nwt clinical practice information notice · the following clinical practice has been approved for...

Policy Standard Protocol Procedure Guidelines

NWT Clinical Practice Information Notice

This clinical practice is approved

Title NWT Infection Prevention and Control Manual Effective Date March 31 2012 Statement of approved clinical practice

The attached NWT Infection Prevention and Control Manual (2012) provides the new standard for the NWT Infection prevention and Control Programs This manual was produced by the Office of the Chief Public Health Officer of the Department of Health and Social Services in consultation with the NWT Infection Control Committee Regional Infection Control Practitioners Nurse Managers Dental Association Canadian Hospital Infection Control Association (CHICA) Ontariorsquos Provincial Infectious Disease Advisory Committee (PIDAC) and First Nations and Inuit Health Branch Health Canada (FNIHB) Infection Control Practitioners

An Infection Prevention and Control Program is mandatory for all healthcare facilities and offices for reducing the risk of infections in patients health care providers other staff and volunteers and visitors The purpose of this Manual is to 1 Provide information on the principles practice and tools of infection prevention and control

in healthcare facilities and offices and

2 Set territorial standards and best practices regarding infection prevention and control within healthcare facilities and offices

Attachment New NWT Infection Prevention and Control Manual (2012)

08

(Signature)

Assistant Deputy Minister

Chief Public Health Officer

X Director Child amp Family Services

Director Adoptions

The information contained in this document is a Departmental

UPON RECEIPT (1) PLEASE FOLLOW THE DIRECTIONS BELOW (2) FILE THIS NOTICE IN YOUR CLINICAL PRACTICE INFORMATION BINDER FOR FUTURE REFERENCE

The following clinical practice has been approved for use in the Northwest Territories Health and Social Services system and has been distributed to

Hospitals Community Health Centers

X Public Health Units X

Doctorsrsquo Offices X

Social Services Offices

Other __________ X

X x X X X

January 2012 | wwwhlthssgovntca

Northwest Territories

Infection Prevention and Control Manual

The NWT Infection Prevention and Control Manual 2012

March 2012 1

ldquoThe Chief Executive Officer of a Board of Management for a hospital or health care facility shall take measures to ensure compliance with standards approved by the Minister for the control of infections in hospitals and

health care facilitiesrdquo

Section 59 of the Northwest Territories

HOSPITAL AND HEALTHCARE FACILITY STANDARDS REGULATION 2009 (R-036-2005)


March 2012 2

TABLE OF CONTENTS

HOSPITAL AND HEALTHCARE FACILITY STANDARDS REGULATION 2009 (R-036-2005) 1

TABLE OF CONTENTS2

ACKNOWLEDGEMENTS 7

PURPOSE 8

UPDATES FROM 2004 MANUAL 10

SECTION 1 - INTRODUCTION 11

Infection Prevention and Control in Healthcare Facilities 12

Roles and Responsibilities for Infection Prevention and Control in Healthcare Facilities 12

Infection Control Practitioners 13

Certification and Training 14

CHICA-Canada Endorsed Infection Prevention amp Control Courses 15

Infection Prevention and Control Committees 16

SECTION-2-PRINCIPLES OF INFECTION PREVENTION AND CONTROL 17

Transmission and Chain of Infection 17

Elements of Routine Practices 18

Interaction Controls 19

Risk Assessment 19

Hand hygiene 19

SECTION-3-PERSONAL PROTECTIVE EQUIPMENT 23

Gloves 23

Masks 25

Eye Protection 26

Putting on PPE 27

Taking off PPE 27

N95 Respirator 27

Environmental Controls 27

Administrative Controls 29


March 2012 3

SECTION-4-ADDITIONAL PRECAUTIONS 31

General 31

Clinical Syndromes requiring Additional Precautions 32

Cohorting 33

Initiation and Discontinuation of Precautions 33

Contact Precautions 34

Droplet Precautions 35

Airborne Precautions 36

Reverse isolationProtective Environments 38

SECTION- 5-INFECTION PREVENTION AND CONTROL PRECAUTIONS 39

Patient placement 39

Patient transport 39

Food and Nutrition 40

Laboratory Transport 41

Visitors 41

Pet visitation 42

Environmental Controls by Area 42

SECTION-6-ENVIRONMENTAL CLEANING 44

General 44

Routine Cleaning 44

Double Cleaning 49

Terminal Cleaning 49

Linen and Laundry Services 50

Waste Management 51

Sharps Disposal 54

BloodBody Substance Spills 55

Contaminated Medical Records 56

SECTION-7-MEDICAL REPROCESSINGSTERILIZATION 57

General Requirements 57

Selection of EquipmentDevices 57

General Reprocessing Requirements 58


March 2012 4

Reusable Medical EquipmentDevices 60

Cleaning 60

Disinfection 61

Sterilization 64

Endoscopic Devices 67

CJD 67

Dental 68

Breaks in Infection Control 70

SECTION-8-OCCUPATIONAL HEALTH AND SAFETY 71

Immunization 71

Tuberculosis Surveillance 73

Mask fit testing 74

Blood-borne Exposures 74

Education 75

Section-9-Reportable Diseases and Special Cases 76

List of reportable diseases 76

Special Cases of Reportable Diseases 79

Respiratory Infections 79

Tuberculosis (TB) 81

Meningitis 83

Antibiotic Resistant Organisms 84

Antibiotic Stewardship 85

MRSA 85

VRE 88

ESBLs and CREs 91

Clostridium difficile 93

SECTION-10-OUTBREAK MANAGEMENT 97

Acute Respiratory Outbreak 98

GastrointestinalEnteric Outbreak 99

Correctional Facilities 99

Child Care Facilities 99


March 2012 5

SECTION-11-CARE OF THE DECEASED 100

SECTION-12-CONSTRUCTION AND DESIGN OF HEALTHCARE FACILITIES 102

SECTION-13-REFERENCES 105

SECTION-14-APPENDICES 107

APPENDIX-1-The NWT Infection Control Committee (ICC) Terms of Reference 107

APPENDIX-2-Audits 110 APPENDIX- 2a)- Hand Hygiene Monitoring Tool 110 APPENDIX -2b)- Hand Hygiene Structural Audit 112 APPENDIX -2c)- NWT Infection Control Cleaning Audit 113

APPENDIX-3-Hand Hygiene 116 APPENDIX- 3a)-Using an Alcohol Based Hand Rub (ABHR) 116 APPENDIX-3b)-Using Plain Soap 117

APPENDIX-4-PPE Types 118 APPENDIX-4a)-Medical Gloves 118 APPENDIX-4c)-Eye Protection 119 APPENDIX-4d)-Masks and N95 Respirators 120

APPENDIX-5-Personal Protective Equipment (PPE) 121 APPENDIX-5a)-Putting on PPE 121 APPENDIX-5b)-Removing PPE 122 APPENDIX-5c)-N95 Respirator Protocol 124 APPENDIX-5d)-Care of Reusable PPE 125

APPENDIX-6-Communicable Disease Reference Chart 126

APPENDIX-7-Cleaning 142 APPENDIX-7a-Checklist for DischargeTransfer Cleaning of all Rooms 142 APPENDIX-7b)-Special Cleaning for MRSA VRE and C difficle 144 APPENDIX-7c)-Cleaning Recommendations Clinic Rooms 145 APPENDIX-7d)-Bed and Stretcher Cleaning 148 APPENDIX-7e)-Blood Spill Floor 149 APPENDIX-7f)-Blood and Body Fluid Carpet Stain Cleaning 150 APPENDIX-7g)-Commode Cleaning 151 APPENDIX-7h)-Damp mopping of floors 152 APPENDIX-7i)-Damp Wiping of Surfaces 153 APPENDIX-7j)-Tub and Shower Cleaning 154 APPENDIX-7k)-Wheelchair Cleaning 155 APPENDIX-7l)-Exam Table Cleaning 156 APPENDIX-7m)-Toy Cleaning 157 APPENDIX-7n)-Routine Washroom Cleaning 158 APPENDIX-7o)-Sample Terminal Cleaning Protocol for Routine Precautions (PIDAC) 159 APPENDIX-7p)-Laundry Handling 161 APPENDIX-7q)-Handling Garbage 162 APPENDIX-7r)- Sharps Handling 163


March 2012 6

APPENDIX 8 Precautions Requirements and Signage 164 APPENDIX-8a)-Contact Precautions 164 APPENDIX-8b)-Droplet Precautions 166 APPENDIX-8c)-Airborne Precautions 168

APPENDIX 9 Disinfectant 170 APPENDIX-9a)-UsesAdvantagesDisadvantages 170 APPENDIX-9b)-Preparing Household Bleach as a Disinfectant 174 APPENDIX-9c)-Antimicrobial Activity of Disinfectants 175

APPENDIX 10 Reprocessing 176 APPENDIX-10a)-Reprocessing Area Set Up Chart 176 APPENDIX-10b)-Cleaning Disinfection and Sterilization 177 APPENDIX-10c)-Sample Autoclave Maintenance Record 182 APPENDIX-10d)-Sample Biological Indicator Record 183 APPENDIX-10e)-Sample Biological Indicator Failure Record 184

APPENDIX-11-Infection Control Information for Homecare Workers 185

APPENDIX-12-Post-exposure Prophylaxis Protocol 186

APPENDIX-13-Glossary 186


March 2012 7

ACKNOWLEDGEMENTS

The Office of the Chief Public Health Officer would like to thank all participants for their valuable contributions to the development of

this manual with special consideration to

NWT Regional Infection Control Practitioners

Medical Health Officers (MHOs)

NWT Nurse Managers

NWT Dental Association

Canadian Hospital Infection Control Association (CHICA)

Ontariorsquos Provincial Infectious Disease Advisory Committee (PIDAC)

First Nations and Inuit Health Branch Health Canada ( FNIHB) Infection Control Practitioners


March 2012 8

PURPOSE

Infection prevention and control is a mandatory component of all healthcare facilities and offices for reducing the risk of infections in patients health care providers other staff and volunteers and visitors The purpose of this Manual is to

1 Provide information on the principles practice and tools of infection prevention and control in healthcare facilities and offices

2 Set Territorial standards and best practices regarding infection prevention and control practices within healthcare facilities and offices

3 Serve as an adjunct to infection prevention and control training and education

4 Provide a framework that NWT healthcare facilities can use to develop processes

to ensure compliance with Accreditation Canada infection prevention and control standards The standards are divided into four subsections

bull Investing in infection prevention and control bull Keeping all people safe from infections bull Providing a safe and suitable work environment bull Being prepared for outbreaks and pandemics

5 Provide foundational information that individual healthcare facilities can use to

develop facility-specific infection prevention and control policies and procedures

6 Provide a list of resources and links to additional andor more detailed infection prevention and control information

7 Serve as a repository for the systematic collection of new information that can be

used to form the next revision of the NWT Infection Prevention and Control Manual

8 Provide a place where individual healthcare facilities can retain facility-specific infection prevention and control information with the result that all necessary information will be together


March 2012 9

Overall infection control is a regional responsibility as per the NWT Hospital and Health Care Facility Standards Regulations (R-036-2005) Therefore the information in the Manual is intended to provide guidance on best practices but is not intended to replace the need for healthcare facilities to develop facility-specific policies and procedures The information in the Manual is based on best practices published by a variety of facilities including Health Canada Public Health Agency of Canada provincial jurisdictions and institutions the Center for Disease Control and organizations such as the Community and Hospital Infection Control Association - Canada The Manual serves as a resource of comprehensive information and planning documents that include specific information about infection prevention and control available in the NWT

Additional Resources

Northwest Territories Severe Infections Disease Contingency (SIDC) Plan httpwwwhlthssgovntcapdfmanuals2004nwt_severe_infectious_disease_contingency_planpdf

Communicable Disease Control Program-Tuberculosis httpwwwhlthssgovntcaenglishservicescommunicable_disease_control_programtuberculosisdefaulthtm

NWT Pandemic Influenza Contingency Plan httpwwwhlthssgovntcapdfreportsdiseases_and_conditions2005englishnwt_pandemic_influenza_contingency_planpdf

Pan-Territorial Pandemic Planning Project Environmental Scan Report httpwwwhlthssgovntcapdfreportshealth_care_system2010englishpan_territorial_pandemic_planning_project_environmental_scan_reportpdf

Northwest Territories Communicable Disease Manual httpwwwhlthssgovntcapdfmanuals2007cdcmanfulldocpdf

Northwest Territories HIVAIDS Manual for Health Professionals httpwwwhlthssgovntcapdfmanuals2006hiv_aids_manualpdf

Guidelines for the Management of Biomedical Waste in the Northwest Territories httpwwwhlthssgovntcapdfmanuals2001clinical_practicepdfpage_102_nwt_guidelines_for_management_and_disposal_of_biomedical_wastepdf


March 2012 10

UPDATES FROM 2004 MANUAL

The 2012 NWT Infection Prevention and Control Manual is a revised version of the 2004 Manual The current version is formatted to highlight the various components involved in preventing infections in health care settings The components are grouped by

bull Administrative support and responsibilities for the provision and implementation of infection control practices and policies

bull Focus on the provision of education and training for infection prevention and control practices

bull Focus on the need for ongoing monitoring and evaluation of infection prevention and control practices including the use of audit tools

bull The importance of engineering controls in preventing the transmission of infections

bull The importance of properly delivered and monitored environmental cleaning and reprocessing practices

bull The responsibility of each individual who works at a health care centre to be aware of and implement infection control Precautions

Other changes include

bull ldquoInfection prevention and controlrdquo replaces ldquoinfection controlrdquo bull ldquoRoutine Precautionsrdquo replaces ldquoStandard Precautionsrdquo

o Additional Precautions refers to Contact Droplet and Airborne Precautions

bull Healthcare setting is the general term that includes hospitals healthcare centres and community health settings

bull ldquoPatientrdquo is used as a general term to include patients clients and residents of hospitals community health facilities and long-term care facilities

bull ldquoStaffrdquo refers to all employees of a healthcare facility including nurses medical and non-medical practitioners and support staff including administrative staff and housekeeping services


March 2012 11

SECTION 1 - INTRODUCTION

Healthcare associated infections (HAIs) have gained rapid status as being important and preventable events that result in significant morbidity mortality and economic costs to the health care system

One in nine hospital patients in Canada will develop an HAI This results in 220000 HAIs per year in Canada with 8500-12000 associated deaths The estimated direct costs of these HAIs in Canada are $1 billion annually This does not include additional costs borne by patients caregivers and the programming costs of home and community care

The Canadian Committee on Antibiotic Resistance estimates that 30 of HAIs can be prevented However the incidence of HAIs is increasing in Canadian hospitals Methicillin-resistant Staphylococcus aureus (MRSA) has increased by 17-fold between 1995 and 2006 and there has been a five-fold increase in Clostridium difficile between 1991-2003

In the Northwest Territories a similar pattern has been seen in terms of increasing numbers of HAIs and antibiotic resistant specimens Annual cases of MRSA C difficile and Extended-spectrum beta-lactamase enterobacteriaciae (ESBL) have all increased significantly over the past five years

Environmental services of cleaning laundry and other support services have been recognized as being a vital component of infection prevention and control strategies Many microorganisms such as C difficile MRSA and norovirus can remain in the environment for extended periods of time Preventing the transmission of infection requires careful cleaning of these areas proper hand hygiene and controls to ensure that these are being carried out

ldquoBreaking the chain of infectionrdquo requires well-resourced well-trained infection prevention and control teams and dedicated staff with proper training to interrupt the links of transmission and prevent HAIs

SECTIO

N-1

-INT

RO

DU

CTIO

N


March 2012 12

Infection Prevention and Control in Healthcare Facilities

Infection prevention and control (IPAC) aims to prevent andor control the introduction acquisition transmission and dissemination of HAIs and other communicable diseases IPAC programs ensure the systematic development implementation and monitoring of processes and activities to achieve these goals

HAIs have a significant impact on the health of patients and contribute to health care costs in terms of prolonged hospital stays readmissions and occasionally legal and litigation costs IPAC programs have been shown to effectively reduce the burden of HAIs and to be cost-effective

The NWT Infection Prevention and Control Manual provides the best practice standards of infection control for health care settings in the NWT Users may create their own policies and procedures for their settings and utilize the resources provided in this Manual

Roles and Responsibilities for Infection Prevention and Control in Healthcare Facilities

The Government of the Northwest Territories (GNWT) requires each hospital to have a Health Service Committee that will

bull Consider every case of HAI including the post-operative infection of wounds and the post-partum infection of mothers and advise the hospital authority as to what measures must be taken to control the infection Health Care Facility Standards Regulation 2009

bull Form subcommittees deemed necessary for further consideration of these issues (eg infection prevention and control committee transfusion sub-committee)

bull Oversee infection prevention and control within all healthcare facilities of the responsible authority

The Office of the Chief Public Health Office (OCPHO) requires that

bull Each Health Authority designate an individual with appropriate education and training as its Infection Prevention and Control Practitioner

bull This person should report to a senior administrator with authority to oversee the implementation of processes to ensure that medical nursing and other staff comply with infection prevention and control directives as appropriate

bull The senior administrator forwards the name and qualifications of the Infection Prevention and Control Practitioner to the OCPHO each time that there is a staffing change


March 2012 13

Infection Prevention and Control Activities in Healthcare Facilities

bull Regular Infection Prevention and Control Committee meetings (minimum quarterly)

bull Surveillance including the timely collection tabulation analysis and reporting of HAI in healthcare facilities

bull Active liaison with and between internal and external stakeholders including o Workplace Health and Safety Committees in healthcare facilities o Public Health and professional organizations involved with infection

prevention and control activities (eg CHICA Canada) o Subcommittee activities o Accreditation Canada o Local and NWT Disaster Planning Teams o Local and NWT Emergency Response and Pandemic Planning Teams

bull Submitting reports and minutes of Infection Prevention and Control meetings to the OCPHO

bull Policy development and revision including regular review and revision of infection prevention and control policies and procedures particularly in regard to new legislation new or emerging diseases related to infection prevention and control and advances in technology

bull Accreditation strategic and operational planning quality control and assurance and risk management communication and reporting activities

Infection Control Practitioners

Most infection prevention and control activities in the NWT are carried out by those with a nursing or similar medical background Due to the vast and changing field all health professionals who are working in infection prevention and control should have access to ongoing education and a community of practice to encourage best practices are adopted across the territory


March 2012 14

In general an Infection Control Practitioner (ICP) should have knowledge and experience in

1 Areas of patient care practices 2 Microbiology infectious diseases 3 Asepsis disinfectionsterilization 4 Adult education 5 Communication 6 Outbreak management 7 Policy development 8 Critical appraisal of the literature 9 Program Administration 10 Surveillance and epidemiology

Certification and Training

The NWT recognizes the importance of effective infection prevention and control in healthcare facilities As such the NWT is committed to the recruitment and retention of qualified Infection Prevention and Control Practitioners The NWT also supports formal training in infection prevention and control for interested healthcare workers

Two organizations1 in Canada provide expert guidance for preventing and controlling infections in healthcare facilities These organizations are

a) CHICA-Canada (Community and Hospital Infection Control Association of Canada)

b) APIC (Association for Professionals in Infection Control and Epidemiology Inc)

Recently these organizations have collaborated to develop professional practice standards and evidence-based resources for Infection Prevention and Control Practitioners across Canada The Professional Practice Standards2 for Infection Prevention and Control Professionals (ICPs) serve as standards for Canadian Infection Prevention and Control Practitioners

1 Resources available at httpwwwchicaorg httpwwwapicorgAMTemplatecfmSection=Home1 2 httpwwwchicaorgpdf08PPSpdf


March 2012 15

The Certification Board of Infection Control and Epidemiology Inc (CBIC) is a voluntary autonomous multidisciplinary board that provides direction for and administers the certification process for professionals in infection control and applied epidemiology CBIC is independent from other Canadian infection control-related organizations or associations Healthcare workers can obtain information about obtaining certification in Infection Prevention and Control from the CBIC3

CHICA-Canada Endorsed Infection Prevention amp Control Courses

CHICA-Canada has endorsed a variety of online and classroom courses that are available to individuals practicing or wishing to practice in the area of infection prevention and control These courses4 are designed to assist individuals prepare for the CBIC Certification Exam Other resources5 are also available CHICA-CANADA offers an introductory online infection prevention and control (IPampC) program The course includes 6 independent modules that are 5-7 weeks in length and a practicum

Upon successful completion of all 6 modules and the practicum students receive a certificate from CHICA-Canada confirming that they have successfully completed the CHICA-Canada Novice Infection Prevention and Control Course

Those hired into a dedicated role as an ICP should preferably be in the process of acquiring or be maintaining their Certification in Infection Control (CIC) credentials through the Certification Board of Infection Control and Epidemiology (CBIC) Information about certification can be found at wwwcbicorg

ICPs are also required to maintain current knowledge and skills through CHICA-endorsed education programs peer networking literature searches and attending professional meetings

Infection Prevention and Control Practitioners are responsible for

1 Leading and maintaining an effective infection prevention and control program within one or more healthcare facilities

2 Developing and or conducting infection prevention and control training and education for healthcare workers

3 Resource available at httpwwwcbicorg 4 httpwwwchicaorgeduc_educationhtmlendorsed 5 httpwwwchicaorglinks_non-acutehtml httpwwwchicaorglinks_evidence_guidelineshtml


March 2012 16

3 Serving as an internal consultant or expert resource to administration managers and healthcare workers in one or more healthcare facilities

4 Identifying the need for risk management and quality assurance activities related to infection prevention and control and leading their implementation

5 Investigating and making recommendations regarding emerging infection prevention and control issues

6 Chairing or serving as a member of the Infection Prevention and Control Committee for healthcare facilities or the NWT

7 Participating in the development of infection prevention and control policies and

procedures for healthcare facilities andor the NWT

8 Attending relevant professional development training programs Infection Prevention and Control Committees

The Department of Health and Social Services (DHSS) recommends that the Infection Prevention and Control Committee should include representatives from

bull Administration bull Workplace Health and Safety bull Laboratory bull Medical bull Nursing bull Public Health bull Central Supply Housekeeping Laundry Pharmacy Physical Facilities and

Maintenance and other service as appropriate

In addition to membership on the Infection Prevention and Control Committee each Health Authority should have at least one staff with CHICA membership

Terms of Reference for the NWT Infection Control Committee is provided in APPENDIX 1


March 2012 17

SECTION-2-PRINCIPLES OF INFECTION PREVENTION AND CONTROL Transmission and Chain of Infection

The lsquoChain of Transmissionrsquo describes the six elements that are required for a microorganism to cause infection in a host The infectious agent must exist in a reservoir and then leave the reservoir through a portal of exit Based on the agentrsquos mode of transmission it must enter a portal of entry to a susceptible host where it causes infection If any one of the links in the chain is broken transmission of infection is interrupted Infection prevention and control measures break the chain of transmission Various measures are used within each link and across multiple links for redundancy in barriers to ensure the prevention of infection

Chain of Transmission and Infection Prevention and Control Measures to Break the Chain

SECTIO

N-2

-PR

INCIP

KES O

F INFECT

IN P

REV

ENT

ION

AN

D CO

NT

RO

L


March 2012 18

Elements of Routine Practices

ldquoRoutine practices are based on the premise that ALL patients are potentially infectious even when asymptomatic and that the same safe standards of practice should be used routinely with all patients to prevent exposure to blood body fluids secretions excretions mucous membranes non-intact skin or soiled items and to prevent the spread of microorganismsrdquo PIDAC Routine Practices and Additional Precautions in all Health Care Settings

There are 3 elements of Routine Practices

bull Interaction Controls o Risk Assessment o Hand Hygiene o Personal Protective Equipment

bull Environmental Controls o Engineering controls o Cleaning o Placement

bull Administrative Controls o Policies and procedures o Education o Monitoring of compliance and feedback

All three elements are required for a comprehensive IPAC program The administrative controls set the foundation for the infection protection and control management program within a health care setting and establish the organizational support for the program Environmental controls establish the engineering controls and infrastructural mechanisms that enable safer workplaces and healthcare settings and the interactions between staff patients and the health care setting Finally the interaction controls are the individual factors that enable safer interactions with patients in healthcare settings

Controls

Interaction

bull Individual factors

Environmental

bull Infrastructure

Administrative

bull Foundation


March 2012 19

Interaction Controls

Routine practices are usually already part of health care providersrsquo daily practice but should also be incorporated into the culture of the entire health care setting Each interaction requires three steps to assess what interaction controls are required

1 Risk Assessment 2 Hand Hygiene 3 Personal Protective Equipment

Risk Assessment

Before each interaction with a patient or their environment a dynamic risk assessment must be done by staff to assess which interventions are required to prevent the transmission of infection

bull Review the chain of transmission and potential factors that may increase the risk

o Recognizing symptoms of infection or the infection status of patient o Immune status of the patient o Immune status of the staff o Cleanliness or contamination of the environment o Resources available for control

bull Consider what types of exposures are involved in the interaction o Provision of direct care o Exposure to blood body fluids secretions excretions tissues o Exposure to contaminated equipment or surfaces

bull Consider what control measures should be used based on the risk o Barrier equipment required o Positioning of staff in relation to patient o Initiating other Environmental Controls or Additional Precautions

Hand hygiene

Hand hygiene (HH) is the most effective means of preventing and controlling the spread of infections among patients staff and visitors HH includes either hand washing (ie the removal of microorganisms with soap and running water) andor hand antisepsis with an alcohol-based hand rub (ABHR)


March 2012 20

HH removes bacteria that colonize the upper layers of skin and are acquired during direct contact with patients other staff and contaminated surfaces in the environment

The 4 ESSENTIAL moments of hand hygiene include

1 BEFORE initial patientpatient environment contact 2 BEFORE aseptic procedure 3 AFTER body fluid exposure risk 4 AFTER patientpatient environment contact

Other indications for HH include

bull Before preparing handling or serving food or medications to a patient bull Immediately after removing gloves and before moving to another activity bull When moving from a contaminated body site to a clean body site during health

care bull Whenever in doubt

Hand condition to enable effective HH

bull Nails must be kept clean and short bull Nail polish if worn must be fresh and free of cracks or chips bull Artificial nails or nail enhancements must not be worn bull Rings are preferably not worn bull Hand and arm jewellery including watches must be removed or pushed up

above the wrist

ABHR is the preferred choice for HH when hands are not visibly soiled If hands are soiled and running water is not available moistened towelettes followed by ABHR may be used

Note Soap and water may be more effective for removing spores from C difficile If a dedicated hand washing sink is available hands should be washed with soap and water after glove removal Otherwise ABHR should be used after glove removal Hand washing should NOT be done in the patientrsquos sink as this will re-contaminate hands Hand washing should be recommended over ABHR during an outbreak of C difficile


March 2012 21

Hand Hygiene Usage Technique Considerations

Alcohol-Based Hand Rub

bull Alcohol is ineffective if hands are visibly soiled

bull Faster and more effective than hand washing when hands are not visibly soiled

bull Mechanical action of rubbing is important to kill bacteria

bull Less drying to hands than hand washing

bull Should contain 70-90 alcohol

bull 1-2 pumps and enough product so that it takes 15 seconds to dry

bull Spread rub over all surfaces of hands concentrating on fingers backs of hands and base of thumbs

bull Continue rubbing until product is dry (15 sec)

bull Do not use ABHR immediately after hand washing

bull ABHR products with 60 alcohol are available but are ineffective against Norovirus

bull There is a very small risk of fire from ABHR Ensure hands are completely dry before use ensure ABHR products are placed and stored according to CSA Standards

bull ABHR may be less effective for C difficile spores

Hand Washing

bull Mechanical action of washing rinsing and drying removes most bacteria viruses

bull Preferred when hands are visibly soiled

bull Wet hands and apply soap with a vigorous lather of all surfaces for a minimum of 15 seconds

bull Use a rubbing motion to rinse soap from hands

bull Dry hands thoroughly by blotting with a paper towel or hand air dryer

bull Plain soap is recommended

bull Soap dispensers should be disposable and never ldquotopped-uprdquo

bull Bar soap should not be used

bull If hand air dryers are used hands-free taps are required

Antimicrobial soaps may be used in intensive unit areas or as surgical hand preparation

Non-alcoholic waterless antiseptic agents should NOT be used as HH agents


March 2012 22

Addressing concerns about ABHR

Ingestion of ABHR

bull Staff may be issued personal ABHR dispensers bull Avoid placing ABHR around the bed space bull Use locked wall dispensers to prevent removal of ABHR bottles bull Use of foam-based ABHR instead of liquid-based products bull Protection of storage supply

Flammability of ABHR

bull A total of 7 non-severe fire incidents have been reported over 35 million Litres of ABHR use in hospitals

bull Collaboration with fire safety and infection control bull Appropriate location of dispensers storage stock management and the disposal

of empty dispensers and expired stock bull Education on hand hygiene technique emphasizing need to allow the handrub to

dry and the vapour disperse before hands are safe for use

A comprehensive HH program incorporates the following Administrative and Environmental controls

bull Administrative controls o Education to staff about when and how to clean their hands o Hand care program to maintain skin integrity o Management champions leadership and support o Ongoing auditing and feedback of HH practices

bull Environmental controls

o HH agents available at point-of-care o HH agents are dispensed in disposable containers and must not be

topped up o Placement and availability of HH agents meet CSA standards (CSA Z8000

or current)

The implementation of a comprehensive HH strategy and the evaluation of compliance with HH practices are required organizational practices by Accreditation Canada

Resources for hand hygiene are available in APPENDIX 3


March 2012 23

SECTION-3-PERSONAL PROTECTIVE EQUIPMENT

The selection of personal protective equipment (PPE) required for an interaction is based upon the risk assessment and what barriers are required to interrupt the chain of transmission The four elements of PPE include gloves gowns masks and eye protection The selection of the type of PPE product depends on the usage The appropriate usage of PPE depends on

bull Administrative controls o Education of staff in the proper use of PPE o Education of patients and visitors in the proper use of PPE o Mask fit testing policy o Ongoing auditing and feedback of PPE practices

bull Environmental controls o PPE resources are available and in sufficient supply o Single use items are used removed and disposed of in an appropriate

receptacle o Where re-usable items are used PPE is sent to a central area for

reprocessing after use o The availability of PPE and wastelinen receptacles follow CSA guidelines

(CSA Z8000 or as current) Gloves

Gloves are worn to protect the health care workerrsquos hands from becoming contaminated with blood or body substances or from contaminated equipment and environmental surfaces Gloves should not be used for interactions where contact is limited to intact skin Hand hygiene should always be the first consideration

The appropriate use of gloves includes

bull Wear the correct size glove bull Gloves should be put on immediately before the activity for which they are

indicated bull Clean hands before putting on gloves for a cleanaseptic procedure bull Gloves must be removed and discarded immediately after the activity for which

they are used bull Hand hygiene must be performed immediately after glove removal

SECTIO

N-3

-PER

SON

AL P

RO

TECT

IVE EQ

UIP

MEN

T


March 2012 24

bull Change or remove gloves if moving from a contaminated body site to a clean body site within the same patient

bull Change or remove gloves after touching a contaminated site and before touching a clean site or the environment

bull Do not wash or re-use gloves o Heavy duty outer gloves for housekeeping may be wiped with a

disinfectant hung dry and re-used by the same person bull The same pair of gloves must not be used for the care of more than one patient

The selection of the best glove to use is based on a risk analysis of the type of setting the task involved (including length of use and stress on glove) and the likelihood of exposure to body substances

Sterile gloves are for sterile procedures and the operating room

Improper use of gloves has been associated with the transmission of pathogens For example re-use of gloves has been linked to the transmission of MRSA and Gram-negative bacilli Gloves should be task-specific and single-use only

Resources for gloves in APPENDIX 4a Gowns

Gowns aprons and other protective apparel are worn to prevent clothing from becoming soiled with blood and body substances Selection of the type of gown is based on an analysis of the interaction including the anticipated degree of contact the potential for blood and body fluid penetration of the gown and the requirement for sterility

Gowns should be cuffed and long-sleeved and fully cover the body front from neck to mid-thigh or below Several sizes should be available to ensure appropriate coverage for staff

The appropriate use of gowns includes

bull Gowns should only be worn when providing care for patients bull When use of a gown is indicated the gown should be put on immediately before

the task and must be worn properly ie tied at top and around the waist bull Remove gown immediately after the task for which it has been used in a manner

that prevents contamination of clothing or skin and prevents agitation of the gown


March 2012 25

bull Discard used gown immediately after removal into appropriate receptacle Do not hang gowns for later use

bull Do not re-use gown Do not go from patient-to-patient wearing the same gown Masks

Masks protect the mucous membranes of the nose and mouth from interactions that are likely to generate splashes or sprays of blood body fluids secretions or excretions or within two meters of a coughing patient

Selection of the type of mask used by staff is based on a risk assessment of the type and length of the procedure and the likelihood of contact with dropletsaerosols

The appropriate use of masks includes

bull Select a mask appropriate to the activity bull Mask should securely cover the nose and mouth bull Change mask if it becomes wet bull Do not touch mask while wearing it bull Remove mask correctly and immediately after completion of task and discard it

into an appropriate waste receptacle bull Do not allow mask to hang or dangle around the neck bull Clean hands after removing the mask bull Do not re-use disposable masks bull Do not fold the mask or put it in a pocket for later use

N95 Respirators

Respirators are masks specifically designed to filter small particles spread by the airborne route such as tuberculosis measles and varicella They are used for aerosol-generating procedures that have been shown to expose staff including

bull Sputum induction bull Diagnostic bronchoscopy bull Autopsy examination bull Laboratory handling of Mycobacterium tuberculosis such as concentrating

respiratory samples for smear and culture

Staff required to wear N95 Respirators must undergo fitting (see Mask Fit Testing)

With each use of an N95 mask staff must perform a fit check

bull Positive pressure seal check


March 2012 26

o Exhale deeply with the mask securely in place noting that the mask will bulge slightly

o Reposition the face and the face-seal if air is leaking and readjust the nose clip for a more secure seal

bull Negative pressure seal check o Inhale deeply with the mask securely in place noting that the mask will

collapse slightly o Reposition the face and the face-seal of the mask if air is leaking and

readjust the nose clip for a more secure seal

Masks for Patients

Masks should be placed on a coughing patient when outside their room to limit the exposure of others to secretions In some circumstances patients with active TB may be required to wear an N95 mask if tolerated as an additional precaution This includes medical transport waiting in public spaces and when outside of a negative pressure room

References for masks in APPENDIX 4b

Eye Protection

Protective eyewear is worn to prevent blood and body substances from contaminating the mucous membranes of the eyes Protective eyewear should be worn during procedures where blood and body substances may be expected to splash or splatter Eye protection includes safety glasses safety goggles face shields and visors attached to masks It does NOT include prescription eye glasses but these may be worn underneath face shields and some types of protective eyewear

Eye protection should be disposable or if reusable should be sent to the reprocessing are and cleaned prior to re-use

The appropriate use of eye protection includes

bull Eye protection must be removed immediately after the task for which it was used and discarded into waste or placed in an appropriate receptacle for cleaning

bull Prescription eye glasses are not acceptable as eye protection References For Eye Protection In APPENDIX 4c


March 2012 27

Putting on PPE

See APPENDIX 5a for Procedure

General sequence of putting on

Hand hygiene ndash Gown ndash Mask ndash Eyewear - Gloves Taking off PPE

See APPENDIX 5b for Procedure

General sequence of taking off

Gloves ndash Gown ndash Hand Hygiene ndash Eyewear ndash Mask ndash Hand Hygiene

N95 Respirator

See APPENDIX 5c for Procedure

Environmental Controls

Environmental controls are the measures that are built into the infrastructure of the healthcare setting such as the provision of equipment cleaning practices and building design

1 Engineering Controls

The design construction renovation and repair of health care settings should be in compliance with the relevant standards from the Canadian Standards Association Existing health care settings should make every attempt to ensure that the facility is meeting these standards

Engineering controls are the preferred controls as they do not depend on individual health care provider compliance


March 2012 28

2 Cleaning

Environmental cleaning maintains a clean and safe health care environment that is an essential component of infection prevention and control There are many microorganisms in the environment that can cause infection in susceptible individuals and these can be transferred to the hands of staff and patients Health care associated outbreaks have been brought under control by increasing the intensity of environmental cleaning

Environmental cleaning requires Administrative Controls

bull Adequate human resources bull Availability of appropriate cleaning products bull Policies and procedures for cleaning and disinfection of rooms and equipment bull Education and training of cleaning staff bull Procedures and increased capacity for outbreak management bull Ongoing review and auditing of cleaning practices

