A set of infection control precautions & practices used for all patient care regardless of their presumed infection status or diagnosis

To prevent the transmission of organisms from contact with blood, body fluids and moist body substances with non-intact skin or mucous membranes

• Hand Hygiene

• Personal Protective Equipment (PPE) (gloves, gowns, masks, eye protection, face protection)

•Accommodation

•Equipment

•Environmental Controls

•Sharps

•Linen

•Waste

•Specimen Collection

•Visitors Guidelines

•Education for Healthcare Workers, Patients/Residents/Clients and Visitors

•Post Mortem Care

Routinely treat all patients/residents/clients as if they are infectious

Use Routine Practices for everyone!

Infectious Agent

Portal of Entry

Susceptiblehost

Reservoirs

Portal of exit

Means of transmission

•Infectious Agent:

•A microorganism with the ability to cause an infectious disease

•Infectious agents are bacteria, viruses, fungi and parasites

•Reservoirs:

•A place within which microorganisms can thrive and reproduce

•Example: Human beings, animals, water

•Portal of Exit:

•A place of exit providing a way for a microorganism to leave the reservoir

•Example: Microorganisms may leave the reservoir through the nose or mouth when someone sneezes or coughs

•Means of Transmission:

•Route or method of transfer by which the infectious microorganism moves or is carried from one place to another to reach their new host

•Contact:

•Direct

•Indirect

•Droplet

•Airborne

•Common Vehicle

•Vector

•Portal of Entry:

•Means by which the infectious microorganism gains entry into the new host

•Example: ingestion, breathing, skin puncture

•Susceptible Host:

•A person who cannot resist a microorganism invading the body, multiplying and resulting in infection

• Direct physical contact between an infected or colonized individual and susceptible host (e.g., Scabies)

• Indirect contact involves passive transfer via intermediate object to susceptible host (e.g., contaminated equipment, hands of HCWs)

• Example: C.Difficile

• Large droplets > 5 um propelled from respiratory tract, coughing, sneezing suctioning or bronchoscopy, a short distance < 1 meter to nasal or oral mucosa of a new host

• Droplets don’t remain suspended in air

• Example: N. Meningitidis

• Dissemination of microorganisms by aerosolization

• Organisms suspended in air in droplet nuclei particles < 5 um

• Can be widely dispersed by air currents

• Example: Tuberculosis

•Common Vehicle:

•Contaminated vehicle (water/food)

•Salmonella

•Vector:

•Non human that transmits infection

•West Nile

Hand hygiene is the single most effective way to prevent infection

•Artificial fingernails, gel nails or extenders should not be worn

•Natural nail tips should not be longer than 0.635 cm (1/4 inch) long

•Nail polish should be removed when chipped

•Avoid wearing hand jewellery

•Hand Lotions:

•Minimize skin irritation that can occur with frequent hand hygiene

•Select lotions compatible with products and gloves used

•Dispensers:

•Do not “top up” partially empty containers

•Hand lotion bottles should not be used

When to Perform Hand Hygiene

Before:-Direct, hands-on care with a patient, resident, or client-Performing invasive procedures.-Handling dressings or touching open wounds.-Preparing, handling, serving, or eating food.-Feeding a patient.-Shifts and breaks.

Between:-Procedures on the same patient where soiling of hands is likely, to avoid cross contamination.

After:-Contact with blood, body fluids, non-intact skin, and/or mucous membranes.

-Contact with items known or considered to be contaminated.

-Removal of gloves.

-Personal use of toilet or wiping nose.

-Shifts & breaks.

•Must contain a minimum of 60% alcohol

•Use in all clinical situations, except when hands are visibly soiled

•Use as an alternative to plain or antimicrobial soap except when hands are visibly soiled

•Apply 2-3 mls of product to the palm of one hand

•Rub hands together, covering all hand surfaces, including fingernails, web spaces, thumbs & palms.

•Ensure hands are dry before performing another task (dries within 15-20 seconds).

NB: Alcohol products are flammable.

Plain Soap (Non-antimicrobial)

• For routine hand washing.

• Hands must be washed with soap & water when hands are visibly soiled with blood, body fluids, secretions, excretions, and exudates from wounds.

•Antimicrobial Soap:

•Before contact with invasive devices

•Before performing any invasive procedure

• Before contact with immunosuppressed patients, residents or clients

•Before/after contact with patients, residents or clients on infection control precautions/isolation

• Wet hands under warm running water.

• Apply soap and distribute over hands.

• Rub hands together vigorously for 10-15 seconds to create a good lather.

• Using friction, cover all hand surfaces including fingernails, web spaces, thumbs and palms.

• Rinse under warm running water.

• Dry hands gently and thoroughly with a disposable towel.

