Cross Infection Control • The aims and objectives of this topic are to :
Describe disease transmission and how cross-infection may be prevented • Discuss the personal hygiene requirements for infection control • Outline the main methods used to control cross-infection • Define the ‘clean to dirty’ principle to be used in the workplace • Define ‘standard’ and ‘special’ precautions and hand washing method
Outlines sharps protocols and sharps disposal • Outline the ways to achieve sterile conditions in a range of health scenarios • Identify the appropriate methods of cleaning and sterilising equipment • Outline the infection control procedure in linen services
INFECTION: The invasion and multiplication of microorganisms in body tissues, especially that causing local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response.
Contagion: The spread of disease from one individual to another.
Contamination: The soiling or making inferior by contact or mixture, as by introduction of organisms into a wound. The deposition of radioactive material in any place where its presence may be harmful or constitute a radiation hazard.
Infectious diseases can occur in even the cleanest workplaces as some diseases are resistant to antibiotics and sterilisation techniques. • If you are injures or become sick, what will happen to your income? • Communicable diseases poses a major threat to health workers because you are constantly exposed to other people’s germs and biological hazards.
Even workers who ‘never touch a client’ can be exposed to blood-borne infections by contact with body fluids and infected wasted on surfaces or equipment. • The dispensary and the product storage area and storage and oils and dirty towels can pose a potential risk of cross contamination through improper handling. • Every workplace should be a safe environment. • Safety is everyone’s business.
Cross Infection Risks. • The chain of infection is the process by which infectious disease occurs and spreads. It begins with the presence of pathogen of causative agent, such as: • Bacterium • Virus • Fungus • Parasite • Or other micro-organism capable of causing disease
All of these 6 links in the Infection Chain must be present for an infection to develop: • A micro-organism that causes disease (infectious agent). • A person such as the health worker or patient who carries the micro-organism (Reservoir). • A way out of the carrier, such as sneezing, coughing, shedding (skin, hair) – (portal of exit).
A method of travelling, such as through the air, through direct physical contact or through contaminated hands, linen, instruments, bandages, etc. (modes of transmission). • A way into the other person, such as breathing, swallowing or skin puncture (portal of entry). • A person who doesn’t have resistance and becomes infected (susceptible host).
How diseases are spread. • There are four ways (modes) in which diseases are transmitted: • Contact transmission may be direct, indirect or droplet spread. • Airborne transmission involves the suspension of droplet nuclei in dust particles in the air. • Common vehicle transmission is the transfer of pathogens to multiple persons through contact with a contaminated object, such as food, water, or blood products. • Vector-borne transmission is the spread of micro-organisms by contact with insects, such as ticks, mosquitoes, or fleas.
The portal of entry is the path by which the pathogen enters the susceptible host, for example: • Respiratory tract – by inhalation • Gastrointestinal/genitourinary tract – by contaminated food, water or objects • Non-intact skin, such as lesion or wound. • The clinical setting increases the number of contacts we have with sick people and these can make us ill, or turn us into carriers of the disease to others.
Prevention is better than cure, the best defence may be to : • Maintain yourself in peak physical fitness • Walk or swim regularly to promote healthy lung function • Eat proper meals and get enough rest • Take measure to counteract stress • Stay away from work if infectious to prevent passing on your illness to others • Use disposable tissues and encourage others to do the same • Have an annual vaccination on the advice of your doctor • Reporting any communicable disease or food –borne disease
For most other pathogens (disease causing organisms) protection is as simple as: • Washing your hands before and after touching any client • Washing your hands after using the toilet or smoking • Washing your hands before eating • Wearing a mask in high-risk situation (eg SARS, FLU) • Using the ‘clean to dirty principle’ during work procedures • Washing the hand before handling food and eating utensils • Washing the hands after changing soiled linen, sorting laundry or disposing of wastes
Other protection measures are: • Covering all cuts and skin breakages with bright coloured occlusive dressings; • Not touching other people on areas where the skin is broken unless gloved; • Avoid touching contaminated tissues and use gloves when disposing of all wastes; • Using rubber or disposable gloves when cleaning and sanitising premises and equipment; • Using disposable equipment in maximum infection risk is involved; • Using paper towels to wipe up floor spills and never use bathroom or floor cleaning cloths for cleaning other areas, especially in the kitchen; • Maintaining all work, treatment and dispensary area in optimum clean and sanitised condition.
THE CLEAN-TO-DIRTY PRINCIPLE: • This is a very simple work habit, easily learned, which can prevent the spread of many common diseases. It involves working with ‘clean’ hands (or gloved hands) through a process to the point where the contact becomes ‘dirty’. • At this point, you should not proceed to the next ‘clean’ task until you have washed your hands, changed your gloves or taken some other standard procedure to restore the ‘clean’ status.