See section on Environmental Cleaning for more information

3 Placement

The appropriate accommodation and patient placement is necessary to minimize the transmission risk to others Single rooms with dedicated bathroom and sink are the preferred option However most health care facilities still have multi-bed rooms that may pose a risk of transmission of microorganisms If single rooms are not available prioritization should be given based on risk of transmission of infection

Patients with a cough or symptoms of a respiratory infection

bull Move out of the waiting room to a separate area or room as soon as possible bull Symptomatic patients should be assessed as soon as possible bull When a single room is not available maintain a spatial separation of at least 2

meters bull Symptomatic patients should be provided with a mask and instructed in hand

hygiene and respiratory etiquette

Other patients presenting with clinical syndromes suggestive of an infectious disease requiring Additional Precautions should be appropriately placed until the need for Precautions can be ruled out


March 2012 29

Administrative Controls

Administrative controls are the measures that health care settings put into place to protect staff and patients from infection 1 Policies and procedures

Clear policies and procedures establish the expectations of staff regarding infection prevention and control The development implementation and updating of infection prevention and control policies and procedures is a component of the Accreditation Canada standards

Policies and procedures may cover daily aspects of infection prevention and control as well as Workplace Health and Safety for a healthy workplace

Further information on Workplace Health and Safety policies and procedures is discussed in the section on Workplace Health and Safety

2 Education

All staff should receive appropriate training and education around infection prevention and control as part of their orientation and on an ongoing regular basis

Basic education on Routine Practices and Additional Precautions (including hand hygiene and the use of PPE) should be provided to all staff Job function specific education should be targeted to staff of the health care facility

Mechanisms should be in place to ensure attendance is recorded at education sessions and is incorporated into the employeersquos performance review

Education should also be provided to patients and visitors of health care settings as they are important vectors in the physical environment Appropriate signage and education should be provided for

bull Hand hygiene bull Not sharing personal items bull Respiratory etiquette

o Not visiting people in a health care facility when ill with a respiratory infection

o Minimizing droplet spread from coughing and sneezing by covering the nose and mouth with a tissue or sleeve turning your head away from other andor maintaining a two meter distance from others

o Immediately disposing of tissues into waste after use


March 2012 30

o Immediate hand hygiene after coughsneeze

3 Monitoring of compliance and feedback

While most health care providers acknowledge the importance of infection prevention and control measures compliance is often unacceptably low For example hand hygiene compliance is in the range of 20-50 The ongoing monitoring and feedback of adherence to IPAC measures is a necessary component of any IPAC program


March 2012 31

SECTION-4-ADDITIONAL PRECAUTIONS General

Additional Precautions are used in addition to Routine Practices to interrupt the transmission of suspected or identified infectious agents Based on the known or suspected mode(s) of transmission of contact droplet or airborne the corresponding type(s) of additional Precautions should be implemented

Additional Precautions are Routine Practices AND

bull Specialized accommodation and signage bull Personal protective equipment bull Dedicated equipment and additional cleaning measures bull Limited transport bull Communication

The use of specialized accommodation and signage are discussed in the types of Precautions as are the appropriate PPE and cleaning measures

Limiting transportation of the patient may be considered in some cases where there is a risk of transmission if the patient leaves the room While normal health care should be maintained it may be medically necessary to limit transport of the infectious patient

Communication is necessary to inform other providers who may be involved in transferring a patient or receiving a patient that may need to be under additional Precautions

In addition to the individual risk assessment as part of Routine Precautions health care settings including ambulatory care settings need to have self-screening measures in place to identify individuals who may require Additional Precautions This includes self-assessment checklists to

bull Prompt patients to immediately identify their symptoms to staff bull Prompt patients to put on a mask bull Prompt patients to isolation waiting rooms

SECTIO

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-AD

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March 2012 32

Clinical Syndromes requiring Additional Precautions

Depending on patient presentation more than one type of Additional Precautions may be required

Syndrome Room Gloves Gown Facial

Protection Additional

Precautions Acute diarrhea andor vomiting of suspected infectious etiology

Single Yes If direct contact with patient or patientrsquos environment and for paediatrics and incontinentnon-compliant patients

No CONTACT

Acute respiratory infection undiagnosed

Single or spatial separation

Yes If direct contact with patient or patientrsquos environment

Yes DROPLET CONTACT

Respiratory infection with risk factors and symptoms suggestive of Tuberculosis

Negative pressure

N95 respirator

AIRBORNE

Suspected meningitis andor sepsis with petechial rash

Single Yes Yes Yes DROPLET

Undiagnosed rash without fever

Yes CONTACT

Rash suggestive of varicella or measles

Negative pressure only immune staff

Yes yes AIRBORNE

Abscess or draining wound that cannot be contained

single Yes If direct contact with patient or patientrsquos environment

CONTACT


March 2012 33

Cohorting

In general single rooms with the appropriate engineering controls are the preferred option for isolation of infectious patients or during an outbreak situation Where single rooms are not available cohorting may be used to help control transmission within a facility

1 Patient cohorting

Includes

bull The placement of individuals who are infected or colonized with the same microorganism in the same room OR

bull Placing those who have been exposed together to limit risk of further transmission

This may involve limiting patients to a restricted area of the unit or treating groups as a cohort

There should be dedicated equipment for each patient or the equipment must be adequately cleaned prior to use between patients in the same room

2 Staff cohorting

Refers to the assignment of specific staff to ONLY care for patients who are colonized or infected with the same microorganism

This may be used in addition to patient cohorting Staff cohorting limits the number of providers who are exposed and reduces cross-infection between clientsresidentspatients via contaminated staff

Initiation and Discontinuation of Precautions

1 Initiation Additional Precautions should be implemented as soon as symptoms of an infection are suspected not only when a diagnosis is confirmed Administrative controls

bull Policy to authorize ANY regulated health care professional to initiate Additional Precautions

bull Policy to inform Infection Control when Additional Precautions are initiated o Infection Control will verify the necessary Precautions for the situation


March 2012 34

o Infection Control will be consulted before discontinuing Additional Precautions

2 Discontinuation

It is important that Additional Precautions are not used longer than necessary as they can pose a barrier to health care The ongoing risk of transmission and need for Additional Precautions should be re-evaluated with the goal of removing them as soon as it is safe to do so

Discontinuation should be in consultation with Infection Control and if there is disagreement the Precautions should remain until there is a definitive diagnosis or expert consultation

Discontinuation of Additional Precautions may be a complicated process requiring clinical assessment and testing of the patient For specific information on the discontinuation of Precautions for common reportable diseases see Reportable Diseases

Specific information of discontinuation by infection is listed in APPENDIX 6

Contact Precautions

Contact Precautions are required for suspected or confirmed infections that are transmitted by direct contact with the patient or by indirect contact with contaminated surfaces The specific infectious agents that require Contact Precautions are listed in APPENDIX 6

In addition antibiotic resistant organisms of VRE MRSA C difficile and ESBL require Contact Precautions because of their risk of transmission through contact with intact skin andor contaminated environmental surfaces

1 Interaction Controls

bull Routine Practices bull PPE

o Gloves o Gown ndash if in contact with skin clothing or the patientrsquos environment

bull Hand hygiene by the patient prior to leaving their room bull Hand hygiene by visitors bull Gowning is not required if only delivering a dietary trays but should be used for

removal of dietary trays


March 2012 35

bull Transport of patient ndash staff should wear gloves and gowns during transport and clean and disinfect equipment used in transport after use

2 Environmental Controls

bull Engineering controls o Placement of HH and PPE according to CSA Standards (CSA Z8000 or as

current) bull Placement

o Ambulatory care examination room or cubicle as soon as possible o In-patient care single room with a dedicated toilet and sink is preferred o Door may be open but appropriate signage should be visible

bull Dedicated equipment if possible or clean and disinfect shared items bull Environmental cleaning (see section on Environmental Cleaning by Area)

o Routine for most rooms

See APPENDIX 7B for special cleaning for MRSA VRE and C difficile

3 Administrative Controls

bull Education for staff patients and visitors on HH and PPE for Contact Precautions bull Policy and procedure for the initiation and use of Contact Precautions bull Ongoing audit and feedback of the use of Contact Precautions bull Effective communication regarding the need for Contact Precautions in those

involved with the patient

See APPENDIX 8a for Contact Precautions Requirements and Signage

Droplet Precautions Droplets are small particles containing microorganisms from the respiratory tract that are expelled during talking coughing or sneezing They can travel up to two meters and can live on surfaces in the environment for extended periods of time Droplet Precautions are used to interrupt the transmission of infections spread by droplets

Examples of infections requiring droplet Precautions include rubella mumps pertussis and respiratory tract viruses such as influenza

Microorganisms spread by droplet transmission are of particular concern to certain vulnerable populations paediatrics frail elderly and those with cardiopulmonary disease

The specific infectious agents that require Droplet Precautions are listed in APPENDIX 8b


March 2012 36


bull Routine practices bull PPE

o Facial protection (mask and eye protection) if within two metres bull Hand hygiene by the patient prior to leaving their room bull Mask for patient when outside room bull Hand hygiene by visitors bull Transport ndash patient should wear a mask during transport




o Ambulatory care triage to a single room or maintain two meter spatial separation

o In-patient care single room with a dedicated toilet and sink is preferred patients to stay in room or wear a mask if coughing within two meters of other patients

o Door may be open but appropriate signage should be visible bull Dedicated equipment if possible or clean and disinfect shared items bull Environmental cleaning (see section on Environmental Cleaning by Area)



bull Education for staff patients and visitors on HH and PPE for Droplet Precautions bull Policy and procedure for the initiation and use of Droplet Precautions bull Ongoing audit and feedback of the use of Droplet Precautions bull Effective communication regarding the need for Droplet Precautions in those

involved with the patient Airborne Precautions

Some microorganisms can remain suspended in airborne particles that can travel in the air or on air currents to the breathing space of persons at some distance away Airborne Precautions interrupt the transmission of these microorganisms by controlling the ventilation and airflow and through the use of respirators


March 2012 37

The specific infectious agents that require Airborne Precautions are listed in APPENDIX 8c

Examples of infections requiring droplet Precautions include tuberculosis varicella and measles Airborne Precautions are also required in aerosol-generating procedure rooms where patients under Airborne Precautions are likely to be seen eg bronchoscopy suit autopsy suite rooms used for sputum induction and laboratory areas

Due to the capacity to spread through the environment it is important to have a high degree of suspicion and implement early airborne isolation of those with symptoms of an airborne infection



o Fit-tested N95 respirator for suspected or confirmed cases of active pulmonary tuberculosis

o N95 respirator for non-immune staff entering the room of a patient with suspected measles or varicella

bull Hand hygiene by the patient prior to leaving their room bull Hand hygiene and Airborne Precautions for visitors bull Transport

o staff should wear an N95 mask for transport o transport should be limited to diagnostic or therapeutic procedures o Generally a surgical mask is acceptable for the patient to wear during

transport However due to the high rates of TB in NWT and the long duration of patient transports a patient on Airborne Precautions for TB should wear an N95 mask during transport if tolerated by the patient



current) o Airborne isolation room meeting CSA Standards (CSA Z3172-10 and CSA

Z8000 or as current) Inward directional airflow (negative pressure) Low-level exhaust near the head of the bed creating a directional

airflow from lsquocleanrsquo part of the room over the bed and to the exhaust


March 2012 38

Dedicated exhaust to the outdoors Minimum 12 air changes per hour Minimum 3 outdoor air changes per hour Windows and door must remain closed Monitoring of functioning with an alarm system indicating proper

pressure relationship bull Placement

o Ambulatory care place directly in a single examining room with the door closed and window open


o Door may be open but appropriate signage should be visible bull Environmental cleaning (see section on Environmental Cleaning by Area)



bull Education for staff patients and visitors on HH and PPE for Airborne Precautions

bull Policy and procedure for the initiation use and discontinuation of Airborne Precautions

bull Policy and procedure for the immunization of staff against measles and varicella bull Policy and procedure for the routine TB screening of staff bull Ongoing audit and feedback of the use of Airborne Precautions including the

monitoring of airborne isolation rooms bull Effective communication regarding the need for Airborne Precautions in those


See APPENDIX 8c for Airborne Precautions Requirements and Signage

Reverse isolationProtective Environments

Severely immunocompromised patients are at an increased risk of acquiring infections while in health care settings Persons with allogenic hematopoietic stem cell transplant (HSCT) or with febrile neutropenia may be placed in a single room and under a Protective Environment

For further guidance on reverse isolation see Guideline for isolation Precautions preventing transmission of infectious agents in healthcare settings 2007 httpwwwcdcgovhicpacpdfisolationIsolation2007pd


March 2012 39

SECTION- 5-INFECTION PREVENTION AND CONTROL PRECAUTIONS Patient placement

Single rooms with dedicated washroom facilities are the new standard for facility design (CSA Z8000) Health care facilities with multiple person rooms need to carefully consider patient placement so as to reduce the risk of hospital-acquired infections Patient placement decisions should be based on the assessment of the presenting symptomsclinical syndrome and the need for Additional Precautions

Some additional considerations for patient placement in a single room

bull Patients who are more likely to soil their environment (paediatrics those who are grossly incontinent persons with profuse bleedingbody fluid drainage)

bull Those who are unwilling andor unable to perform proper HH (paediatrics impaired mental capacity)

bull Those who may share contaminated articles with other patients

Patient placement in ambulatory care settings (offices out-patient departments etc) is not only the location of the patient but the timing of the appointment Patients with known conditions that require Additional Precautions are preferably seen at the end of the day to minimize contact with other patients and to allow time for cleaning and disinfecting of the room after the visit Again consideration of Additional Precautions depends on the likelihood of the patient contaminating the office environment during the visit

Patient transport

1 Interaction Controls bull Transport staff should adhere to Routine Practices and the Additional

Precautions required by the patient they are transporting bull Transport staff should ensure that the patient is wearing a mask (N95 respirator

for TB airborne Precautions and surgical mask for non-TB airborne and droplet Precautions) and does not have unnecessary contact with environmental surfaces outside of their room

SETIO

N-5

-INFECT

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March 2012 40


bull Housekeeping staff should be informed of transfers of patients under Additional Precautions so that they are available to provide the appropriate cleaning of the transport vehicle and other areas as needed


bull Nursing staff are responsible for communicating the need for Additional Precautions to transporting staff and environmental cleaning staff involved in patient transfers

Food and Nutrition

1 Interaction Controls bull Routine Precautions and Additional Precautions as required for delivery and

pick up of dietary trays bull Contact Precautions are not required for the delivery of dietary trays (unless

deliverer will have other contact with the patient environment) bull Nursing staff are responsible for delivering and picking up dietary trays for

patients on Additional Precautions o Dietary trays will be left at the unit desk o A dirty tray cart will be provided on the floor for removal of the used tray


bull Disposable dishware utensils and trays are not required for any patient for infection control purposes

bull Dietary trays that contain any patient care equipment or instruments (eg instruments needles syringes etc)

o Bring to the attention of the Nurse-in-Chargenursing staff for appropriate point-of-use disposal

bull Dietary trays that are contaminated with visible evidence of blood or other body substances should

o Be placed in a designated container and transported to the Central Supply Room (CSR) for reprocessing

bull Patients who are under Additional Precautions within facilities with common eating areas may need to remain within their room and have dietary trays delivered until they are no longer under Additional Precautions


March 2012 41

Laboratory Transport

1 Interaction Controls bull Apply Routine Precautions and the appropriate Additional Precautions for the

collection and handling of laboratory specimens bull Ensure hand hygiene after handling or transporting any laboratory specimens


bull Place each laboratory specimen in an appropriate leak-proof primary container (ie vacutainer tube specimen cup etc) Care should be taken when collecting and handling specimens to avoid contamination of the outside of the container

bull Secure lids tightly to prevent leakage bull Place the specimen(s) into a plastic zip-lock type bag imprinted with biological

hazard symbol and the legend ldquoBIOHAZARDrdquo (each bag should contain a sheet of absorbant material eg ldquoDri-Moprdquo)

bull Seal the bag before transporting it to the laboratory 3 Administrative Controls

bull Ensure the requisition slip(s) are completely filled out and inserted into the outside pocket of the specimen bag

bull Ensure samples are held at the appropriate temperature and arrive at the laboratory for processing within the required amount of time

Visitors

Visitors to health care settings should bull Be aware of restrictions on visitation due to outbreak or other conditions within

the facility bull Be aware through easy to understand signage of how and when to perform HH bull Be directed to check in with the nursing station if visiting a patient under

Additional Precautions bull Receive education on how to wear the necessary PPE if visiting a patient under

Additional Precautions bull Visitors who are household contacts of the tuberculosis patient they are visiting

MAY have already been exposed in the household and do not need to wear an N95 respirator if they are Mantoux positive


March 2012 42

Pet visitation

While pets may be used for therapy in health care settings they may also be a vector for introducing infectious agents into that setting The current recommendation is

bull animal visitation as therapy for in-patients is not allowed bull pet visitation for palliative patients may be allowed under supervised conditions

and under the guidance of infection control practitioner bull service animals required by visitors or patients with disabilities are allowed but

their presence in the hospital should be made known to infection control practitioner

Environmental Controls by Area

Additional Precautions apply to every setting where patients receive health care However the patientrsquos interaction with the environment will vary as will the underlying health of others who are exposed to that environment This table provides the general environmental controls for Contact Droplet and Airborne Precautions in the Acute Care Long-term Care Ambulatory Care and Home Care settings See APPENDIX Infection Control Information for Homecare Workers

Health Care

Setting Contact Precautions Droplet Precautions Airborne Precautions

Acute Care

bull Remove and launder all curtains (privacy window shower) when visibly soiled and on terminal cleaning

bull Special cleaning for MRSA VRE and C difficile

bull Dedicated equipment

bull Routine cleaning bull Special attention

to high-touch items within vicinity of the patient

bull Dedicated equipment if possible

bull Routine cleaning bull Maintain Airborne

Precautions and door closed until sufficient time for removal of airborne microorganisms (35 minutes for 999 removal efficiency at 12 air changes per hour)

Long-term Care

bull Remove and launder all curtains (privacy window shower)


to high-touch items within


Precautions and door closed until sufficient time


March 2012 43

Health Care Setting

Contact Precautions Droplet Precautions Airborne Precautions

when visibly soiled and on terminal cleaning



bull Clean and disinfect shared items

vicinity of the patient


for removal of airborne microorganisms (207 minutes for 999 removal efficiency at 2 air changes per hour)

Ambulatory Care

bull Special cleaning for VRE and C difficile

bull Clean and disinfect shared items or cover before use






Home Care

bull No special cleaning requirements

bull Routine cleaning bull Dedicated

equipment if possible

bull Routine household cleaning


March 2012 44

SECTION-6-ENVIRONMENTAL CLEANING General

Environmental cleaning is a core component of infection prevention and control environmental controls within any health care facility Environmental cleaning consists of

bull Routine cleaning and maintenance of the facility bull Additional cleaning and disinfection of high-touch surfaces and

equipmentdevices between patients bull Ongoing auditing feedback and education of cleaning practices

Environmental cleaning spans the entire process of ensuring the cleanliness and disinfection of health care facilities

bull Consideration of environmental surfaces and facilities during the design and renovation of health care setting (as per CSA Z8000 or as current)

bull Consideration of infection prevention and control requirements in the purchase of medical equipment and devices (as per CSA Standards)

bull Staffing and other resource requirements to maintain appropriate environmental cleaning under routine conditions and times of enhanced cleaning needs (ie outbreaks)

bull Consideration of areas where reusable devices can be replaced by single-use devices

Routine Cleaning

Specific recommendations for Environmental Cleaning can be found in Best Practices for Environmental Cleaning for Infection Prevention and Control in All Health Care Settings wwwoahppcaresourcesdocumentspidacBest20Practices20for20Environmental20Cleaningpdf

SECTIO

N-6

-ENV

IRO

NM

ENT

AL CLEA

NIN

G


March 2012 45


Before Cleaning

bull Assess environment for the need for Additional Precautions in addition to Routine Practices

bull Gather materials required for cleaning and be aware of the proper use of cleaning and disinfecting materials

bull Prepare room for cleaning by removing clutter

During Cleaning

bull Clean from the least soiled areas to the most soiled areas and from high surfaces to low surfaces

bull Remove gross soil and debris prior to cleaning and disinfection o Be alert for sharps and use a mechanical device to dispose of them into a

sharps container (see Sharps Disposal) inform supervisor of incident bull Avoid generating dust or aerosols that may disperse microorganisms into the

environment o Use a HEPA filter vacuum for carpets o Do not shake mops

bull Change cleaning solutions as recommended by the manufacturer o More frequently in heavily contaminated areas o Immediately after cleaning blood and body fluid spills or lsquodirtyrsquo areas o Prepare fresh bleach diluted solution daily o Do not top-up containers of cleaningdisinfection solution

After cleaning

bull Do not overstock rooms bull Clean and disinfect cleaning tools between uses including daily laundering of

mop heads bull Daily cleaning of carts used


Surfaces and Materials

bull Surfaces and furniture fixtures should o Follow CSA guidelines (CSA Z8000 or as current) o Be easy to maintain and repair o Prevent microbial growth (eg metals and hard plastics)


March 2012 46

o Prevent the harbouring of microorganisms (eg no seams and nonporous)

o Be able to withstand routine cleaning practices bull Cloth furnishings should

o Be well maintained and easily accessible and removable for cleaning o Be able to withstand routine cleaning practices o Be cleaned and disinfected immediately in the event of contamination

with blood or body fluids o Be avoided in patient care areas particularly for immunocompromised

patients bull Carpeting should

o Be able to withstand cleaning and disinfection with hospital-grade cleaners

o Have water resistant backing to prevent mould growth and be removed if it remains wet after 72 hours

o Not be used in Burn units Intensive care units Operating rooms Transplant units Oncology units

bull Plastic coverings should o Inspected for damage making them porous to fluids o Be cleaned and disinfected regularly

Avoid using cleaning products that can damage the integrity of the plastic (eg phenolics accelerated hydrogen peroxide methanols)

bull Electronic equipment should o Have plastic coverings that allow for cleaning and disinfection

Cleaning agents and disinfectants

Cleaning is the removal of foreign materials from a surface or object Microorganisms are physically removed with water detergents and mechanical action

bull Cleaning alone may be sufficient for some items or may be done as a step before disinfection

bull Detergents and other cleaning agents should have a drug identification number (DIN) from Health Canada and be used according to the manufacturersrsquo recommendations Household bleach does not require a DIN

bull Cleaning agents include o Quarternary ammonium compounds (QUATs)


March 2012 47

o Enzymatic cleaners o Soap and water o Detergents o 05 Accelerated hydrogen peroxide

Disinfection is the process of killing or inactivating most infectious agents on surfaces

bull Disinfection is categorized as low-level disinfection or high-level disinfection o Low-level disinfection (LLD) eliminates bacteria some fungi and enveloped

viruses o High-level disinfection (HLD) eliminates bacteria enveloped viruses fungi

mycobacteria and non-enveloped viruses bull Only LLD is used for Environmental Cleaning as this includes non-critical equipment

and devices that only touch intact skin and not mucous membranes bull Low-level disinfection products include (suggested contact time but dependent on

manufacturer) o 3 Hydrogen peroxide (30 minutes) o 70-95 Alcohol (10 minutes) o Sodium hypochlorite 150 dilution 1000ppm (10 minutes) ndash see below o 05 Accelerated hydrogen peroxide (5 minutes) o QUATs o Iodophors o Phenolics (should not be used in nurseries or equipment that comes into

contact with infants such as scales) bull Sodium Hypochlorite (bleach) solutions are cheap and easily prepared

disinfectants for routine cleaning use o Read the MSDS and use appropriate PPE o Check manufacturer recommendations regarding use and contact time ndash

chlorine bleach may damage some surfaces o Add bleach to water not water to bleach o Do NOT mix bleach with ammonia (including urine) or acid-based products

as this may release chlorine gas which is very toxic o Check the shelf-life and expiry date of the concentrated bleach solution o Do not premix bleach solutions as it loses potency over time

Make a fresh bleach solution daily

See APPENDIX 9a on Disinfectants

See APPENDIX 9b on How To Prepare Bleach Solutions


March 2012 48

Frequency of cleaning

The frequency of cleaning and disinfecting of areas depends on

bull Frequency of contact with surfaces o High-touch surfaces are areas with frequent contact with hands that

require more frequent cleaning and disinfection Examples include doorknobs elevator buttons telephones call bells bedrails light switches computer keyboards monitoring equipment haemodialysis machines wall areas around the toilet and edges of privacy curtains

o Low-touch surfaces are areas with minimal contact with hands that require regular cleaning and when areas are soiled or with patient turnover Examples include floors walls ceilings mirrors and window sills

bull Type of activities taking place in that area o Clinical areas more prone to contamination need to be cleaned more

often than areas used for administrative purposes bull Vulnerability of patients in that area

o Patient care areas with more susceptible patients due to their medical condition or lack of immunity require more frequent cleaning More susceptible patients include oncology transplant neonatal burn and haemodialysis patients

bull Probability of surface contamination o The level of surface contamination with blood and body fluids can be

divided into light moderate and heavy contamination

The Overall Frequency of Cleaning and Disinfecting for Areas is in APPENDIX 10b

Environmental Cleaning Auditing Tools are in APPENDIX 2c

Environmental Cleaning Resources are in APPENDIX 7


March 2012 49


bull Policies and procedures regarding routine cleaning practices bull Compliance with Workplace Hazardous Materials Information System (WHMIS)

requirements for labelling of cleaning materials including Material Safety Data Sheets (MSDS)

bull Appropriate supplies of PPE and cleaning materials bull Education and training in Environmental Cleaning bull Ongoing monitoring auditing and feedback of cleaning measures

Double Cleaning

Double cleaning may be required for sensitive areas or areas under outbreak to enhance environmental controls Double cleaning refers to repeating the cleaning regimen immediately after it has been done once (ie twice in a row) It does not refer to cleaning the same area twice per day The need for and completion of double cleaning should be documented

Terminal Cleaning

Terminal cleaning is the thorough cleaning of a patient room following discharge transfer or death Health care providers must dispose of any medical equipment or supplies left in the room Any remaining personal articles of the patient must be disposed of appropriately Shared personal care items should be discarded

See APPENDIX 7b for MRSA VRE and C difficile Cleaning

See APPENDIX 7o for Sample Terminal Cleaning List for Routine Precautions


March 2012 50

Linen and Laundry Services

Soiled linen can be a source of microbial contamination While soiled linen is rarely implicated in the transmission of infections all soiled linen should be handled in the same manner regardless of the patientrsquos specific diagnosis

1 Interaction controls

bull Routine Practices including hand hygiene and PPE for staff handling soiled laundry

o Gloves ndash if potential for contact with linen soiled with blood or body fluids

o Gowns ndash if contamination of clothing likely to occur

o Face protection ndash if potential for aerosolization of blood and body fluids


bull Handling of soiled linen should be done using Precautions to prevent contamination of the workplace and staff

o Remove gross soil with a gloved hand and dispose into toilet or hopper

o Contain contaminated laundry at point-of-care and with minimal agitation to avoid contaminating the surrounding environment

o Use designated bags as per institutional policy

o Contain wet laundry by wrapping in a dry sheet or towel and placing in a leak-proof laundry bag Double-bagging is NOT recommended Tie linen bags securely and do not overfill

o Cloth linen bags are washed in the same cycle as the linen contained in them

bull Laundry equipment is used and maintained according to manufacturerrsquos instruction

bull Clean laundry is packaged transported and stored in a way that maintains their cleanliness throughout


bull Laundry facilities must comply with CSA Standards (CSA Z8000 or as current) bull Policy and staff education to ensure disposal of sharps at point-of-use to avoid

risk of sharps in soiled linens

See APPENDIX 7p on Laundry Handling


March 2012 51

Waste Management

Biomedical waste disposal should follow the Guideline for the Management of Biomedical Waste in the Northwest Territories httpwwwhlthssgovntcapdfmanuals2001clinical_practicepdfpage_102_nwt_guidelines_for_management_and_disposal_of_biomedical_wastepdf Biomedical waste is contaminated infectious waste from a health care setting that requires treatment prior to disposal in landfill sites or sanitary sewer systems This includes

bull Human anatomical waste bull Human and animal cultures or specimens (excluding urine and feces) bull Human blood and blood products bull Items contaminated with blood or blood products that would release liquid or

semi-liquid blood if compressed bull Body fluids visibly contaminated with blood bull Body fluids from surgery treatment or diagnosis (excluding urine and feces) bull Sharps bull Broken glass contaminated with blood or body fluid

Waste should be segregated at the point-of-use stored in the appropriate container and transported and disposed of as required

Regular waste should not be disposed of as biomedical waste (ie red bags) There is a significant cost for the removal and disposal of biomedical waste Mixing of biomedical waste with regular waste results in an increased cost for disposal and should be avoided

Currently all biomedical waste in NWT is shipped to southern facilities for incineration and disposal Biomedical waste including human anatomical waste animal waste microbiological laboratory waste contaminated sharps and cytotoxic waste is considered infectious and potentially harmful under the Environmental Protection Act (EPA) of the NWT


bull Staff handling waste shall wear o Coveralls gowns or aprons o Heavy-duty waterproof gloves AND o Protective goggles or face shields

bull A dedicated hand washing sink must be available to waste handlers


March 2012 52


bull Biomedical waste should be o Segregated into either a plastic bag or rigid container with a non-

removable lid The container should be capable of withstanding the weight of the biomedical waste without tearing cracking or breaking

o Collected in waterproof waste bags that resist puncture leaking and breaking

o Double-bagged if the first bag is stretched damaged or soiled on the exterior

o Closed tied and removed when the bag is three-quarters full bull Transport of waste

o Such that there is minimal handling of waste o Defined transport route that avoid patient and other clean areas o Leak-proof carts used for transport are cleaned regularly


March 2012 53

Waste Category

Description Colour Code

Disposal

General Waste

Waste from offices kitchens washrooms public areas

PPE waste from Additional Precaution rooms

Dressings sponges diapers incontinent pads PPE disposable drapes dialysis tubing and filters empty IV bags and tubing catheters empty specimen containers lab coats and aprons and pads that will not release liquid or semi-liquid blood if compressed

Black

Landfill

Sharps Needles syringes lancets blades clinical glass Yellow

Incineration

Human Anatomical

Waste

Tissues organs body parts

Red

Pack in impervious sealed container and kept refrigerated or frozen until disposal (no longer than one week)

Incineration

Microbiologic Laboratory

Waste

Diagnostic specimens cultures vaccines Yellow

Incineration

Incineration is the current method of disposal of biomedical waste in the NWT Landfill after- treatment to inactivate spores may be another option for some biomedical waste


bull Education and training of waste handlers bull Workplace safety for waste handlers bull Adequate access and availability of PPE materials and resources

See APPENDIX 7q on Waste Handling


March 2012 54

Sharps Disposal

Sharps are any devices capable of causing cuts or puncture wounds and include needles sutures lancets blades and clinical glass


bull Gloves and other PPE do not protect against needle sticks or cuts bull Never re-cap needles bull Never reach into a sharps container bull Take care when handling contaminated instruments or handling needles and

sharps bull Dispose of all needles and sharps promptly


bull Usage of needle-less devices or safety-engineered needles bull Placement of sharps containers should meet CSA Standards (CSA Z8000 or as

current) bull Sharps containers should be rigid puncture-resistant containers that allow for

safe one-handed disposal bull Sharps containers should be sealed and replaced when they are three-quarters

full or have reached the fill line


bull Provision of adequate and appropriate supply of sharps containers bull Compliance with Workplace Safety Regulation on safety engineered

needless(pending new legislation) bull Education and training on safe use and disposable of sharps

4 Safe Disposal of Incorrectly Disposed Sharp

bull Put on gloves bull Bring a sharps container to the site of the sharp bull Use tongs or another implement to pick up the sharp with the sharp area

furthest away from your body bull Carefully place the sharp into the sharp container bull NEVER recap a needle bull Report the incident to management

See APPENDIX 7r on How to Dispose of a Sharp


March 2012 55

BloodBody Substance Spills

All spills of blood and body fluids or any other potentially infectious material should be cleaned from all surfaces as soon as possible 1 Interaction Controls

bull Restrict the area until the spill has been cleaned disinfected and the area is dry bull PPE

o Gloves o Gown and facial protection if possibility of splashing or aerosols or large

spills bull Inspect the area for sharps and dispose of accordingly prior to cleaning


bull Contain the spill by wiping up with disposable towel bull Dispose of material in regular waste unless it contains biomedical waste (soiled

materials that are so wet that blood can be squeezed out of them) bull Disinfection of the area

o 110 solution of 525 sodium hypochlorite in water for major spills o 1100 solution of 525 sodium hypochlorite in water for minor spills

See APPENDIX 9b on preparing bleach solutions


bull Access to PPE equipment and cleaning supplies for staff bull Education for staff bull Notify manager of spills bull Any significant blood-borne exposures should be reported to Infection Control

(see lsquoBlood-borne Exposuresrsquo)

See APPENDIX 7e on Protocol for Cleaning Blood Spills on Floors

See APPENDIX 7f on Protocol for Cleaning Blood Spills on Carpets


March 2012 56

Contaminated Medical Records A contaminated document is any document soiled with blood or body fluid Contaminated documents should either be appropriately replaced or placed in protective covering to avoid transmission of microorganisms Contamination of medical documents should be prevented by keeping charts away from patient care areas where they may be soiled Replacement

bull Place contaminated record in a clear plastic folder bull Photocopyscan the document bull Certify copy of original record bull Clean and disinfect the copier bull Shred and dispose of the original document

Containment

bull Keep documents that cannot be replaced in plastic isolation that allows viewing


March 2012 57

SECTION-7-MEDICAL REPROCESSINGSTERILIZATION General Requirements

The safe reprocessing of medical equipmentdevices bull Prevents transmission of microorganisms to patients and to staff bull Minimizes damage to the equipmentdevice

Reprocessing includes

bull Collection of used equipment with contained transport to central reprocessing bull Initial cleaning of equipment including inspection bull Disinfection +- sterilization depending on equipment with process indicators bull Rinsing and drying with re-inspection bull Clean transportation and storage bull Inventory management bull Ongoing auditing of processes to ensure disinfection and sterility

Selection of EquipmentDevices

All significant medical equipmentdevice purchases should be made in consultation with purchasing medical units and services using the device risk management infection prevention and control occupational health and safety support services maintenance and biomedical engineering Purchases need to take into account the types of reprocessing required for the device its lifespan and the ability of the health care facility to meet the manufacturer CSA and Health Canada requirements

Single-use devices are items that are used for one patient and then disposed This eliminates the need for reprocessing and thereby the risk of transmission of infection They are the safest option from an infection prevention and control perspective but not all equipment is available as single-use Additionally some single-use devices do not meet the manufacturing quality standards required by some users of the devices Single use devices should be considered for

bull Sharps or devices with sharp components that can cause occupational injury bull Devices with narrow lumens that are difficult to clean effectively

SECTIO

N-7

-MED

ICAL R

EPR

OCESSIN

GST

ERILIZA

TIO

N


March 2012 58

Reusable devices can be safely used but need to adhere to reprocessing standards to ensure they do not pose a risk of transmission of infection Decisions about the purchase of single-use or reusable devices should consider the health care facilityrsquos ability to provide the necessary reprocessing Smaller facilities may be able to ship materials to larger facilities for reprocessing with the following considerations

bull Safe mechanism for collecting and transporting equipment to central reprocessing bull Clean transportation of equipment back to the originating facility bull Processes to ensure the maintenance of sterility during transportation

o Visual inspection for soilage or wetness

Section 62 of the NWT Hospital and Health Care Facility Standards Regulations states that ldquoA disposable device intended to be used on a patient during a single procedure shall not be used on a patient for more than one procedure and shall not be used on another patientrdquo Products designated as lsquosingle-usersquo do not have manufacturer reprocessing recommendations and therefore reuse of such devices may be of risk to patient safety and liability

