Infection ControlInfection ControlJodie BurrJodie Burr

Infection Control CoordinatorInfection Control Coordinator

Women’s and Children’s Women’s and Children’s HospitalHospital

Infection Control UnitInfection Control Unit

24 Hour Infection Control Service24 Hour Infection Control Service During office hours page 18041*During office hours page 18041* After hours ring 9 for Infectious After hours ring 9 for Infectious

Disease Consultant on callDisease Consultant on call

Infection Control TeamInfection Control Team meet weekly, concerns, enquiry's, meet weekly, concerns, enquiry's,

issues can be discussedissues can be discussed

Primary Role of Primary Role of Infection ControlInfection Control

Prevent nosocomial infectionsPrevent nosocomial infections Reduce mortality, morbidity, and costReduce mortality, morbidity, and cost Educate and adviseEducate and advise

staffstaffpatientspatientstheir familiestheir familiesthe communitythe community

Surveillance of nosocomial infectionsSurveillance of nosocomial infections Policy development, implementation Policy development, implementation

and assessmentand assessment

IC Issues specific to IC Issues specific to PaediatricsPaediatrics

Communicable diseases affect a higher Communicable diseases affect a higher % of paediatric patients than adults% of paediatric patients than adults non-immunenon-immune - acquire - spread - acquire - spread paediatric personnel are at a greater risk paediatric personnel are at a greater risk

for exposure to communicable diseases - for exposure to communicable diseases - immune statusimmune status

May lack the mental / physical ability May lack the mental / physical ability to adhere to IC principlesto adhere to IC principles lack of hygienelack of hygiene unable to understand / comply with IC unable to understand / comply with IC

principlesprinciples

IC Issues specific to IC Issues specific to PaediatricsPaediatrics

More likely to have contact with More likely to have contact with contaminated environmental contaminated environmental surfaces and objectssurfaces and objects

Parents and siblingsParents and siblingsmay have the same infectious agentmay have the same infectious agentinvolved in patient care - education involved in patient care - education

about transmission and IC principlesabout transmission and IC principles

ImmunizationImmunization

It is important to know your health and It is important to know your health and immunization historyimmunization history chicken poxchicken pox measlesmeasles flu vaccinationflu vaccination pertussispertussis

For vaccinations contact ICGP or Risk For vaccinations contact ICGP or Risk ManagementManagement

IC Link NursesIC Link Nurses

Educate ward/unit staffEducate ward/unit staff

Ensure compliance with infection Ensure compliance with infection control guidelinescontrol guidelines

Assist with outbreaks or disease Assist with outbreaks or disease exposuresexposures

Develop patient & staff information Develop patient & staff information brochuresbrochures

Promote infection control initiativesPromote infection control initiatives

Standard + Additional Standard + Additional PrecautionsPrecautions

Standard PrecautionsStandard Precautions all patients all times

Additional PrecautionsAdditional Precautions some patients some times

Standard PrecautionsStandard Precautions

Work practices necessary to fulfil Work practices necessary to fulfil basic infection control requirementsbasic infection control requirements

For all patients regardless of For all patients regardless of diagnosis or diagnosis or presumedpresumed infectious statusinfectious status

Standard PrecautionsStandard Precautions

Apply to:Apply to: BloodBlood All body fluids - excretion and All body fluids - excretion and

secretions (including sweat)secretions (including sweat) Non-intact skinNon-intact skin Mucus membranesMucus membranes

Regardless of whether there is Regardless of whether there is visible blood or body fluidsvisible blood or body fluids

Hand HygieneHand Hygiene

The single most effective method in The single most effective method in the prevention of disease the prevention of disease transmissiontransmission

80 % hospital acquired infections are 80 % hospital acquired infections are thought to be transmitted by handsthought to be transmitted by hands

Healthcare workers think they wash Healthcare workers think they wash their hands more than what they dotheir hands more than what they do

Hand HygieneHand Hygiene

Soap and WaterSoap and Water mechanical removal of most transient mechanical removal of most transient

flora and soilflora and soil minimal microbial killminimal microbial kill no sustained activityno sustained activity

15 seconds15 seconds

Hand HygieneHand Hygiene

Antimicrobial SoapsAntimicrobial Soaps removes soil, removes transient and removes soil, removes transient and

reduces resident florareduces resident flora may have sustained activitymay have sustained activity