Before you handle the ‘dirty’ linens (soiled sheets, towels or disposable linens) you should first organise the replacement supplies with ‘clean hand’ status. • Next you strip the dirty linen and stow it in the laundry bags. The treatment table and/or bed protecting sheets are then wiped down with a disinfectant or sanitising solution. • ‘Clean hand’ status should then be restored by either washing your hands and/or removing and disposing of the gloves. ‘Clean hand’ status now allows you to remake the bed or massage table without the risk of transferring pathogens from the dirty linen to the clean linen.
Personal Hygiene. • There are three ways that infections are transmitted in any health related industry: • From sick clients (through direct contact or air transmission); • From poor housekeeping routines (germs lingering on surfaces); • Through poor personal hygiene (germs hitchhiking to the workplace on workers).
You have a major part to play in stopping the transport of germs from one person to another or from place to place: • Keep yourself scrupulously clean by bathing and hair washing daily; • Wear clean uniforms or work clothes every day; • Wash your work clothes or uniforms regularly in a separate wash using laundry disinfectants; • Wear appropriate personal protection clothing, as required;
All PPE must be changed or discarded when soiled; • Wash your hands before you touch anything clean after you have touched anything dirty; • Wash your hands before and after each client contact; • Use clinical hand washing routines whenever you come in contact with contaminated or general wastes; • Keep your work area scrupulously clean and tidy.
Your first, last and best line of defence. WASH YOUR HANDS: • Every time you touch something ‘dirty’ • Every time you do something ‘dirty’ • Every time you touch something ‘clean’ • Every time you do something ‘clean’ • THIS IS NOT JUST A HOLD THEM UNDER THE TAPS AND SWIPE THEM ON YOUR TROUSER SEAT WASH.
GENERAL HAND WASHING. • If you are wearing gloves: Remove disposable gloves and put them in the disposal unit. • If you are not wearing gloves: remove any jewellery (you should ideally leave this at home as it harbours germs). • Wash hands: • Turn on the tap and let the water run • Wet hands under running water • Lather up the hands with liquid disinfectant soap • Rub lather well into hands and wrists • Rinse under running water • Use hot air dryer or disposable towels to dry hands
CLINICAL LEVEL HAND WASHING: • You should not be wearing any jewellery (leave it at home or put rings on a neck chain). • Turn on the hands free tap and let the water run. • Wet hands under running water. • Lather up the hands from dispenser. • Rub lather well into hands and wrists.
Rinse well under running water. • Rinse and dry on single-use sterile towel or sterile disposable wipe. • This level of handwash should also be used after possible contamination with blood and body fluid spills or handling wastes.
STANDARD PRECAUTIONS • The National Code of Practice for the Human Immunodeficiency virus and Hepatitis B and the Workplace define general precautions as: • “a strategy which requires employees to treat the blood or body fluids of all persons as potential sources of infection, independent of diagnosis or perceived risk. It involves the wearing of gloves, other protective clothing, hand washing and such infection control measure that are designed to place a barrier between potentially infection blood or body fluids and employees” NOHSC:2010 (1993).
For you the following the Standard Precautions means: • Washing your hands before and after any potential contamination with blood or body fluids; • Wearing personal protective clothing (PPE) when handling biological wastes or where you could come in contact with blood and body fluids; • Treating every person as a potential carrier of a life threatening disease; • Follow workplace procedures in the handling of sharps, spills and waste disposal.
Sharps Protocols: • Remain focussed on the job and follow the procedures; • Unsheath the sharps only when close to the client, do not walk across the room with an exposed sharp; • Follow strict clinical hand washing regimes and wear the appropriate PPE; • Take special care when replacing lancet in multi-use devices for finger prick testing; • Dispose of all sharps in the Sharps Container; • Handle sharps container carefully and ensure that you avoid injury when putting used sharps into their disposal containers; • Observe the fill line indicated on most sharps containers; • Mount sharps containers in locations convenient to the closest point of use.
Blood and Body Substance Spills. • General precautions must be followed at all times and safety glasses should be worn if there is a danger of blood or body fluids getting into the eyes. • The ‘clean to dirty’ principles must be applied to spill management. Gloves must be worn at all times during the procedure and strict hand washing routines followed. • Use only the specially marked clinical waste disposal containers or bags. • Biological spills must be cordoned off until the area is cleaned and dried.