General Reprocessing Requirements 1 Interaction Controls

bull Routine Practices by staff involved in reprocessing bull PPE

o Gloves that cover wrists and forearms tear-resistant allow dexterity disposable

o Impermeable gown or water-proof apron o Face protection o Hair covering

bull Eyewash stations available if biological andor chemical agents (as per Workplace Safety Standards)

bull NO smokingeatingdrinkingpersonal items in the reprocessing area bull NO artificial fingernails or jewellery that can tear gloves bull Work restrictions if exudative skin conditions that may contaminate medical

equipment


March 2012 59


bull Engineering controls of the physical plant of the Central Reprocessing Area ensuring CSA Standards (CSA Z8000 or as current) including

o Decontamination sinks o Hand hygiene sinks o Separation of clean and dirty areas o Air quality (CSA Z3148-08 or as current)

10 Total air changes per hour 2 minimum outdoor air changes per hour Negative pressure Outdoor air exhaust 18-20⁰C temperature

bull Engineering controls of health care facility to ensure flow of soiled materials is separate from clean areas by walls or partitions and meet CSA standards (CSA Z8000 CSA Z3148-08 or as current)

bull Availability of cleaning disinfecting and sterilizing products as recommended by the manufacturer

bull Inventory control to manage usage of equipment and the number of times items can be reprocessed without degradation

bull Environmental cleaning of reprocessing area with dedicated cleaning equipment and cleaning

o Per shift ndash sinks o Daily - counters shelves floors o Every six months - walls light fixtures sprinkler heads and other fixtures


bull Education and training of staff involved in reprocessing bull Occupational Health requirements of staff bull Policies and procedures on

o Roles and responsibilities for reprocessing o Ongoing auditing monitoring and documentation of reprocessing o Ensuring external contractors meet same standards

bull Documentation of disinfection and sterilization practices o Essential component of risk management for reprocessing devices

bull The monitoring of reprocessing is a required organizational practice for health care facilities under Accreditation Canada

See APPENDIX 10 for the Reprocessing Area Layout Chart

httpshopcsacaencanadasterilizationcancsa-z3148-


March 2012 60

Reusable Medical EquipmentDevices

The level of reprocessing of medical equipmentdevices is based on Spauldingrsquos Classification of noncritical semicritical and critical devices All equipment requires cleaning and disinfection but the level of disinfection and the need for sterilization depends on the use of the device and the risk of transmission of infection

Classification Definition Examples Reprocessing

Critical Enters sterile tissue including the vascular system

Surgical instruments Biopsy instruments Foot care equipment

CLEA

NIN

G

Sterilization

Semicritical

Contacts non-intact skin or mucous membranes but do not penetrate them

Respiratory therapy equipment

Anaesthesia equipment Tonometer

High level disinfection (sterilization preferred if heat-tolerable)

Noncritical

Touches only intact skin and not mucous membranes

ECG machine Oximeters Bedpans commodes

urinals

Low level disinfection (occasionally cleaning alone)

Adapted from PIDAC Best Practices for Cleaning Disinfection and Sterilization in All Health Care Settings 2010

Cleaning

1 Initial Cleaning

At point-of-use

bull Remove gross soil bull Ensure sharps (eg Sutures) are removed by the user bull Disassemble equipment but keeps sets of equipment together bull Soak equipment to prevent organic material from drying on it

o Avoid prolonged soaking o Use detergentenzymatic cleaner as part of soaking

Enzymatic Cleaner is essential for devices with a lumen o Soak 15 minutes in milk bath if appropriate (or may occur during

sterilization cycle) o Apply lubricant if required


March 2012 61

Physically remove organic material ndash use brushes and cloths

bull Inspect the equipment for stains and tissue or rust bull Ensure equipment is in good working order bull Manual or mechanical cleaning of equipment bull Rinse equipment thoroughly with warm water to remove residuals Devices with

a lumen should be rinsed in sterile pyrogen-free water bull Completely dry (air-dry or with a clean lint-free towel for items that may rust)

Equipment requiring cleaning only bull Package for storage

Equipment requiring disinfection or sterilization bull Prepare equipment for these steps

Disinfection

The safe use of disinfection requires awareness of the disinfectant being used bull Manufacturer recommended product for device bull Provides appropriate level of disinfection bull Contact time is specified bull Appropriate dilution of prepared solutions (if required) bull Shelf-life of concentrated product and testing strips to monitor concentration

o High-level disinfectants have chemical test strips to ensure an effective concentration

o Check each new bottlepackage opened o Check with each use (daily)

bull Safe storage and available MSDS bull Appropriate PPE for use


March 2012 62

High Level Disinfection Products

Product Contact

time Usage Notes

Glutaraldehyde 2

20min at 20degC

Heat sensitive devices lensed instruments endoscopes anaesthesia equipment

Irritating to skin need proper ventilation

Accelerated hydrogen peroxide 7

20 min at 20degC

Heat sensitive devices delicate devices

Do NOT use for copper brass carbon-tipped devices and anodized aluminum

Hydrogen peroxide 6

30 minutes Semicritical equipment


Ortho-phthalaldehyde (OPA) 055

10 min at 10degC

Endoscopy devices heat-sensitive devices

Stains protein including hands expensive

Do NOT use for cystoscopes (causes sensitization)

Examples of semi-critical devices requiring high-level disinfection laryngoscopes bronchoscopes anaesthesia equipment specula sonography probes that contact mucous membranes or non-intact skin fingernail care equipment used on multiple patients


March 2012 63

Low Level Disinfection Products

Product Contact time Usage Notes

Alcohols (60-95) 10 minutes Noncritical equipment (eg stethoscopes home health care

Evaporates quickly flammable

Chlorines Major blood spill 110 (05)

Minor blood spill 1100 (005)

Surface cleaning 150 (01)

Noncritical equipment

Blood spills

Inexpensive

Rapid acting

Use in well-ventilated area

Accelerated hydrogen peroxide (05)

5 min at 20degC Isolation room surfaces clinic or procedure room

Hydrogen peroxide 3

10 minutes Noncritical equipment floors walls furnishings

Phenolics Floors walls furnishings hard surfaces and equipment

Do NOT use in nurseries

Corrosive toxic if inhaled Do not use on food surfaces

QUATs Floors walls furnishings blood spills prior to disinfection

Do NOT use on instruments

Examples of noncritical devices requiring low-level disinfection environmental surfaces (dental lamps dialysis machines) bedpans commodes stethoscopes blood pressure cuffs oximeters glucose meters ECG machines baby scales iv poles wheelchairs sonography probes that touch skin only

Never mix chlorine based products Mixing can produce toxic gases


March 2012 64

Sterilization

Sterilization eliminates ALL microorganisms from semicritical or critical equipment

Steam sterilization is the preferred method Chemical sterilization of heat-sensitive devices may be used

Unacceptable methods of sterilization include

bull Boiling bull Ultraviolet irradiation bull Glass Bead Sterilization bull Chemiclave bull Microwave oven

Sterilization requires

1 Wrapping of equipment (as per CSA Z3143-09 or as current) 2 Proper loading of the sterilizer (based on method used) 3 Monitoring

a Mechanical indicator b Chemical integrator c Biological indicator

4 Documentation of reprocessing process and results of indicators 5 Proper storage of sterile items 6 Maintenance of the sterilizer

1 Wrapping

bull Choose appropriate wrapping material wrap in square or envelope technique bull Place items such that there is adequate exposure to the sterilizer

o Devices with lumens should be open and unobstructed bull Apply external chemical indicator tape to seal package (if not self-sealing) and

label Improperly cleaned instruments may insulate organisms from the sterilizer Improperly wrapped items may prevent penetration of the sterilizer and

improper packaging can melt


March 2012 65

2 Loading bull Follow the manufacturer requirements bull Distilled water should be used for steam sterilizers bull Do not layer packages bull Use the appropriate cycle time and allow for drying time bull Place chemical integrator strip and biological indicator if required bull Improper loading or overloading impedes thorough contact of the sterilizing

agent with all items

3 Indicators

Mechanical

bull Record that sterilizer parameters have been met temperature time and pressure

bull Insufficient time temperature or pressure will not kill all microorganisms

Chemical

bull Ensure that the package indicator and chemical integrator inside the package have changed color with cycle

bull Bowie-Dick test for pre-vacuum air-dynamic steam sterilizers each day the sterilizer is used before the first processed load

Biological

bull Must be done ONCE a day or with each NEW cycle of the sterilizer bull Turn biologic incubator to pre-heat before running the cycle bull Wait until load has cooled at least 10-20 minutes before removing bull Check control and indicator samples bull Biological indicators are spores (Geobacillus stearothermophilus for steam

sterilizers Bacillus atrophaeus for dry heat sterilizers) with a color indicator to identify whether they have survived the sterilization process If the biological indicator shows spores have survived take the sterilizer

out of service If the chemical and mechanical indicators passed ndash re-challenge the

sterilizer If the repeat test kills the biological indicator spores return the sterilizer

to service If the repeat test shows spore growth take the sterilizer out of service

and inform Infection Control


March 2012 66

If the chemical and mechanical indicators failed - take the sterilizer out of service and inform Infection Control

Do not return to service until 3 consecutive negative biological indicators Identify remove and reprocess all equipment sterilized in that sterilizer

since last biological indicator test

4 Documentation

bull Record of each device to be sterilized o Inspection of condition o Date and time of sterilization o Results of mechanical chemical and biological indicators o Person completing reprocessing

5 Storage

bull Sterile storage rooms should meet CSA standards (CSA Z8000 Z3172-10) o Clean dry limited traffic dust free o At least 1 meter away from debris drains moisture and vermin to

prevent contamination o Minimum 4 total air changes per hour temperature between 20-23degC

Relative Humidity 30-60 (preferably 40-50) o First in first out inventory management o Visual inspection of equipment for discoloration soil wetness or

dampness indicating need for removal and reprocessing

6 Maintenance

bull Follow manufacturer recommendations for cleaning and preventive maintenance

See APPENDIX 10b for Protocol of Cleaning Disinfecting and Sterilizing

See APPENDIX 10 for Documentation Tools for Reprocessing


March 2012 67

Endoscopic Devices

Endoscopic devices are unique medical equipment for reprocessing due to their long and narrow lumens andor their penetration into sterile cavities Health care facilities using endoscopic equipment should have written policies and procedures for their disinfectionsterilization Disposable accessory equipment such as biopsy forceps should be used Automated Endoscopic Reprocessors are available for the sterilization of endoscopes

Critical endoscopes

bull Enter sterile cavities and joints (eg arthroscopes laparscopes) bull Need sterilization

Semicritical endoscopes

bull Enter semicritical spaces such as hollow viscera (eg colonoscopes) bull Minimum requirement of High-level disinfection

CJD

Creutzfeldt-Jakob disease (CJD) is a prion infection where prions are protein fragments that are resistant to usual methods of sterilization Specific reprocessing recommendations for devices used on patients at high-risk for CJD are provided by Public Health Agency of Canada High-risk patients

bull Confirmed probable or possible CJD or other related prion diseases bull Suspected CJD ndash undiagnosed rapidly progressive dementia and CJD not ruled

out bull Asymptomatic carrier of genetic transmissible spongiform encephalopathy

High-infectivity tissue

bull Brain bull Cerebrospinal fluid bull Dura mater bull Pituitary gland bull Posterior eye (optic nerve and retina) bull Spinal cord and spinal ganglia bull Trigeminal ganglia


March 2012 68

Decisions regarding reprocessing of instruments used should be made in consultation with the PHAC manual Infection Control Guidelines Classic Creutzfeldt-Jakob Disease in Canada Quick Reference Guide 2007 httpwwwphac-aspcgccanois-sinppdfcjd-engpdf

Dental

Dental offices are subject to the same infection prevention and control practices as other ambulatory health care settings outlined in this manual Dental practitioners should also refer to the Canadian Dental Association Infection Prevention and Control in the Dental Office Manual for standards specific to dental practice Any discrepancies or concerns should be discussed with the OCPHO httpwwwsdaaskcaWorkplace20IssuesHealthampSafetypdfCDA-InfectionControlManual2006pdf

Mobile dental operations are also expected to maintain standards of infection prevention and control Portable devices and equipment used in mobile clinics must still meet infection control standards in their use transport and disposal

Specific considerations for mobile and office dental care


bull Appropriate use of Routine Precautions and Additional Precautions


o Clients requiring Additional Precautions are booked at the end of the day or in a facility that has the appropriate engineering controls

o Adequate supplies are available for PPE Environmental Cleaning Single-use or proper reprocessing of equipment

o Appropriate regular waste medical waste and sharps containment and disposal Containers of suctioned fluids that may contain blood or saliva may be

poured down a drain if it is connected to a sanitary sewer system or septic tank

o Appropriate disposal of hazardous waste (eg dental amalgam)


March 2012 69

bull Reprocessing of instruments o Designated reprocessing area with separation of clean and dirty areas

and dedicated sections for Receiving cleaning and decontamination Preparation and packaging Sterilization Storage of processed instruments

o Heat-tolerant critical and semi-critical instruments should be sterilized by heat

o Sterilization by ldquoliquid chemical sterilantsrdquo or ldquobead sterilizersrdquo should NOT be used

o Documentation of reprocessing processes and results of indicators

bull Water Quality o Dental unit waterlines (DUW) should follow maintenance procedures o Treatment should be postponed during a Boil Water Advisory o All incoming water lines should be flushed for 1-5 minutes after any

disruption to the water supply system

bull Dental handpieces connected to air or water systems o Flush for a minimum of 20-30 seconds after each patient o Sterilize after each patient o Suction lines should be rinsed with water between patients to remove

loosely adherent debris and microorganisms and to reduce the likelihood of infectious material and backflow Suction lines are to be cleaned with an enzymatic cleaner at least weekly

o Disinfect light between patients or use light cover to prevent contamination between patients from soiled gloves used to reposition light source

3 Administration Controls bull Dental practitioners are compliant with Occupational Health and Safety

Standards bull Policies and procedures for cleaning and reprocessing bull Ongoing documentation monitoring and auditing of infection control practices

including but not limited to o Hand hygiene o Environmental Cleaning o Disinfection and Sterilization of medical equipment


March 2012 70

Breaks in Infection Control

The purpose of the ongoing monitoring documentation and auditing of infection control and in particular reprocessing practices is to

bull Identify early inadequate infection control bull Prevent the risk of transmission of infection through contaminated materials

If auditing or other investigation reveals that insufficiently disinfected or sterilized equipment has been in use in the health care setting

bull Identify and recall all equipment that may have been affected bull Stop the use of that cleaning process to prevent further inadequately

reprocessed devices bull Identify whether any potentially contaminated equipment was used on whom

for what when bull Inform Infection Control the Health Authority and the OCPHO of the incident


March 2012 71

SECTION-8-OCCUPATIONAL HEALTH AND SAFETY

Health care settings should establish a clear expectation that staff do not come to work when ill Staff should remain off work when ill with symptoms that are likely due to an infectious disease such as

bull Influenza-like illnessAcute respiratory infection bull Gastroenteritis bull Conjunctivitis bull Infected skin lesions (if direct contact with patients or food) bull Varicellaherpes zoster if in an exposed area

Immunization

The Government of NWT Hospital and Health Care Facility Standards Regulations 2009 state that hospital and health care facility staff shall show proof of immunization or undertake an immunization program In order to meet the ldquoHospital Standards Regulationsrdquo s61 and s62ldquoSafeguard the health of staff and prevent transmission of infectious diseases in the hospitalrdquo all staff will have proof of up-to date immunization as well as Mantoux status

bull Before entering into employment a person shall show proof of current immunization and TB exposure status according to the attached standard All job postings must include this requirement

bull During the personrsquos employment immunization will be kept current according to the attached standard

bull A designated employee will keep the staff memberrsquos record of immunization and a record of completion available to human resources

bull Staff immunizations are provided free of charge by the employer

SECTIO

N-8

-OCCU

PA

TIO

NA

L HEA

LTH

AN

D SA

FETY


March 2012 72

Adult Immunization Checklist and Standard

Vaccine Work Area Indications

TetanusDiphtheria All areas All adults every 10 years

TetanusDiphtheria

Pertussis All areas Once as an adult

Influenza

Recommended for all health care workers

Necessary according to policy for all extended care staff

Once a year in the late fall

23-valent Pneumococcal

All areas Staff gt65 years old or at high risk of pneumococcal disease

MMR All areas

Require two doses

All adults born after 1970 unless immune to measles mumps and rubella

Varicella Certain patient care staff Two doses (over 13 years of age)

No history of chicken pox or no serological evidence of immunity

Hepatitis B

Laboratory Diagnostic Imaging (certain staff at risk)

Physical Services

Laundry

Housekeeping

Materials Management

Reprocessing

Patient Care

Respiratory Therapy

Staff at risk for bloodbody fluid exposures


March 2012 73

The Infection Prevention and Control Accreditation Standards for health care facilities specify an organizational policy and procedure to administer the influenza vaccination as a required organizational practice

Hepatitis B

bull Staff who receive hepatitis B immunization just prior to work entry should have hepatitis B antibody testing to ensure an adequate immune response (titre ge12 IUmL)

o A second series of Hepatitis B vaccine should be given to non-responders who are non-immune to an initial booster

bull Staff who have received hepatitis B immunization in the past and never had antibody testing should be tested prior to work entry

o If the first test shows an inadequate immunity level give a booster dose and recheck in one month

bull If an employee refuses hepatitis B antibody testing andor vaccine or is not immune after two full series then a review of the scope of practice is required to remove the likelihood of transmitting hepatitis B to patients and to reduce the liability of the employer

Tuberculosis Surveillance

The Government of NWT Hospital and Health Care Facility Standards Regulations 2009 specify that hospital employees are required to undergo base-line tuberculin testing Annual tuberculin skin testing is required for

bull Staff with negative base-line testing and o there is an ongoing risk of exposure to patients or

specimens from tuberculosis or o if practice is in a community with high prevalence

of TB bull All other staff require skin testing at least every three

years bull Staff who have a positive Mantoux test require a baseline chest x-ray Annual

screening is required with a symptom inquiry and clinical assessment as necessary

httpwwwjusticegovntcaPDFREGSHOSPITAL20INSURANCE20AND20HEALTH20AND20SOCIAL20SERVICES20ADMINISTRATIONHospital20and20Health20Care20Facility20Standardspdf


March 2012 74

Mask fit testing

Staff who will be required to wear an N95 respirator must bull Undergo fit-testing at least every two years or sooner if there is a change in the

userrsquos physical condition that could affect the fit of the respirator bull Receive education on the proper use of N95 respirators including how to

perform a seal-check (see Masks section) Blood-borne Exposures

Blood-borne exposures should be reported to the manager immediately for assessment

Significant exposures in health care settings are percutaneous (needle-stick) or mucous membrane (splash) exposure to blood or body fluids that may be contaminated with blood-borne pathogens

Significant exposures should be managed as per the Northwest Territories HIVAIDS Manual for Health Professionals lsquoPost-Exposure Prophylaxis Protocolrsquo httpwwwhlthssgovntcapdfmanuals2006hiv_aids_manualpdf

Staff at risk of blood-borne exposures should ensure their immunization status to hepatitis B (See Immunization section of this manual) Other reference Canadian Immunization Guide 2006 6th edition or as current

Blood-borne exposures should be

bull Assessed immediately because if post-exposure prophylaxis (PEP) is required it is best started within hours of the incident

bull Treated with first aid and washed thoroughly encouraging bleeding of sharps wounds

bull Appropriately managed regarding testing of the source and baseline and follow-up testing of the exposed person

bull Assessed for the need for PEP based on risk o High risk exposures to have PEP initiated as soon as possible after

exposure and no later than 72 hours post-exposure

A significant component of reducing blood-borne exposures is transitioning to needle-less devices and safety-engineered needles All NWT health care facilities will strive to implement needless systems and engineered safety devices in accordance with Workerrsquos Safety Compensation Commission (WSCC) regulations


March 2012 75

Education

Ongoing education and training for staff around infection prevention and control and topic specific areas based on job description Multiple references on the need for education and training are made throughout the manual Education should be documented and provided on an on-going basis

Reference materials regarding infection prevention and control should be readily available to staff Appendices included in this manual should be used for staff education and reference Additional sources of information include

bull Association for Professionals in Infection Control and Epidemiology (APIC) bull Canadian Standards Association (CSA) bull Centers for Disease Control and Prevention (CDC) bull Community and Hospital Infection Control Association (CHICA) Canada bull Government of Northwest Territories (GNWT) bull National Advisory Committee on Immunization (NACI) bull Provincial Infectious Diseases Advisory Committee (PIDAC) bull Public Health Agency of Canada (PHAC) bull Society for Healthcare Epidemiology of America (SHEA)


March 2012 76

Section-9-Reportable Diseases and Special Cases List of reportable diseases

Under the Public Health Act and Disease Surveillance Regulations 2009 the diseases listed under

bull Schedule 3 Part 1 AND bull Schedule 3 Part 2 AND bull Schedule 3 Part 3

are reportable for the purposes of protecting the public and to control transmission of communicable disease which will reduce morbidity and mortality

Reporting requirements (under the Public Health Act)

23 A health care professional shall provide the Chief Public Health Officer with the information required by the regulations within the time set out in the regulations if the health care professional

a) diagnoses a reportable disease in a person or is of the opinion on reasonable grounds that a person who he or she examines or treats is infected with a reportable disease or

b) performs a reportable test on a person or causes a reportable test to be performed on a person

Reportable Diseases Conditions and Tests (under the Disease Surveillance Regulations)

6 The communicable diseases and other health conditions listed in Schedule 3 are prescribed as reportable diseases 7 (1) A health care professional who diagnoses a reportable disease or who is of the opinion that a person who he or she examines or treats is infected with a reportable disease shall provide the Chief Public Health Officer with the information required by the applicable form contained in the Communicable Disease Manual published by the Department of Health and Social Services in March 2007 as amended from time to time (2) A health care professional shall in respect of a reportable disease listed in Part 1 of Schedule 3

(a) immediately notify the Chief Public Health Officer of the diagnosis or opinion by means of telephone fax or e-mail and (b) within 24 hours after making the diagnosis or forming the opinion provide the required information to the Chief Public Health Officer

SECTIO

N-9

-REP

OR

TA

BLE D

ISEASES A

ND

SPECIA

L CASES


March 2012 77

(3) A health care professional shall in respect of a reportable disease listed in Part 2 of Schedule 3 within 24 hours after making the diagnosis or forming the opinion

(a) notify the Chief Public Health Officer of the diagnosis or opinion by means of telephone fax or e-mail and (b) provide the required information to the Chief Public Health Officer

(4) A health care professional shall in respect of a reportable disease listed in Part 3 of Schedule 3 provide the required information to the Chief Public Health Officer within seven days after the day the diagnosis is made or the opinion is formed (5) A person in charge of a health facility where a person with a reportable disease or suspected reportable disease is examined tested or treated shall take measures to ensure that information is provided to the Chief Public Health Officer in accordance with this section and section 8 and shall provide the Chief Public Health Officer with the required information if circumstances prevent a health care professional from doing so 9 The tests listed in Schedule 4 for reportable diseases are prescribed as reportable tests 10 (1) A health care professional who performs a reportable test or who causes a reportable test to be performed shall provide to the Chief Public Health Officer in a form approved by the Chief Public Health Officer information in respect of

(a) the name place of residence place of birth date of birth ethnicity gender and health care number of the person in respect of whom the test is conducted (b) the result of the test (c) the name and profession of and contact information for the health care professional and (d) any additional information the Chief Public Health Officer requires in respect of the test or the person being tested for the purposes of public health surveillance and health protection

(2) A requirement to provide any of the information referred to in subsection (1) does not apply if the Chief Public Health Officer determines that the information is not required

(a) in respect of a particular reportable test or (b) for a negative result in respect of a particular reportable test

(3) The information referred to in this section must be provided within three months after the day the result is obtained

See APPENDIX 6 for Reportable and Other Infectious Diseases

Refer to the NWT Communicable Disease Manual for the specific public health management of each reportable disease httpwwwhlthssgovntcapdfmanuals2007cdcmanfulldocpdf


March 2012 78

Schedule 3 - Reportable Diseases ndash Public Health Act as of September 2009

Part 1

Reportable to Chief Public Health Officer by telephone immediately and followed within 24 hours by a written report

Part 2

Must be reported within 24 hours

Part 3

Within 7 days after the day the diagnosis is made or the opinion is formed

1 Anthrax 2 Botulism 3 Diphtheria 4 Food poisoning including

communicable enteric infections

5 Gastroenteritis epidemic including institutional outbreaks

6 Hepatitis all forms 7 Legionellosis 8 Plague 9 Poliomyelitis 10 Rabies or exposure to

rabies 11 Salmonellosis 12 Severe acute respiratory

syndrome (SARS) 13 Epidemic forms of any

disease

1 Amoebiasis 2 Campylobacteriosis 3 Cholera 4 Clostridium difficile associated

disease 5 Encephalitis 6 Escherichia coli

(verotoxigenic) 7 Group A streptococcal

infections invasive including toxic shock syndrome necrotizing fasciitis myositis and pneumonitis

8 Group B streptococcal infections neonatal

9 Haemophilus influenzae type B infections invasive (Hib)

10 Hantaviral disease including hantavirus pulmonary syndrome

11 Hemorrhagic fevers 12 Influenza 13 Malaria 14 Measles 15 Meningitis 16 Meningococcal disease

invasive 17 Pertussis (whooping cough) 18 Pneumococcal disease

invasive 19 Rubella 20 Rubella congenital syndrome 21 Shigellosis 22 Syphilis 23 Tetanus 24 Tuberculosis 25 Typhoid and paratyphoid

fevers 26 Unusual clinical manifestations

of a disease 27 Vaccine adverse event

1 Acquired immunodeficiency syndrome (AIDS)

2 Adverse reaction to blood or blood products

3 Brucellosis 4 Chancroid 5 Chicken pox (varicella) 6 Chlamydial infections 7 Creutzfeldt-Jakob disease 8 Cryptosporidiosis 9 Cyclospora 10 Cytomegalovirus infection

congenital 11 Giardiasis symptomatic cases

only 12 Gonococcal infections 13 Hemolytic uremic syndrome 14 Herpes simplex congenital or

neonatal 15 Human immunodeficiency virus

(HIV) infections 16 Human T-cell lymphotropic virus

infections 17 Leprosy 18 Listeriosis 19 Lyme disease 20 Methicillin-resistant

staphylococcus aureus (MRSA) 21 Mumps 22 Penicillin-resistant streptococcal

pneumonia 23 PsittacosisOrnithosis 24 Q fever 25 Respiratory syncytial virus (RSV) 26 Tapeworm infestations including

echinococcal disease 27 Toxoplasmosis symptomatic only 28 Trichinosis 29 Tularemia 30 Vancomycin-resistant enterococci

(VRE)


March 2012 79

Special Cases of Reportable Diseases

Common reportable diseases requiring Additional Precautions are presented in detail below to provide further information on that disease and as an example for other infections requiring similar Precautions

Antibiotic resistant organisms (AROs) are also presented in detail due to their specific infection prevention and control needs

Respiratory Infections

Influenza-like illness Influenza and influenza-like illness are acute respiratory illnesses caused by viruses that infect the respiratory tract Epidemiology

The Public Health Agency of Canada case definition of Influenza-like Illness (ILI) is ldquoAcute onset of respiratory illness with fever and cough and with one or more of the following sore throat arthralgia myalgia or prostration which could be due to influenza virus In children under 5 gastrointestinal symptoms may also be present In patients under five or 65 and older fever may not be prominentrdquo

Influenza peaks in the fall and winter months Risk factors for complications of influenza include young children people aged 50 or older underlying long-term heart or lung problems pregnancy immunosuppression from cancer or HIV health-care workers living in a congregate setting Transmission of influenza is by aerosolized droplets and contaminated surfaces


bull Droplet Precautions bull Signage to alert other patients visitors and staff of the need for Droplet

Precautions and minimize the number of people entering the room bull Alert environmental cleaning staff of Droplet Precautions and need for

associated cleaning bull Educate patient on respiratory etiquette and hand hygiene bull Patients should wear a surgical mask and be placed in a single room or at least

two meters away from others


March 2012 80


bull Place patients with respiratory symptoms in single rooms bull Droplet precaution cleaning of rooms bull Ambulatory care bookings of patients should be at the beginning or end of the

day to minimize contact with other patients


bull Alert Infection Control about the patient bull Ensure staff compliance with influenza immunization (see Occupational

Health) o Staff who are ineligible for influenza immunization may require

reassignment or be considered for antiviral prophylaxis

Severe Respiratory Infection (SRI)

Surveillance and infection prevention and control is necessary to detect and prevent the spread of an emerging severe respiratory infection (SRI) While Severe Acute Respiratory Syndrome (SARS) is unlikely to re-emerge it signalled the importance of vigilance for SRIs

bull SRIs require Airborne Precautions

Respiratory Syncytial Virus (RSV)

Respiratory syncytial virus (RSV) is a respiratory infection that is the most common cause of lower respiratory tract infections in children Virtually all children have been exposed to RSV by three years of age However infections can lead to more serious illnesses in premature babies and children with underlying medical conditions

Epidemiology

RSV presents with wheezing coughing rhinorrhea and fever in children Symptoms in adults are similar to the common cold Symptoms usually last between five to seven days Transmission occurs by droplet spread The virus may remain on surfaces for some time and spread infection through touching of the contaminated surfaces




associated cleaning bull Identify high risk individuals who may require hospitalization

o Children with severe underlying cardiopulmonary conditions


March 2012 81

o Children receiving chemotherapy for malignancy o Premature infants o Elderly people o Immunocompromised adult patients

bull Educate patients on respiratory etiquette and hand hygiene

2 Environmental controls

bull Place patients with respiratory symptoms in single rooms bull Droplet precaution cleaning of rooms

3 Administrative controls

bull Alert Infection Control about the patient bull Identify high-risk infants who may require Palinizumab (Synagisreg) prophylaxis

according to the NWT Communicable Disease Manual

Tuberculosis (TB)

Tuberculosis is spread by the airborne route from Mycobacterium tuberculosis in droplets that can remain in the air for hours The risk of infection depends on

bull The infectiousness of the patient bull The ventilation of the room bull The length of time the patient is exposed to others

Patients who have latent TB infection (LTBI) have a 10 lifetime risk of having active TB of which the highest risk is within the first two years Patients with LTBI do NOT need Additional Precautions Only patients with active tuberculosis of the lungs are infectious and require infection prevention and control measures

For further information on tuberculosis see the NWT Tuberculosis Manual httpwwwhlthssgovntcapdfmanuals2003tbmanualpdf

For patients with Suspected or Confirmed TB


bull Airborne Precautions including N95 respirators bull Signage to alert other patients visitors and staff of the need for Airborne

Precautions and minimize the number of people entering the room bull Minimize transport of patient out of negative pressure room and require the

patient to wear a mask if transport is required


March 2012 82

o An N95 respirator is preferred especially for medical transport or prolonged times outside of negative pressure room

o A surgical mask is acceptable if an N95 respirator is not tolerated bull Plan any procedures for the end of the schedule to allow time for cleaning and

ventilation of the procedure room bull Alert environmental cleaning staff of the need for Airborne Precautions when

cleaning bull Nursing staff are responsible for delivering and removing food trays from the

room bull Nursing staff are responsible for Directly Observed Therapy (DOT) of the

patientrsquos anti-TB medications which includes o documentation of directly observing ingestion of the medications OR o documentation and reporting of any refused doses


bull Airborne Precautions room meeting CSA Standards (CSA Z3172-10 Special requirements for heating ventilation and air-conditioning (HVAC) systems in health care facilities or as current)

bull Keep the door of the airborne isolation room closed at all times bull After patient discharge keep the airborne isolation signage for one hour to

ensure there are no remaining airborne pathogens bull Routine terminal cleaning of the room


bull Alert Infection Control of any patients with suspected or confirmed TB bull Staff who have contact with TB patients must undergo annual tuberculin skin

testing or earlier if a contact of an active case and regular mask fit testing (see Occupational Health)

bull Education and training on TB and airborne Precautions bull Notification of the OCPHO regarding the case bull Planning and communication for any facility transfers

httpshopcsacaencanadahealth-care-facility-engineeringcancsa-z3172-10invt27013482010


March 2012 83

4 Discontinuation of Precautions

Scenario Discontinuation

Requirement Results Follow-Up

Suspect Case bull 3 smear negative sputum samples on 3 separate days

bull Any positive results should be followed up as a case

Case -culture positive - unconfirmed smear status

bull Completion of 2 weeks of daily DOT therapy AND

bull 3 consecutive sputa are smear negative for AFB on 3 separate days AND

bull Clinical improvement

If any sputa sample is positive repeat sputa collection weekly until bull 3 consecutive sputa are smear

negative for AFB on 3 separate days AND

bull Clinical improvement Case -culture positive -smear positive


bull 3 consecutive sputa are smear negative for AFB on 3 separate days

Any concerns about the discontinuation of airborne Precautions should be discussed with the OCPHO

Meningitis

The three most common causes of bacterial meningitis are Neisseria meningitides Streptococcus pneumonia and Haemophilus influenzae type b Suspect cases of meningitis may be due to non-bacterial causes but cases should be under appropriate Precautions until an alternative diagnosis is made All three bacterial causes of meningitis require Droplet Precautions 1 Interaction controls



associated cleaning


bull Place patients with suspect meningitis in single rooms bull Droplet precaution cleaning of rooms


March 2012 84


bull Alert Infection Control about the patient bull Droplet Precautions may be removed if an alternative diagnosis is made

Antibiotic Resistant Organisms

Antibiotic Resistant Organisms (AROs) are increasingly important considerations within overall infection prevention and control practices within health care settings AROs include

bull methicillin-resistant Staphylococcus aureus (MRSA) bull vancomycin-intermediate Staphylococcus aureus (VISA) bull vancomycin-resistant Staphylococcus aureus (VRSA) bull vancomycin-resistant enterococci (VRE) bull extended-spectrum beta-lactamase producing bacteria (ESBL) bull carbapenem-resistant enterobacteriaciae (CRE)

o includes New Delhi metallo-beta-lactamase (NDM1)

While Clostridium difficile is not an ARO it is included in this section because many of the same infection prevention and control issues apply

Infection prevention and control is responsible for

bull Preventing the development of AROs through antimicrobial stewardship bull Screening for the identification of patients admitted to hospital with an ARO bull Preventing the transmission of AROs within the health care setting bull Educating patients and visitors on hand hygiene and other methods of

preventing transmission of AROs within the health care setting and in the community

bull Monitoring the incidence of hospital care acquired AROs

Surveillance of AROs is part of the hospital infection control Accreditation Standards

While the risk of infection with an ARO is greater in a hospital setting community health care practices are an essential component of preventing the development and transmission of AROs


March 2012 85

Antibiotic Stewardship

Antibiotic stewardship is the judicious use of antibiotics to prevent the propagation of resistant strains Programs include

bull Surveillance of antibiotic resistance patterns and antibiotic usage bull Appropriate antibiotic prescribing with the correct dosage and appropriate

duration bull The use of formulary restrictions preauthorization requirements prescriber

feedback and education and other tools to prevent excessive or inappropriate prescribing

bull Guidelines and plans for antibiotic prescribing bull Auditing and monitoring

Antibiotic stewardship is a coordinated effort between all prescribing practitioners hospitals and laboratories

MRSA When Staphylococcus aureus becomes resistant to beta-lactam antibiotics (eg cloxacillin) they become known as methicillin-resistant Staphylococcus aureus (MRSA) Different strains of MRSA are characterized by their production of various toxins Panton-Valentine leukocidin (PVL) is one of the beta-pore-forming cytotoxins that is associated with increased virulence and is present in the majority of community-associated MRSA strains The challenge lies in antibiotic treatment for MRSA infections and controlling the spread of MRSA in hospitals and the community MRSA may also be resistant to other antibiotics including vancomycin aminoglycosides macrolides and quinolones MRSA can be divided into hospital-acquired MRSA (HA-MRSA) and community-acquired MRSA (CA-MRSA) CA-MRSA is defined by either the epidemiology of someone who has not had recent exposure to a health care setting or by the microbiologic typing of the strain of MRSA There is cross-over between HA-MRSA and CA-MRSA making this distinction less relevant for infection prevention and control purposes The transmission of MRSA is typically from person-to-person through Direct Contact and through Indirect Contact with contaminated environments

The MRSA status of patient is divided into lsquocolonizationrsquo and lsquoinfectionrsquo Approximately 60 of healthy adults have S aureus on their skin and mucous membranes and MRSA


March 2012 86

can be carried in the same way Patients who are colonization will have MRSA in their nares axilla perineum etc but do not have symptoms or disease If the MRSA enters a body site and multiplies it can cause an infection

