infection control principles and practices session 4 infection control for lpha train the trainer...

Infection Control Principles and Infection Control Principles and PracticesPracticesSession 4Session 4

Infection Control for LPHAInfection Control for LPHA

Train the Trainer CourseTrain the Trainer Course

August 25, 2005 August 25, 2005

TopicsTopics

• Chain of infectionChain of infection

• Standard precautionsStandard precautions

• Transmission-based precautionsTransmission-based precautions

• Attachments from PHEPAttachments from PHEP

ObjectivesObjectives

• Understand the various Understand the various precautions used to prevent precautions used to prevent disease transmissiondisease transmission

• Be able to practice the correct Be able to practice the correct precautions for a given disease precautions for a given disease and taskand task

Chain of InfectionChain of Infection

Agent↓

Reservoir↓

Portal of exit↓

Mode of transmission↓

Portal of entry↓

Susceptible host

Standard PrecautionsStandard Precautions

Method of infection control that uses Method of infection control that uses

1)1) work practices, work practices,

2)2) engineering controls, and engineering controls, and

3)3) personal protective equipment (PPE)personal protective equipment (PPE)

to reduce or eliminate exposure to to reduce or eliminate exposure to infectious agents. infectious agents.

Standard precautionsStandard precautions

1) Work practices1) Work practices• hand hygienehand hygiene• no eating, drinking in areas with risk of no eating, drinking in areas with risk of

transmissiontransmission• no re-capping of used needlesno re-capping of used needles

2) Engineering controls2) Engineering controls• safety devices on sharp medical devicessafety devices on sharp medical devices• sharps containerssharps containers• hand washing facilitieshand washing facilities


3)3) PPEPPE• used as last resort when exposure has used as last resort when exposure has

not been eliminated by work practices not been eliminated by work practices and engineering controlsand engineering controls

• provides protection to skin, clothing, provides protection to skin, clothing, nose, mouth, eyesnose, mouth, eyes

• examples: gowns, gloves, goggles, examples: gowns, gloves, goggles, masksmasks


• considers all person potentially considers all person potentially infectiousinfectious

• applies to all individuals, regardless applies to all individuals, regardless of presence/type of symptomsof presence/type of symptoms

• used against exposure to blood, all used against exposure to blood, all body fluids, secretions, excretions body fluids, secretions, excretions (except sweat), mucous membranes, (except sweat), mucous membranes, non-intact skin non-intact skin


• hand hygienehand hygiene

• infectious waste managementinfectious waste management

• sharps safety devicessharps safety devices

• PPEPPE

• respiratory hygiene/cough etiquetterespiratory hygiene/cough etiquette


• Hand hygieneHand hygiene

– sinks, soap, paper towels sinks, soap, paper towels available in convenient locationsavailable in convenient locations

– alcohol gel in convenient alcohol gel in convenient locations for stafflocations for staff


• Wash hands:Wash hands:– before and after client contactbefore and after client contact– after removing gloves and other PPEafter removing gloves and other PPE– after contact with contaminated surfaces and after contact with contaminated surfaces and

items, specimens, even when gloves are wornitems, specimens, even when gloves are worn– before eating or drinkingbefore eating or drinking– after using restroomafter using restroom– after coughing, sneezing, blowing noseafter coughing, sneezing, blowing nose


CDC Hand Hygiene GuidelinesCDC Hand Hygiene Guidelines

• Wash with soap and warm water, using Wash with soap and warm water, using friction for at least15 seconds. Dry with a friction for at least15 seconds. Dry with a paper towel. Finally turn off the faucet with paper towel. Finally turn off the faucet with a clean paper towel.a clean paper towel.

• Use of alcohol hand sanitizer is the Use of alcohol hand sanitizer is the preferred method of hand hygiene in preferred method of hand hygiene in health care settingshealth care settings..


• Infectious waste managementInfectious waste management– sharps containerssharps containers• puncture resistant puncture resistant • leak-proof, closableleak-proof, closable• labeled with biohazard labeled with biohazard

symbol or redsymbol or red• do not overfilldo not overfill


• Infectious waste managementInfectious waste management– biohazard bagsbiohazard bags• for disposal of items with blood, body fluids for disposal of items with blood, body fluids

that arethat are– pourablepourable– dripabledripable– squeezablesqueezable– flakableflakable


• Infectious waste managementInfectious waste management– LPHA can haul waste without license if LPHA can haul waste without license if

weight does not exceed 50 pounds per weight does not exceed 50 pounds per month month

– keep log of waste disposalkeep log of waste disposal• datedate• amount and description (e.g. 5 sharps amount and description (e.g. 5 sharps

containers)containers)• destinationdestination• transported bytransported by


• Sharps safety Sharps safety devicesdevices– Needlestick Safety Needlestick Safety

and Prevention Actand Prevention Act• mandates use of mandates use of

sharps with sharps with engineered safety engineered safety devicesdevices

• users must evaluateusers must evaluate


• Personal protective Personal protective equipmentequipment– glovesgloves– gownsgowns– apronsaprons– goggles, face shieldsgoggles, face shields– surgical/procedure surgical/procedure

masksmasks– respiratorsrespirators


• Respiratory hygiene/cough etiquetteRespiratory hygiene/cough etiquette– cover mouth and nose with tissue when cover mouth and nose with tissue when

coughing, sneezingcoughing, sneezing– immediately toss tissueimmediately toss tissue– wash hands with soap and water or use wash hands with soap and water or use

alcohol gelalcohol gel– have client wear mask if possiblehave client wear mask if possible– barriers for front line staffbarriers for front line staff


• Respiratory Respiratory hygiene/cough hygiene/cough etiquetteetiquette– suppliessupplies

