example – infections transmitted by the airborne route Examples are TB, meningococcal disease, Influenza, Chicken pox

• Rooms or vehicles may require deep clean Some patients may need to be transported on their own e.g. active C. diff This depends on the situation / infection

MRSA and C. diff • MRSA Transport on their own if the patient is heavily colonised and has a skin shedding condition e.g. psoriasis, eczema or open uncovered wounds and treat linen as infected

• Clostridium difficile Transport on their own if the patient is still symptomatic and treat linen as infected NB If the patient is confirmed as having been clear of symptoms for 48 hours this is not necessary If the patient has an episode of diarrhoea while in an ambulance the ambulance must be thoroughly cleaned before transporting another patient as C. diff spores will have been expelled into the environment

Chemex│visit chemexuk.com Distance Learning│IPC Guidance for Non-Clinical Staff