Risk factors for colonization andor infection

bull Crowdinglarge numbers of people in close proximity bull Close contact between individuals bull Dirtyunclean environments bull Sharing of personal items (eg dishes towels) bull Broken skinwounds bull Prolonged hospitalizations bull Multiple antibiotics

Clinical presentations

bull Sepsis bull Skin and soft tissue infections

o Boils abscesses purulent draining wounds bull Pneumonia


bull Contact Precautions in addition to Routine Precautions bull If there is a potential for aerosolization of MRSA Droplet Precautions are also

required bull Signage to alert other patients visitors and staff of the need for Additional

Precautions and minimize the number of people entering the room bull Alert environmental cleaning staff of Contact Precautions and need for

associated cleaning bull Alert transporting and receiving staff of need for Additional Precautions


bull Single room accommodation If single room is unavailable prioritize MRSA patients based on

o Respiratory infection (and need for Droplet Precautions) o Colonized tracheostomy or other risk of aerosolization o Uncontained draining wound or stoma o Desquamating skin condition (eg psoriasis burn)

o Poor personal hygiene o Cognitive impairment


March 2012 87

bull Provision of PPE outside the room for donning bull Provision of waste receptacles and hand hygiene facilities inside the room for

doffing bull Dedicated use non-critical equipment

o Thermometers tympanic probes blood pressure cuffs stethoscope IV poles etc

bull Limit supplies stored in room to minimize waste bull Environmental cleaning

o Daily and terminal cleaning as per Contact Precautions o Discard cleaning materials and solutions after use in the patientrsquos room

and do not use the same cleaning materials in other rooms bull In community health care settings long-term care institutions outside the

hospital and correctional facilities o Patients with an MRSA infection ie open draining skin and soft tissue

infection Scheduled at the end of the day Use of Contact Precautions (plus Droplet Precautions for MRSA

pneumonia) Environmental cleaning of room and equipment

o Patients with MRSA colonization non-draining skin and soft tissue infections or small easily contained wounds Routine Precautions Risk assessment guided use of Contact Precautions depending on

nature of visit and provision of direct care or procedures that may contaminate the environment

Routine cleaning of potentially contaminated surfaces


Screening protocols for MRSA

Hospital Admission Screening

bull Hospitals are expected to screen patients at increased risk of MRSA on admission and

o all patients transferred as well as hospitalized in the last year o known to be previously positive or o known high incidence in communities

bull Specimens Anterior nares AND perianal perineal or groin AND lesionwound incisions ulcers


March 2012 88

bull Additional Precautions may be instituted for o Positive screening result o Admission prior to screening results if high risk or colonization or

infection o Flagged MRSA positive patient

bull Alert Infection Control of MRSA positive results and discuss high risk patients

Discontinuation of Contact Precautions (based on PIDACrsquos Screening Testing and Surveillance for Antibiotic-Resistant Organisms)

bull For empirically implemented Contact Precautions in a high risk patient

o Discontinue if screening results negative bull For infected patients

o Re-screen gt48 hours after discontinuation of antibiotics

o 3 sets of negative cultures at least 1 week apart bull For colonized patients

o Discuss consideration of decolonization with the OCPHO o Longer-term care patients may spontaneously clear MRSA

re-screen no more than every 3 months If screen negative discontinue after 3 sets of negative cultures at

least 1 week apart bull If patients remain in hospital after Contact Precautions have been removed re-

screen weekly to monitor for re-colonization bull Discuss discontinuation of Contact Precautions with Infection Control

Additional material on MRSA is available at wwwphac-aspcgccaid-micamrsa-engphp

VRE

Enterococci are Gram-positive cocci that typically are present in and can cause infection of the gastrointestinal tract perineum skin oropharynx andor bile Colonization with enterococci commonly occurs during hospitalization but many people are colonized without symptoms or infection Bowel colonization may last for weeks to months In some cases colonization may lead to an HAI Enterococci that are resistant to vancomycin are termed vancomycin-resistant enterococci (VRE) The main species of VRE are Enterococcus faecium and Enterococcus faecalis VRE may cause infection in the blood urinary tract wounds

Clinical Practice Guidelines (CPI) available at

httpwwwhlthssgovntcapdfmanuals2001clinical_practicehtmldefaulthtm


March 2012 89

Risk factors for infection include bull Previous antibiotic use particularly vancomycin and 2nd or 3rd generation

cephalosporins bull Urinary catheters and other invasive devices bull Critical illness requiring intensive care bull Recent hospitalization in facilities outside of Canada bull Immunocompromising condition bull Exposure to (or contact with) someone with VRE

The risk of acquiring VRE increases with the duration of stay in hospital and having had VRE previously Treatment of VRE is based on the sensitivities of the cultured specimen as multi-drug resistance may be present The need to use second and third-line antibiotics results in significantly higher mortality rate for patients with VRE bacteremia versus vancomycin-sensitive enterococcal infections Rising rates of VRE is also a risk for increasing vancomycin-resistant staphylococcal infections as the resistance genes can be transferred from enterococci to staphylococci Decolonization of VRE is not effective and is not recommended

The transmission of VRE is person-to-person through Direct Contact or Indirect Contact Enterococci can survive on surfaces from 5 days to several weeks and on unwashed hands for several hours


bull Routine Precautions and Contact Precautions bull Signage to alert other patients visitors and staff of the need for Additional

Precautions and minimize the number of people entering the room bull Alert environmental cleaning staff of VRE Contact Precautions and need for



bull Single room accommodation If single room is unavailable prioritize VRE patients based on

o Diarrhea not contained by diaper or other fecal incontinence o Wound or stoma drainage not contained by dressing or appliance o Cognitive impairment o Poor compliance with personal hygiene

bull Cohorted patients should have dedicated materials for toileting bull Provision of PPE outside the room for donning


March 2012 90

bull Provision of waste receptacles and hand hygiene facilities inside the room for doffing

bull Dedicated use non-critical equipment o Thermometers tympanic probes blood pressure cuffs stethoscope IV

poles etc bull Limit supplies stored in room to minimize waste bull Environmental cleaning

o Daily cleaning Fresh mop head and bucket for each VRE room Low-level disinfectant to all surfaces in that room Discard cleaning materials and solutions after use in the patientrsquos

room and do not use the same cleaning materials in other rooms o Usual terminal cleaning plus

Removal of all dirtyused items removal of curtains prior to cleaning discard soap toilet paper paper towels glove box toilet brush clean and disinfect all surfaces hang clean curtains

bull Double cleaning in outbreak settings bull In community health care settings

o Patients with VRE infection (eg uncontained fecal matter or wound) Scheduled at the end of the day Use of Contact Precautions Environmental cleaning of room and equipment

o Patients with VRE colonization Routine Precautions Risk assessment guided use of Contact Precautions depending

on nature of visit and provision of direct care or procedures that may contaminate the environment



Screening protocols for VRE


bull Hospitals are expected to screen patients at increased risk of VRE on admission bull Specimens Stool OR rectalanal swab bull Additional Precautions may be instituted for

o Positive screening result


March 2012 91

o Admission prior to screening results if high risk of colonization or infection (hospitalization within past 12 months previous colonization or infection with VRE exposure to VRE outbreak recent exposure to 2nd or 3rd generation cephalosporins)

o Flagged VRE positive patient bull Alert Infection Control of VRE positive results and discuss high risk patients

Discontinuation of Contact Precautions

bull For empirically implemented Contact Precautions in a high risk patient o Discontinue if screening results negative

bull For infected patients o Maintain Precautions for duration of acute care stay o Re-screen gt48 hours after discontinuation of antibiotics o 3 negative cultures with the last one at least three months after the last

positive culture bull For colonized patients

o Begin re-screening 3 months after last positive specimen 3 cultures one week apart for 3 consecutive months

bull Discuss discontinuation of Contact Precautions with Infection Control

Additional material on VRE is available at wwwphac-aspcgccanois-sinpvre-erv-engphp

ESBLs and CREs Enterobacteriaceae are a group of Gram-negative bacteria that include organisms such as Escherichia coli and Klebsiella pneumoniae As the use of antibiotics against these organisms has continued they have developed enzymes and other mechanisms that make them resistant Enterobacteriaceae with a beta-lactamase enzyme can inactivate the beta-lactam class of antibiotics including penicillins cephalosporins and carbapenems Extended-spectrum beta-lactamase (ESBL) producing bacteria are resistant to third-generation cephalosporins (eg cefotaxime ceftriaxone ceftazidime) Since ESBLs further resistance has developed creating Carbapenem-resistant Enterobacteriaceae (CRE) that are resistant to carbapenems A notable example of CRE is the New Delhi metallo-beta-lactamase 1 (NDM-1) resistance that has been detected in several strains of Enterobacteriaceae

Risk factors for ESBL and CRE infection and colonization include

bull Extensive treatment with cephalosporins and carbapenems bull Lengthy hospital stay particular in intensive care


March 2012 92

bull Severe clinical status (eg neutropenia TPN recipient transplant neonate) bull Indwelling catheters bull Mechanical ventilation

Enterobacteriaceae is spread from person-to-person by direct contact and may survive in the environment causing spread by indirect contact The duration of bowel colonization and shedding is unclear and a previous history of colonization or infection increases the risk for current carriage






bull Single room accommodation If single room is unavailable prioritize ESBL and CRE patients based on


bull Cohorted patients should have dedicated materials for toileting bull Provision of PPE outside the room for donning bull Provision of waste receptacles and hand hygiene facilities inside the room for

doffing bull Dedicated use noncritical equipment



o Routine and terminal cleaning for Contact Precautions bull In community health care settings

o Patients with ESBL or CRE infection (eg uncontained fecal matter or wound) Scheduled at the end of the day Use of Contact Precautions


March 2012 93

Environmental cleaning of room and equipment o Asymptomatic patients with ESBL or CRE colonization

Routine Precautions Risk assessment guided use of Contact Precautions depending




Screening protocols for ESBL or CRE


bull Routine admission screening is currently not recommended bull Targeted screening is based on the health care facility bull Specimens Rectal Swab OR stool or urine bull Alert Infection Control of ESBL or CRE positive results and discuss high risk

patients


bull Decolonization for ESBL or CRE is not recommended bull Most patients should remain under Contact Precautions for the duration of their

acute care stay and be presumed to have ESBL or CRE if readmitted within 12 months

bull For treated infections Contact Precautions may be discontinued if o 3 consecutive negative cultures from all colonizedinfected sites taken at

least one week apart in the absence of antibiotic therapy o Discuss discontinuation of Contact Precautions with Infection Control

Additional material on ESBL and CRE is available at httpwwwphac-aspcgccanois-sinpguideipcm-mpciipcm-mpci-engphp

Clostridium difficile

Clostridium difficile is a Gram-positive spore-forming anaerobic bacillus Some strains produce toxins (toxin A and toxin B) that cause diarrhea While most strains are not resistant to antibiotics recent outbreaks have been due to the NAP1 strain which is resistant to clindamycin and fluoroquinolones and causes more severe infection The ability to produce spores that can survive in the environment for months despite chemical cleaning makes C difficile a challenging infection to manage in health care settings


March 2012 94

Risk factors for infection include

bull History of antibiotic use bull Immunosuppression including post-transplant and chemotherapy bull Proton pump inhibitor use bull Bowel disease and bowel surgery bull Prolonged hospitalization

Additional risk factors that predispose some people to develop infection with C difficile

bull Prior history of infection with C difficile bull Increased age bull Recent surgery bull Infection with NAP1 strain

C difficile is spread person-to-person through direct contact with infected persons and through indirect contact with spore-contaminated surfaces Individuals may be colonized and have no symptoms but infection is associated with diarrhea and in severe cases toxic megacolon shock and death


bull Hand Washing with soap and water is somewhat more effective for removing spores than ABHR however

o The patientrsquos sink should NOT be used for staff hand hygiene o A dedicated staff hand washing sink should be available at the point of

PPE removal o If no sink is available ABHR is still the preferred option


Precautions and minimize the number of people entering the room bull Alert environmental cleaning staff of C difficile Contact Precautions and need for



bull Single room accommodation If single room is unavailable prioritize C difficile patients based on

o Diarrhea not contained by diaper or other fecal incontinence o Wound or stoma drainage not contained by dressing or appliance o Cognitive impairment


March 2012 95

o Poor compliance with personal hygiene bull Cohorted patients should have dedicated materials for toileting

o Cohorted patients may have different strains of C difficile and lsquoping-pongrsquo infections




o Do NOT use rectal thermometers bull Limit supplies stored in room to minimize waste bull Environmental cleaning

o Daily cleaning Fresh mop head and bucket for each C difficile room Sporicidal agent for disinfection

bull Sodium hypochlorite (150 dilution 1000 ppm) bull Accelerated hydrogen peroxide (45) bull Peracetic acid (16)

Discard cleaning materials and solutions after use in the patientrsquos room and do not use the same cleaning materials in other rooms

o Usual terminal cleaning plus Removal of all dirtyused items removal of curtains prior to cleaning discard soap toilet paper paper towels glove box toilet brush clean and disinfect all surfaces hang clean curtains

bull In community health care settings o Patients with C difficile infection (eg uncontained fecal matter)

Scheduled at the end of the day Use of Contact Precautions Environmental cleaning of room and equipment with sporicidal

agent


March 2012 96


bull Discontinue antibiotics (other than treatment for C difficile) bull Routine assessment of admitted patients and initiation of Contact Precautions

with onset of diarrhea bull Screening for C difficile

o Collect stool samples for detection of cytotoxin as soon as possible after onset of diarrhea

o Do not test formed stool o A single negative PCR test can be used to rule out infection but 2 negative

EIA tests are needed to rule out infection bull Discontinuing Contact Precautions

o Suspected infection A single negative PCR test can be used to rule out infection but 2

negative EIA tests are needed to rule out infection If C difficile is still suspected other testing may be used (eg

colonoscopy) o Confirmed infection

Discontinue after at least 48 hours diarrhea-free Do terminal cleaning at end of Contact Precautions Re-testing is not necessary to discontinue Precautions

See APPENDIX 7b for Cleaning Protocol for MRSA VRE and C difficile


March 2012 97

SECTION-10-OUTBREAK MANAGEMENT

See the NWT Communicable Disease Manual for additional information on Outbreak control httpwwwhlthssgovntcapdfmanuals2007cdcmanfulldocpdf

bull Under the Disease Surveillance Regulations 2009 epidemic forms of disease are to be reported to the OCPHO IMMEDIATELY by telephone

An outbreak is any abnormal number or presentation of a disease For a health care setting it is a greater than expected number of patients or workers who are ill with similar symptoms at a particular place and time

Any health care provider that suspects or recognizes an outbreak should inform the OCPHO and infection control for that facility

Infection prevention and control in health care facilities is a key element of preventing mitigating and ending outbreaks Several hospital outbreaks have ended once enhanced environmental cleaning was implemented


bull Awareness of an outbreak influences a health care providerrsquos risk assessment and decision on what types of Precautions are necessary

bull Heightened surveillance and early reporting of symptoms to identify potentially infectious patients

o Identification of susceptible groups Patients and healthcare workers Congregated arrangements of the elderly or young children

including long-term care facilities and day cares Persons with underlying medical conditions or compromised

immune status o Early identification of the cause of the outbreak

Obtain laboratory confirmation but initiate Additional Precautions based on symptoms before confirmation of organism

o Initial assessment and treatment of ill persons bull Early implementation of Additional Precautions based on the type of outbreak

o Including cohorting of patients o Cohorting of staff

bull Appropriate signage to alert staff visitors and patients that an area is under outbreak and entry to the area may be restricted

The Office of the Chief Public Health Officer (OCPHO) 867-920-8646

SECTIO

N-1

0-O

UT

BR

EAK

MA

NA

GEM

ENT


March 2012 98

o Enforcing Occupational Health Illness Policies with follow-up of ill staff to determine if they are part of the outbreak

o May implement screening of patients and staff


bull Adequate PPE supplies and dedicated equipment for the outbreak area bull Enhanced environmental cleaning in outbreak area

o May include double-cleaning o Enhanced use of low-level disinfectants o Single use of mop heads and other cleaning materials for each affected

room o May include twice daily cleaning

bull Dedicated toileting facilities if shared rooms

3 Administration Controls

bull Formation of an outbreak management team with the involvement of the OCPHO bull Adequate staffing for enhanced environmental cleaning and if staff cohorting

implemented bull Ongoing monitoring and auditing of enhanced infection control measures bull Communication of outbreak in a health care facility

o Internally to staff patients visitors administration o To other sending and receiving facilities o To stakeholders when the outbreak is over

bull Occupational health and safety measures in place and enforced including o Illness policies o Immunization o Appropriate education and use of PPE

bull Debriefing and follow-up risk planning o Reinforce the importance of preparedness strategies for outbreak

prevention identification management and evaluation

Acute Respiratory Outbreak

In general an influenza-like illness respiratory outbreak exists when there are at least two or more cases presenting with acute respiratory tract illness within 48 hours in a specific area Cases may be among patients andor staff Respiratory outbreaks are common in the fall and winter months Suspect ILI in those presenting with two or more of the following symptoms

i Cough ii Runny nosesneezing


March 2012 99

iii Sore throathoarseness iv Nasal congestion v Sore muscles

vi Headache vii Chills

viii Anorexia GastrointestinalEnteric Outbreak

In general a gastrointestinal outbreak exists when there are at least two or more cases presenting with vomiting andor diarrhea illness within 48 hours in a specific area Cases may be among patients andor staff Common causes of gastrointestinal outbreaks in health care settings include norovirus (Norwalk-like virus) and Clostridium difficle Gastrointestinal illness usually has an acute onset between 12 to 60 hours and signs and symptoms may include

i Abdominal cramps ii Nausea

iii Vomiting iv Watery non-bloody diarrhea v Headache

vi Fever or chills vii Dehydration may be severe in elderly or young children

Correctional Facilities

Correctional facilities under the Northwest Territories may provide health services and have other infection prevention and control issues common to congregate settings This manual does not attempt to address all of the concerns related to Correctional Facilities due to specific concerns regarding antibiotic-resistant organisms particularly MRSA

Child Care Facilities Outbreak management in accordance to Daycare Regulations and in consultation with the CPHO and Chief Environmental Health Officer


March 2012 100

SECTION-11-CARE OF THE DECEASED

Care of the deceased ranges from events and locations leading up to death handling of the body storage in a morgue autopsy (if performed) and processing of the body for funerary services Appropriate handling of the body is necessary at each of these stages to prevent the risk of transmission of infection Planned Precautions can be implemented if the deceased was known to be infected with a contagious disease However presumptive Precautions may be required if testing is not readily available to guide decision-making In this case the risk assessment of the interaction and the likelihood of infectious agents are used to determine the necessary infection prevention and control needed

General Handling

bull Ideally health care facilities with a morgue andor autopsy areas should have appropriate facilities with negative pressure rooms that meet CSA Standards (CSA Z3172-10 or as current) If negative pressure is unavailable health care facilities should aim to provide appropriate ventilation

bull In general body bags should be used on all deceased infectious patients especially if there is a possibility of leakage of body fluids

bull If bodies are to be held for less than 48 hours storage at 6degC or less is appropriate Storage for longer than 48 hours in a NWT health care facility requires the authorization of the Office of the Chief Public Health Officer

When the infectious agent is known diseases are classified by their risk very high risk high risk medium risk and low risk

Very High High Medium Low

Interaction

Airborne Precautions

No viewing touching or preparation

Cover face of cadaver with facemask and other portals of secretions

Droplet Precautions


Contact Precautions

Droplet Precautions if excess secretions or aerosols


Routine Precautions

Viewing and touching is allowed

SECTIO

N-1

1-CA

RE O

F TH

E DECEA

SED


March 2012 101


Environmental

Body Bag

No embalming

Airborne PPE

Low-level disinfection with terminal cleaning

Body bag for CJD if leakage of body fluids

Droplet Precautions and supervision for ritual preparations


Body bag for leakage of body fluids

Embalming may be carried out

Viewing and touching allowed with Contact Precautions


Hygienic preparation is permitted

Administration

Medical Officer of Health may prevent viewings for severe infections

May require sealed coffin with metal liner

Droplet Precautions for family wishing to view the body

Examples

Invasive Group A Streptococcus sepsis if lt24hrs antibiotics Rabies Plague

CJD Typhus

HIV and Hepatitis BCor D if body fluid seepage

Untreated meningococcal disease MRSA Tuberculosis VRE

Adapted from the NWT Care of the Deceased Policy and Procedure


March 2012 102

See the NWT Infection Control Policy and Procedure on Care of the Deceased with an Infectious Disease httpwwwhlthssgovntcapdfmanuals2001clinical_practicepdfpage_82_nwt_infection_control_policy_and_procedures_on_care_of_the_deceased_with_an_infectious_diseasepdf

SECTION-12-CONSTRUCTION AND DESIGN OF HEALTHCARE FACILITIES

Approximately 500-1000 deaths in Canadian hospitals per year are due to the construction maintenance and repair of the facility These activities can release bacteria fungi and hazardous materials affecting vulnerable patients within the facility Plans for construction renovation or maintenance of health care facilities should incorporate infection control considerations throughout the process See Canadian Standards Association Z31713-07 Infection control during construction renovation and maintenance of health care facilities

The most significant risks arise from the generation of dust and moulds and disruption of the ventilation and water supply that can release fungal and bacterial organisms into the environment Any planned procedure should undergo a risk assessment to determine the level of preventive measures required based on the population risk group involved and the construction activity type

Population Risk Group Examples Construction

Type Examples

1 ndash Lowest Office area public area housekeeping closets etc

A Inspection and non-invasive activities painting minor plumbing

2 ndash Medium Outpatient clinics admissiondischarge areas physiotherapy etc

B Short duration cutting of walls or ceilings that creates minimal dust small patch sanding short plumbing work (lt30min)

3 ndash Med to High Emergency room diagnostic imaging day surgery labour and delivery etc

C Generate moderate to high level dust new wall larger removals plumbing (lt1hr)

4 ndash Highest ICU CCU operating rooms oncology units CSR etc

D High levels of dust heavy demolition construction over consecutive shifts plumbing with water disruption gt1hr


SECTIO

N-1

2-CO

NST

RU

CTIO

N A

ND

DESIG

N O

F HEA

LTH

CAR

E FACILIT

IES


March 2012 103

Construction Activity Risk Group Type A Type B Type C Type D 1 I II II IIIIV 2 I II III IV 3 I III IIIIV IV 4 I-III IIIIV IIIIV IV

A Risk Assessment Matrix is used to classify the level of preventive measure required

Preventive Measures I

bull Consult infection prevention and control bull Identify essential services that could be disrupted bull Identify and move high-risk patients bull Minimize patient exposures to construction bull Examples

o HEPA filter vacuum for dust control o Maintain a dry work environment o Schedule water disruptions during low user activity

Preventive Measures II

bull PM I plus bull Determine routes of transport for clean or sterile supplies and equipment bull Establish construction traffic routes bull Designate an elevator for construction traffic bull Establish a water temperature standard bull Determine methods to clean water systems bull Ensure an effective surveillance system is in place bull Examples

o Minimize dust with drop sheets sealing of windows doors and air vents walk-off mats at entrance to area

o Debris in covered containers and remove in evening

Preventive Measures III amp IV

bull PM I and II plus bull A multidisciplinary team shall meet to determine the appropriate

preventative measures bull Examples

o Impermeable dust barriers (hoarding) o Blocking the ventilation system o Negative air pressure and use of portable HEPA air filtration units


March 2012 104

o Cleaning of ventilation system if contaminated during construction o Use of anterooms for construction sites

The multidisciplinary team shall include expertise in the following areas bull Infection prevention and control bull Administration bull Project management bull Environmental services bull Health care (eg medical or nursing staff) bull Design (eg architects engineers) bull Operations and maintenance bull Construction

The Infection Prevention and Control member shall

bull Be an active member of the multidisciplinary team throughout the life of the construction project

bull Ensure that the appropriate preventive measures are initiated and adhered to bull Have the authority to stop construction if there is a significant failure to adhere

to the required preventive measures

Design of Health Care Facilities

The design planning of health care facilities is an opportunity to embed the engineering controls of infection prevention and control into the facility

The design of health care facilities should meet the Canadian Standards Association requirements specified in

Z8000-11 Canadian health care facilities and

Z3172-10 Special requirements for heating ventilation and air-conditioning (HVAC) systems in health care facilities

Various sections within this manual refer to these standards as a prompt to users to consider and implement these standards where they apply


March 2012 105

SECTION-13-REFERENCES


Communicable Disease Manual

TB Manual

HIVAIDS Manual

Clinical Practice Notices

Guidelines for the management of biomedical waste in the Northwest Territories

Care of the Deceased Policy and Procedure

Canadian Standards Association

Z31710-09 Handling of waste materials in health care facilities and veterinary health care facilities

Z31713 Fundamentals of infection control during the construction and renovation of health care facilities


Z8000-11 Canadian health care facilities

Z3148-08 Decontamination of reusable medical devices

Provincial Infectious Diseases Advisory Committee

Best Practices for Infection Prevention and Control Programs in Ontario

Routine Practices and Additional Precautions including Annex A B and C

Best Practices for Environmental Cleaning for Prevention and Control of Infections

Best Practices for Cleaning Disinfection and Sterilization of Medical EquipmentDevices

Best Practices for Hand Hygiene

Centers for Disease Control and Prevention

Guideline for Disinfection and Sterilization in Healthcare Facilities 2008

Guideline for isolation Precautions preventing transmission of infectious agents in healthcare settings 2007

Guide to infection prevention for outpatient settings

SECTIO

N-1

3-R

EFEREN

CES


March 2012 106

Qmentum Program Accreditation Canada

Infection Prevention and Control Standards

Canadian Agency for Drugs and Technologies in Health

Reprocessing of single-use medical devices in Canada 2008

Canadian Dental Association

Infection Prevention and Control in the Dental Office 2006

Federal Bureau of Prisons Clinical Practice Guidelines

Management of methicillin-resistant Staphylococcus aureus (MRSA) infections

Sioux Lookout Regional Infection Control Network

Australian Commission on Safety and Quality in Healthcare

Australian guidelines for the prevention and control of infection in healthcare 2010

Newfoundland and Labrador Department of Health and Community Services

Guideline for routine practices and additional Precautions 2009

CUPE

Health care associated infections a backgrounder httpcupecahealth-carehealth-care-associated-infections


March 2012 107

SECTION-14-APPENDICES

Northwest Territories Infection Control Committee

Terms of Reference 20112012

Title

diams NWT Infection Control Committee

Purpose

diams The NWT Infection Control Committee will share consistent best practices to prevent the acquisition and transmission of infections including antibiotic resistant organisms (AROs) in health care facilities and communities

diams This committee will communicate promote and educate to obtain adherence to NWT Infection Control Standards Public Health Act Legislation and Regulations Accreditation Canada Qmentum Standards and Required Organizational Practices (ROPS and applicable supplementary CSA standards

Membership (members)

1 Representatives from all health care facility infection control committees (4)

2 General Practitioner (physician or nurse practitioner)

3 Public Health Nurse

4 Regional representation (Community Health Nurse Manager of Health Services long term care facility or other health related position)

5 Senior Microbiology Laboratory Representative

6 ChiefDeputy Public Health Officer

7 Communicable Disease Specialist (Department of Health and Social Services)

8 Chief Environmental Health Officer

9 Communications Officer

10 Nursing Consultant Primary Care Unit

APPEN

DIX-1-The N

WT Infection Control Com

mittee (ICC) Term

s of Reference


March 2012 108

bull The Chairperson is appointed by the Chief Public Health Officer (CPHO) at the recommendation of the committee for a 2 year (renewable) term

bull Ad hoc participation of professionals such as pediatrician dentist pharmacist and internal medicine shall be requested as indicated

bull The membership is for a preferred period of two years ideally with no more than 50 member to change at any given time

Secretariat A secretariat function will be provided by the Health Protection Unit to assist the Chairperson

Quorum

diams Recommendations require a quorum of 50 of the voting members

Schedule of Meetings

diams Meetings shall be held quarterly or as necessary

diams The chairperson shall call special meetings as required

diams A standard agenda will be used

diams A record of decision amp actions will be recorded at each meeting transcribed and circulated to members according to the distribution list at least one week before the next meeting

Duties and Responsibilities

Review revise update develop recommend and evaluate infection control standards

To develop recommend and evaluate guidelines for AROs detection surveillance prevention of emergence and transmission

Make recommendations to the Chief Public Health Officer regarding Infection Control policies standards protocols resources and training

Share best practices between authorities to enhance consistent infection control standards and antibiotic stewardship

Develop an Infection Control Communication Strategy and Campaign targeting decision makers health care providers organizations and the general public this campaign will include handwashing messages and programs environmental cleaning standards AROs Control and Prevention Guidelines

Develop a workplan for the upcoming year


March 2012 109

Committee Performance Guide

diams Annual report on activities to CPHO DHSS and to regional authorities

diams Statistical information is reviewed and evaluated

Reporting Structure

diams The committee reports to the Chief Public Health Officer

Review and Update

diams The Terms of Reference of the Infection Control Committee shall be reviewed annually each April or more often if needed


March 2012 110

APPENDIX-2-Audits

MD- Physician OT- Occupational

H-Housekeeping LPN- RN-Registered Nurse PT-Physical

D-Dietary

KEY D ndash Bed closest to door W- Bed closest to window

HW - Handwash

HR- Alcohol hand rub

Bed Location D W D W D W D W D W D W D W Isolation Precautions Y N

Healthcare Worker Type

Opportunity Requiring Hand Hygiene Intervention M-missed O-observed

Before pt contactentering room

After patient contact After pt environment contact (bedside table bed rail curtain door)

Before invasive procedure(IV foley line placement)

After invasive procedure

Before wound care After wound care

After removing gloves

Before body fluid contact

After body fluid contact

After leaving an

Hand Hygiene Monitoring Tool Department Date Day of week

Time AMPM TO AMPM Monitor

APPEN

DIX- 2a)- H

and Hygiene M

onitoring Tool


March 2012 111

isolation room Before eatingbreak After eatingbreak Outcome Hand Wash Alcohol Hand Rub No Action ndash Missed Opportunity

PPE worn (glovesgownmask)

Nails short not colored or artificial

Small flat ring on hand


March 2012 112

Hand Hygiene Structural Audit

Date Auditor

Area

ABHR -Alcohol-based hand rubs

OBSERVATION YES NO COMMENTS

ABHR available at point of care

ABHR containers are full

Soap is available at sinks

Glove dispensers are stocked with 2 Or more sizes

Hand hygiene education is documented (education binder)

Hand hygiene educational posters are visible for staff

Hand hygiene educational posters are visible for patientsvisitors

APPEN

DIX -2b)- H

and Hygiene Structural A

udit


March 2012 113

Department Date of Review

Reviewer

Criteria REQUIREMENTS RATING ACTION NEEDED C NI NA

Patient Rooms

Horizontal surfaces are clean No visible soil on vertical surfaces Trash cans not overflowing Bathroom is clean Hand-hygiene products available Soap and paper towels available PPE available as needed

Isolation Rooms

Appropriate signage in place Supplies and PPE available Trash and linen handled per policy Appropriate PPE used by staff Appropriate patientfamily education

Airborne precautions Door closed Negative pressure is

monitored

Appropriate air exchange

Hand Hygiene

Sinks for handwashing are appropriately stocked with soap paper towels trash cans Sinks are available in all areas as needed Alcohol handrubs are available in patient rooms and other areas as needed Placement of alcohol handrubs is compliant with safety recommendations Handwashinghand hygiene is monitored for staff compliance

Refrigerators

Daily temperature checks are documented with appropriate temps Refrigerator has single use (medication foods specimens) Items are appropriately labeled Refrigerator is clean and defrosted (if necessary)

Linens (clean)

Linens are in good condition Stored on covered cart or in linen room Covered for transport

APPEN

DIX -2c)- N

WT Infection Control Cleaning A

udit


March 2012 114


Linens (soiled)

In hamper with impervious liner or hamper is cleaned on specific schedule Hamper is covered Soiled linen covered for transport Soiled linen is bagged at bedside Removed from building on specified schedule

Halls Uncluttered

Horizontal and vertical surfaces are clean Full unobstructed access to exits

Administrative areas

Offices

Conference rooms

Nurses stations

Horizontal and vertical surfaces are clean

Trash is not overflowing Carpet if used is not soiled

Bathrooms are clean

Hazardous Biohazard materials and

Biomedical waste

Storage areas have appropriate signage

OSHA-compliant storage containers

Picked up for transport on specified schedule

Appropriate sharps containers in use

Sharps containers no more than 23 full

Sharps containers secured for transport

Appropriate biomedical waste manifests maintained

DisinfectionSterilization

Equipment is in good working condition

Appropriate processes in place for chemical disinfection

Appropriate sterilization records are maintained

Chemicalbiological monitors are used as appropriate

Preventive maintenance program in place

Employee protection measures are implemented

Event-related sterilization packaging is used

Storage

Storage areas are clean and uncluttered

Supplies are at least 457 cm18 in from ceiling

Supplies are at least 153 cm 6 in from floor


March 2012 115


Supplies are not stored under sinks

Clean utility

Door to room is labeled Environment is clean Clean equipment is taggedbagged as ready to use

No supplies stored under sink All supplies off the floor

Soiled Utility

Door to room is labeled Biohazard symbol on door if biomedical waste in room

Soiled linen in hamper with impervious liner or hamper is cleaned on specific schedule

Room is uncluttered Clean supplies not in room Appropriate PPE available

Waiting Areas


Trash is not overflowing Area is uncluttered If appropriate supplies for respiratory hygiene available and posted instructions in place

Public Bathrooms

All surfaces are clean Handwashing supplies are available

Trash is not overflowing If cleaning checklist is used appropriately signed off

Laboratory


Biomedical waste is handled per policy

PPE is used as needed and per policy

Hand-hygiene policies are followed

Pharmacy


Hoods are maintained per policy Hand-hygiene policies are followed Equipment is clean Medication labeling and expiration practices are appropriate

Adapted from Infection Control Manual for Hospitals Second Edition C ndash Compliance NI ndash Needs Improvement NA ndash Not Applicable


March 2012 116

APPENDIX-3-Hand Hygiene

APPEN

DIX- 3a)-U

sing an Alcohol Based H

and Rub (ABH

R)


March 2012 117

APPEN

DIX-3b)-U

sing Plain Soap


March 2012 118

APPENDIX-4-PPE Types Medical Gloves

Type Use Advantage Disadvantage Vinyl bull Protection for

o Minimal exposure to bloodbody fluidsinfectious agents

o Contact with strong acids and bases salts alcohols

o Short duration tasks o Protection for staff with

documented skin breakdown

bull Good level of protection but based on the quality of manufacturer

bull Medium chemical resistance

bull Not recommended for contact with solvents aldehydeskeytones

Latex bull Activities that require sterility bull Protection for o Heavy exposure to bloodbody

fluid infectious agents o Contact with weak acids and

bases alcohols

bull Good barrier qualities bull Strong and durable bull Has re-seal qualities bull Good comfort and fit bull Good protection from

most caustics and detergents

bull Not recommended for contact with oils grease and organic s

bull Contraindicated for individuals who have allergic reactions or sensitivity to latex

Nitrile bull Protection for o Heavy exposure to blood and

body fluidsinfectious agents o Tasks of longer duration o Tasks with high stress on gloves o Tasks requiring additional

dexterity o Chemical and chemotherapeutic

agents o Recommendation for contact

with oils grease acids bases o Sensitivity to latex o Preferred replacement for vinyl

gloves when a documented allergy or sensitivity occurs

bull Offers good dexterity bull Strong and durable bull Puncture resistant bull Good comfort and fit bull Excellent resistance to

chemicals

bull Not recommended for contact with solvents keytones esters

Neoprene bull Replacement sterile gloves for latex when a documented allergy or sensitivity occurs

bull Recommended for contact with acids bases alcohol fats oils phenol glycol ethers

bull Good barrier qualities bull Strong and durable bull Good comfort and fit bull Good protection from

caustics

bull Not recommended for contact with solvents

Adapted from Sunnybrook Health Sciences Centre Patient Care Policy Manual Section II Infection Prevention and Control and the London Health Science Centre Occupational Health and Safety Services manual ldquoGlove selection and userdquo Revised April 2005