15 seconds (antiseptic handwash)15 seconds (antiseptic handwash) 60 seconds (clinical handwash)60 seconds (clinical handwash) 2 minutes (surgical scrub)2 minutes (surgical scrub)

Hand HygieneHand Hygiene

Alcohol Handrubs / GelsAlcohol Handrubs / Gels very rapid killvery rapid kill destroys transient and reduces resident destroys transient and reduces resident

floraflora no residual activity (except with no residual activity (except with

antiseptic)antiseptic) will not remove or denature soilingwill not remove or denature soiling

15 seconds15 seconds

Areas most frequently Areas most frequently missedmissed

Personal Protective Personal Protective EquipmentEquipment

Eye and/or facial protection (goggles, Eye and/or facial protection (goggles, face shields) face shields)

GlovesGloves GownsGowns MasksMasks

Assess the likely hood of Assess the likely hood of contamination and prepare contamination and prepare accordinglyaccordingly

Equipment ReprocessingEquipment Reprocessing

If it comes into contact with:If it comes into contact with:

intact skin = cleanintact skin = clean

mucous membranes = high level mucous membranes = high level disinfectiondisinfection

sterile site = sterilisesterile site = sterilise

All items must be cleaned firstAll items must be cleaned first Single-use items must not be reusedSingle-use items must not be reused

Environmental ControlsEnvironmental Controls

CleaningCleaning detergent and water is adequatedetergent and water is adequate ensure patient care areas are cleaned ensure patient care areas are cleaned

regularlyregularly minimize clutterminimize clutter

Linen and LaundryLinen and Laundry no need to mark ‘infectious’no need to mark ‘infectious’ if the skip is wet then place in a plastic if the skip is wet then place in a plastic

bagbag

WasteWaste General Waste (Green Bin)General Waste (Green Bin)

dressings, bandages, nappies, sanitary dressings, bandages, nappies, sanitary pads, flowers, kitchen waste, plastic, pads, flowers, kitchen waste, plastic, paper, empty containers of blood, body paper, empty containers of blood, body fluid, IV lines, urinary cathetersfluid, IV lines, urinary catheters

Medical Waste (Yellow Bin)Medical Waste (Yellow Bin) ALL sharps, bags or tubing of blood, ALL sharps, bags or tubing of blood,

human tissue, lab specimens and human tissue, lab specimens and cultures, cytoxic waste (sealed in purple cultures, cytoxic waste (sealed in purple cytoxic container or bag first)cytoxic container or bag first)

Blood and Body SpillsBlood and Body Spills

Small spillsSmall spillswipe up with paper towelwipe up with paper toweldetergent and waterdetergent and water

Large spills (easy to clean surface)Large spills (easy to clean surface)wipe up with paper towelwipe up with paper toweldetergent and waterdetergent and water

Large spills (difficult to clean Large spills (difficult to clean surfaces)surfaces)

wipe up with paper towelwipe up with paper toweldetergent and waterdetergent and waterwipe over with Miltonwipe over with Milton(R)(R)

Assessment of Risk FactorsAssessment of Risk Factors

Your knowledge or experience with Your knowledge or experience with the situation or procedurethe situation or procedure

The likely hood of exposure to blood The likely hood of exposure to blood or body fluids at the timeor body fluids at the time

The patients ability to cooperate The patients ability to cooperate through out the procedurethrough out the procedure

Additional PrecautionsAdditional Precautions

Are applied in addition to Standard Are applied in addition to Standard PrecautionsPrecautions

Apply with:Apply with: highly transmissible organismshighly transmissible organisms epidemiologically significant organismsepidemiologically significant organisms

Additional PrecautionsAdditional Precautions

May include:May include: Single room accommodation (ensuite Single room accommodation (ensuite

for some)for some) Special ventilation (negative, positive Special ventilation (negative, positive

pressure)pressure) Special room cleaningSpecial room cleaning Dedicated patient equipmentDedicated patient equipment Rostering of immune staffRostering of immune staff Extended sterilization (or use of Extended sterilization (or use of

disposable equipment)disposable equipment) Cohorting may be consideredCohorting may be considered