SPILLS KITS: • Standard cleaning equipment should be provided in all areas as a spills kit: • A large (10) litre container with lid, lined with zip seal or tie seal thick plastic liner for waste disposal • A disposable cardboard scraper and pan(similar to pooper scooper) or a pooper scooper which can be disinfected/sterilised • Paper towels and tissues • Cleaning cloths • Plastic wash bowls and/or plastic buckets
Hospital grade detergents and disinfectants • Disposable rubber gloves • Plastic apron and eye protection where appropriate • Broom • Mop and bucket • Hose for wet are sluicing • Disposable items should be replaced after each use of the spills kit. • With all spills management protocols, it is essential that the area is left clean and dry.
Contaminated equipment: • Any area which may come into contact with skin, such as treatment tables, equipment and instruments must be disinfected using a hospital grade disinfectant. • Any equipment which is designed to come into contact with the mouth, ears or rectal orifices (thermometers, examination instruments etc) must be sterilised according to manufacturer’s instructions. • If using disposable items or equipment contaminated with body substances or fluids, the disposal methods in health services Codes of Practice, manufacture’s instructions and local health regulation must be followed.
Infection Control in Laundry and Linen Services. • Linen is full of germs from hair and skin contact. • People who are not sick have active germs cultures on their skin and hair. • Human bodies can be infested with parasites that can spread through contact with used linen and towels. • Even if your work does not involve handling linen in a treatment area or clinical setting, massage therapists and others who handle linen that has been in contact with skin should follow the same common sense precautions.
Danger points for infection control in linen. • Bagging linen. • Storage of soiled linen in treatment areas • Clean storage • To control danger points • Procedures for handling linen • Special PPE equipment to safeguard employees • Specially marked linen hampers to prevent cross contamination
Rules: • Treat every client as a potential carrier of an infectious disease, even if they do not look sick. • Use standard precautions for all client contact procedures to ensure maximum safety for all concerned. • Use gloves and the ‘Clean to Dirty Principle’ in all workplace procedures. • If you have a cut or broken skin, keep it covered at all times when at work with a waterproof dressing.
Use disposable or rubber work gloves. • Use disposable equipment and consumables in preference to items that require sterilisation where there is soiling or contamination. • Take special care when handling ‘sharps’ and dispose of them in specially marked containers. • Wipe down all surfaces, including treatment tables, with hospital grade disinfectant. • Allow all surfaces to air dry or wipe dry with a disposable paper towel.
Cover pillows and tables with disposable cloths or use a clean sheet, towel and pillowslip for each client. • Dispose of all contaminated dressings by burning or by using a chemical disposal facility. • Use sluices or the toilet to flush urine or faeces, not the laundry tub or sink. • Sanitise all towels and soiled linen in chemical agents prior to washing or use a commercial laundry that specialises in dealing with clinic linens.
WASTE HANDLING. • It only becomes a problem only if we fail to keep the natural decay agents (and the secondary infection agents that thrive in decaying matter) in their proper place.
The primary agents of destruction and decomposition are: • Necrosis: Where tissues die in still living things and in the process of decay of recently dead flesh, it provides a breeding ground for some very virulent diseases and destructive flesh-eating bacteria. • Liquid Putrefaction: This occurs where decay organisms invade living organisms through damplastics. age sites. • Biodegradability: This is the natural process of breaking down non-living things from food wastes and paper to biodegradable .
The consequences of not paying proper attention to wast disposal and handling are: • Infection: Where the decay agent or disease living in the decay environment, invades the body through skin contact (topical infections), inhalation or through broken skin. • Contamination: This is the process whereby a biological or chemical agent ‘spoils’ a normally harmless, inert or previously sterilised food or medicinal product, making it dangerous to consume or use.
Decay agents are everywhere, from the simple organisms that rot the apples in your fruit bowl to the real nasties that will devour living tissue. • By far the most common nasties are those like E. Coli ( the culprit in otitis media, cystitis and diarrhoea) which do no harm in their own place by wreak havoc when let loose outside. • Again, your first and best defence against the scum of the Universe is to wash hands. • You second line of defence is to wear heavy duty cloves and protective clothing.
Your third line of defence is to keep everything in the waste area as clean as possible. • Your duty of care is to handle and dispose of all wastes correctly and in the proper disposal units. • Handle and dispose of all biological wastes with great care. • Always wear gloves and issued protective apron or gowns when handling wastes.
Using different coloured gloves will help you make sure that you never use waste disposal gloves for other duties. • Remove and wash your gloves before washing your hands • Use general level hand washing routines after disposing of general wastes. • Use clinical level hand washing routines after disposing of contaminated wastes.
Biological waste handling: • In handling general and food wastes, use bin liners, and wash and sanitise bins on a regular basis. • Never empty clinical or contaminated waste into the general waste disposal bins. • For small quantities of biological wastes a small sanitary incinerator (where this is permitted by local by-laws), or chemical-bin waste services (similar to Ladysan), can be used.