APPEN

DIX-4a)-M

edical Gloves


March 2012 119

Eye Protection

Type Use Advantage Disadvantage

Safety Glasses

bull Protection for o Exposure to

infectious droplets or bloodbody fluids

bull Maybe cleaned and re-used until visibility is compromised

bull Maybe worn over prescription glasses

bull Good visibility

bull With continued used visibility may be compromised

Goggles





bull Poor visibility

Face Shield





Visor attached to mask

bull Protection for o Minimal

exposure to infectious droplets or bloodbody fluids

bull May be worn with prescription glasses

bull Quick to put on

APPEN

DIX-4c)-Eye Protection


March 2012 120

Masks and N95 Respirators


Standard Face Mask (procedure mask or ldquoisolationrdquo mask)

bull Protection For o Minimal exposure to

infectious droplets o Short duration tasks o Tasks that do not

involve exposure to bloodbody fluids

o Protection from patient during transportation outside room

bull Inexpensive bull Not fluid or water resistant

Fluid Resistant Mask

bull Protection for o Heavy exposure to


bull Good comfort and fit

bull Fluid resistant

bull Expensive

Surgical Mask

bull Protection For o Exposure to


o Long duration tasks


bull Fluid resistant bull Inexpensive

NIOSH ndash certified N95 respirator

bull Protection from airborne pathogens

bull Provides protection from small particle aerosols

bull Better face seal prevents leakage around mask

bull Required fit testing training and seal checking

bull Expensive bull Uncomfortable

for long periods of use

APPEN

DIX-4d)-M

asks and N95 Respirators


March 2012 121

APPENDIX-5-Personal Protective Equipment (PPE)

APPEN

DIX-5a)-Putting on PPE


March 2012 122

APPEN

DIX-5b)-Rem

oving PPE


March 2012 123


March 2012 124

APPEN

DIX-5c)-N

95 Respirator Protocol


March 2012 125

APPEN

DIX-5d)-Care of Reusable PPE


March 2012 126

APPENDIX-6-Communicable Disease Reference Chart

Disease causative organisms

PHNC Mode Of Transmission Additional Precautions

Duration Of Precautions

Comments

Abscess draining Direct Contact Contact Until stops or contained

Minor or limited abscesses that are contained do not require Additional Precautions

Adenovirus Direct Contact (Conjunctivitis Gastroenteritis)

Contact Duration of conjunctivitis only diapered children for gastroenteritis

Direct Contactbull Droplet (Pneumonia)

Contact Droplet

Duration of illness

Amebiasis (entamoeba histolytica)

2 Fecal Oral Route Routine

Anthrax (Bacillus anthracis)

1 Not Transmitted From Person-To-Person (Cutaneous Or Inhalational)

Routine At all times

Botulism (Clostridium botulinum)

1 Not Transmitted From Person-To-Person



March 2012 127




Comments

Bronchiolitis Droplet Direct Contact

Contact Droplet

Duration of illness

Precautions for infants and young children

Brucellosis 3 Routine

Campylobacteriosis 2 Fecal Oral Route Routine Contact

Contact precautions for diapered or incontinent patients and children lt6 years old

Chickenpox 3 Airborne Airborne 5 days after rash or when all lesions crusted over

Contact Infection Control IMMEDIATELY if suspected case

Chlamydia 3 Person-To-Person Routine

Cholera 2 Fecal Oral Route Routine Contact

Contact precautions for diapered or incontinent patients and children under the age of 6 Notify infection control for specific instruction for suspected case

Clostridium difficile 2 Fecal Oral Route Contact Until normal


March 2012 128




Comments

(Spores) stools for at least 48 hours and terminal cleaning completed

Congenital rubella 2 Droplet Direct Contact (Urine)

Contact Droplet

Infant to be placed on precautions for each admission until 1 year of age unless nasopharyngeal and urine viral cultures taken after the age of 3 months are negative

Notify infection control immediately for specific instructions for suspected case

Conjunctivitis viral Direct And Indirect Contact

Contact Duration of infection

Coxsackievirus (Enteroviral infection)

Droplet Direct Contact Routine Adult

At all times


March 2012 129




Comments

Contact Pediatric

Duration of illness

Includes hand foot and mouth disease herpangina aseptic meningitis

Creutzfeldt- Jakob Disease (CJD) (Subacute spongiform encephalopathy)

3 Direct And Indirect Contact


Contact Infection Control For Additional Information

Cryptosporidiosis 2 Fecal Oral Route Routine Contact

Requires contact precautions for diapered or incontinent patients and children under the age of 6

Cyclospora infection 3 Fecal Oral Route Routine Contact


Cytomegalovirus (cmv) 3 Direct Contact (Mucosal Exposure To Infective Body Fluids)


Dengue Routine


March 2012 130




Comments

Diarrhea Acute Suspect Gastroenteritis

1 (if epidemic)

Fecal Oral Route Routine Contact

48 hours after normal stool or infectious cause ruled out


Diphtheria 1 Droplet (Pharyngeal) Direct Contact (Cutaneous)

Droplet Contact

Until finished antibiotics and two cultures 24 hours apart are negative


Encephalitis 2 Direct And Indirect Contact Fecal Oral Route

Routine Adult

Until specific etiology established or enterovirus ruled out

Contact Pediatric

Enterobiasis(Enterobius vermicularis oxyuriasis pinworm)

Direct Contact Routine At all times

Epiglottitis (Haemophilus

2 Droplet Direct Contact Routine Adult

At all times


March 2012 131




Comments

Influenzae Type B Group A Streptococcus (Igas) Invasive Staphylococcus Aureus)

Droplet Pediatric if Haemophilus Influenzae Type B Otherwise Routine

Until 24 hours of effective antimicrobial therapy received unless Haemophilus influenzae type b ruled out

Epstein-Barr VIRUS (Infectious Mononucleosi

Direct And Indirect Contact


Erythema Infectiosum ( Parvovirus B-19 Fifth Disease)

Droplet Direct Contact Routine Fifth Disease

At all times

Droplet A plastic Crisis

7 days for patients with transient A plastic or Erythrocyte crisis For duration of hospitalization for immunocompromized patients with chronic


March 2012 132




Comments

infection

Escherichia Coli 2 (verotoxigenic)


Duration of illness

Contact precautions for diapered or incontinent patients and children under the age of 6

Giardia Lamblia 3 Fecal Oral Route Routine Contact


Gonococcal Ophthalmia Neonatorum

3 Vertical Routine

Gonorrhea 3 Person-To-Person Routine

Group A Streptococcal Disease Invasive

2 Respiratory Sections Wound Drainage Skin Exudates

Droplet Contact

24 hours after effective antibiotics

Group B Streptococcal Disease Neonatal

2 Vertical Routine

Hand Foot And Mouth Disease


Routine Adult

At all times


March 2012 133




Comments

Fecal Oral Route Contact Pediatric

Duration of illness

Haemophilus Influenzae Type B (Invasive Disease)


At all times

Droplet Pediatric

Until 24 hours after effective antibiotic therapy

Hantavirus Pulmonary Syndrome

2 Routine

Hemorrhagic Fever (Ebola Lassa Fever Marburg Virus Other Viral Causes)

2 Direct And Indirect Contact Possibly Airborne If Pneumonia

Airborne

Contact

Until symptoms resolve

For Lassa Fever - duration of viral shedding

Notify infection control immediately for specific instructions for suspected case Once in hemorrhagic phase infection control must approve movement from private negative air pressure room N-95 mask unless in hemorrhagic phase then Positive air pressure respirators required


March 2012 134




Comments

Hepatitis A 1 Fecal Oral Route Routine Contact

Until 14 days after onset and no more than 7 days after jaundice


Hepatitis B C D 1 Mucosal Or Percutaneous Exposure To Infective Body Fluids


Herpes Simplex Virus (Hsv)

3 Direct Contact Encephalitis Routine

At all times

Mucocutaneous (Disseminated Or Primary amp Extensive) Contact Neonatal Contact Recurrent Routine

Until lesions resolved

Duration of illness

At all times

Hiv (Human Immunodeficiency

3 Mucosal Or Percutaneous Exposure To Infective Body Fluids



March 2012 135




Comments

Virus)

Aids (Acquired Immunodeficiency Syndrome)

Blood Transfusion Or Organ Transplant If Contaminated Blood Or Organ Infected Mother To The Fetus Or Baby Breast Milk

Human T-Cell Lymphotropic Virus

3 Routine

Influenza 2 Droplet Droplet Duration of illness once fever and cough resolve

Influenza patients can be cohorted only if type is known and the same Influenza A with A or B with B but not A with B

Legionnaires Disease (Legionella Pneumophila)



Leprosy 3 Contentious Transmission From Nasal Mucosa

Routine Contact


March 2012 136




Comments

Lice (Pediculosis)



Contact If In Pediatric Unit Or If Heavily Infected

Until 24 hours after effective treatment

Listeriosis 3 Contaminated Sources Routine

Lyme Disease (Borrelia Burgdorferi)



Malaria (Plasmodium Sp)



Measles 2 Respiratory Secretions Airborne 4 days after rash starts

Notify Infection Control immediately if suspect measles

Meningitis 2 Bacterial Respiratory Secretions

Droplet Until 24 hours of effective antibiotics


March 2012 137




Comments

Viral Direct And Indirect Contact

Contact duration of illness

Meningococcal Disease Invasive

2 Respiratory Secretions Droplet Until 24 hours of effective antibiotics

Includes bacteremia meningitis Invasive defined as from blood CSF pericardial fluid peritoneal fluid joint fluid or intra-operative swab from normally sterile site

Methicillin Resistant Staphylococcus Aureus


Contact Variable Discuss precautions with Infection Control

Mumps 3 Respiratory Secretions Droplet 5 days after swelling

Norovirus Norwalk Gastroenteritis



Penicillin-Resistant Streptococcal Pneumonia

3

Respiratory Secretions Droplet


March 2012 138




Comments

Pertussis 2 Respiratory Secretions Droplet 5 days of effective therapy

Inform Infection Control immediately

Plague 1 Bubonic Routine Inform Regional Infection Control immediately

Pneumonic Droplet 72 hours of effective therapy


Pneumococcal Disease Invasive

2

Poliomyelitis 1 Fecal Oral Route Routine

Psittacosis 3 Rarely Transmitted From Person-To-Person

Routine

Q Fever 3 Not Transmitted From Person-To-Person

Routine

Rabies 1 Not Transmitted From Person-To-Person

Routine


March 2012 139




Comments

Respiratory Syncytial Virus (Rsv)

3 Respiratory Secretions Droplet Contact

Duration of illness

Rheumatic Fever Not Transmitted From Person-To-Person


Roseola (Roseola Infantum Exanthem Subitum Human Herpesvirus 6 Sixth Disease)


Rubella 2 Droplet Direct Contact Droplet Contact

4 days after rash

Infants with Congenital Rubella Syndrome may shed

Salmonellosis 1 Fecal Oral Route Routine Contact


Sars 1 Droplet Droplet Inform Infection Control immediately

Scabies (Sarcoptes Scabiei)


Contact Until 24 hours after effective


March 2012 140




Comments

treatment

Shigellosis 2 Fecal Oral Route Routine Contact


Syphilis 2 Person-To-Person Routine

Tapeworm Infestations

3 Ingestion Of Contaminated Food Or Water

Routine

Tetanus 2 Not Spread Person To Person

Routine

Toxoplasmosis Symptomatic Only

3 Vertical Routine

Trichinosis 3 Person-To-Person Routine

Tuberculosis 2 Airborne Airborne Inform Infection Control See Manual for


March 2012 141




Comments

Discontinuation

Tularemia 3 Not Spread Person-To-Person

Routine

Typhoid D Paratyph Fever

2 Fecal Oral Route

Routine Contact


Vancomycin-Resistant Enterococci (Vre)


Contact Duration of stay Inform Infection Control see Manual for discontinuation

West Nile Virus Not Transmitted From Person-To-Person


Yellow Fever Not Transmitted From Person-To-Person



March 2012 142

APPENDIX-7-Cleaning

Checklist for DischargeTransfer Cleaning of all Rooms

1 Are all dirtyused items removed Yes No bull Disposable items Yes No

2 Are the curtains removed before starting to clean if visibly soiled Yes No

3 Are clean cloths mop (all supplies) and solution used to clean the room Yes No

4 Did you fill one bucket of the disinfectant so it is the correct strength Yes No

5 Did you check to see that the mattress pillows and chairs are not torn Yes No

6 There is to be no double dipping with used cloths Yes No

7 Did you use several cloths to clean a room Yes No

8 Did you always work from top to bottom Yes No

9 Did you clean all surfaces and allow for appropriate contact time (10 minutes-see APPENDIX A)

bull Mattress Yes No bull Pillow Yes No bull Bp Cuff Yes No bull Bedrails and Bed Controls Yes No bull Call Bell Yes No bull Stethoscope and Column Yes No bull Flow Meters Yes No bull Suction Tube and Outer

Container Yes No

bull Pull Cord in Washroom Yes No bull Overbed Table Yes No bull Inside Drawers Yes No bull TV Control Yes No bull Soap Dispenser Yes No bull Door Handles Yes No bull Light Switches Yes No bull Light Cord Yes No bull Chair Yes No

10 Did you clean the phone well Yes No 11 Are the following cleaned thoroughly before being used by another patient

bull CommodesHigh Toilet Seat Yes No

bull Wheelchairs Yes No

APPEN

DIX-7a-Checklist for D

ischargeTransfer Cleaning of all Rooms


March 2012 143


bull Monitors Yes No

bull IV Poles Yes No

12 If the sharps container was 23 full or more was it replaced Yes No

13 Was the outer canister of the suction container and tubing cleaned Yes No

14 Was all tape removed from surfaces Yes No

15 Was the sheepskin washed between patients Yes No

16 Was the lift mesh or sheet washed between patients Yes No

Additions When Cleaning a Room for a Patient on Additional Precautions 1 Are the curtains removed before starting to clean the room that was used

for additional precautions Yes No

2 Was glove box discarded Yes No

3 Are the following discarded

bull Hand Soap Yes No

bull Toilet Paper Yes No

bull Disinfectant Yes No

4 Was the sharps container replaced Yes No

NOTE Avoid stockpiling items in the room in order to prevent wastage


March 2012 144

SPECIAL CLEANING FOR MRSA VRE AND C difficle

DAILY CLEANING Use a fresh bucket cloth and mop head

Floors

Bathrooms

Horizontal Surfaces (tables bed rails call bells work surfaces mattressescovers doorknobs sinks light fixtures chairs)

Nursing Station

Walls ndash check for visible soiling

CLEANING AT DISCHARGETRANSFER

Remove all dirtyused items from the room before cleaning the room (eg suction container wheelchairs medical supplies disposable items)

diams Items which can be cleaned must be cleaned before removing from the room

diams Medical supplies which can be reprocessed should be bagged and sent for reprocessing

diams Discard disposable items and items that cannot be reprocessed

Remove Bed Curtains and send for laundering

Work from top to bottom and from clean area (eg windows) to dirty area (eg bathroom)


Bathrooms including commodeshigh toilet seat

Horizontal Surfaces ndash bedrails and bed controls call bell overbed table inside drawers TV controls soap dispenser door handles light switches light cord chairs suction tube and outer container pull cord in washroom flow meters stethoscope and column telephone IV poles monitors wheelchairs

Patient beds (includes mattressescovers)

Floors

Discard glove box soap toilet paper toilet brush sharps container and replace with new items

APPEN

DIX-7b)-Special Cleaning for M

RSA V

RE and C difficle


March 2012 145

Cleaning Recommendations Clinic Rooms Between Patients

Daily Staff Responsibility

Regular clinic visit

Exam table baby scale stethescope and blood pressure cuff (if used) and any other equipment table or surfaces

Virex solution

After each patient

Aerosolizing procedure (ieNasal-pharyngeal swabbing)

All surfaces including exam table sink counter and desk etc and equipment

Virex solution After each patient

Toys NO SOFT TOYS SHOULD BE PROVIDED IN THE CLINICS

Toys should be kept to a minimum

Mouthed toys or toys visibly soiled should be removed from circulation immediately

Virex or 10 bleach solution should be used

Should be kept to a minimum Only use those toys that can be cleaned Clean toys on a daily basis

Note In rooms where aerosolizing procedures may be completed

bull remove all clutter magazines supplies etc off of the surfaces within a 2 metre radius of the patient being tested

bull Clean all surfaces between patients

APPEN

DIX-7c)-Cleaning Recom

mendations Clinic Room

s


March 2012 146

Cleaning Recommendations Clinics Public Health Homecare

Cleaning Staff Cleaning staff that are working after hours and during the day who do not have direct patient care should follow the regular routine infection control practice of hand hygiene respiratory hygiene (cough and sneeze etiquette) and use personal protective equipment as directed by the employer (WHIMIS and WSCC recommendations)

Clinic Rooms

Desks and surfaces on chairs that can be cleaned Virex solution Daily

Employee must place desk top items in the center of the desk at the end of the day

Countertops and sinks Virex solution Daily

Employee to keep surface areas clutter free by end of the day for cleaning

Exam table Virex solution Daily

Floors Carpet

Virex solution Vacuum

Daily Daily

Bathrooms Public and Staff

Countertops sinks toilets and floors Virex Daily

Phones Light switches and door handles Virex Daily

Hallways

Carpet Floors

Vacuum Virex

Daily Daily

Waiting Rooms

Surfaces Carpet

Virex Vacuum

Daily Daily


March 2012 147

Floors Virex Daily

Reception and Chart areas

Surfaces Floors Carpet

Virex Virex Virex

Daily Daily Daily

Clinic Staff to keep surfaces clutter free and toys to a minimum

Staff LunchKitchen Area

Counter sink surfaces table tops Virex Daily Clinic staff to ensure

area is clutter free and dishes put away at the end of the day Floors

Carpets Virex

Vacuum Daily Daily

Clean Dirty Utility areas including vaccine storage area (Public Health) and Resource room (Public Health)

Surfaces sinks counters Floors

Virex Virex

Daily Daily

Clinic staff to ensure surfaces are free of clutter

Private Offices with no direct patient care

Desk top Floor Carpet

Virex Virex

Vacuum

Daily Daily Daily

Staff member to ensure items on desk are moved to the center of the desk at the end of the day

Virex II This is a low- level hospital grade quaternary disinfectant detergent and deodorizer It is a no-rinse cleaner and disinfectant approved for cleaning all non-porous surfaces washable painted surfaces hard surface flooring porcelain fixtures tubs tile metal and plastic laminates like Formica It is safe to use in areas where newborns children and maternity clients are waiting or being seen It is a broad spectrum veridical bactericidal and fungicidal agent

( Yellowknife Health and Social Services Authority)


March 2012 148

APPEN

DIX-7d)-Bed and Stretcher Cleaning


March 2012 149

APPEN

DIX-7e)-Blood Spill Floor


March 2012 150

APPEN

DIX-7f)-Blood and Body Fluid Carpet Stain Cleaning


March 2012 151

APPEN

DIX-7g)-Com

mode Cleaning


March 2012 152

APPEN

DIX-7h)-D

amp m

opping of floors


March 2012 153

APPEN

DIX-7i)-D

amp W

iping of Surfaces


March 2012 154

APPEN

DIX-7j)-Tub and Show

er Cleaning


March 2012 155

APPEN

DIX-7k)-W

heelchair Cleaning


March 2012 156

APPEN

DIX-7l)-Exam

Table Cleaning


March 2012 157

Sample Procedure for Cleaning Toys

After each use clean disinfect and rinse thoroughly

bull Toys that may be lsquomouthedrsquo (eg infant and toddler toys)

Daily clean with detergent and approved disinfectant

bull High-touch surfaces of shared electronic games (eg keyboards joysticks)

bull High-touch surfaces of playhousesclimbersrocking horses bull High-touch surfaces in playrooms (eg tables chairs

doorknobs) bull Discard shared books magazines puzzles cards and comics

when visibly soiled and after use in rooms where the patient is on Additional Precautions

Scheduled clean

bull Clean toy storage binsboxescupboards shelves bull Clean all surfaces of playhousesclimbers

Adapted from CHICA-Canadarsquos lsquoToys Position Statementrsquo

APPEN

DIX-7m

)-Toy Cleaning


March 2012 158

APPEN

DIX-7n)-Routine W

ashroom Cleaning


March 2012 159

Sample Terminal Cleaning Protocol for Routine Precautions (PIDAC)

1 Assessment 992256 Check for Additional Precautions signs and follow the indicated precautions 992256 Walk through room to determine what needs to be replaced (eg toilet paper paper

towels soap alcohol-based hand rub (ABHR) gloves sharps container) and whether any special materials are required this may be done before or during the cleaning process

2 Assemble supplies 992256 Ensure an adequate supply of clean cloths is available 992256 Prepare fresh disinfectant solution according to manufacturerrsquos instructions 3 Perform hand hygiene and put on gloves 4 Remove dirty linen 992256 Strip the bed discarding linen into soiled linen bag roll sheets carefully to prevent

aerosols 992256 Inspect bedside curtains and window treatments clean or change if visibly soiled 992256 Remove gloves and perform hand hygiene 5 Apply clean gloves and clean room working from clean to dirty and from high to low areas of the room 992256 Use fresh cloth(s) for cleaning each patientresident bed space if a bucket is used

bull do not lsquodouble-diprsquo cloth(s) back into cleaning solution once used bull change the cleaning cloth when it is no longer saturated with disinfectant and

after cleaning heavily soiled areas such as toilet and bedpan cleaner bull if there is more than one patientresident bed space in the room use fresh

cloth(s) for each and complete the cleaning in each bed space before moving to the next

992256 Start by cleaning doors door handles push plate and touched areas of frame 992256 Check walls for visible soiling and clean if required remove tape from walls clean

stains 992256 Clean light switches and thermostats 992256 Clean wall mounted items (eg ABHR dispenser glove box holder top of suction

bottle intercom blood pressure manometer) 992256 Use glass cleaner to remove fingerprints and soil from low level interior glass

partitions glass door panels mirrors and windows 992256 Check privacy curtains for visible soiling and replace if required in long-term care

change curtain 992256 Clean all furnishings and horizontal surfaces in the room including chairs window

sill television telephone computer keypads night table and other tables or desks Lift items to clean the tables Pay particular attention to high-touch surfaces

APPEN

DIX-7o)-Sam

ple Terminal Cleaning Protocol for Routine Precautions (PID

AC)


March 2012 160

992256 Clean equipment (eg IV pole and pump walkers wheelchairs) 992256 Clean inside and outside of patientresident cupboard or locker 6 Clean the bed 992256 Clean top and sides of mattress turn over and clean underside 992256 Clean exposed bed springs and frame 992256 Check for cracks or holes in mattress and have mattress replaced as required 992256 Inspect for pest control (bed bugs) 992256 Clean headboard foot board bed rails call bell and bed controls pay particular

attention to areas that are visibly soiled and surfaces frequently touched by staff 992256 Clean all lower parts of bed frame including casters 992256 Allow mattress to dry 7 Clean bathroomshower 8 Clean floors 9 Disposal 992256 Place soiled cloths in designated container for laundering 992256 Check sharps container and change when 23 full (do not dust the top of a sharps

container) 992256 Remove soiled linen bag and replace with fresh bag 992256 Place obvious waste in receptacles 992256 Close garbge bags and remove clean garbage canholder if soiled and add a clean bag 10 Remove gloves and perform hand hygiene DO NOT LEAVE ROOM WEARING SOILED GLOVES 11 Remake bed and replenish supplies as required (eg gloves ABHR soap paper towel toilet brush) 12 Return cleaned equipment (eg IV poles and pumps walkers commodes) to clean storage area


March 2012 161

APPEN

DIX-7p)-Laundry H

andling


March 2012 162

APPEN

DIX-7q)-H

andling Garbage


March 2012 163

APPEN

DIX-7r)- Sharps H

andling


March 2012 164

APPENDIX 8 Precautions Requirements and Signage

CONTACT PRECAUTIONS

Element Acute Complex Continuing

CareRehab Long Term

Care AmbulatoryClinic Setting

Home Health Care

Accommodation

Door May Be Open

No Restrictions on

Accommodation

Single Room with dedicated toilet and patient sink Placement in on a case by case basis Remain in room unless required for diagnostic therapeutic or ambulation purposes

Not required to remain in room unless symptomatic

Identify patients who require precautions

May go outside the facility but cannot visit other patients rooms

Encourage patient to perform hand hygiene on entering the setting

Signage Yes Flag Chart

Gloves For all activities in the room bed space For direct care

Gown For all activities where skin or clothing will come in contact with the patient or the patientrsquos environment For direct care

Equipment and items in the

environment

Dedicate if possible As per routine practices

As per routine practices

Chart (paper or mobile electronic) should not be taken into room

Clean and disinfect shared items (eg Assigned dining area) or cover with a sheet before use

Clean and disinfect shared items (eg Chair examination table) or cover with a sheet before use

Environmental Cleaning

VRE and Cdifficile rooms require special cleaning Routine cleaning for all other rooms

No special cleaning

requirements Remove and launder all curtains (privacy window shower) when visibly soiled and on terminal cleaning

Transport

Staff wear gloves and gown for direct contact with patient during transport

Staff wear appropriate PPE for direct contact with the patient during transport

Not applicable

Clean and disinfect equipment used for transport after use Communication Effective communication regarding precautions must be given to patients and their families other departments other facilities and

transport services prior to transfer

APPEN

DIX-8a)-Contact Precautions


March 2012 165


March 2012 166

DROPLET PRECAUTIONS

Element Acute Complex

Continuing CareRehab

Long Term Care AmbulatoryClinic

Setting Home Health Care

Accommodation

Door may be open Discuss feasibility of spatial separation with patient (eg when sleeping)

Single Room with dedicated toilet and patient sink preferred

Patient to remain in room or bed space if feasible or wear a mask (if tolerated) if coughing within two metres of other patients until no longer infectious

Triage patient away from waiting area to a single rooms as soon as possible or maintain a two metre spatial separation

Cohorting of those who are confirmed to have the same infectious agent may be acceptable

Draw privacy curtain Patient to wear a mask and perform hand hygiene

Remain in room unless required for diagnostic therapeutic or ambulation purposes

Signage Yes Not applicable Facial Protection Yes within 2 metres of patient


environment

Dedicate if possible Chart (paper or mobile electronic) should not be taken into the room


Routine Cleaning

Transport Patient to wear a mask during transport Limit

transport unless required for diagnostic or therapeutic procedures

Patient to wear a mask during

transport

Patient to wear a mask for duration of visit and

during transport Not applicable

Communication Effective communication regarding precautions must be given to patient families other departments other facilities and transport services prior to transfer

APPEN

DIX-8b)-D

roplet Precautions


March 2012 167


March 2012 168

AIRBORNE PRECAUTIONS



Long Term Care

AmbulatoryClinic Setting Home Health Care

Accommodation Airborne isolation room or transfer Airborne isolation room if available

or alternate arrangements if possible

Not applicable

Signage Yes Not applicable N95 Respirator TB

For entry to room For duration of visit For entry to patientrsquos home

Measles Varicella

Only immune staff to enter room N95 not required if immune

Equipment and Items in the Environment

As per Routine Practices


Routine cleaning Routine household cleaning

Transport

Patient to wear a mask during transport

Not applicable Transport staff to wear an N95 mask during transport Limit transport unless required for diagnostic or therapeutic procedures


APPEN

DIX-8c)-A

irborne Precautions


March 2012 169


March 2012 170

APPENDIX 9 Disinfectant Disinfectants Advantages and Disadvantages

Process Option UsesComments AdvantagesComments DisadvantagesComments

Alcohols (70-95)

bull External surfaces of some equipment (eg stethoscopes)

bull Noncritical

equipment used for home health care

Disinfection is achieved after 10 minutes of contact Observe fire code restrictions for storage of alcohol

bull Non-toxic bull Low cost bull Rapid action bull Non-staining bull No residue bull Effective on clean

equipmentdevices that can be immersed

bull Evaporates quickly not a good surface disinfectant

bull Evaporation may diminish concentration

bull Flammable store in a cool well ventilated area refer to Fire Code restrictions for storage of large volumes of alcohol

bull Coagulates protein a poor cleaner

bull May dissolve lens mountings

bull Hardens and swells plastic tubing

bull Harmful to silicone causes brittleness

bull May harden rubber or cause deterioration of glues

bull Inactivated by organic material

bull Contraindicated in the OR Chlorines

bull Hydrotherapy tanks exterior surfaces of dialysis equipment cardiopulmonary training mannequin environmental surface

bull Noncritical equipment used for home health care

bull Blood spills

Dilution of Household Bleach Undiluted 525

bull Low cost bull Rapid action bull Readily available in

non hospital settings bull Sporicidal

bull Corrosive to metals bull Inactivated by organic

material for blood spills blood must be removed prior to disinfection

bull Irritant to skin and mucous membranes

bull Should be used immediately once diluted

bull Use in well-ventilated areas

bull Must be stored in closed containers away from ultraviolet light amp heat to prevent deterioration

bull Stains clothing and carpets

APPEN

DIX-9a)-U

sesAdvantagesD

isadvantages


March 2012 171

Process Option

UsesComments AdvantagesComments DisadvantagesComments

sodium hypochlorite 50000 ppm available chlorine Blood spill ndash major dilute 110 with tap water to achieve 05 or 5000 ppm chlorine Blood spill ndash minor dilute 1100 with tap water to achieve 005 or 500 ppm chlorine Surface cleaning soaking of items dilute 150 with tap water to achieve 01 or 1000 ppm chlorine REF Health CanadaPHAC lsquoHand Washing Cleaning Disinfection and Sterilization in Health Care rsquo Table 7 page17]

Accelerated Hydrogen Peroxide 05 (7 solution diluted 116)

bull Isolation room surfaces

bull Clinic and procedure room surfaces

bull Low-level disinfection is achieved after 5 minutes of contact at 20⁰C

bull Monitoring not required however test kits are available from the manufacturer

bull Safe for environment bull Non toxic bull Rapid action bull Available in a wipe bull Active in the presence

of organic materials bull Excellent cleaning

ability due to detergent properties

bull Contraindicated for use on copper brass carbon tipped devices and anodized aluminum

Accelerated Hydrogen Peroxide 45

bull Disinfection of toilet bowls sinks basins and commodes in

bull Sporicidal bull Available in a gel

format to ensure vertical surface

bull Expensive bull Contraindicated for use on

copper brass carbon tipped devices and


March 2012 172

Process Option


washrooms of C difficile patients

bull Following cleaning sterility is achieved with a 45 solution after 10 minutes of contact

bull Do not use on medical devices or equipment or as a general environmental surface cleaner or disinfectant

adhesion during required contact time

bull Safe for environment bull Non-toxic

anodized aluminum rubber plastic

bull Do not use on monitors

Hydrogen Peroxide 3 (non-antiseptic formulations)


bull Floors walls furnishings

Disinfection is achieved with a 3 solution after 30 minutes of contact

bull Rapid action bull Safe for the

environment bull Non-toxic

bull Contraindicated for use on copper zinc brass aluminum

bull Store in cool place protect from light

Iodophors (Non-antiseptic formulations)

bull Hydrotherapy tanks

bull Thermometers bull Hard surface and

equipment that do not touch mucous membranes (eg IV poles wheelchairs beds call bells)

DO NOT use antiseptic iodophors as hard surface disinfectants

bull Rapid action bull Non-toxic

bull Corrosive to metal unless combined with inhibitors

bull Inactivated by organic materials

bull May stain fabrics and synthetic material s


March 2012 173

Process Option


Phenolics

bull Floors walls and furnishings

bull Hard surfaces and equipment that do not touch mucous membranes (eg IV poles wheelchairs beds call bells)

DO NOT use phenolics in nurseries

bull Leaves residual film on environmental surfaces

bull Commercially available with added detergents to provide one-step cleaning and disinfecting

bull Slightly broader spectrum of activity than QUATs

bull Do not use in nurseries or equipment contacting infant (eg baby scales)

bull Not recommended for use on food contact surfaces

bull May be absorbed through skin or rubber

bull May be toxic if inhaled bull Corrosive bull Some synthetic flooring

may become sticky with repetitive use

Quaternary ammonium compounds (Quats)

bull Floors wall and furnishings

bull Blood spills prior to disinfection

bull Non-corrosive non-toxic low irritant

bull Good cleaning ability usually have detergent properties

bull May be used on food surfaces

Do not use to disinfect instruments bull Limited use as disinfectant

because of narrow microbial spectrum

bull Diluted solutions may support the growth of microorganisms

bull May be neutralized by various materials (eg gauze)

[httpwwwoahppcaresourcesdocumentspidacBest20Practices20for20Environmental20Cleaningpdf


March 2012 174

Preparing Household Bleach as a Disinfectant Household Bleach is 525 sodium hypochlorite solution (50000 ppm)

Level Required What For How to make Contact time

110 Dilution (1 part bleach in 9 parts water) 5000 ppm

Large blood spill (after surface cleaning)

25 ml bleach in 225 ml water Same as 5 tsp bleach in 1 cup water

20 minutes

150 Dilution (1 part bleach in 49 parts water) 1000ppm

Surface cleaning 10 ml bleach in 490 ml water Same as 2 tsp bleach in 2 cups water

10 minutes


Minor blood spill 5ml bleach in 495 ml water Same as 1 tsp bleach in 2 cups water

10 minutes

bull Precautions for preparing and using sodium hypochlorite solutions from bleach bull Follow the safety precautions and the manufacturerrsquos directions when working

with concentrated solutions of bleach (sodium hypochlorite) Use PPE when handling

bull Chlorine bleach can stain and damage some surfaces (eg metals some plastics) bull Add bleach to water not water to bleach bull Allow the bleach solution to sit for the full contact time to ensure it is effective bull Don NOT mix bleach solution with ammonia products ndash this can produce chlorine

gas which is toxic bull Check the expiry date of the concentrated solution bull Make a fresh bleach solution daily bull Pre-clean surfaces to allow bleach solution to be effective

APPEN

DIX-9b)-Preparing H

ousehold Bleach as a Disinfectant


March 2012 175

Antimicrobial Activity of Disinfectants6

Anti-microbial activity

Disinfectant Spores Mycobacteria Other bacteria Viruses Enveloped Non- enveloped

Glutaraldehyde 2 (3h-10 min)

Good 3 h

Good 20 min

Good 10 min

Good 10 min

Good 10 min

Peracetic acid 02-035 (10 min)

Good Good Good Good Good

Alcohol 60-70 (ethanol or isopropanol) (1-10 min)

None Moderate Good Good Moderate

Peroxygen compounds 3-6 (20 min)

None Poor Good Good Moderate

Chlorine releasing agents gt1000 ppm Cl2 (15-60 min)


Clear soluble phenolics 1-2

None Good Good Poor None

Quaternary ammonia components 01-05

None Variable Moderate Moderate Poor

6 International Federation of Infection Control

Less active against M avium intracellulare

Potentially toxic Should not be used in neonatal wards

Dilute solutions may allow the growth of Gram-negative bacilli

APPEN

DIX-9c)-A

ntimicrobial A

ctivity of Disinfectants


March 2012 176

APPEN

DIX-10a)-Reprocessing A

rea Set Up Chart

APPENDIX 10 Reprocessing

Steam Sterilizer

ldquoCleanrdquo Sink ldquoDirtyrdquo Sink

Plastic Shelving Unit For (ldquoDIRTYrdquo) Supplies

Also use storage space above or below ldquoDIRTY Sinkrdquo area

SUPPLIES bull ldquoDirtyrdquo Cleaning Container bull Enzymatic Cleaner bull Dedicated Reusable Elbow-length

Gloves ndash hung up bull Disposable Tooth Brushes Nail

Brushes Bur Brushes Pipe Cleaners bull Empty 1 gallon distilled water jug bull Disinfectant Wipes

Plastic Shelving Unit (ldquoCLEANrdquo Supplies) Also use space above or below ldquoCLEAN Sinkrdquo area

SUPPLIES bull ldquoCleanrdquo Cleaning Container bull Disposable PPE (gowns masks with eye protection hair

covers) bull Distilled Water bull Sterile Water bull BlueGreen Drying (Huck) Cloths bull High Level Disinfectant and Testing Strips bull Self Seal Sterilization Pouches (all necessary sizes) bull Sterilizer cleaning solutions bull Chemical and Biological Indicators bull Permanent (Fine Point) Marking Pen bull Disinfectant Wipes

Waterless Hand Cleaner amp Soap amp Paper Towels (In Dispensers)