• Turn off faucet using a clean disposable towel.

• NB: Faucets are dirty!

The selection of gowns, gloves, masks and/or face protection should include consideration of the following:

•Probability of exposure to blood and/or body fluids

•Amount of blood and/or body fluids likely to be encountered

•Probable route of transmission

Assessment of Risk

Gloves

•Additional measure to, not a substitute for hand hygiene

•Clean, non-sterile gloves of appropriate size should be worn

•Single-use disposable gloves should never be reused or washed

Gloves

•Worn for contact with blood, body fluids, secretions and excretions, mucous membranes, draining wounds, or non-intact skin

•Worn for handling items visibly soiled with blood, body fluids, secretions or excretions

•Worn when the HCW has open sores of his/her hands

Gloves

•Put on directly before contact with patient, resident or client or just before task/procedure requiring gloves

•Change gloves between:

•Care activities/procedures with the same patient, resident or client

•After contact with materials that may contain high concentrations of microorganisms

Gloves

•Gloves should be long enough to fit over the cuff of a gown

•Should be removed prior to leaving the patient’s or resident’s room

•Hand hygiene must be performed following glove removal

Gowns

•Routine gown use is not recommended

•Used to protect uncovered skin and prevent soiling of clothing during procedures/ care activities likely to generate splashes or sprays of blood, body fluids, secretions or excretions

Gowns

•Remove gown when task complete, when leaving the room or when gown is heavily soiled/wet

•Gowns are single-use:

•Disposable gowns are discarded

•Cloth gowns are laundered after use

•Perform hand hygiene after removing gown

Masks

•Surgical/procedure masks protect the mucous membranes of the nose and mouth during procedures likely to generate splashes/sprays of blood, body fluids, secretions or excretions

•Should be worn within 1 meter (3 ft) of a coughing patient, resident or client

Masks

•Discard masks which are crushed, wet, have dangled around the neck or have become contaminated with patient secretions

•Perform hand hygiene following mask removal

Eye Protection

•Used to protect mucous membranes of eyes during procedures/ care activities that are likely to generate splashes, sprays or aerosols of blood, body fluids, secretions or excretions

•Eye protection must fit over prescription glasses

•Reusable eye protection must be cleaned

•Perform hand hygiene following removal

Face Protection

•Used to protect the mucous membranes of the eyes, nose and mouth during procedures/care activities that are likely to generate splashes, sprays or aerosols of blood, body fluids, secretions or excretions

•Face protection must fit over prescription glasses

•Face protection shall be of appropriate size-large enough to protect mucous membranes of the face

Respiratory Etiquette

Simple measures individuals can utilize to minimize the spread of respiratory organisms

•Cover your cough

•Cover your mouth and nose with a tissue when you cough or sneeze OR cough or sneeze into your upper sleeve, not your hands

Respiratory Etiquette

•Put your used tissue in the waste basket

•You may be asked to put on a surgical mask to protect others

•Clean your hands after coughing or sneezing

•Wash with soap and water OR clean with alcohol-based hand rub

Donning:

•Perform Hand Hygiene

•Put on long sleeve gown with opening of gown at back

•Tie neck and waist ties

•Apply mask/respirator, seal check (if N95) to ensure correct fit, reapply glasses

•Apply protective eyewear if appropriate

•Apply gloves, pulling gloves up over cuff of gown

Removing:

•Prior to Exiting Room or Area

•Remove gloves using “glove to glove, skin to skin” technique, Discard

•Perform Hand Hygiene

•Untie neck ties first, then waist ties on the gown

•Place fingers of one hand under the opposite cuff and pull cuff over hand

Removing:

•Prior to Exiting Room or Area

•Using the gown covered hand, pull the gown down over the other hand

•Pull the gown down off the arms, being careful that the hands do not touch the outside of the gown

Removing:

•Prior to Exiting Room or Area

•Hold the gown away from your uniform and roll it up with the contaminated side inside in a away that minimizes air disturbance. Dispose into garbage or laundry hamper

•Perform Hand Hygiene/Use paper towel to open door

Removing:

•Immediately After Exiting Room or Area

•Remove eye protection/face shield if worn

•Remove mask/respirator according to manufacturer’s instructions

•Take care to prevent self contamination

•Discard into garbage

•Perform hand hygiene

•Single rooms not required for routine care

•Single rooms with dedicated bathroom facilities for acute care when:

•Patients soil their environment

•Patients have inadequate hygiene

•Dedicate equipment for individuals on infection precautions or isolation

•Establish and monitor regular cleaning schedules with assignment of responsibility and accountability

•Clean and reprocess reusable equipment between patients/residents/clients

•Reprocessing of a specific item depends upon:

•Intended use of an item

•Risk of infection to the patient, resident or client

•Amount of soil present

•Visibly soiled equipment must be cleaned immediately

•Handle soiled items in a manner that prevents exposure of skin, mucous membranes and contamination of clothing and environment

•Staff responsible for cleaning contaminated equipment must wear appropriate PPE and be properly trained

•Hand hygiene must be performed after having contact with soiled equipment

•All horizontal and frequently touched surfaces should be cleaned daily and more often if soiled

•Spills of blood and body fluids must be cleaned with a disinfectant immediately

•Disposable dishware, utensils and dietary trays are not required

•Used needles/sharps must not be recapped or manipulated by hand

•Handle with care to avoid injuries

•Discard in designated puncture resistant containers located in the area where the items were used

•Consider all soiled linen to be potentially infectious

•Wear appropriate PPE to protect skin, mucous membranes and clothing from exposure to soiled linen

•Bag at site of collection

•Double bag only if possibility of leakage

•Handle linen with a minimum of agitation

•Hand hygiene should be performed after having contact with all soiled linen

• Wear appropriate PPE to protect skin, mucous membranes and clothing from exposure to waste

•Place in bag at point of origin

•Double bagging of waste is not required

•Hand hygiene should be performed after having contact with waste

•All clinical specimens are considered potentially infectious-appropriate PPE should be worn during collection/handling

•All specimens must be placed in leak-proof containers with secure lids to prevent leakage

•Avoid contamination of the outside of specimen containers/laboratory requisitions

•Perform hand hygiene following specimen collection

•Visitors to hospitals and personal care homes should be aware of and comply with infection control practices including hand hygiene as instructed by the healthcare worker (HCW)

•HCWs shall receive training on the fundamentals of Routine Practices

•Patients/residents/clients shall be instructed by the HCWs regarding infection prevention and control practices

•Use PPE to prevent exposure to blood and other body fluids

•Eye protection and masks are not routinely required unless aerosols of blood and body fluids are expected to be generated

•Remove all PPE immediately after use and follow with hand hygiene

• Are infection control precautions and practices required in addition to Routine Practices.

•Needed to interrupt transmission in the clinical setting.

•Based on the means of transmission of the infectious agent.

•Some microorganisms may be transmitted by more than one route necessitating more than one type of Additional Precautions.

•Single room with own bathroom preferred

•Door may be left open

•Gloves on entry into room/bedspace

•Gown if physical contact with patient/environment is likely

•Equipment dedicated to the patient and then decontaminate

•Example: C.Difficile, Antibiotic Resistant Organisms (AROs)

•Single room with own bathroom preferred

•Door may remain open

•Surgical/procedure mask required for susceptible people within 1 meter (3 ft) of patient/resident

•Equipment dedicated to the patient/resident and then decontaminated

•No special ventilation of room required

•Example: Pertussis, Mumps, N.Meningitidis

•Door must remain closed at all times

•Special ventilation and air exchanges required

• Single room with own bathroom required

•N95 respirator, fit tested, for everyone entering room

•Surgical/procedure mask for patient/resident during transport

•Example: Tuberculosis

•Single room with own bathroom preferred

•Door may be left open

•Surgical/procedure mask required for susceptible people within 1 meter (3 ft) of patient/resident

•Gloves on entry into room/bedspace

•Gown if physical contact with patient/resident or their environment is likely

•Equipment dedicated to the patient/resident and then decontaminated

•Example: RSV

•Single room with own bathroom required

•Door must remain closed at all times

•Special ventilation and air exchanges required

•N95 respirator, fit tested, for everyone entering the room

•Gloves on entry to room or bedspace

•Gown if physical contact with patient/resident or their environment is likely

•Equipment dedicated to the patient and then decontaminated

•Example: Chickenpox

• Use disposable equipment whenever possible for patients/residents on isolation-otherwise, use dedicated equipment

•Ensure reusable equipment is cleaned before use on another patient/resident

•Limit amount of supplies brought into isolation room

•Ensure correct signage is posted on the patient’s or resident’s door

• All staff and visitors must comply with precautions.

•HCW must practice IP&C principles and be competent with Routine Practices

•Recognize, understand and use signage to prevent transmission of infection if Routine Practices are indicated

•Maintain good personal hygiene and Respiratory Etiquette

•Accept annual Influenza immunization and maintain protection for other vaccine-preventable infections such as Hepatitis B, Measles etc

•Consider the risks of infection transmission when reporting for work while ill with common communicable diseases, such as colds

•Eat and store food in designated places in the workplace

•Act as a resource to co-workers about IP&C issues, including communicating to co-workers about the need to use PPE for contact with specific patients

•Advocate for patient/resident/client concerns about IP&C