Principles of Infection Prevention and

Control

Liz Van Horne

Manager, Core Competencies

Senior Infection Prevention & Control Professional

OAHPP

Outbreak Management Workshop

September 15, 2010

Objectives

• To describe the principles of infection prevention and

control for:

– Routine Practices

– Additional Precautions

– Rationale for use

How do we implement the principles?

• Framework for all infection prevention and control

programs is built around consistent use of

– Routine Practices and

– Additional Precautions

• Implementation will vary depending on the health care

setting

• Principles remain the same

Principles and Rationale of Routine

Practices• All patients are potentially infectious, therefore:

– Same principles of practice should be used

• ALL the time

• With ALL patients

– ALL contact with blood, body fluid, secretions,

excretions, mucous membranes, non-intact skin or

soiled items could potentially transmit infectious

organisms

Routine Practices prevent transmission of organisms from:

Resident/Patient to

resident/patient

Resident/Patient to staff

Staff to resident/patient

Staff to staff

Elements of Routine Practices

• Risk assessment

• Environmental controls

• Administrative controls

• Sufficient and accessible barrier equipment, i.e. PPE

Risk Assessment

• Dynamic process based on continuing changes in

information as care progresses, thus must be done before

each interaction with a client/patient/resident (PIDAC)

Assessing Risk

• Risk of transmission involves factors related to:

– Client/patient/resident infection status

– Client/patient/resident characteristics

– Type of care activities being performed

– Resources available for control

– Health care provider immune status

Risk Assessment

Do I need protection because of a risk of exposure to blood,

secretions/excretions or body fluids?

Do I need protection because of the patient’s symptoms?

What are the organizational requirements for a patient with an

identified infection?

Will hands be exposed to

blood/body fluid or contaminated

items?

If yes,Wear gloves and perform

hand hygiene

Will face be exposed to

splash, spray, cough or

sneeze?

If yes,Wear facial protection

Will clothing or skin be exposed

to splashes?If yes, Wear a gown

Hand Hygiene –

• Elements of a hand hygiene program for all health care SETTINGS

– Multifaceted and multidisciplinary

– Point of care hand hygiene products

– Education on where, when, and how to clean hands

– Skin integrity

• Elements for health care FACILITIES

– Management support

– Environmental and system supports

– Observational audits and feedback

Alcohol-Based Hand Rub (ABHR)

• Preferred method of cleaning hands

– Can be performed without leaving the resident/patient

– Use when hands are not visibly soiled

• 70-90% alcohol

• Non-alcohol products are not to be used

Personal Protective Equipment

• PPE used alone or in combination to prevent exposure of health care

provider

• Selection based on the risk assessment

• PPE should be put on just prior to the interaction and removed

immediately after the interaction is done

• Staff must have quick, easy access to sufficient supplies of PPE

Personal Protective Equipment (PPE)

Putting On PPE Taking Off PPE

Gown

Mask or respirator

Goggles or face shield

Gloves

Gloves

Gown

Hand hygiene

Goggles or face shield

Mask or respirator

Hand hygiene

Gloves

• Medical grade gloves must be used for contact with mucous membranes,

non-intact skin, blood and body fluids

• Gloves are NOT required for routine health care activities that are limited

to intact skin

– Eg. taking blood pressure, bathing, dressing

• Compliance with hand hygiene

Appropriate Glove Use

• Task specific and single-use for the task

• Size must be correct

• Clean hands before putting on gloves

• Remove gloves immediately after the activity

• Clean hands after removing gloves

• Change gloves when moving from contaminated body site to a clean body

site on the same patient

• Do not wash or re-use gloves

• Gloves must be changed in between patients or when moving from a dirty

to clean procedure on the same patient

Types of Gloves

• Good quality vinyl gloves are suitable for most tasks

• Latex/synthetic gloves (nitrile or neoprene) are prefereable for clinical

procedures where manual dexterity or prolonged contact are expected

• Powdered latex gloves have been associated with latex allergy

• Gloves that fit snugly around the wrist are preferred for use with gowns

Gowns

• Only wear when providing care for patients

• Put on immediately before task

• Removed immediately after task

Masks and Respirators

• Masks

– To protect the mucous membranes of the health care provider when

anticipated splashes of blood or body fluids are anticipated

– Used in operating theatres and for performing aseptic procedures

– Place on coughing patient to limit dissemination of respiratory

secretions

• Respirators

– To prevent inhalation of small particles that may contain infectious

agents transmitted via airborne route

– Must be fit-tested

– Used for aerosol-generating procedures

• Sputum induction, diagnostic bronchoscopy

Eye Protection

• Used to protect the mucous membranes when splashing is anticipated

– Safety glasses

– Safety goggles

– Face shields

– Visors attached to masks

(does not include prescription eye glasses)

• Disposable or reusable

– Central processing area or assigned staff member to clean reusable

eye protection between uses is recommended

Environmental Controls

• Accommodation and Placement

• Environment and equipment cleaning

• Dishware and eating utensils

• Linen and waste

– Laundry

– Waste management

– Handling of sharps

Accommodation and Placement

• Single rooms with dedicated bathroom and sink are

preferred for all patients

• Decision making considerations for placement:

– Is patient soiling environment due to poor hygiene or incontinence?

– Does patient have an infection that might be transmitted to others?

– What is the condition of others in the unit?

– Does the patient have an indwelling device or non-intact skin?

– What is the susceptibility level of the patient or potential roommates?

– Can they follow directions on hygiene?

Environment and Equipment Cleaning

• Cleaning and disinfection of non-critical equipment

between patients

• High-level disinfection of semi-critical and sterilization of

critical medical equipment

• Daily and terminal cleaning of rooms

• Cleaning requirements for rooms with C. difficile or VRE

positive patients

Dishes, Linen and Waste

• Dishware and utensils do not need special processing

– Regular dishwashing processes are effective

• Laundry – soiled with blood/body fluids -- handle

ROUTINELY

– Bag/contain at the site of collection

– Use leak-proof bags/containers if contaminated with blood/body

substances

• Waste

– Protective apparel (gloves, footwear)

– Sharps disposal

Administrative Controls

• Policies and procedures

• Education

• Healthy workplace policies

• Respiratory etiquette

• Immunization

• Monitoring of compliance and feedback

• Staffing

Additional Precautions

Principles and Rationale of Additional

Precautions

• Additional Precautions are used in addition to Routine

Practices when a patient has a certain microorganism

– Includes suspect cases eg. diarrhea with no identified

cause

– Includes colonization eg. MRSA

• Application of Additional Precautions may differ depending

on the health setting and the needs – eg. long term care

and community

Elements of Additional Precautions

• Specialized accommodation and signage

• Barrier equipment

• Dedicated equipment

• Additional cleaning

• Limited transport procedures

• Communication

Additional Precautions

• Interventions used in ADDITION to Routine Practices

• Protect staff and patients from transmission of known or suspected

infectious agents

• Based on mode of transmission:

– Contact

– Droplet

– Airborne

• May be combined for some agents

– e.g. Droplet + Contact

What does this mean to Public Health?

Remember...

• Infection prevention and control involves applying principles to the

situation

• There are few ‘black and white’ rules – only a variety of gray shades

Questions?