Ultrasonic Cleaner

Pouching Area

Cold Soak High Level Disinfection Container

Reprocessing Record Keeping Manual

Cleanest Area

Dirty Area

Drying And Inspection Area

Reprocessing Procedure Manual

Place Plastic Medical Device Container in designated ldquoDIRTYrdquo Sink

OR Place Plastic Medical Device

Container inside ldquoDIRTYrdquo Cleaning Container to be used as the ldquoDIRTYrdquo

sink

Clean Area

Sharps Container

Correct (Dirty To Clean) Work Flow

Place ldquoCLEANrdquo Cleaning Container inside designated ldquoCLEAN ldquo Sink OR Use ldquoCLEANrdquo Cleaning Container as the ldquoCLEANrdquo sink


March 2012 177

APPEN

DIX-10b)-Cleaning D

isinfection and Sterilization


March 2012 178


March 2012 179


March 2012 180


March 2012 181

Cleaning Disinfection and Sterilization

STERILIZATION FAILURE

FAILIf ANY of the indicators have failed the whole batch has failed

bull Report the failure to the Nurse-in-Charge IMMEDIATELYbull Find ALL items from that sterilizer since the last successful load

bullHold these items separate and do NOT allow them to be usedbull See if you can find the cause of the problem with the sterilizationbull If a problem is found do a ldquotestrdquo load or a single re-pouched item

PASSED re-testbull Re-process all items on hold

FAILED re-test or canrsquot find problembull Place lsquoOut of Orderrsquo sign take out of use until repaired or replacedbull Back up plan for instruments

TEST loadsbull after sterility failurebull after repairsbull after maintenance


March 2012 182

Sample Autoclave Maintenance Record

Daily Weekly Monthly Quarterly Yearly

Month

Year _______ Day

Clean external surfaces

Clean amp examine door gasket

Drain water from reservoir

Wash inside chamber amp trays

Refill reservoir with distilled water

Flush the systems

Remove amp clean door gasket

Service by Biomed

Initial (ensure master signature sheet is signed once a year)

Comments

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Sample Biological Indicator Record

APPEN

DIX-10c)-Sam

ple Autoclave M

aintenance Record


March 2012 183

Autoclave Type _____________ Serial Number _________________ Name of Biological Indicator Geobacillus Stearothermophilus LOT NUMBER _____________ EXPIRY DATE _____________ Process must do this with every day you do a load of autoclaving

a Ensure instruments have no rust no blood or tissue on them before autoclaving ndash clean under running water soak with enzyme agent 15 min place in milk bath with hinges open for 15 min air dry in covered container to prevent contamination with dust particles package in sterilizing envelope or pack (sutureIUD set)

b Remove from use any instruments with rust c Date each pack and initial and a number( eg 6 packs in load ndash label each pack with 1 2 3 4 5 6) d Indicators of sterility 1)tape turns color with black stripes 2) test strip inserted in suture amp IUD packs 3) biological indicator e Optimal Time temperature amp pressure X min at Y degrees C amp Z psi ndash review if failure of 1 2 or 3 indicators of sterility f Allow packs to dry thoroughly in autoclave before removing ndash wet packs allow contaminants to cross through

Date Type of Pack selection -Pre-pack -Loose

Time in

Time out

Temperature pressure reached

1 Tape turned black strips

2 Internal test strip

3 a Processed Biological Indicator yellow or purple

3 b Controlled Biological Indicator yellow or purple

Passed or Failed ndash as according to legend below

of packs in each load

Initials of Operator

Comments -Report failure to NIC Manager of Health amp enter incident into risk management pro -Do not use any instruments from the load that FAILED

________C ______psi

_______ _C ______psi

________ C ______psi

Sign Master Signature Sheet once a year Legend (any time the bold amp italic happens ndash it is indicative of the failure in the process)

1 Tape 2 Internal Test Strip 3 a Color of Processed Biological Indicator

3 bColor of Controlled Biological Indicator

Interpretation

Turned black stripes Turned black Changes to Purple Remains Yellow Pass No black stripes No black strips on strip Remains Yellow Remains Yellow Fail Changes to Purple Changes to Purple Fail

APPEN

DIX-10d)-Sam

ple Biological Indicator Record


March 2012 184

Sample Biological Indicator Failure Record

Form to be completed with each failure of testing Date of Report Health Centre Autoclave Barnstead Serial Number Serial Number Description Of Situation please include following forms

- Record of steam sterilization loads - Record of biological indicators - Sterilizer maintenance record

Date of Failed BI Date of last passed BI CommentsConcerns identified during process review

Equipment Management a _____Equipment was kept in quarantine - All sterilized packaging is accounted for

o All equipment sterilized with same load number in question o All equipment sterilized since last PASS biological o All equipment sterilized after Biological Indicator FAILED

b _____Equipment was NOT kept in quarantine - Number of packages released from quarantine ___________ - Attach a list of packages not accounted for - Attach a list of clients where the released equipment was used

Date of Repeat Biological Indicator Results of Repeat Biological Indicator

o __PASS - equipment must be repackaged and re-sterilized ndash fax or email completed form to Manager of Health

o __FAIL -inform Manager of Health by phone o -remove autoclave from service until further instructions

NOTIFICATION Date Nurse in Charge

Manager

Biomed Director of Risk Management (incident report) Other actionscomments

APPEN

DIX-10e)-Sam

ple Biological Indicator Failure Record


March 2012 185

APPENDIX-11-Infection Control Information for Homecare Workers Hand Hygiene

The Homecare and support workers (HSW) will take the following hand hygiene products with them to the home

bull Alcohol based hand rub (ABHR) bull Liquid soap in a dispenser bull Paper towels

If hands are heavily soiled and there is no running water available in the home hands will be cleaned with a moist towelette then with ABHR

Bar soap will not be used

Supply containerbag

This has not been associated with the spread of infection as it normally doesnrsquot come in contact with the client and the HSW washes their hands before picking it up to leave the home

The bag is not to be place on the floor or hung from a doorknob

It should be made of material that is easily cleaned if it is visibly soiled and the interior should be cleaned on a regular basis according to use

If it is known that a highly infectious condition exists in the home materials will be removed from the bag in the car and carried into the home in a paper bag where they will be disposed of or contained in a plastic bag and returned to the workplace for disposal

Pests andor Infestations

While it is unlikely that infestations such as lice or bed bugs in the home cause disease it is important to guard against transmission from house to house on home care bags andor equipment As above if it is know that there are pestsinfestations in a home the HSW will immediately notify a supervisor As above materials will be removed from the bag in the car and carried into the house in a paper bag

bull Limit supplies brought into the home to one use only bull The HSW will not sit ion upholstered chairs beds andor couches bull If you must use equipment which is to be returned place it in a Ziploc bag bull Use disposable protective gown and gloves for direct care bull If you suspect your clothing has been contaminated change clothing and shower as soon as

possible and place clothing in dryer on high for 15 min bull Contact Environmental Health Officer for further information on Bed Bug Control

nwtinfectioncontrolmanualpdf


TABLE OF CONTENTS

ACKNOWLEDGEMENTS

PURPOSE








Infection Prevention and Control Committees

SECTION-2-PRINCIPLES OF INFECTION PREVENTION AND CONTROL

Transmission and Chain of Infection



Risk Assessment

Hand hygiene


Gloves

Gowns

Masks

Eye Protection

Putting on PPE

Taking off PPE

N95 Respirator



SECTION-4-ADDITIONAL PRECAUTIONS

General


Cohorting


Contact Precautions

Droplet Precautions



SECTION- 5-INFECTION PREVENTION AND CONTROL PRECAUTIONS

Patient placement

Patient transport

Food and Nutrition


Visitors

Pet visitation


SECTION-6-ENVIRONMENTAL CLEANING

General

Routine Cleaning

Double Cleaning

Terminal Cleaning


Waste Management

Sharps Disposal


Contaminated Medical Records

SECTION-7-MEDICAL REPROCESSINGSTERILIZATION

General Requirements


General Reprocessing Requirements


Cleaning

Disinfection

Sterilization

Endoscopic Devices

CJD

Dental



Immunization


Mask fit testing

Blood-borne Exposures

Education

Section-9-Reportable Diseases and Special Cases

List of reportable diseases



Tuberculosis (TB)

Meningitis



MRSA

VRE

ESBLs and CREs




GastrointestinalEnteric Outbreak


Child Care Facilities





APPENDIX-2-Audits


APPENDIX-4-PPE Types



APPENDIX-7-Cleaning


APPENDIX 9 Disinfectant


APPENDIX-11-Infection Control Information for Homecare Workers

APPENDIX-1-The NWT Infection Control Committee (ICC) Terms of Reference

APPENDIX- 2a)- Hand Hygiene Monitoring Tool

APPENDIX -2b)- Hand Hygiene Structural Audit

APPENDIX -2c)- NWT Infection Control Cleaning Audit

APPENDIX- 3a)-Using an Alcohol Based Hand Rub (ABHR)

APPENDIX-3b)-Using Plain Soap

APPENDIX-4a)-Medical Gloves

APPENDIX-4c)-Eye Protection

APPENDIX-4d)-Masks and N95 Respirators

APPENDIX-5a)-Putting on PPE

APPENDIX-5b)-Removing PPE

APPENDIX-5c)-N95 Respirator Protocol

APPENDIX-5d)-Care of Reusable PPE

APPENDIX-7a-Checklist for DischargeTransfer Cleaning of all Rooms

APPENDIX-7b)-Special Cleaning for MRSA VRE and C difficle

APPENDIX-7c)-Cleaning Recommendations Clinic Rooms

APPENDIX-7d)-Bed and Stretcher Cleaning

APPENDIX-7e)-Blood Spill Floor

APPENDIX-7f)-Blood and Body Fluid Carpet Stain Cleaning

APPENDIX-7g)-Commode Cleaning

APPENDIX-7h)-Damp mopping of floors

APPENDIX-7i)-Damp Wiping of Surfaces

APPENDIX-7j)-Tub and Shower Cleaning

APPENDIX-7k)-Wheelchair Cleaning

APPENDIX-7l)-Exam Table Cleaning

APPENDIX-7m)-Toy Cleaning

APPENDIX-7n)-Routine Washroom Cleaning

APPENDIX-7o)-Sample Terminal Cleaning Protocol for Routine Precautions (PIDAC)

APPENDIX-7p)-Laundry Handling

APPENDIX-7q)-Handling Garbage

APPENDIX-7r)- Sharps Handling

APPENDIX-8a)-Contact Precautions

APPENDIX-8b)-Droplet Precautions

APPENDIX-8c)-Airborne Precautions

APPENDIX-9a)-UsesAdvantagesDisadvantages

APPENDIX-9b)-Preparing Household Bleach as a Disinfectant

APPENDIX-9c)-Antimicrobial Activity of Disinfectants

APPENDIX-10a)-Reprocessing Area Set Up Chart

APPENDIX-10b)-Cleaning Disinfection and Sterilization

APPENDIX-10c)-Sample Autoclave Maintenance Record

APPENDIX-10d)-Sample Biological Indicator Record

APPENDIX-10e)-Sample Biological Indicator Failure Record

APPENDIX-12-Post-exposure Prophylaxis Protocol

APPENDIX-13-Glossary

infection-control-manualpdf


TABLE OF CONTENTS

ACKNOWLEDGEMENTS

PURPOSE













Risk Assessment

Hand hygiene


Gloves

Gowns

Masks

Eye Protection

Putting on PPE

Taking off PPE

N95 Respirator




General


Cohorting


Contact Precautions

Droplet Precautions




Patient placement

Patient transport

Food and Nutrition


Visitors

Pet visitation



General

Routine Cleaning

Double Cleaning

Terminal Cleaning


Waste Management

Sharps Disposal








Cleaning

Disinfection

Sterilization

Endoscopic Devices

CJD

Dental



Immunization


Mask fit testing


Education





Tuberculosis (TB)

Meningitis



MRSA

VRE

ESBLs and CREs











APPENDIX-2-Audits





APPENDIX-7-Cleaning

















































January 2012 | wwwhlthssgovntca


Infection Prevention and Control Manual


March 2012 1






March 2012 2

TABLE OF CONTENTS


TABLE OF CONTENTS2

ACKNOWLEDGEMENTS 7

PURPOSE 8













Risk Assessment 19

Hand hygiene 19


Gloves 23

Masks 25

Eye Protection 26

Putting on PPE 27

Taking off PPE 27

N95 Respirator 27




March 2012 3


General 31


Cohorting 33











Visitors 41

Pet visitation 42



General 44

Routine Cleaning 44

Double Cleaning 49



Waste Management 51

Sharps Disposal 54








March 2012 4


Cleaning 60

Disinfection 61

Sterilization 64


CJD 67

Dental 68



Immunization 71


Mask fit testing 74


Education 75






Meningitis 83



MRSA 85

VRE 88

ESBLs and CREs 91








March 2012 5













March 2012 6








March 2012 7

ACKNOWLEDGEMENTS





NWT Nurse Managers






March 2012 8

PURPOSE















March 2012 9











March 2012 10
















March 2012 11








SECTIO

N-1

-INT

RO

DU

CTIO

N


March 2012 12















March 2012 13












March 2012 14











March 2012 15












March 2012 16














March 2012 17




SECTIO

N-2

-PR

INCIP

KES O

F INFECT

IN P

REV

ENT

ION

AN

D CO

NT

RO

L


March 2012 18








Controls

Interaction


Environmental

bull Infrastructure

Administrative

bull Foundation


March 2012 19




Risk Assessment






Hand hygiene



March 2012 20









above the wrist




March 2012 21















Hand Washing













March 2012 22


Ingestion of ABHR












or current)




March 2012 23













SECTIO

N-3

-PER

SON

AL P

RO

TECT

IVE EQ

UIP

MEN

T


March 2012 24
















March 2012 25








N95 Respirators








March 2012 26






Masks for Patients



Eye Protection







March 2012 27

Putting on PPE







N95 Respirator








March 2012 28

2 Cleaning





3 Placement








March 2012 29






2 Education










March 2012 30





March 2012 31










SECTIO

N-5

-AD

DIT

ION

AL P

RECA

UT

ION

S


March 2012 32







No CONTACT




Yes DROPLET CONTACT


Negative pressure

N95 respirator

AIRBORNE




Yes CONTACT



Yes yes AIRBORNE



CONTACT


March 2012 33

Cohorting


1 Patient cohorting

Includes





2 Staff cohorting








March 2012 34


2 Discontinuation





Contact Precautions









March 2012 35


















March 2012 36
















March 2012 37

















March 2012 38


















March 2012 39








Patient transport




SETIO

N-5

-INFECT

ION

PR

EVEN

TIO

N A

ND

CON

TR

OL P

RECA

UT

ION

S


March 2012 40





Food and Nutrition













March 2012 41











Visitors







March 2012 42

Pet visitation







Health Care


Acute Care









Long-term Care







March 2012 43

Health Care Setting









Ambulatory Care








Home Care






March 2012 44










Routine Cleaning


SECTIO

N-6

-ENV

IRO

NM

ENT

AL CLEA

NIN

G


March 2012 45


Before Cleaning




During Cleaning






After cleaning







March 2012 46


















March 2012 47
















March 2012 48















March 2012 49





Double Cleaning


Terminal Cleaning





March 2012 50






















March 2012 51

Waste Management











March 2012 52









March 2012 53

Waste Category


Disposal

General Waste




Black

Landfill


Incineration

Human Anatomical

Waste


Red


Incineration


Waste


Incineration






March 2012 54

Sharps Disposal


















March 2012 55

















March 2012 56



Containment



March 2012 57









SECTIO

N-7

-MED

ICAL R

EPR

OCESSIN

GST

ERILIZA

TIO

N


March 2012 58











equipment


March 2012 59


















March 2012 60






CLEA

NIN

G

Sterilization

Semicritical





Noncritical



urinals



Cleaning

1 Initial Cleaning

At point-of-use






March 2012 61






Disinfection






March 2012 62


Product Contact

time Usage Notes

Glutaraldehyde 2

20min at 20degC




20 min at 20degC



Hydrogen peroxide 6




10 min at 10degC






March 2012 63









Blood spills

Inexpensive

Rapid acting




Hydrogen peroxide 3










March 2012 64

Sterilization









1 Wrapping






March 2012 65



3 Indicators

Mechanical



Chemical



Biological








March 2012 66




4 Documentation


5 Storage





6 Maintenance





March 2012 67

Endoscopic Devices


Critical endoscopes




CJD







March 2012 68


Dental













March 2012 69















March 2012 70









March 2012 71




Immunization






SECTIO

N-8

-OCCU

PA

TIO

NA

L HEA

LTH

AN

D SA

FETY


March 2012 72




TetanusDiphtheria


Influenza






MMR All areas

Require two doses




Hepatitis B


Physical Services

Laundry

Housekeeping


Reprocessing

Patient Care

Respiratory Therapy



March 2012 73


Hepatitis B















March 2012 74

Mask fit testing
















March 2012 75

Education





March 2012 76












SECTIO

N-9

-REP

OR

TA

BLE D

ISEASES A

ND

SPECIA

L CASES


March 2012 77











March 2012 78


Part 1


Part 2


Part 3








disease
























(VRE)


March 2012 79














March 2012 80













Epidemiology








March 2012 81








Tuberculosis (TB)











March 2012 82

















March 2012 83
















Meningitis




associated cleaning




March 2012 84















March 2012 85











March 2012 86

















March 2012 87




















March 2012 88














VRE





March 2012 89














March 2012 90


















March 2012 91














March 2012 92

















March 2012 93









patients










March 2012 94

















March 2012 95













agent


March 2012 96













March 2012 97


















SECTIO

N-1

0-O

UT

BR

EAK

MA

NA

GEM

ENT


March 2012 98



















March 2012 99












March 2012 100



General Handling






Interaction




Droplet Precautions


Contact Precautions



Routine Precautions


SECTIO

N-1

1-CA

RE O

F TH

E DECEA

SED


March 2012 101


Environmental

Body Bag

No embalming

Airborne PPE










Administration




Examples


CJD Typhus





March 2012 102






Type Examples










SECTIO

N-1

2-CO

NST

RU

CTIO

N A

ND

DESIG

N O

F HEA

LTH

CAR

E FACILIT

IES


March 2012 103















March 2012 104














March 2012 105




TB Manual

HIVAIDS Manual




















SECTIO

N-1

3-R

EFEREN

CES


March 2012 106














CUPE



March 2012 107




Title


Purpose














APPEN

DIX-1-The N


mittee (ICC) Term

s of Reference


March 2012 108





Quorum















March 2012 109




Reporting Structure


Review and Update



March 2012 110

APPENDIX-2-Audits



D-Dietary


HW - Handwash













After leaving an



APPEN

DIX- 2a)- H

and Hygiene M

onitoring Tool


March 2012 111






March 2012 112


Date Auditor

Area










APPEN

DIX -2b)- H


udit


March 2012 113


Reviewer


Patient Rooms


Isolation Rooms



monitored


Hand Hygiene


Refrigerators


Linens (clean)


APPEN

DIX -2c)- N


udit


March 2012 114


Linens (soiled)


Halls Uncluttered



Offices

Conference rooms

Nurses stations



Bathrooms are clean


Biomedical waste
















Storage





March 2012 115



Clean utility



Soiled Utility




Waiting Areas



Public Bathrooms



Laboratory





Pharmacy





March 2012 116


APPEN

DIX- 3a)-U


and Rub (ABH

R)


March 2012 117

APPEN

DIX-3b)-U

sing Plain Soap


March 2012 118












bases alcohols












chemicals





caustics



APPEN

DIX-4a)-M

edical Gloves


March 2012 119

Eye Protection


Safety Glasses







Goggles






Face Shield










APPEN



March 2012 120














bull Expensive

Surgical Mask













APPEN

DIX-4d)-M



March 2012 121


APPEN



March 2012 122

APPEN

DIX-5b)-Rem

oving PPE


March 2012 123


March 2012 124

APPEN

DIX-5c)-N



March 2012 125

APPEN



March 2012 126





Comments






Contact Droplet

Duration of illness










March 2012 127




Comments


Contact Droplet

Duration of illness












March 2012 128




Comments



Contact Droplet







At all times


March 2012 129




Comments

Contact Pediatric

Duration of illness












Dengue Routine


March 2012 130




Comments


1 (if epidemic)





Droplet Contact




Routine Adult


Contact Pediatric





At all times


March 2012 131




Comments









At all times




March 2012 132




Comments

infection



Duration of illness





3 Vertical Routine




Droplet Contact



2 Vertical Routine



Routine Adult

At all times


March 2012 133




Comments


Duration of illness



At all times

Droplet Pediatric



2 Routine



Airborne

Contact





March 2012 134




Comments








At all times



Duration of illness

At all times





March 2012 135




Comments

Virus)




3 Routine







Routine Contact


March 2012 136




Comments

Lice (Pediculosis)

















March 2012 137




Comments














3



March 2012 138




Comments







2



Routine


Routine


Routine


March 2012 139




Comments



Duration of illness






4 days after rash









March 2012 140




Comments

treatment






Routine


Routine


3 Vertical Routine




March 2012 141




Comments

Discontinuation


Routine


2 Fecal Oral Route

Routine Contact










March 2012 142

APPENDIX-7-Cleaning












Container Yes No





APPEN




March 2012 143



















March 2012 144



Floors

Bathrooms


Nursing Station













Floors


APPEN


RSA V

RE and C difficle


March 2012 145





Virex solution

After each patient












APPEN



s


March 2012 146



Clinic Rooms






Floors Carpet


Daily Daily




Hallways

Carpet Floors

Vacuum Virex

Daily Daily

Waiting Rooms

Surfaces Carpet

Virex Vacuum

Daily Daily


March 2012 147

Floors Virex Daily



Virex Virex Virex

Daily Daily Daily





Carpets Virex

Vacuum Daily Daily



Virex Virex

Daily Daily




Virex Virex

Vacuum

Daily Daily Daily





March 2012 148

APPEN



March 2012 149

APPEN



March 2012 150

APPEN



March 2012 151

APPEN

DIX-7g)-Com

mode Cleaning


March 2012 152

APPEN

DIX-7h)-D

amp m

opping of floors


March 2012 153

APPEN

DIX-7i)-D

amp W

iping of Surfaces


March 2012 154

APPEN


er Cleaning


March 2012 155

APPEN

DIX-7k)-W

heelchair Cleaning


March 2012 156

APPEN

DIX-7l)-Exam

Table Cleaning


March 2012 157









Scheduled clean



APPEN

DIX-7m

)-Toy Cleaning


March 2012 158

APPEN

DIX-7n)-Routine W

ashroom Cleaning


March 2012 159















APPEN

DIX-7o)-Sam


AC)


March 2012 160





March 2012 161

APPEN

DIX-7p)-Laundry H

andling


March 2012 162

APPEN

DIX-7q)-H

andling Garbage


March 2012 163

APPEN

DIX-7r)- Sharps H

andling


March 2012 164


CONTACT PRECAUTIONS


CareRehab Long Term


Home Health Care

Accommodation

Door May Be Open

No Restrictions on

Accommodation










environment








No special cleaning


Transport



Not applicable



APPEN



March 2012 165


March 2012 166

DROPLET PRECAUTIONS





Accommodation










environment



Routine Cleaning




transport




APPEN

DIX-8b)-D

roplet Precautions


March 2012 167


March 2012 168




Long Term Care




Not applicable



Measles Varicella






Transport




APPEN

DIX-8c)-A

irborne Precautions


March 2012 169


March 2012 170



Alcohols (70-95)


bull Noncritical

















bull Blood spills











APPEN

DIX-9a)-U

sesAdvantagesD

isadvantages


March 2012 171

Process Option



















March 2012 172

Process Option



























March 2012 173

Process Option


Phenolics
























March 2012 174






20 minutes



10 minutes



10 minutes





APPEN

DIX-9b)-Preparing H



March 2012 175





Good 3 h

Good 20 min

Good 10 min

Good 10 min

Good 10 min

















APPEN

DIX-9c)-A

ntimicrobial A



March 2012 176

APPEN


rea Set Up Chart


Steam Sterilizer











Ultrasonic Cleaner

Pouching Area



Cleanest Area

Dirty Area






sink

Clean Area

Sharps Container




March 2012 177

APPEN

DIX-10b)-Cleaning D



March 2012 178


March 2012 179


March 2012 180


March 2012 181










March 2012 182



Month

Year _______ Day






Flush the systems


Service by Biomed


Comments

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31


APPEN

DIX-10c)-Sam

ple Autoclave M

aintenance Record


March 2012 183





Time in

Time out










________C ______psi

_______ _C ______psi

________ C ______psi




Interpretation


APPEN

DIX-10d)-Sam



March 2012 184












Manager


APPEN

DIX-10e)-Sam



March 2012 185






Supply containerbag











TABLE OF CONTENTS

ACKNOWLEDGEMENTS

PURPOSE













Risk Assessment

Hand hygiene


Gloves

Gowns

Masks

Eye Protection

Putting on PPE

Taking off PPE

N95 Respirator




General


Cohorting


Contact Precautions

Droplet Precautions




Patient placement

Patient transport

Food and Nutrition


Visitors

Pet visitation



General

Routine Cleaning

Double Cleaning

Terminal Cleaning


Waste Management

Sharps Disposal








Cleaning

Disinfection

Sterilization

Endoscopic Devices

CJD

Dental



Immunization


Mask fit testing


Education





Tuberculosis (TB)

Meningitis



MRSA

VRE

ESBLs and CREs











APPENDIX-2-Audits





APPENDIX-7-Cleaning



















































TABLE OF CONTENTS

ACKNOWLEDGEMENTS

PURPOSE













Risk Assessment

Hand hygiene


Gloves

Gowns

Masks

Eye Protection

Putting on PPE

Taking off PPE

N95 Respirator




General


Cohorting


Contact Precautions

Droplet Precautions




Patient placement

Patient transport

Food and Nutrition


Visitors

Pet visitation



General

Routine Cleaning

Double Cleaning

Terminal Cleaning


Waste Management

Sharps Disposal








Cleaning

Disinfection

Sterilization

Endoscopic Devices

CJD

Dental



Immunization


Mask fit testing


Education





Tuberculosis (TB)

Meningitis



MRSA

VRE

ESBLs and CREs











APPENDIX-2-Audits





APPENDIX-7-Cleaning


















































March 2012 1






March 2012 2

TABLE OF CONTENTS


TABLE OF CONTENTS2

ACKNOWLEDGEMENTS 7

PURPOSE 8













Risk Assessment 19

Hand hygiene 19


Gloves 23

Masks 25

Eye Protection 26

Putting on PPE 27

Taking off PPE 27

N95 Respirator 27




March 2012 3


General 31


Cohorting 33











Visitors 41

Pet visitation 42



General 44

Routine Cleaning 44

Double Cleaning 49



Waste Management 51

Sharps Disposal 54








March 2012 4


Cleaning 60

Disinfection 61

Sterilization 64


CJD 67

Dental 68



Immunization 71


Mask fit testing 74


Education 75






Meningitis 83



MRSA 85

VRE 88

ESBLs and CREs 91








March 2012 5













March 2012 6








March 2012 7

ACKNOWLEDGEMENTS





NWT Nurse Managers






March 2012 8

PURPOSE















March 2012 9











March 2012 10
















March 2012 11








SECTIO

N-1

-INT

RO

DU

CTIO

N


March 2012 12















March 2012 13












March 2012 14











March 2012 15












March 2012 16














March 2012 17




SECTIO

N-2

-PR

INCIP

KES O

F INFECT

IN P

REV

ENT

ION

AN

D CO

NT

RO

L


March 2012 18








Controls

Interaction


Environmental

bull Infrastructure

Administrative

bull Foundation


March 2012 19




Risk Assessment






Hand hygiene



March 2012 20









above the wrist




March 2012 21















Hand Washing













March 2012 22


Ingestion of ABHR












or current)




March 2012 23













SECTIO

N-3

-PER

SON

AL P

RO

TECT

IVE EQ

UIP

MEN

T


March 2012 24
















March 2012 25








N95 Respirators








March 2012 26






Masks for Patients



Eye Protection







March 2012 27

Putting on PPE







N95 Respirator








March 2012 28

2 Cleaning





3 Placement








March 2012 29






2 Education










March 2012 30





March 2012 31










SECTIO

N-5

-AD

DIT

ION

AL P

RECA

UT

ION

S


March 2012 32







No CONTACT




Yes DROPLET CONTACT


Negative pressure

N95 respirator

AIRBORNE




Yes CONTACT



Yes yes AIRBORNE



CONTACT


March 2012 33

Cohorting


1 Patient cohorting

Includes





2 Staff cohorting








March 2012 34


2 Discontinuation





Contact Precautions









March 2012 35


















March 2012 36
















March 2012 37

















March 2012 38


















March 2012 39








Patient transport




SETIO

N-5

-INFECT

ION

PR

EVEN

TIO

N A

ND

CON

TR

OL P

RECA

UT

ION

S


March 2012 40





Food and Nutrition













March 2012 41











Visitors







March 2012 42

Pet visitation







Health Care


Acute Care









Long-term Care







March 2012 43

Health Care Setting









Ambulatory Care








Home Care






March 2012 44










Routine Cleaning


SECTIO

N-6

-ENV

IRO

NM

ENT

AL CLEA

NIN

G


March 2012 45


Before Cleaning




During Cleaning






After cleaning







March 2012 46


















March 2012 47
















March 2012 48















March 2012 49





Double Cleaning


Terminal Cleaning





March 2012 50






















March 2012 51

Waste Management











March 2012 52









March 2012 53

Waste Category


Disposal

General Waste




Black

Landfill


Incineration

Human Anatomical

Waste


Red


Incineration


Waste


Incineration






March 2012 54

Sharps Disposal


















March 2012 55

















March 2012 56



Containment



March 2012 57









SECTIO

N-7

-MED

ICAL R

EPR

OCESSIN

GST

ERILIZA

TIO

N


March 2012 58











equipment


March 2012 59


















March 2012 60






CLEA

NIN

G

Sterilization

Semicritical





Noncritical



urinals



Cleaning

1 Initial Cleaning

At point-of-use






March 2012 61






Disinfection






March 2012 62


Product Contact

time Usage Notes

Glutaraldehyde 2

20min at 20degC




20 min at 20degC



Hydrogen peroxide 6




10 min at 10degC






March 2012 63









Blood spills

Inexpensive

Rapid acting




Hydrogen peroxide 3










March 2012 64

Sterilization









1 Wrapping






March 2012 65



3 Indicators

Mechanical



Chemical



Biological








March 2012 66




4 Documentation


5 Storage





6 Maintenance





March 2012 67

Endoscopic Devices


Critical endoscopes




CJD







March 2012 68


Dental













March 2012 69















March 2012 70









March 2012 71




Immunization






SECTIO

N-8

-OCCU

PA

TIO

NA

L HEA

LTH

AN

D SA

FETY


March 2012 72




TetanusDiphtheria


Influenza






MMR All areas

Require two doses




Hepatitis B


Physical Services

Laundry

Housekeeping


Reprocessing

Patient Care

Respiratory Therapy



March 2012 73


Hepatitis B















March 2012 74

Mask fit testing
















March 2012 75

Education





March 2012 76












SECTIO

N-9

-REP

OR

TA

BLE D

ISEASES A

ND

SPECIA

L CASES


March 2012 77











March 2012 78


Part 1


Part 2


Part 3








disease
























(VRE)


March 2012 79














March 2012 80













Epidemiology








March 2012 81








Tuberculosis (TB)











March 2012 82

















March 2012 83
















Meningitis




associated cleaning




March 2012 84















March 2012 85











March 2012 86

















March 2012 87




















March 2012 88














VRE





March 2012 89














March 2012 90


















March 2012 91














March 2012 92

















March 2012 93









patients










March 2012 94

















March 2012 95













agent


March 2012 96













March 2012 97


















SECTIO

N-1

0-O

UT

BR

EAK

MA

NA

GEM

ENT


March 2012 98



















March 2012 99












March 2012 100



General Handling






Interaction




Droplet Precautions


Contact Precautions



Routine Precautions


SECTIO

N-1

1-CA

RE O

F TH

E DECEA

SED


March 2012 101


Environmental

Body Bag

No embalming

Airborne PPE










Administration




Examples


CJD Typhus





March 2012 102






Type Examples










SECTIO

N-1

2-CO

NST

RU

CTIO

N A

ND

DESIG

N O

F HEA

LTH

CAR

E FACILIT

IES


March 2012 103















March 2012 104














March 2012 105




TB Manual

HIVAIDS Manual




















SECTIO

N-1

3-R

EFEREN

CES


March 2012 106














CUPE



March 2012 107




Title


Purpose














APPEN

DIX-1-The N


mittee (ICC) Term

s of Reference


March 2012 108





Quorum















March 2012 109




Reporting Structure


Review and Update



March 2012 110

APPENDIX-2-Audits



D-Dietary


HW - Handwash













After leaving an



APPEN

DIX- 2a)- H

and Hygiene M

onitoring Tool


March 2012 111






March 2012 112


Date Auditor

Area










APPEN

DIX -2b)- H


udit


March 2012 113


Reviewer


Patient Rooms


Isolation Rooms



monitored


Hand Hygiene


Refrigerators


Linens (clean)


APPEN

DIX -2c)- N


udit


March 2012 114


Linens (soiled)


Halls Uncluttered



Offices

Conference rooms

Nurses stations



Bathrooms are clean


Biomedical waste
















Storage





March 2012 115



Clean utility



Soiled Utility




Waiting Areas



Public Bathrooms



Laboratory





Pharmacy





March 2012 116


APPEN

DIX- 3a)-U


and Rub (ABH

R)


March 2012 117

APPEN

DIX-3b)-U

sing Plain Soap


March 2012 118












bases alcohols












chemicals





caustics



APPEN

DIX-4a)-M

edical Gloves


March 2012 119

Eye Protection


Safety Glasses







Goggles






Face Shield










APPEN



March 2012 120














bull Expensive

Surgical Mask













APPEN

DIX-4d)-M



March 2012 121


APPEN



March 2012 122

APPEN

DIX-5b)-Rem

oving PPE


March 2012 123


March 2012 124

APPEN

DIX-5c)-N



March 2012 125

APPEN



March 2012 126





Comments






Contact Droplet

Duration of illness










March 2012 127




Comments


Contact Droplet

Duration of illness












March 2012 128




Comments



Contact Droplet







At all times


March 2012 129




Comments

Contact Pediatric

Duration of illness












Dengue Routine


March 2012 130




Comments


1 (if epidemic)





Droplet Contact




Routine Adult


Contact Pediatric





At all times


March 2012 131




Comments









At all times




March 2012 132




Comments

infection



Duration of illness





3 Vertical Routine




Droplet Contact



2 Vertical Routine



Routine Adult

At all times


March 2012 133




Comments


Duration of illness



At all times

Droplet Pediatric



2 Routine



Airborne

Contact





March 2012 134




Comments








At all times



Duration of illness

At all times





March 2012 135




Comments

Virus)




3 Routine







Routine Contact


March 2012 136




Comments

Lice (Pediculosis)

















March 2012 137




Comments














3



March 2012 138




Comments







2



Routine


Routine


Routine


March 2012 139




Comments



Duration of illness






4 days after rash









March 2012 140




Comments

treatment






Routine


Routine


3 Vertical Routine




March 2012 141




Comments

Discontinuation


Routine


2 Fecal Oral Route

Routine Contact










March 2012 142

APPENDIX-7-Cleaning












Container Yes No





APPEN




March 2012 143



















March 2012 144



Floors

Bathrooms


Nursing Station













Floors


APPEN


RSA V

RE and C difficle


March 2012 145





Virex solution

After each patient












APPEN



s


March 2012 146



Clinic Rooms






Floors Carpet


Daily Daily




Hallways

Carpet Floors

Vacuum Virex

Daily Daily

Waiting Rooms

Surfaces Carpet

Virex Vacuum

Daily Daily


March 2012 147

Floors Virex Daily



Virex Virex Virex

Daily Daily Daily





Carpets Virex

Vacuum Daily Daily



Virex Virex

Daily Daily




Virex Virex

Vacuum

Daily Daily Daily





March 2012 148

APPEN



March 2012 149

APPEN



March 2012 150

APPEN



March 2012 151

APPEN

DIX-7g)-Com

mode Cleaning


March 2012 152

APPEN

DIX-7h)-D

amp m

opping of floors


March 2012 153

APPEN

DIX-7i)-D

amp W

iping of Surfaces


March 2012 154

APPEN


er Cleaning


March 2012 155

APPEN

DIX-7k)-W

heelchair Cleaning


March 2012 156

APPEN

DIX-7l)-Exam

Table Cleaning


March 2012 157









Scheduled clean



APPEN

DIX-7m

)-Toy Cleaning


March 2012 158

APPEN

DIX-7n)-Routine W

ashroom Cleaning


March 2012 159















APPEN

DIX-7o)-Sam


AC)