• tissuetissue• alcohol gelalcohol gel• waste basketswaste baskets

– educationeducation• postersposters• signssigns


• Additional work practicesAdditional work practices– restriction of eating, drinking, applying restriction of eating, drinking, applying

makeup in areas of contaminationmakeup in areas of contamination– exclusion of sick staffexclusion of sick staff– exclusion of ill clients from LPHA when exclusion of ill clients from LPHA when

possiblepossible

Transmission-basedTransmission-basedprecautionsprecautions

Measures practiced in addition to Measures practiced in addition to standard precautions that are based standard precautions that are based on the confirmed or suspected on the confirmed or suspected presence of a specific communicable presence of a specific communicable disease, and the mode(s) of disease, and the mode(s) of transmission of that disease transmission of that disease

Modes of transmissionModes of transmission

• contactcontact

• dropletdroplet

• airborneairborne

• common vehiclecommon vehicle

• vector-bornevector-borne


• Contact transmissionContact transmission– direct: person to person by physical direct: person to person by physical

contactcontact– indirect: person to intermediary object indirect: person to intermediary object

to personto person• handshands• contaminated items, equipment, surfacescontaminated items, equipment, surfaces

– most common mode of transmission most common mode of transmission


• Diseases spread by contact Diseases spread by contact transmissiontransmission– staph skin infectionsstaph skin infections– norovirusnorovirus– rotavirusrotavirus– hepatitis Ahepatitis A


• Droplet transmissionDroplet transmission– large particle droplets (5microns or large particle droplets (5microns or

greater) come in contact with mucous greater) come in contact with mucous membranes (eyes, nose, mouth) membranes (eyes, nose, mouth)

– occurs during coughing, sneezing, occurs during coughing, sneezing, talking, performing suctioning or talking, performing suctioning or bronchoscopybronchoscopy

– droplets travel approx. 3 feet, then fall droplets travel approx. 3 feet, then fall


• Diseases spread by droplet transmissionDiseases spread by droplet transmission– pertussispertussis– influenzainfluenza– mumpsmumps

• Diseases spread by droplet and contact Diseases spread by droplet and contact transmissiontransmission– adenovirusadenovirus– SARS (also airborne transmission)SARS (also airborne transmission)


• Airborne transmissionAirborne transmission– droplets evaporate into droplet nuclei droplets evaporate into droplet nuclei

(less than 5 microns) that can spread (less than 5 microns) that can spread via air currents for up to 25 feet via air currents for up to 25 feet

– requires special air handlingrequires special air handling


• Diseases spread by airborne transmissionDiseases spread by airborne transmission– TBTB– measlesmeasles

• Diseases spread by airborne and contact Diseases spread by airborne and contact transmissiontransmission– SARSSARS– monkeypoxmonkeypox– smallpoxsmallpox– disseminated shinglesdisseminated shingles

Transmission-based Transmission-based precautionsprecautions

Contact precautionsContact precautions– physical separation of infectious persons physical separation of infectious persons

(exclusion from work, school, daycare, social (exclusion from work, school, daycare, social settings, crowded areas)settings, crowded areas)

– use of private rooms/areasuse of private rooms/areas– cleaning/disinfection of cleaning/disinfection of

environment/contaminated equipment and environment/contaminated equipment and surfaces/patient care itemssurfaces/patient care items

– hand hygienehand hygiene– use of PPEuse of PPE


Droplet precautionsDroplet precautions– physical separation of infectious physical separation of infectious

persons (exclusion from work, school, persons (exclusion from work, school, daycare, social settings, crowded areas)daycare, social settings, crowded areas)

– maintain distance of maintain distance of ≥ 3 feet≥ 3 feet– use of private rooms/areasuse of private rooms/areas– use of PPEuse of PPE


Airborne precautionsAirborne precautions– no shared airno shared air• negative pressure rooms: 6-12 air negative pressure rooms: 6-12 air

exchanges/hour, exhaust directly to exchanges/hour, exhaust directly to outside or filtered first, or use of outside or filtered first, or use of portable HEPA filtration unitsportable HEPA filtration units• physical separation of infectious physical separation of infectious

personperson• use of PPEuse of PPE

Quiz timeQuiz time(see notes page for answer)(see notes page for answer)

List the types of IC precautions List the types of IC precautions used to reduce transmission of used to reduce transmission of SARS and smallpox.SARS and smallpox.

1.1. ______

2.2. ______

3.3. ______

plus________plus________

ReferencesReferences

• Siegel JD, et al. CDC HICPAC, “Guideline for Isolation Siegel JD, et al. CDC HICPAC, “Guideline for Isolation Precautions: Preventing Transmission of Infectious Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007.” Agents in Healthcare Settings 2007.” – http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdfhttp://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf

• OSHA Bloodborne Pathogens Standard, 29 CFROSHA Bloodborne Pathogens Standard, 29 CFR 1910.10301910.1030– http://www.osha.gov/SLTC/bloodbornepathogens/index.htmlhttp://www.osha.gov/SLTC/bloodbornepathogens/index.html

• WI Public Health Emergency PlanWI Public Health Emergency Plan

Infection Control Principles Infection Control Principles and Practicesand Practices

Gwen Borlaug, CIC, MPHGwen Borlaug, CIC, MPH

Infection Control EpidemiologistInfection Control Epidemiologist

Bureau of Communicable DiseasesBureau of Communicable Diseases

1 West Wilson Street Room 3181 West Wilson Street Room 318

Madison, WI 53701Madison, WI 53701

[email protected]@wisconsin.gov

infection control principles and practices session 4 infection control for lpha train the trainer...

Documents

infection control principles

use of alcohol hand

engineered safety devicesusers

various precautions

correct precautions

body fluids

clean paper towel

paper towels available