Bed Management CATEGORY ACATEGORY A

Very High Risk of Cross Infection or Adverse OutcomeVery High Risk of Cross Infection or Adverse OutcomeMandatory Negative pressure single roomMandatory Negative pressure single room

CATEGORY BCATEGORY B High Level of Cross Infection High Level of Cross InfectionMandatory Single room or cohort same contagious agentMandatory Single room or cohort same contagious agent

CATEGORY CCATEGORY C Moderate Risk of Cross Infection Moderate Risk of Cross InfectionSingle Room in Selected Circumstances Single Room in Selected Circumstances

CATEGORY DCATEGORY DHigh Risk to the Newborn Rooming in not allowedHigh Risk to the Newborn Rooming in not allowed

CATEGORY ECATEGORY ELow risk of Cross Infection No segregation requiredLow risk of Cross Infection No segregation required

INFECTION / CONDITION SETTING A B C D EAsthma If trigger thought to be viral (npa to confirm) Barmah Forest virus Bat lyssa virus (see rabies) Bronchiolitis Botulism Brucellosis Chicken pox (varicella zoster virus) Active disease

Susceptible contact (appendix 1 for how to determine) Cellulitis Includes, orbital and preseptal Chlamydial infection Conjunctivitis Viral (other than adenovirus), bacterial or chlamydial

Suspected or proven adenovirus conjunctivitis in family,or hospital outbreak

Croup Cystic fibrosis exacerbation P. aeruginosa status, proximity to other CF patients see p 8 Creutzfeldt-Jakob disease Patient at risk of having been exposed to agent Cytomegalovirus disease Congenital, Nursery, Neonatal, Oncology, Renal Dengue Diphtheria Pharyngeal or cutaneous Eczema, infected Streptococcal

non Streptococcal, proximity to burns patients non Streptococcal, all other situations

Epiglottitis Epstein-Barr virus (glandular fever) Erythema multiforme Febrile convulsion In the absence of respiratory or gastroenteritic symptoms Gastritis If the cause is infective, which is unlikely

all other causes

Respiratory Syncitial VirusRespiratory Syncitial Virus Highly contagious and nosocomial Highly contagious and nosocomial

infection commoninfection common Causes upper and lower respiratory Causes upper and lower respiratory

infectioninfection Usually occurs during winterUsually occurs during winter No vaccine at presentNo vaccine at present Can be reinfected during the same Can be reinfected during the same

seasonseason Transmitted by contact or dropletTransmitted by contact or droplet Can survive for several hours in the Can survive for several hours in the

environmentenvironment

RotavirusRotavirus Highly contagious and nosocomial Highly contagious and nosocomial

infection is commoninfection is common Usually a winter disease but pattern Usually a winter disease but pattern

changingchanging Onset is sudden and lasts for 4 - 6 daysOnset is sudden and lasts for 4 - 6 days Mainly infants and children up to 3 Mainly infants and children up to 3

years affectedyears affected Transmitted usually through contactTransmitted usually through contact Can survive in environment for several Can survive in environment for several

hourshours

Gastrogard-RGastrogard-RTMTM

Hospital Acquired Rotavirus diarrhoea Hospital Acquired Rotavirus diarrhoea prevention programprevention program

Eligible if:Eligible if:aged between 0 days and 48 monthsaged between 0 days and 48 monthsregardless of whether they already have regardless of whether they already have

or develop gastroenteritisor develop gastroenteritis Ineligible if:Ineligible if:

cow’s milk protein intolerant (not cow’s milk protein intolerant (not lactose intolerant)lactose intolerant)

if on a protein restricted dietif on a protein restricted dietfastingfastingbreast fedbreast fed

Varicella Zoster VirusVaricella Zoster VirusChicken PoxChicken Pox

Highly contagiousHighly contagious Most cases in children, over 90% Most cases in children, over 90%

of adult population is immuneof adult population is immune Transmitted by droplet and Transmitted by droplet and

contactcontact Infectious 2 days prior and 4 - 6 Infectious 2 days prior and 4 - 6

days after rashdays after rash Now a notifiable diseaseNow a notifiable disease Vaccination now availableVaccination now available

Varicella Zoster VirusVaricella Zoster VirusChicken PoxChicken Pox

BUG WATCHBUG WATCH

Infection Control Awareness Infection Control Awareness Program for VisitorsProgram for Visitors