March 2012 160





March 2012 161

APPEN

DIX-7p)-Laundry H

andling


March 2012 162

APPEN

DIX-7q)-H

andling Garbage


March 2012 163

APPEN

DIX-7r)- Sharps H

andling


March 2012 164


CONTACT PRECAUTIONS


CareRehab Long Term


Home Health Care

Accommodation

Door May Be Open

No Restrictions on

Accommodation










environment








No special cleaning


Transport



Not applicable



APPEN



March 2012 165


March 2012 166

DROPLET PRECAUTIONS





Accommodation










environment



Routine Cleaning




transport




APPEN

DIX-8b)-D

roplet Precautions


March 2012 167


March 2012 168




Long Term Care




Not applicable



Measles Varicella






Transport




APPEN

DIX-8c)-A

irborne Precautions


March 2012 169


March 2012 170



Alcohols (70-95)


bull Noncritical

















bull Blood spills











APPEN

DIX-9a)-U

sesAdvantagesD

isadvantages


March 2012 171

Process Option



















March 2012 172

Process Option



























March 2012 173

Process Option


Phenolics
























March 2012 174






20 minutes



10 minutes



10 minutes





APPEN

DIX-9b)-Preparing H



March 2012 175





Good 3 h

Good 20 min

Good 10 min

Good 10 min

Good 10 min

















APPEN

DIX-9c)-A

ntimicrobial A



March 2012 176

APPEN


rea Set Up Chart


Steam Sterilizer











Ultrasonic Cleaner

Pouching Area



Cleanest Area

Dirty Area






sink

Clean Area

Sharps Container




March 2012 177

APPEN

DIX-10b)-Cleaning D



March 2012 178


March 2012 179


March 2012 180


March 2012 181










March 2012 182



Month

Year _______ Day






Flush the systems


Service by Biomed


Comments

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31


APPEN

DIX-10c)-Sam

ple Autoclave M

aintenance Record


March 2012 183





Time in

Time out










________C ______psi

_______ _C ______psi

________ C ______psi




Interpretation


APPEN

DIX-10d)-Sam



March 2012 184












Manager


APPEN

DIX-10e)-Sam



March 2012 185






Supply containerbag











TABLE OF CONTENTS

ACKNOWLEDGEMENTS

PURPOSE













Risk Assessment

Hand hygiene


Gloves

Gowns

Masks

Eye Protection

Putting on PPE

Taking off PPE

N95 Respirator




General


Cohorting


Contact Precautions

Droplet Precautions




Patient placement

Patient transport

Food and Nutrition


Visitors

Pet visitation



General

Routine Cleaning

Double Cleaning

Terminal Cleaning


Waste Management

Sharps Disposal








Cleaning

Disinfection

Sterilization

Endoscopic Devices

CJD

Dental



Immunization


Mask fit testing


Education





Tuberculosis (TB)

Meningitis



MRSA

VRE

ESBLs and CREs











APPENDIX-2-Audits





APPENDIX-7-Cleaning



















































TABLE OF CONTENTS

ACKNOWLEDGEMENTS

PURPOSE













Risk Assessment

Hand hygiene


Gloves

Gowns

Masks

Eye Protection

Putting on PPE

Taking off PPE

N95 Respirator




General


Cohorting


Contact Precautions

Droplet Precautions




Patient placement

Patient transport

Food and Nutrition


Visitors

Pet visitation



General

Routine Cleaning

Double Cleaning

Terminal Cleaning


Waste Management

Sharps Disposal








Cleaning

Disinfection

Sterilization

Endoscopic Devices

CJD

Dental



Immunization


Mask fit testing


Education





Tuberculosis (TB)

Meningitis



MRSA

VRE

ESBLs and CREs











APPENDIX-2-Audits





APPENDIX-7-Cleaning


















































March 2012 2

TABLE OF CONTENTS


TABLE OF CONTENTS2

ACKNOWLEDGEMENTS 7

PURPOSE 8













Risk Assessment 19

Hand hygiene 19


Gloves 23

Masks 25

Eye Protection 26

Putting on PPE 27

Taking off PPE 27

N95 Respirator 27




March 2012 3


General 31


Cohorting 33











Visitors 41

Pet visitation 42



General 44

Routine Cleaning 44

Double Cleaning 49



Waste Management 51

Sharps Disposal 54








March 2012 4


Cleaning 60

Disinfection 61

Sterilization 64


CJD 67

Dental 68



Immunization 71


Mask fit testing 74


Education 75






Meningitis 83



MRSA 85

VRE 88

ESBLs and CREs 91








March 2012 5













March 2012 6








March 2012 7

ACKNOWLEDGEMENTS





NWT Nurse Managers






March 2012 8

PURPOSE















March 2012 9











March 2012 10
















March 2012 11








SECTIO

N-1

-INT

RO

DU

CTIO

N


March 2012 12















March 2012 13












March 2012 14











March 2012 15












March 2012 16














March 2012 17




SECTIO

N-2

-PR

INCIP

KES O

F INFECT

IN P

REV

ENT

ION

AN

D CO

NT

RO

L


March 2012 18








Controls

Interaction


Environmental

bull Infrastructure

Administrative

bull Foundation


March 2012 19




Risk Assessment






Hand hygiene



March 2012 20









above the wrist




March 2012 21















Hand Washing













March 2012 22


Ingestion of ABHR












or current)




March 2012 23













SECTIO

N-3

-PER

SON

AL P

RO

TECT

IVE EQ

UIP

MEN

T


March 2012 24
















March 2012 25








N95 Respirators








March 2012 26






Masks for Patients



Eye Protection







March 2012 27

Putting on PPE







N95 Respirator








March 2012 28

2 Cleaning





3 Placement








March 2012 29






2 Education










March 2012 30





March 2012 31










SECTIO

N-5

-AD

DIT

ION

AL P

RECA

UT

ION

S


March 2012 32







No CONTACT




Yes DROPLET CONTACT


Negative pressure

N95 respirator

AIRBORNE




Yes CONTACT



Yes yes AIRBORNE



CONTACT


March 2012 33

Cohorting


1 Patient cohorting

Includes





2 Staff cohorting








March 2012 34


2 Discontinuation





Contact Precautions









March 2012 35


















March 2012 36
















March 2012 37

















March 2012 38


















March 2012 39








Patient transport




SETIO

N-5

-INFECT

ION

PR

EVEN

TIO

N A

ND

CON

TR

OL P

RECA

UT

ION

S


March 2012 40





Food and Nutrition













March 2012 41











Visitors







March 2012 42

Pet visitation







Health Care


Acute Care









Long-term Care







March 2012 43

Health Care Setting









Ambulatory Care








Home Care






March 2012 44










Routine Cleaning


SECTIO

N-6

-ENV

IRO

NM

ENT

AL CLEA

NIN

G


March 2012 45


Before Cleaning




During Cleaning






After cleaning







March 2012 46


















March 2012 47
















March 2012 48















March 2012 49





Double Cleaning


Terminal Cleaning





March 2012 50






















March 2012 51

Waste Management











March 2012 52









March 2012 53

Waste Category


Disposal

General Waste




Black

Landfill


Incineration

Human Anatomical

Waste


Red


Incineration


Waste


Incineration






March 2012 54

Sharps Disposal


















March 2012 55

















March 2012 56



Containment



March 2012 57









SECTIO

N-7

-MED

ICAL R

EPR

OCESSIN

GST

ERILIZA

TIO

N


March 2012 58











equipment


March 2012 59


















March 2012 60






CLEA

NIN

G

Sterilization

Semicritical





Noncritical



urinals



Cleaning

1 Initial Cleaning

At point-of-use






March 2012 61






Disinfection






March 2012 62


Product Contact

time Usage Notes

Glutaraldehyde 2

20min at 20degC




20 min at 20degC



Hydrogen peroxide 6




10 min at 10degC






March 2012 63









Blood spills

Inexpensive

Rapid acting




Hydrogen peroxide 3










March 2012 64

Sterilization









1 Wrapping






March 2012 65



3 Indicators

Mechanical



Chemical



Biological








March 2012 66




4 Documentation


5 Storage





6 Maintenance





March 2012 67

Endoscopic Devices


Critical endoscopes




CJD







March 2012 68


Dental













March 2012 69















March 2012 70









March 2012 71




Immunization






SECTIO

N-8

-OCCU

PA

TIO

NA

L HEA

LTH

AN

D SA

FETY


March 2012 72




TetanusDiphtheria


Influenza






MMR All areas

Require two doses




Hepatitis B


Physical Services

Laundry

Housekeeping


Reprocessing

Patient Care

Respiratory Therapy



March 2012 73


Hepatitis B















March 2012 74

Mask fit testing
















March 2012 75

Education





March 2012 76












SECTIO

N-9

-REP

OR

TA

BLE D

ISEASES A

ND

SPECIA

L CASES


March 2012 77











March 2012 78


Part 1


Part 2


Part 3








disease
























(VRE)


March 2012 79














March 2012 80













Epidemiology








March 2012 81








Tuberculosis (TB)











March 2012 82

















March 2012 83
















Meningitis




associated cleaning




March 2012 84















March 2012 85











March 2012 86

















March 2012 87




















March 2012 88














VRE





March 2012 89














March 2012 90


















March 2012 91














March 2012 92

















March 2012 93









patients










March 2012 94

















March 2012 95













agent


March 2012 96













March 2012 97


















SECTIO

N-1

0-O

UT

BR

EAK

MA

NA

GEM

ENT


March 2012 98



















March 2012 99












March 2012 100



General Handling






Interaction




Droplet Precautions


Contact Precautions



Routine Precautions


SECTIO

N-1

1-CA

RE O

F TH

E DECEA

SED


March 2012 101


Environmental

Body Bag

No embalming

Airborne PPE










Administration




Examples


CJD Typhus





March 2012 102






Type Examples










SECTIO

N-1

2-CO

NST

RU

CTIO

N A

ND

DESIG

N O

F HEA

LTH

CAR

E FACILIT

IES


March 2012 103















March 2012 104














March 2012 105




TB Manual

HIVAIDS Manual




















SECTIO

N-1

3-R

EFEREN

CES


March 2012 106














CUPE



March 2012 107




Title


Purpose














APPEN

DIX-1-The N


mittee (ICC) Term

s of Reference


March 2012 108





Quorum















March 2012 109




Reporting Structure


Review and Update



March 2012 110

APPENDIX-2-Audits



D-Dietary


HW - Handwash













After leaving an



APPEN

DIX- 2a)- H

and Hygiene M

onitoring Tool


March 2012 111






March 2012 112


Date Auditor

Area










APPEN

DIX -2b)- H


udit


March 2012 113


Reviewer


Patient Rooms


Isolation Rooms



monitored


Hand Hygiene


Refrigerators


Linens (clean)


APPEN

DIX -2c)- N


udit


March 2012 114


Linens (soiled)


Halls Uncluttered



Offices

Conference rooms

Nurses stations



Bathrooms are clean


Biomedical waste
















Storage





March 2012 115



Clean utility



Soiled Utility




Waiting Areas



Public Bathrooms



Laboratory





Pharmacy





March 2012 116


APPEN

DIX- 3a)-U


and Rub (ABH

R)


March 2012 117

APPEN

DIX-3b)-U

sing Plain Soap


March 2012 118












bases alcohols












chemicals





caustics



APPEN

DIX-4a)-M

edical Gloves


March 2012 119

Eye Protection


Safety Glasses







Goggles






Face Shield










APPEN



March 2012 120














bull Expensive

Surgical Mask













APPEN

DIX-4d)-M



March 2012 121


APPEN



March 2012 122

APPEN

DIX-5b)-Rem

oving PPE


March 2012 123


March 2012 124

APPEN

DIX-5c)-N



March 2012 125

APPEN



March 2012 126





Comments






Contact Droplet

Duration of illness










March 2012 127




Comments


Contact Droplet

Duration of illness












March 2012 128




Comments



Contact Droplet







At all times


March 2012 129




Comments

Contact Pediatric

Duration of illness












Dengue Routine


March 2012 130




Comments


1 (if epidemic)





Droplet Contact




Routine Adult


Contact Pediatric





At all times


March 2012 131




Comments









At all times




March 2012 132




Comments

infection



Duration of illness





3 Vertical Routine




Droplet Contact



2 Vertical Routine



Routine Adult

At all times


March 2012 133




Comments


Duration of illness



At all times

Droplet Pediatric



2 Routine



Airborne

Contact





March 2012 134




Comments








At all times



Duration of illness

At all times





March 2012 135




Comments

Virus)




3 Routine







Routine Contact


March 2012 136




Comments

Lice (Pediculosis)

















March 2012 137




Comments














3



March 2012 138




Comments







2



Routine


Routine


Routine


March 2012 139




Comments



Duration of illness






4 days after rash









March 2012 140




Comments

treatment






Routine


Routine


3 Vertical Routine




March 2012 141




Comments

Discontinuation


Routine


2 Fecal Oral Route

Routine Contact










March 2012 142

APPENDIX-7-Cleaning












Container Yes No





APPEN




March 2012 143



















March 2012 144



Floors

Bathrooms


Nursing Station













Floors


APPEN


RSA V

RE and C difficle


March 2012 145





Virex solution

After each patient












APPEN



s


March 2012 146



Clinic Rooms






Floors Carpet


Daily Daily




Hallways

Carpet Floors

Vacuum Virex

Daily Daily

Waiting Rooms

Surfaces Carpet

Virex Vacuum

Daily Daily


March 2012 147

Floors Virex Daily



Virex Virex Virex

Daily Daily Daily





Carpets Virex

Vacuum Daily Daily



Virex Virex

Daily Daily




Virex Virex

Vacuum

Daily Daily Daily





March 2012 148

APPEN



March 2012 149

APPEN



March 2012 150

APPEN



March 2012 151

APPEN

DIX-7g)-Com

mode Cleaning


March 2012 152

APPEN

DIX-7h)-D

amp m

opping of floors


March 2012 153

APPEN

DIX-7i)-D

amp W

iping of Surfaces


March 2012 154

APPEN


er Cleaning


March 2012 155

APPEN

DIX-7k)-W

heelchair Cleaning


March 2012 156

APPEN

DIX-7l)-Exam

Table Cleaning


March 2012 157









Scheduled clean



APPEN

DIX-7m

)-Toy Cleaning


March 2012 158

APPEN

DIX-7n)-Routine W

ashroom Cleaning


March 2012 159















APPEN

DIX-7o)-Sam


AC)


March 2012 160





March 2012 161

APPEN

DIX-7p)-Laundry H

andling


March 2012 162

APPEN

DIX-7q)-H

andling Garbage


March 2012 163

APPEN

DIX-7r)- Sharps H

andling


March 2012 164


CONTACT PRECAUTIONS


CareRehab Long Term


Home Health Care

Accommodation

Door May Be Open

No Restrictions on

Accommodation










environment








No special cleaning


Transport



Not applicable



APPEN



March 2012 165


March 2012 166

DROPLET PRECAUTIONS





Accommodation










environment



Routine Cleaning




transport




APPEN

DIX-8b)-D

roplet Precautions


March 2012 167


March 2012 168




Long Term Care




Not applicable



Measles Varicella






Transport




APPEN

DIX-8c)-A

irborne Precautions


March 2012 169


March 2012 170



Alcohols (70-95)


bull Noncritical

















bull Blood spills











APPEN

DIX-9a)-U

sesAdvantagesD

isadvantages


March 2012 171

Process Option



















March 2012 172

Process Option



























March 2012 173

Process Option


Phenolics
























March 2012 174






20 minutes



10 minutes



10 minutes





APPEN

DIX-9b)-Preparing H



March 2012 175





Good 3 h

Good 20 min

Good 10 min

Good 10 min

Good 10 min

















APPEN

DIX-9c)-A

ntimicrobial A



March 2012 176

APPEN


rea Set Up Chart


Steam Sterilizer











Ultrasonic Cleaner

Pouching Area



Cleanest Area

Dirty Area






sink

Clean Area

Sharps Container




March 2012 177

APPEN

DIX-10b)-Cleaning D



March 2012 178


March 2012 179


March 2012 180


March 2012 181










March 2012 182



Month

Year _______ Day






Flush the systems


Service by Biomed


Comments

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31


APPEN

DIX-10c)-Sam

ple Autoclave M

aintenance Record


March 2012 183





Time in

Time out










________C ______psi

_______ _C ______psi

________ C ______psi




Interpretation


APPEN

DIX-10d)-Sam



March 2012 184












Manager


APPEN

DIX-10e)-Sam



March 2012 185






Supply containerbag











TABLE OF CONTENTS

ACKNOWLEDGEMENTS

PURPOSE













Risk Assessment

Hand hygiene


Gloves

Gowns

Masks

Eye Protection

Putting on PPE

Taking off PPE

N95 Respirator




General


Cohorting


Contact Precautions

Droplet Precautions




Patient placement

Patient transport

Food and Nutrition


Visitors

Pet visitation



General

Routine Cleaning

Double Cleaning

Terminal Cleaning


Waste Management

Sharps Disposal








Cleaning

Disinfection

Sterilization

Endoscopic Devices

CJD

Dental



Immunization


Mask fit testing


Education





Tuberculosis (TB)

Meningitis



MRSA

VRE

ESBLs and CREs











APPENDIX-2-Audits





APPENDIX-7-Cleaning



















































TABLE OF CONTENTS

ACKNOWLEDGEMENTS

PURPOSE













Risk Assessment

Hand hygiene


Gloves

Gowns

Masks

Eye Protection

Putting on PPE

Taking off PPE

N95 Respirator




General


Cohorting


Contact Precautions

Droplet Precautions




Patient placement

Patient transport

Food and Nutrition


Visitors

Pet visitation



General

Routine Cleaning

Double Cleaning

Terminal Cleaning


Waste Management

Sharps Disposal








Cleaning

Disinfection

Sterilization

Endoscopic Devices

CJD

Dental



Immunization


Mask fit testing


Education





Tuberculosis (TB)

Meningitis



MRSA

VRE

ESBLs and CREs











APPENDIX-2-Audits





APPENDIX-7-Cleaning


















































March 2012 3


General 31


Cohorting 33











Visitors 41

Pet visitation 42



General 44

Routine Cleaning 44

Double Cleaning 49



Waste Management 51

Sharps Disposal 54








March 2012 4


Cleaning 60

Disinfection 61

Sterilization 64


CJD 67

Dental 68



Immunization 71


Mask fit testing 74


Education 75






Meningitis 83



MRSA 85

VRE 88

ESBLs and CREs 91








March 2012 5













March 2012 6








March 2012 7

ACKNOWLEDGEMENTS





NWT Nurse Managers






March 2012 8

PURPOSE















March 2012 9











March 2012 10
















March 2012 11








SECTIO

N-1

-INT

RO

DU

CTIO

N


March 2012 12















March 2012 13












March 2012 14











March 2012 15












March 2012 16














March 2012 17




SECTIO

N-2

-PR

INCIP

KES O

F INFECT

IN P

REV

ENT

ION

AN

D CO

NT

RO

L


March 2012 18








Controls

Interaction


Environmental

bull Infrastructure

Administrative

bull Foundation


March 2012 19




Risk Assessment






Hand hygiene



March 2012 20









above the wrist




March 2012 21















Hand Washing













March 2012 22


Ingestion of ABHR












or current)




March 2012 23













SECTIO

N-3

-PER

SON

AL P

RO

TECT

IVE EQ

UIP

MEN

T


March 2012 24
















March 2012 25








N95 Respirators








March 2012 26






Masks for Patients



Eye Protection







March 2012 27

Putting on PPE







N95 Respirator








March 2012 28

2 Cleaning





3 Placement








March 2012 29






2 Education










March 2012 30





March 2012 31










SECTIO

N-5

-AD

DIT

ION

AL P

RECA

UT

ION

S


March 2012 32







No CONTACT




Yes DROPLET CONTACT


Negative pressure

N95 respirator

AIRBORNE




Yes CONTACT



Yes yes AIRBORNE



CONTACT


March 2012 33

Cohorting


1 Patient cohorting

Includes





2 Staff cohorting








March 2012 34


2 Discontinuation





Contact Precautions









March 2012 35


















March 2012 36
















March 2012 37

















March 2012 38


















March 2012 39








Patient transport




SETIO

N-5

-INFECT

ION

PR

EVEN

TIO

N A

ND

CON

TR

OL P

RECA

UT

ION

S


March 2012 40





Food and Nutrition













March 2012 41











Visitors







March 2012 42

Pet visitation







Health Care


Acute Care









Long-term Care







March 2012 43

Health Care Setting









Ambulatory Care








Home Care






March 2012 44










Routine Cleaning


SECTIO

N-6

-ENV

IRO

NM

ENT

AL CLEA

NIN

G


March 2012 45


Before Cleaning




During Cleaning






After cleaning







March 2012 46


















March 2012 47
















March 2012 48















March 2012 49





Double Cleaning


Terminal Cleaning





March 2012 50






















March 2012 51

Waste Management











March 2012 52









March 2012 53

Waste Category


Disposal

General Waste




Black

Landfill


Incineration

Human Anatomical

Waste


Red


Incineration


Waste


Incineration






March 2012 54

Sharps Disposal


















March 2012 55

















March 2012 56



Containment



March 2012 57









SECTIO

N-7

-MED

ICAL R

EPR

OCESSIN

GST

ERILIZA

TIO

N


March 2012 58











equipment


March 2012 59


















March 2012 60






CLEA

NIN

G

Sterilization

Semicritical





Noncritical



urinals



Cleaning

1 Initial Cleaning

At point-of-use






March 2012 61






Disinfection






March 2012 62


Product Contact

time Usage Notes

Glutaraldehyde 2

20min at 20degC




20 min at 20degC



Hydrogen peroxide 6




10 min at 10degC






March 2012 63









Blood spills

Inexpensive

Rapid acting




Hydrogen peroxide 3










March 2012 64

Sterilization









1 Wrapping






March 2012 65



3 Indicators

Mechanical



Chemical



Biological








March 2012 66




4 Documentation


5 Storage





6 Maintenance





March 2012 67

Endoscopic Devices


Critical endoscopes




CJD







March 2012 68


Dental













March 2012 69















March 2012 70









March 2012 71




Immunization






SECTIO

N-8

-OCCU

PA

TIO

NA

L HEA

LTH

AN

D SA

FETY


March 2012 72




TetanusDiphtheria


Influenza






MMR All areas

Require two doses




Hepatitis B


Physical Services

Laundry

Housekeeping


Reprocessing

Patient Care

Respiratory Therapy



March 2012 73


Hepatitis B















March 2012 74

Mask fit testing
















March 2012 75

Education





March 2012 76












SECTIO

N-9

-REP

OR

TA

BLE D

ISEASES A

ND

SPECIA

L CASES


March 2012 77











March 2012 78


Part 1


Part 2


Part 3








disease
























(VRE)


March 2012 79














March 2012 80













Epidemiology








March 2012 81








Tuberculosis (TB)











March 2012 82

















March 2012 83
















Meningitis




associated cleaning




March 2012 84















March 2012 85











March 2012 86

















March 2012 87




















March 2012 88














VRE





March 2012 89














March 2012 90


















March 2012 91














March 2012 92

















March 2012 93









patients










March 2012 94

















March 2012 95













agent


March 2012 96













March 2012 97


















SECTIO

N-1

0-O

UT

BR

EAK

MA

NA

GEM

ENT


March 2012 98



















March 2012 99












March 2012 100



General Handling






Interaction




Droplet Precautions


Contact Precautions



Routine Precautions


SECTIO

N-1

1-CA

RE O

F TH

E DECEA

SED


March 2012 101


Environmental

Body Bag

No embalming

Airborne PPE










Administration




Examples


CJD Typhus





March 2012 102






Type Examples










SECTIO

N-1

2-CO

NST

RU

CTIO

N A

ND

DESIG

N O

F HEA

LTH

CAR

E FACILIT

IES


March 2012 103















March 2012 104














March 2012 105




TB Manual

HIVAIDS Manual




















SECTIO

N-1

3-R

EFEREN

CES


March 2012 106














CUPE



March 2012 107




Title


Purpose














APPEN

DIX-1-The N


mittee (ICC) Term

s of Reference


March 2012 108





Quorum















March 2012 109




Reporting Structure


Review and Update



March 2012 110

APPENDIX-2-Audits



D-Dietary


HW - Handwash













After leaving an



APPEN

DIX- 2a)- H

and Hygiene M

onitoring Tool


March 2012 111






March 2012 112


Date Auditor

Area










APPEN

DIX -2b)- H


udit


March 2012 113


Reviewer


Patient Rooms


Isolation Rooms



monitored


Hand Hygiene


Refrigerators


Linens (clean)


APPEN

DIX -2c)- N


udit


March 2012 114


Linens (soiled)


Halls Uncluttered



Offices

Conference rooms

Nurses stations



Bathrooms are clean


Biomedical waste
















Storage





March 2012 115



Clean utility



Soiled Utility




Waiting Areas



Public Bathrooms



Laboratory





Pharmacy





March 2012 116


APPEN

DIX- 3a)-U


and Rub (ABH

R)


March 2012 117

APPEN

DIX-3b)-U

sing Plain Soap


March 2012 118












bases alcohols












chemicals





caustics



APPEN

DIX-4a)-M

edical Gloves


March 2012 119

Eye Protection


Safety Glasses







Goggles






Face Shield










APPEN



March 2012 120














bull Expensive

Surgical Mask













APPEN

DIX-4d)-M



March 2012 121


APPEN



March 2012 122

APPEN

DIX-5b)-Rem

oving PPE


March 2012 123


March 2012 124

APPEN

DIX-5c)-N



March 2012 125

APPEN



March 2012 126





Comments






Contact Droplet

Duration of illness










March 2012 127




Comments


Contact Droplet

Duration of illness












March 2012 128




Comments



Contact Droplet







At all times


March 2012 129




Comments

Contact Pediatric

Duration of illness












Dengue Routine


March 2012 130




Comments


1 (if epidemic)





Droplet Contact




Routine Adult


Contact Pediatric





At all times


March 2012 131




Comments









At all times




March 2012 132




Comments

infection



Duration of illness





3 Vertical Routine




Droplet Contact



2 Vertical Routine



Routine Adult

At all times


March 2012 133




Comments


Duration of illness



At all times

Droplet Pediatric



2 Routine



Airborne

Contact





March 2012 134




Comments








At all times



Duration of illness

At all times





March 2012 135




Comments

Virus)




3 Routine







Routine Contact


March 2012 136




Comments

Lice (Pediculosis)

















March 2012 137




Comments














3



March 2012 138




Comments







2



Routine


Routine


Routine


March 2012 139




Comments



Duration of illness






4 days after rash









March 2012 140




Comments

treatment






Routine


Routine


3 Vertical Routine




March 2012 141




Comments

Discontinuation


Routine


2 Fecal Oral Route

Routine Contact










March 2012 142

APPENDIX-7-Cleaning












Container Yes No





APPEN




March 2012 143



















March 2012 144



Floors

Bathrooms


Nursing Station













Floors


APPEN


RSA V

RE and C difficle


March 2012 145





Virex solution

After each patient












APPEN



s


March 2012 146



Clinic Rooms






Floors Carpet


Daily Daily




Hallways

Carpet Floors

Vacuum Virex

Daily Daily

Waiting Rooms

Surfaces Carpet

Virex Vacuum

Daily Daily


March 2012 147

Floors Virex Daily



Virex Virex Virex

Daily Daily Daily





Carpets Virex

Vacuum Daily Daily



Virex Virex

Daily Daily




Virex Virex

Vacuum

Daily Daily Daily





March 2012 148

APPEN



March 2012 149

APPEN



March 2012 150

APPEN



March 2012 151

APPEN

DIX-7g)-Com

mode Cleaning


March 2012 152

APPEN

DIX-7h)-D

amp m

opping of floors


March 2012 153

APPEN

DIX-7i)-D

amp W

iping of Surfaces


March 2012 154

APPEN


er Cleaning


March 2012 155

APPEN

DIX-7k)-W

heelchair Cleaning


March 2012 156

APPEN

DIX-7l)-Exam

Table Cleaning


March 2012 157









Scheduled clean



APPEN

DIX-7m

)-Toy Cleaning


March 2012 158

APPEN

DIX-7n)-Routine W

ashroom Cleaning


March 2012 159















APPEN

DIX-7o)-Sam


AC)


March 2012 160





March 2012 161

APPEN

DIX-7p)-Laundry H

andling


March 2012 162

APPEN

DIX-7q)-H

andling Garbage


March 2012 163

APPEN

DIX-7r)- Sharps H

andling


March 2012 164


CONTACT PRECAUTIONS


CareRehab Long Term


Home Health Care

Accommodation

Door May Be Open

No Restrictions on

Accommodation










environment








No special cleaning


Transport



Not applicable



APPEN



March 2012 165


March 2012 166

DROPLET PRECAUTIONS





Accommodation










environment



Routine Cleaning




transport




APPEN

DIX-8b)-D

roplet Precautions


March 2012 167


March 2012 168




Long Term Care




Not applicable



Measles Varicella






Transport




APPEN

DIX-8c)-A

irborne Precautions


March 2012 169


March 2012 170



Alcohols (70-95)


bull Noncritical

















bull Blood spills











APPEN

DIX-9a)-U

sesAdvantagesD

isadvantages


March 2012 171

Process Option



















March 2012 172

Process Option



























March 2012 173

Process Option


Phenolics
























March 2012 174






20 minutes



10 minutes



10 minutes





APPEN

DIX-9b)-Preparing H



March 2012 175





Good 3 h

Good 20 min

Good 10 min

Good 10 min

Good 10 min

















APPEN

DIX-9c)-A

ntimicrobial A



March 2012 176

APPEN


rea Set Up Chart


Steam Sterilizer











Ultrasonic Cleaner

Pouching Area



Cleanest Area

Dirty Area






sink

Clean Area

Sharps Container




March 2012 177

APPEN

DIX-10b)-Cleaning D



March 2012 178


March 2012 179


March 2012 180


March 2012 181










March 2012 182



Month

Year _______ Day






Flush the systems


Service by Biomed


Comments

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31


APPEN

DIX-10c)-Sam

ple Autoclave M

aintenance Record


March 2012 183





Time in

Time out










________C ______psi

_______ _C ______psi

________ C ______psi




Interpretation


APPEN

DIX-10d)-Sam



March 2012 184












Manager


APPEN

DIX-10e)-Sam



March 2012 185






Supply containerbag











TABLE OF CONTENTS

ACKNOWLEDGEMENTS

PURPOSE













Risk Assessment

Hand hygiene


Gloves

Gowns

Masks

Eye Protection

Putting on PPE

Taking off PPE

N95 Respirator




General


Cohorting


Contact Precautions

Droplet Precautions




Patient placement

Patient transport

Food and Nutrition


Visitors

Pet visitation



General

Routine Cleaning

Double Cleaning

Terminal Cleaning


Waste Management

Sharps Disposal








Cleaning

Disinfection

Sterilization

Endoscopic Devices

CJD

Dental



Immunization


Mask fit testing


Education





Tuberculosis (TB)

Meningitis



MRSA

VRE

ESBLs and CREs











APPENDIX-2-Audits





APPENDIX-7-Cleaning



















































TABLE OF CONTENTS

ACKNOWLEDGEMENTS

PURPOSE













Risk Assessment

Hand hygiene


Gloves

Gowns

Masks

Eye Protection

Putting on PPE

Taking off PPE

N95 Respirator




General


Cohorting


Contact Precautions

Droplet Precautions




Patient placement

Patient transport

Food and Nutrition


Visitors

Pet visitation



General

Routine Cleaning

Double Cleaning

Terminal Cleaning


Waste Management

Sharps Disposal








Cleaning

Disinfection

Sterilization

Endoscopic Devices

CJD

Dental



Immunization


Mask fit testing


Education





Tuberculosis (TB)

Meningitis



MRSA

VRE

ESBLs and CREs











APPENDIX-2-Audits





APPENDIX-7-Cleaning


















































March 2012 4


Cleaning 60

Disinfection 61

Sterilization 64


CJD 67

Dental 68



Immunization 71


Mask fit testing 74


Education 75






Meningitis 83



MRSA 85

VRE 88

ESBLs and CREs 91








March 2012 5













March 2012 6








March 2012 7

ACKNOWLEDGEMENTS





NWT Nurse Managers






March 2012 8

PURPOSE















March 2012 9











March 2012 10
















March 2012 11








SECTIO

N-1

-INT

RO

DU

CTIO

N


March 2012 12















March 2012 13












March 2012 14











March 2012 15












March 2012 16














March 2012 17




SECTIO

N-2

-PR

INCIP

KES O

F INFECT

IN P

REV

ENT

ION

AN

D CO

NT

RO

L


March 2012 18








Controls

Interaction


Environmental

bull Infrastructure

Administrative

bull Foundation


March 2012 19




Risk Assessment






Hand hygiene



March 2012 20









above the wrist




March 2012 21















Hand Washing













March 2012 22


Ingestion of ABHR












or current)




March 2012 23













SECTIO

N-3

-PER

SON

AL P

RO

TECT

IVE EQ

UIP

MEN

T


March 2012 24
















March 2012 25








N95 Respirators








March 2012 26






Masks for Patients



Eye Protection







March 2012 27

Putting on PPE







N95 Respirator








March 2012 28

2 Cleaning





3 Placement








March 2012 29






2 Education










March 2012 30





March 2012 31










SECTIO

N-5

-AD

DIT

ION

AL P

RECA

UT

ION

S


March 2012 32







No CONTACT




Yes DROPLET CONTACT


Negative pressure

N95 respirator

AIRBORNE




Yes CONTACT



Yes yes AIRBORNE



CONTACT


March 2012 33

Cohorting


1 Patient cohorting

Includes





2 Staff cohorting








March 2012 34


2 Discontinuation





Contact Precautions









March 2012 35


















March 2012 36
















March 2012 37

















March 2012 38


















March 2012 39








Patient transport




SETIO

N-5

-INFECT

ION

PR

EVEN

TIO

N A

ND

CON

TR

OL P

RECA

UT

ION

S


March 2012 40





Food and Nutrition













March 2012 41











Visitors







March 2012 42

Pet visitation







Health Care


Acute Care









Long-term Care







March 2012 43

Health Care Setting









Ambulatory Care








Home Care






March 2012 44










Routine Cleaning


SECTIO

N-6

-ENV

IRO

NM

ENT

AL CLEA

NIN

G


March 2012 45


Before Cleaning




During Cleaning






After cleaning







March 2012 46


















March 2012 47
















March 2012 48















March 2012 49





Double Cleaning


Terminal Cleaning





March 2012 50






















March 2012 51

Waste Management











March 2012 52









March 2012 53

Waste Category


Disposal

General Waste




Black

Landfill


Incineration

Human Anatomical

Waste


Red


Incineration


Waste


Incineration






March 2012 54

Sharps Disposal


















March 2012 55

















March 2012 56



Containment



March 2012 57









SECTIO

N-7

-MED

ICAL R

EPR

OCESSIN

GST

ERILIZA

TIO

N


March 2012 58











equipment


March 2012 59


















March 2012 60






CLEA

NIN

G

Sterilization

Semicritical





Noncritical



urinals



Cleaning

1 Initial Cleaning

At point-of-use






March 2012 61






Disinfection






March 2012 62


Product Contact

time Usage Notes

Glutaraldehyde 2

20min at 20degC




20 min at 20degC



Hydrogen peroxide 6




10 min at 10degC






March 2012 63









Blood spills

Inexpensive

Rapid acting




Hydrogen peroxide 3










March 2012 64

Sterilization









1 Wrapping






March 2012 65



3 Indicators

Mechanical



Chemical



Biological








March 2012 66




4 Documentation


5 Storage





6 Maintenance





March 2012 67

Endoscopic Devices


Critical endoscopes




CJD







March 2012 68


Dental













March 2012 69















March 2012 70









March 2012 71




Immunization






SECTIO

N-8

-OCCU

PA

TIO

NA

L HEA

LTH

AN

D SA

FETY


March 2012 72




TetanusDiphtheria


Influenza






MMR All areas

Require two doses




Hepatitis B


Physical Services

Laundry

Housekeeping


Reprocessing

Patient Care

Respiratory Therapy



March 2012 73


Hepatitis B















March 2012 74

Mask fit testing
















March 2012 75

Education





March 2012 76












SECTIO

N-9

-REP

OR

TA

BLE D

ISEASES A

ND

SPECIA

L CASES


March 2012 77











March 2012 78


Part 1


Part 2


Part 3








disease
























(VRE)


March 2012 79














March 2012 80













Epidemiology








March 2012 81








Tuberculosis (TB)











March 2012 82

















March 2012 83
















Meningitis




associated cleaning




March 2012 84















March 2012 85











March 2012 86

















March 2012 87




















March 2012 88














VRE





March 2012 89














March 2012 90


















March 2012 91














March 2012 92

















March 2012 93









patients










March 2012 94

















March 2012 95













agent


March 2012 96













March 2012 97


















SECTIO

N-1

0-O

UT

BR

EAK

MA

NA

GEM

ENT


March 2012 98



















March 2012 99












March 2012 100



General Handling






Interaction




Droplet Precautions


Contact Precautions



Routine Precautions


SECTIO

N-1

1-CA

RE O

F TH

E DECEA

SED


March 2012 101


Environmental

Body Bag

No embalming

Airborne PPE










Administration




Examples


CJD Typhus





March 2012 102






Type Examples










SECTIO

N-1

2-CO

NST

RU

CTIO

N A

ND

DESIG

N O

F HEA

LTH

CAR

E FACILIT

IES


March 2012 103















March 2012 104














March 2012 105




TB Manual

HIVAIDS Manual




















SECTIO

N-1

3-R

EFEREN

CES


March 2012 106














CUPE



March 2012 107




Title


Purpose














APPEN

DIX-1-The N


mittee (ICC) Term

s of Reference


March 2012 108





Quorum















March 2012 109




Reporting Structure


Review and Update



March 2012 110

APPENDIX-2-Audits



D-Dietary


HW - Handwash













After leaving an



APPEN

DIX- 2a)- H

and Hygiene M

onitoring Tool


March 2012 111






March 2012 112


Date Auditor

Area










APPEN

DIX -2b)- H


udit


March 2012 113


Reviewer


Patient Rooms


Isolation Rooms



monitored


Hand Hygiene


Refrigerators


Linens (clean)


APPEN

DIX -2c)- N


udit


March 2012 114


Linens (soiled)


Halls Uncluttered



Offices

Conference rooms

Nurses stations



Bathrooms are clean


Biomedical waste
















Storage





March 2012 115



Clean utility



Soiled Utility




Waiting Areas



Public Bathrooms



Laboratory





Pharmacy





March 2012 116


APPEN

DIX- 3a)-U


and Rub (ABH

R)


March 2012 117

APPEN

DIX-3b)-U

sing Plain Soap


March 2012 118












bases alcohols












chemicals





caustics



APPEN

DIX-4a)-M

edical Gloves


March 2012 119

Eye Protection


Safety Glasses







Goggles






Face Shield










APPEN



March 2012 120














bull Expensive

Surgical Mask













APPEN

DIX-4d)-M



March 2012 121


APPEN



March 2012 122

APPEN

DIX-5b)-Rem

oving PPE


March 2012 123


March 2012 124

APPEN

DIX-5c)-N



March 2012 125

APPEN



March 2012 126





Comments






Contact Droplet

Duration of illness










March 2012 127




Comments


Contact Droplet

Duration of illness












March 2012 128




Comments



Contact Droplet







At all times


March 2012 129




Comments

Contact Pediatric

Duration of illness












Dengue Routine


March 2012 130




Comments


1 (if epidemic)





Droplet Contact




Routine Adult


Contact Pediatric





At all times


March 2012 131




Comments









At all times




March 2012 132




Comments

infection



Duration of illness





3 Vertical Routine




Droplet Contact



2 Vertical Routine



Routine Adult

At all times


March 2012 133




Comments


Duration of illness



At all times

Droplet Pediatric



2 Routine



Airborne

Contact





March 2012 134




Comments








At all times



Duration of illness

At all times





March 2012 135




Comments

Virus)




3 Routine







Routine Contact


March 2012 136




Comments

Lice (Pediculosis)

















March 2012 137




Comments














3



March 2012 138




Comments







2



Routine


Routine


Routine


March 2012 139




Comments



Duration of illness






4 days after rash









March 2012 140




Comments

treatment






Routine


Routine


3 Vertical Routine




March 2012 141




Comments

Discontinuation


Routine


2 Fecal Oral Route

Routine Contact










March 2012 142

APPENDIX-7-Cleaning












Container Yes No





APPEN




March 2012 143



















March 2012 144



Floors

Bathrooms


Nursing Station













Floors


APPEN


RSA V

RE and C difficle


March 2012 145





Virex solution

After each patient












APPEN



s


March 2012 146



Clinic Rooms






Floors Carpet


Daily Daily




Hallways

Carpet Floors

Vacuum Virex

Daily Daily

Waiting Rooms

Surfaces Carpet

Virex Vacuum

Daily Daily


March 2012 147

Floors Virex Daily



Virex Virex Virex

Daily Daily Daily





Carpets Virex

Vacuum Daily Daily



Virex Virex

Daily Daily




Virex Virex

Vacuum

Daily Daily Daily





March 2012 148

APPEN



March 2012 149

APPEN



March 2012 150

APPEN



March 2012 151

APPEN

DIX-7g)-Com

mode Cleaning


March 2012 152

APPEN

DIX-7h)-D

amp m

opping of floors


March 2012 153

APPEN

DIX-7i)-D

amp W

iping of Surfaces


March 2012 154

APPEN


er Cleaning


March 2012 155

APPEN

DIX-7k)-W

heelchair Cleaning


March 2012 156

APPEN

DIX-7l)-Exam

Table Cleaning


March 2012 157









Scheduled clean



APPEN

DIX-7m

)-Toy Cleaning


March 2012 158

APPEN

DIX-7n)-Routine W

ashroom Cleaning


March 2012 159















APPEN

DIX-7o)-Sam


AC)


March 2012 160





March 2012 161

APPEN

DIX-7p)-Laundry H

andling


March 2012 162

APPEN

DIX-7q)-H

andling Garbage


March 2012 163

APPEN

DIX-7r)- Sharps H

andling


March 2012 164


CONTACT PRECAUTIONS


CareRehab Long Term


Home Health Care

Accommodation

Door May Be Open

No Restrictions on

Accommodation










environment








No special cleaning


Transport



Not applicable



APPEN



March 2012 165


March 2012 166

DROPLET PRECAUTIONS





Accommodation










environment



Routine Cleaning




transport




APPEN

DIX-8b)-D

roplet Precautions


March 2012 167


March 2012 168




Long Term Care




Not applicable



Measles Varicella






Transport




APPEN

DIX-8c)-A

irborne Precautions


March 2012 169


March 2012 170



Alcohols (70-95)


bull Noncritical

















bull Blood spills











APPEN

DIX-9a)-U

sesAdvantagesD

isadvantages


March 2012 171

Process Option



















March 2012 172

Process Option



























March 2012 173

Process Option


Phenolics
























March 2012 174






20 minutes



10 minutes



10 minutes





APPEN

DIX-9b)-Preparing H



March 2012 175





Good 3 h

Good 20 min

Good 10 min

Good 10 min

Good 10 min

















APPEN

DIX-9c)-A

ntimicrobial A



March 2012 176

APPEN


rea Set Up Chart


Steam Sterilizer











Ultrasonic Cleaner

Pouching Area



Cleanest Area

Dirty Area






sink

Clean Area

Sharps Container




March 2012 177

APPEN

DIX-10b)-Cleaning D



March 2012 178


March 2012 179


March 2012 180


March 2012 181










March 2012 182



Month

Year _______ Day






Flush the systems


Service by Biomed


Comments

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31


APPEN

DIX-10c)-Sam

ple Autoclave M

aintenance Record


March 2012 183





Time in

Time out










________C ______psi

_______ _C ______psi

________ C ______psi




Interpretation


APPEN

DIX-10d)-Sam



March 2012 184












Manager


APPEN

DIX-10e)-Sam



March 2012 185






Supply containerbag











TABLE OF CONTENTS

ACKNOWLEDGEMENTS

PURPOSE













Risk Assessment

Hand hygiene


Gloves

Gowns

Masks

Eye Protection

Putting on PPE

Taking off PPE

N95 Respirator




General


Cohorting


Contact Precautions

Droplet Precautions




Patient placement

Patient transport

Food and Nutrition


Visitors

Pet visitation



General

Routine Cleaning

Double Cleaning

Terminal Cleaning


Waste Management

Sharps Disposal








Cleaning

Disinfection

Sterilization

Endoscopic Devices

CJD

Dental



Immunization


Mask fit testing


Education





Tuberculosis (TB)

Meningitis



MRSA

VRE

ESBLs and CREs











APPENDIX-2-Audits





APPENDIX-7-Cleaning



















































TABLE OF CONTENTS

ACKNOWLEDGEMENTS

PURPOSE













Risk Assessment

Hand hygiene


Gloves

Gowns

Masks

Eye Protection

Putting on PPE

Taking off PPE

N95 Respirator




General


Cohorting


Contact Precautions

Droplet Precautions




Patient placement

Patient transport

Food and Nutrition


Visitors

Pet visitation



General

Routine Cleaning

Double Cleaning

Terminal Cleaning


Waste Management

Sharps Disposal








Cleaning

Disinfection

Sterilization

Endoscopic Devices

CJD

Dental



Immunization


Mask fit testing


Education





Tuberculosis (TB)

Meningitis



MRSA

VRE

ESBLs and CREs











APPENDIX-2-Audits





APPENDIX-7-Cleaning


















































March 2012 5













March 2012 6








March 2012 7

ACKNOWLEDGEMENTS





NWT Nurse Managers






March 2012 8

PURPOSE















March 2012 9











March 2012 10
















March 2012 11








SECTIO

N-1

-INT

RO

DU

CTIO

N


March 2012 12















March 2012 13












March 2012 14











March 2012 15












March 2012 16














March 2012 17




SECTIO

N-2

-PR

INCIP

KES O

F INFECT

IN P

REV

ENT

ION

AN

D CO

NT

RO

L


March 2012 18








Controls

Interaction


Environmental

bull Infrastructure

Administrative

bull Foundation


March 2012 19




Risk Assessment






Hand hygiene



March 2012 20









above the wrist




March 2012 21















Hand Washing













March 2012 22


Ingestion of ABHR












or current)




March 2012 23













SECTIO

N-3

-PER

SON

AL P

RO

TECT

IVE EQ

UIP

MEN

T


March 2012 24
















March 2012 25








N95 Respirators








March 2012 26






Masks for Patients



Eye Protection







March 2012 27

Putting on PPE







N95 Respirator








March 2012 28

2 Cleaning





3 Placement








March 2012 29






2 Education










March 2012 30





March 2012 31










SECTIO

N-5

-AD

DIT

ION

AL P

RECA

UT

ION

S


March 2012 32







No CONTACT




Yes DROPLET CONTACT


Negative pressure

N95 respirator

AIRBORNE




Yes CONTACT



Yes yes AIRBORNE



CONTACT


March 2012 33

Cohorting


1 Patient cohorting

Includes





2 Staff cohorting








March 2012 34


2 Discontinuation





Contact Precautions









March 2012 35


















March 2012 36
















March 2012 37

















March 2012 38


















March 2012 39








Patient transport




SETIO

N-5

-INFECT

ION

PR

EVEN

TIO

N A

ND

CON

TR

OL P

RECA

UT

ION

S


March 2012 40





Food and Nutrition













March 2012 41











Visitors







March 2012 42

Pet visitation







Health Care


Acute Care









Long-term Care







March 2012 43

Health Care Setting









Ambulatory Care








Home Care






March 2012 44










Routine Cleaning


SECTIO

N-6

-ENV

IRO

NM

ENT

AL CLEA

NIN

G


March 2012 45


Before Cleaning




During Cleaning






After cleaning







March 2012 46


















March 2012 47
















March 2012 48















March 2012 49





Double Cleaning


Terminal Cleaning





March 2012 50






















March 2012 51

Waste Management











March 2012 52









March 2012 53

Waste Category


Disposal

General Waste




Black

Landfill


Incineration

Human Anatomical

Waste


Red


Incineration


Waste


Incineration






March 2012 54

Sharps Disposal


















March 2012 55

















March 2012 56



Containment



March 2012 57









SECTIO

N-7

-MED

ICAL R

EPR

OCESSIN

GST

ERILIZA

TIO

N


March 2012 58











equipment


March 2012 59


















March 2012 60






CLEA

NIN

G

Sterilization

Semicritical





Noncritical



urinals



Cleaning

1 Initial Cleaning

At point-of-use






March 2012 61






Disinfection






March 2012 62


Product Contact

time Usage Notes

Glutaraldehyde 2

20min at 20degC




20 min at 20degC



Hydrogen peroxide 6




10 min at 10degC






March 2012 63









Blood spills

Inexpensive

Rapid acting




Hydrogen peroxide 3










March 2012 64

Sterilization









1 Wrapping






March 2012 65



3 Indicators

Mechanical



Chemical



Biological








March 2012 66




4 Documentation


5 Storage





6 Maintenance





March 2012 67

Endoscopic Devices


Critical endoscopes




CJD







March 2012 68


Dental













March 2012 69















March 2012 70









March 2012 71




Immunization






SECTIO

N-8

-OCCU

PA

TIO

NA

L HEA

LTH

AN

D SA

FETY


March 2012 72




TetanusDiphtheria


Influenza






MMR All areas

Require two doses




Hepatitis B


Physical Services

Laundry

Housekeeping


Reprocessing

Patient Care

Respiratory Therapy



March 2012 73


Hepatitis B















March 2012 74

Mask fit testing
















March 2012 75

Education





March 2012 76












SECTIO

N-9

-REP

OR

TA

BLE D

ISEASES A

ND

SPECIA

L CASES


March 2012 77











March 2012 78


Part 1


Part 2


Part 3








disease
























(VRE)


March 2012 79














March 2012 80













Epidemiology








March 2012 81








Tuberculosis (TB)











March 2012 82

















March 2012 83
















Meningitis




associated cleaning




March 2012 84















March 2012 85











March 2012 86

















March 2012 87




















March 2012 88














VRE





March 2012 89














March 2012 90


















March 2012 91














March 2012 92

















March 2012 93









patients










March 2012 94

















March 2012 95













agent


March 2012 96













March 2012 97


















SECTIO

N-1

0-O

UT

BR

EAK

MA

NA

GEM

ENT


March 2012 98



















March 2012 99












March 2012 100



General Handling






Interaction




Droplet Precautions


Contact Precautions



Routine Precautions


SECTIO

N-1

1-CA

RE O

F TH

E DECEA

SED


March 2012 101


Environmental

Body Bag

No embalming

Airborne PPE










Administration




Examples


CJD Typhus





March 2012 102






Type Examples










SECTIO

N-1

2-CO

NST

RU

CTIO

N A

ND

DESIG

N O

F HEA

LTH

CAR

E FACILIT

IES


March 2012 103















March 2012 104














March 2012 105




TB Manual

HIVAIDS Manual




















SECTIO

N-1

3-R

EFEREN

CES


March 2012 106














CUPE



March 2012 107




Title


Purpose














APPEN

DIX-1-The N


mittee (ICC) Term

s of Reference


March 2012 108





Quorum















March 2012 109




Reporting Structure


Review and Update



March 2012 110

APPENDIX-2-Audits



D-Dietary


HW - Handwash













After leaving an



APPEN

DIX- 2a)- H

and Hygiene M

onitoring Tool


March 2012 111






March 2012 112


Date Auditor

Area










APPEN

DIX -2b)- H


udit


March 2012 113


Reviewer


Patient Rooms


Isolation Rooms



monitored


Hand Hygiene


Refrigerators


Linens (clean)


APPEN

DIX -2c)- N


udit


March 2012 114


Linens (soiled)


Halls Uncluttered



Offices

Conference rooms

Nurses stations



Bathrooms are clean


Biomedical waste
















Storage





March 2012 115



Clean utility



Soiled Utility




Waiting Areas



Public Bathrooms



Laboratory





Pharmacy





March 2012 116


APPEN

DIX- 3a)-U


and Rub (ABH

R)


March 2012 117

APPEN

DIX-3b)-U

sing Plain Soap


March 2012 118












bases alcohols












chemicals





caustics



APPEN

DIX-4a)-M

edical Gloves


March 2012 119

Eye Protection


Safety Glasses







Goggles






Face Shield










APPEN



March 2012 120














bull Expensive

Surgical Mask













APPEN

DIX-4d)-M



March 2012 121


APPEN



March 2012 122

APPEN

DIX-5b)-Rem

oving PPE


March 2012 123


March 2012 124

APPEN

DIX-5c)-N



March 2012 125

APPEN



March 2012 126





Comments






Contact Droplet

Duration of illness










March 2012 127




Comments


Contact Droplet

Duration of illness












March 2012 128




Comments



Contact Droplet







At all times


March 2012 129




Comments

Contact Pediatric

Duration of illness












Dengue Routine


March 2012 130




Comments


1 (if epidemic)





Droplet Contact




Routine Adult


Contact Pediatric





At all times


March 2012 131




Comments









At all times




March 2012 132




Comments

infection



Duration of illness





3 Vertical Routine




Droplet Contact



2 Vertical Routine



Routine Adult

At all times


March 2012 133




Comments


Duration of illness



At all times

Droplet Pediatric



2 Routine



Airborne

Contact





March 2012 134




Comments








At all times



Duration of illness

At all times





March 2012 135




Comments

Virus)




3 Routine







Routine Contact


March 2012 136




Comments

Lice (Pediculosis)

















March 2012 137




Comments














3



March 2012 138




Comments







2



Routine


Routine


Routine


March 2012 139




Comments



Duration of illness






4 days after rash









March 2012 140




Comments

treatment






Routine


Routine


3 Vertical Routine




March 2012 141




Comments

Discontinuation


Routine


2 Fecal Oral Route

Routine Contact










March 2012 142

APPENDIX-7-Cleaning












Container Yes No





APPEN




March 2012 143



















March 2012 144



Floors

Bathrooms


Nursing Station













Floors


APPEN


RSA V

RE and C difficle


March 2012 145





Virex solution

After each patient












APPEN



s


March 2012 146



Clinic Rooms






Floors Carpet


Daily Daily




Hallways

Carpet Floors

Vacuum Virex

Daily Daily

Waiting Rooms

Surfaces Carpet

Virex Vacuum

Daily Daily


March 2012 147

Floors Virex Daily



Virex Virex Virex

Daily Daily Daily





Carpets Virex

Vacuum Daily Daily



Virex Virex

Daily Daily




Virex Virex

Vacuum

Daily Daily Daily





March 2012 148

APPEN



March 2012 149

APPEN



March 2012 150

APPEN



March 2012 151

APPEN

DIX-7g)-Com

mode Cleaning


March 2012 152

APPEN

DIX-7h)-D

amp m

opping of floors


March 2012 153

APPEN

DIX-7i)-D

amp W

iping of Surfaces


March 2012 154

APPEN


er Cleaning


March 2012 155

APPEN

DIX-7k)-W

heelchair Cleaning


March 2012 156

APPEN

DIX-7l)-Exam

Table Cleaning


March 2012 157









Scheduled clean



APPEN

DIX-7m

)-Toy Cleaning


March 2012 158

APPEN

DIX-7n)-Routine W

ashroom Cleaning


March 2012 159















APPEN

DIX-7o)-Sam


AC)


March 2012 160





March 2012 161

APPEN

DIX-7p)-Laundry H

andling


March 2012 162

APPEN

DIX-7q)-H

andling Garbage


March 2012 163

APPEN

DIX-7r)- Sharps H

andling


March 2012 164


CONTACT PRECAUTIONS


CareRehab Long Term


Home Health Care

Accommodation

Door May Be Open

No Restrictions on

Accommodation










environment








No special cleaning


Transport



Not applicable



APPEN



March 2012 165


March 2012 166

DROPLET PRECAUTIONS





Accommodation










environment



Routine Cleaning




transport




APPEN

DIX-8b)-D

roplet Precautions


March 2012 167


March 2012 168




Long Term Care




Not applicable



Measles Varicella






Transport




APPEN

DIX-8c)-A

irborne Precautions


March 2012 169


March 2012 170



Alcohols (70-95)


bull Noncritical

















bull Blood spills











APPEN

DIX-9a)-U

sesAdvantagesD

isadvantages


March 2012 171

Process Option



















March 2012 172

Process Option



























March 2012 173

Process Option


Phenolics
























March 2012 174






20 minutes



10 minutes



10 minutes





APPEN

DIX-9b)-Preparing H



March 2012 175





Good 3 h

Good 20 min

Good 10 min

Good 10 min

Good 10 min

















APPEN

DIX-9c)-A

ntimicrobial A



March 2012 176

APPEN


rea Set Up Chart


Steam Sterilizer











Ultrasonic Cleaner

Pouching Area



Cleanest Area

Dirty Area






sink

Clean Area

Sharps Container




March 2012 177

APPEN

DIX-10b)-Cleaning D



March 2012 178


March 2012 179


March 2012 180


March 2012 181










March 2012 182



Month

Year _______ Day






Flush the systems


Service by Biomed


Comments

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31


APPEN

DIX-10c)-Sam

ple Autoclave M

aintenance Record


March 2012 183





Time in

Time out










________C ______psi

_______ _C ______psi

________ C ______psi




Interpretation


APPEN

DIX-10d)-Sam



March 2012 184












Manager


APPEN

DIX-10e)-Sam



March 2012 185






Supply containerbag











TABLE OF CONTENTS

ACKNOWLEDGEMENTS

PURPOSE













Risk Assessment

Hand hygiene


Gloves

Gowns

Masks

Eye Protection

Putting on PPE

Taking off PPE

N95 Respirator




General


Cohorting


Contact Precautions

Droplet Precautions




Patient placement

Patient transport

Food and Nutrition


Visitors

Pet visitation



General

Routine Cleaning

Double Cleaning

Terminal Cleaning


Waste Management

Sharps Disposal








Cleaning

Disinfection

Sterilization

Endoscopic Devices

CJD

Dental



Immunization


Mask fit testing


Education





Tuberculosis (TB)

Meningitis



MRSA

VRE

ESBLs and CREs











APPENDIX-2-Audits





APPENDIX-7-Cleaning



















































TABLE OF CONTENTS

ACKNOWLEDGEMENTS

PURPOSE













Risk Assessment

Hand hygiene


Gloves

Gowns

Masks

Eye Protection

Putting on PPE

Taking off PPE

N95 Respirator




General


Cohorting


Contact Precautions

Droplet Precautions




Patient placement

Patient transport

Food and Nutrition


Visitors

Pet visitation



General

Routine Cleaning

Double Cleaning

Terminal Cleaning


Waste Management

Sharps Disposal








Cleaning

Disinfection

Sterilization

Endoscopic Devices

CJD

Dental



Immunization


Mask fit testing


Education





Tuberculosis (TB)

Meningitis



MRSA

VRE

ESBLs and CREs











APPENDIX-2-Audits





APPENDIX-7-Cleaning


















































March 2012 6








March 2012 7

ACKNOWLEDGEMENTS





NWT Nurse Managers






March 2012 8

PURPOSE















March 2012 9











March 2012 10
















March 2012 11








SECTIO

N-1

-INT

RO

DU

CTIO

N


March 2012 12















March 2012 13












March 2012 14











March 2012 15












March 2012 16














March 2012 17




SECTIO

N-2

-PR

INCIP

KES O

F INFECT

IN P

REV

ENT

ION

AN

D CO

NT

RO

L


March 2012 18








Controls

Interaction


Environmental

bull Infrastructure

Administrative

bull Foundation


March 2012 19




Risk Assessment






Hand hygiene



March 2012 20









above the wrist




March 2012 21















Hand Washing













March 2012 22


Ingestion of ABHR












or current)




March 2012 23













SECTIO

N-3

-PER

SON

AL P

RO

TECT

IVE EQ

UIP

MEN

T


March 2012 24
















March 2012 25








N95 Respirators








March 2012 26






Masks for Patients



Eye Protection







March 2012 27

Putting on PPE







N95 Respirator








March 2012 28

2 Cleaning





3 Placement








March 2012 29






2 Education










March 2012 30





March 2012 31










SECTIO

N-5

-AD

DIT

ION

AL P

RECA

UT

ION

S


March 2012 32







No CONTACT




Yes DROPLET CONTACT


Negative pressure

N95 respirator

AIRBORNE




Yes CONTACT



Yes yes AIRBORNE



CONTACT


March 2012 33

Cohorting


1 Patient cohorting

Includes





2 Staff cohorting








March 2012 34


2 Discontinuation





Contact Precautions









March 2012 35


















March 2012 36
















March 2012 37

















March 2012 38


















March 2012 39








Patient transport




SETIO

N-5

-INFECT

ION

PR

EVEN

TIO

N A

ND

CON

TR

OL P

RECA

UT

ION

S


March 2012 40





Food and Nutrition













March 2012 41











Visitors







March 2012 42

Pet visitation







Health Care


Acute Care









Long-term Care







March 2012 43

Health Care Setting









Ambulatory Care








Home Care






March 2012 44










Routine Cleaning


SECTIO

N-6

-ENV

IRO

NM

ENT

AL CLEA

NIN

G


March 2012 45


Before Cleaning




During Cleaning






After cleaning







March 2012 46


















March 2012 47
















March 2012 48















March 2012 49





Double Cleaning


Terminal Cleaning





March 2012 50






















March 2012 51

Waste Management











March 2012 52









March 2012 53

Waste Category


Disposal

General Waste




Black

Landfill


Incineration

Human Anatomical

Waste


Red


Incineration


Waste


Incineration






March 2012 54

Sharps Disposal


















March 2012 55

















March 2012 56



Containment



March 2012 57









SECTIO

N-7

-MED

ICAL R

EPR

OCESSIN

GST

ERILIZA

TIO

N


March 2012 58











equipment


March 2012 59


















March 2012 60






CLEA

NIN

G

Sterilization

Semicritical





Noncritical



urinals



Cleaning

1 Initial Cleaning

At point-of-use






March 2012 61






Disinfection






March 2012 62


Product Contact

time Usage Notes

Glutaraldehyde 2

20min at 20degC




20 min at 20degC



Hydrogen peroxide 6




10 min at 10degC






March 2012 63









Blood spills

Inexpensive

Rapid acting




Hydrogen peroxide 3










March 2012 64

Sterilization









1 Wrapping






March 2012 65



3 Indicators

Mechanical



Chemical



Biological








March 2012 66




4 Documentation


5 Storage





6 Maintenance





March 2012 67

Endoscopic Devices


Critical endoscopes




CJD







March 2012 68


Dental













March 2012 69















March 2012 70









March 2012 71




Immunization






SECTIO

N-8

-OCCU

PA

TIO

NA

L HEA

LTH

AN

D SA

FETY


March 2012 72




TetanusDiphtheria


Influenza






MMR All areas

Require two doses




Hepatitis B


Physical Services

Laundry

Housekeeping


Reprocessing

Patient Care

Respiratory Therapy



March 2012 73


Hepatitis B















March 2012 74

Mask fit testing
















March 2012 75

Education





March 2012 76












SECTIO

N-9

-REP

OR

TA

BLE D

ISEASES A

ND

SPECIA

L CASES


March 2012 77











March 2012 78


Part 1


Part 2


Part 3








disease
























(VRE)


March 2012 79














March 2012 80













Epidemiology








March 2012 81








Tuberculosis (TB)











March 2012 82

















March 2012 83
















Meningitis




associated cleaning




March 2012 84















March 2012 85











March 2012 86

















March 2012 87




















March 2012 88














VRE





March 2012 89














March 2012 90


















March 2012 91














March 2012 92

















March 2012 93









patients










March 2012 94

















March 2012 95













agent


March 2012 96













March 2012 97


















SECTIO

N-1

0-O

UT

BR

EAK

MA

NA

GEM

ENT


March 2012 98



















March 2012 99












March 2012 100



General Handling






Interaction




Droplet Precautions


Contact Precautions



Routine Precautions


SECTIO

N-1

1-CA

RE O

F TH

E DECEA

SED


March 2012 101


Environmental

Body Bag

No embalming

Airborne PPE










Administration




Examples


CJD Typhus





March 2012 102






Type Examples










SECTIO

N-1

2-CO

NST

RU

CTIO

N A

ND

DESIG

N O

F HEA

LTH

CAR

E FACILIT

IES


March 2012 103















March 2012 104














March 2012 105




TB Manual

HIVAIDS Manual




















SECTIO

N-1

3-R

EFEREN

CES


March 2012 106














CUPE



March 2012 107




Title


Purpose














APPEN

DIX-1-The N


mittee (ICC) Term

s of Reference


March 2012 108





Quorum















March 2012 109




Reporting Structure


Review and Update



March 2012 110

APPENDIX-2-Audits



D-Dietary


HW - Handwash













After leaving an



APPEN

DIX- 2a)- H

and Hygiene M

onitoring Tool


March 2012 111






March 2012 112


Date Auditor

Area










APPEN

DIX -2b)- H


udit


March 2012 113


Reviewer


Patient Rooms


Isolation Rooms



monitored


Hand Hygiene


Refrigerators


Linens (clean)


APPEN

DIX -2c)- N


udit


March 2012 114


Linens (soiled)


Halls Uncluttered



Offices

Conference rooms

Nurses stations



Bathrooms are clean


Biomedical waste
















Storage





March 2012 115



Clean utility



Soiled Utility




Waiting Areas



Public Bathrooms



Laboratory





Pharmacy





March 2012 116


APPEN

DIX- 3a)-U


and Rub (ABH

R)


March 2012 117

APPEN

DIX-3b)-U

sing Plain Soap


March 2012 118












bases alcohols












chemicals





caustics



APPEN

DIX-4a)-M

edical Gloves


March 2012 119

Eye Protection


Safety Glasses







Goggles






Face Shield










APPEN



March 2012 120














bull Expensive

Surgical Mask













APPEN

DIX-4d)-M



March 2012 121


APPEN



March 2012 122

APPEN

DIX-5b)-Rem

oving PPE


March 2012 123


March 2012 124

APPEN

DIX-5c)-N



March 2012 125

APPEN



March 2012 126





Comments






Contact Droplet

Duration of illness










March 2012 127




Comments


Contact Droplet

Duration of illness












March 2012 128




Comments



Contact Droplet







At all times


March 2012 129




Comments

Contact Pediatric

Duration of illness












Dengue Routine


March 2012 130




Comments


1 (if epidemic)





Droplet Contact




Routine Adult


Contact Pediatric





At all times


March 2012 131




Comments









At all times




March 2012 132




Comments

infection



Duration of illness





3 Vertical Routine




Droplet Contact



2 Vertical Routine



Routine Adult

At all times


March 2012 133




Comments


Duration of illness



At all times

Droplet Pediatric



2 Routine



Airborne

Contact





March 2012 134




Comments








At all times



Duration of illness

At all times





March 2012 135




Comments

Virus)




3 Routine







Routine Contact


March 2012 136




Comments

Lice (Pediculosis)

















March 2012 137




Comments














3



March 2012 138




Comments







2



Routine


Routine


Routine


March 2012 139




Comments



Duration of illness






4 days after rash









March 2012 140




Comments

treatment






Routine


Routine


3 Vertical Routine




March 2012 141




Comments

Discontinuation


Routine


2 Fecal Oral Route

Routine Contact










March 2012 142

APPENDIX-7-Cleaning












Container Yes No





APPEN




March 2012 143



















March 2012 144



Floors

Bathrooms


Nursing Station













Floors


APPEN


RSA V

RE and C difficle


March 2012 145





Virex solution

After each patient












APPEN



s


March 2012 146



Clinic Rooms






Floors Carpet


Daily Daily




Hallways

Carpet Floors

Vacuum Virex

Daily Daily

Waiting Rooms

Surfaces Carpet

Virex Vacuum

Daily Daily


March 2012 147

Floors Virex Daily



Virex Virex Virex

Daily Daily Daily





Carpets Virex

Vacuum Daily Daily



Virex Virex

Daily Daily




Virex Virex

Vacuum

Daily Daily Daily





March 2012 148

APPEN



March 2012 149

APPEN



March 2012 150

APPEN



March 2012 151

APPEN

DIX-7g)-Com

mode Cleaning


March 2012 152

APPEN

DIX-7h)-D

amp m

opping of floors


March 2012 153

APPEN

DIX-7i)-D

amp W

iping of Surfaces


March 2012 154

APPEN


er Cleaning


March 2012 155

APPEN

DIX-7k)-W

heelchair Cleaning


March 2012 156

APPEN

DIX-7l)-Exam

Table Cleaning


March 2012 157









Scheduled clean



APPEN

DIX-7m

)-Toy Cleaning


March 2012 158

APPEN

DIX-7n)-Routine W

ashroom Cleaning


March 2012 159















APPEN

DIX-7o)-Sam


AC)


March 2012 160





March 2012 161

APPEN

DIX-7p)-Laundry H

andling


March 2012 162

APPEN

DIX-7q)-H

andling Garbage


March 2012 163

APPEN

DIX-7r)- Sharps H

andling


March 2012 164


CONTACT PRECAUTIONS


CareRehab Long Term


Home Health Care

Accommodation

Door May Be Open

No Restrictions on

Accommodation










environment








No special cleaning


Transport



Not applicable



APPEN



March 2012 165


March 2012 166

DROPLET PRECAUTIONS





Accommodation










environment



Routine Cleaning




transport




APPEN

DIX-8b)-D

roplet Precautions


March 2012 167


March 2012 168




Long Term Care




Not applicable



Measles Varicella






Transport




APPEN

DIX-8c)-A

irborne Precautions


March 2012 169


March 2012 170



Alcohols (70-95)


bull Noncritical

















bull Blood spills











APPEN

DIX-9a)-U

sesAdvantagesD

isadvantages


March 2012 171

Process Option



















March 2012 172

Process Option



























March 2012 173

Process Option


Phenolics
























March 2012 174






20 minutes



10 minutes



10 minutes





APPEN

DIX-9b)-Preparing H



March 2012 175





Good 3 h

Good 20 min

Good 10 min

Good 10 min

Good 10 min

















APPEN

DIX-9c)-A

ntimicrobial A



March 2012 176

APPEN


rea Set Up Chart


Steam Sterilizer











Ultrasonic Cleaner

Pouching Area



Cleanest Area

Dirty Area






sink

Clean Area

Sharps Container




March 2012 177

APPEN

DIX-10b)-Cleaning D



March 2012 178


March 2012 179


March 2012 180


March 2012 181










March 2012 182



Month

Year _______ Day






Flush the systems


Service by Biomed


Comments

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31


APPEN

DIX-10c)-Sam

ple Autoclave M

aintenance Record


March 2012 183





Time in

Time out










________C ______psi

_______ _C ______psi

________ C ______psi




Interpretation


APPEN

DIX-10d)-Sam



March 2012 184












Manager


APPEN

DIX-10e)-Sam



March 2012 185






Supply containerbag











TABLE OF CONTENTS

ACKNOWLEDGEMENTS

PURPOSE













Risk Assessment

Hand hygiene


Gloves

Gowns

Masks

Eye Protection

Putting on PPE

Taking off PPE

N95 Respirator




General


Cohorting


Contact Precautions

Droplet Precautions




Patient placement

Patient transport

Food and Nutrition


Visitors

Pet visitation



General

Routine Cleaning

Double Cleaning

Terminal Cleaning


Waste Management

Sharps Disposal








Cleaning

Disinfection

Sterilization

Endoscopic Devices

CJD

Dental



Immunization


Mask fit testing


Education





Tuberculosis (TB)

Meningitis



MRSA

VRE

ESBLs and CREs











APPENDIX-2-Audits





APPENDIX-7-Cleaning



















































TABLE OF CONTENTS

ACKNOWLEDGEMENTS

PURPOSE













Risk Assessment

Hand hygiene


Gloves

Gowns

Masks

Eye Protection

Putting on PPE

Taking off PPE

N95 Respirator




General


Cohorting


Contact Precautions

Droplet Precautions




Patient placement

Patient transport

Food and Nutrition


Visitors

Pet visitation



General

Routine Cleaning

Double Cleaning

Terminal Cleaning


Waste Management

Sharps Disposal








Cleaning

Disinfection

Sterilization

Endoscopic Devices

CJD

Dental



Immunization


Mask fit testing


Education





Tuberculosis (TB)

Meningitis



MRSA

VRE

ESBLs and CREs











APPENDIX-2-Audits





APPENDIX-7-Cleaning

















































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