Basic Infection Control for Outpatient Oncology Setting

8/3/2019 Basic Infection Control for Outpatient Oncology Setting

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Lina Vince Cruz-De Castro, RN, MAN



Hand hygiene

Personal Protective Equipment (PPE

Respiratory Hygiene and Cough Etiquette Injection Safety

Cleaning and Disinfection of Devices andEnvironmental Surfaces





Clean hands

single most important factor in preventing the

spread of pathogens and antibiotic resistance

reduces the incidence of HAIs

▪ nearly 2 million patients in the United States get an

infection in hospitals (CDC)

▪ about 90,000 of these patients die as a result of theirinfection (CDC)



substantial evidences

Semmelweis demonstrated that the mortality rate among mothers who

delivered in the First Obstetrics Clinic at the General Hospital of Vienna was significantly lower when hospital staff cleaned theirhands with an antiseptic agent than when they washed theirhands with plain soap and water.

Recent studies HAI rates were lower when antiseptic handwashing wasperformed by personnel

HAI went down when adherence to recommended handhygiene practices improved







Visibly soiled or contaminated

with body secretions

Soap & Water



Handwashing with Soap and Water: • Wet hands first with water

• Apply soap to hands

• Rub hands vigorously for at least 15seconds, covering all surfaces of handsand fingers

Rinse hands with water and drythoroughly with paper towel

• Use paper towel to turn off waterfaucet



Visibly Clean

Alcohol based handrub

(ABHR)

(60-95% alcohol)



Using Alcohol-based Hand Rub(follow manufacturer’s directions):

• Dispense the recommended volumeof product

• Apply product to the palm of one

hand • Rub hands together, covering all

surfaces of hands and fingers untilthey are dry (no rinsing is required)







Always perform hand hygiene in the following situations:

1. Before touching a patient, even if gloves will be worn

2. Before exiting the patient’s care area after touching thepatient or the patient’s immediate environment

3. After contact with blood, body fluids or excretions, or wounddressings

4. Prior to performing an aseptic task (e.g., accessing a port,

preparing an injection)5. If hands will be moving from a contaminated-body site to a

clean-body site during patient care6. After glove removal









1. Key situations where hand hygieneshould be performed include:

a. Before touching a patient, even if gloves willbe worn



1. Key situations where handhygiene should be performedinclude:

b. Before exiting the patient’s carearea after touching the patient or thepatient’s immediate environment

c. After contact with blood, bodyfluids or excretions, or wounddressings



1. Key situations where hand hygieneshould be performed include:

d. Prior to performing an aseptic task(e.g., placing an IV, preparing aninjection)

e. If hands will be moving from acontaminated-body site to a clean-bodysite during patient care

f. After glove removal



2. Use soap and water

when hands are visibly soiled (e.g.,blood, body fluids)

after caring for patients with knownor suspected infectious diarrhea (e.g.,Clostridium difficile, norovirus).

Otherwise, the preferred method of hand decontamination is withan alcohol-based hand rub.



Remember towash you hands…





“specialized clothing or equipment worn by an employeefor protection against infectiousmaterials” (OSHA)

PPE refers to a variety of barriers and respirators usedalone or in combination toprotect mucous membranes,airways, skin, and clothing fromcontact with infectious agents(CDC)



Gloves – protect hands

Gowns/aprons – protect skin and/or clothing

Masks and respirators– protect mouth/nose

Respirators – protect respiratory tract from airborne

infectious agents

Goggles – protect eyes

Face shields – protect face, mouth, nose, and

eyes



Gown first

Mask or respirator

Goggles or faceshield

Gloves

*Combination of PPE will affect

sequence – be practical

PPE Use in Healthcare Settings



• Always perform hand hygiene beforedonning PPE

• If wearing a gown, don the gown first andfasten in back accordingly



• If wearing a facemask or respirator:

• Secure ties or elastic band at the back of thehead and/or neck

• Fit flexible band to nose bridge

• Fit snug to face and below chin



• If wearing goggles or face shield, put it on

face and adjust to fit

• If wearing gloves in combination with otherPPE, don gloves last



Keep gloved hands away from face

Avoid touching or adjusting other PPE

Remove gloves if they become torn; perform

hand hygiene before donning new gloves

Limit surfaces and items touched




Gloves

Face shield or goggles

Gown

Mask or respirator




At doorway, before leaving patient

room or in anteroom*

Remove respirator outside room, after

door has been closed*

* Ensure that hand hygiene facilities are available at the

point needed, e.g., sink or alcohol-based hand rub






Gloves

Use when touching blood, body fluids, secretions,

excretions, contaminated items; for touching mucus

membranes and nonintact skin

Gowns

Use during procedures and patient care activities

when contact of clothing/ exposed skin withblood/body fluids, secretions, or excretions is

anticipated



Mask and goggles or a face shield

Use during patient care activities likely to

generate splashes or sprays of blood, body

fluids, secretions, or excretions




Giving a bed bath?

Suctioning oralsecretions?

Transporting a patient ina wheel chair?

Responding to an

emergency where bloodis spurting?

Drawing blood from avein?

Cleaning an incontinent

patient with diarrhea?

Irrigating a wound?

Taking vital signs?




Giving a bed bath?

Generally none Suctioning oral secretions?

Gloves and mask/goggles

or a face shield – sometimes gown Transporting a patient in a wheel chair?

Generally none required Responding to an emergency where blood is spurting?

Gloves, fluid-resistant

gown, mask/goggles or aface shield

Drawing blood from a vein?

Gloves Cleaning an incontinent patient with diarrhea?

Gloves w/wo gown Irrigating a wound?

Gloves, gown,mask/goggles or a faceshield

Taking vital signs?

Generally none




• Expanded Precautions include

– Contact Precautions– Droplet Precautions

– Airborne Infection Isolation




Contact Precautions

Gown and gloves for contact with patient or environment of

care (e.g., medical equipment, environmental surfaces)

In some instances these are required for entering patient’s environment

Droplet Precautions

Surgical masks within 3 feet of patient

Airborne Infection Isolation

Particulate respirator*

*Negative pressure isolation room also required





1. Facilities should assure that sufficient andappropriate PPE is available and readily

accessible to HCP

2. Educate all HCP on proper selection and use of

PPE



3. Remove and discard PPE before leavingthe patient’s room or area



4. Wear gloves▪ for potential contact with blood, body fluids, mucous

membranes, non-intact skin or contaminated equipment

a. Do not wear the same pair of gloves for the care of more than one patient

b. Do not wash gloves for the purpose of reuse

c. Perform hand hygiene immediately after removinggloves



5. Wear a gown▪ to protect skin and clothing

▪ during procedures or activities where contact withblood or body fluids is anticipated

a. Do not wear the same gown for the care of

more than one patient



6. Wear mouth, nose and eye protection▪ during procedures that are likely to generate splashes

or sprays of blood or other body fluids

7. Wear a surgical mask▪ when placing a catheter or injecting material into

epidural or subdural space



PPE is available to protect you fromexposure to infectious agents in thehealthcare workplace

Know what type of PPE is necessary for

the duties you perform and use it correctly





SARS outbreaks in 2003

▪ prompt implementation of infection control measures at the first

point of encounter

▪ reception and triage areas in emergency departments, outpatientclinics, and physician offices

new component of Standard Precautions

derived from recommended source control measures for M. tuberculosis



Five elements of Respiratory Hygiene/CoughEtiquette

1) education

2) posted signs▪

with instructions▪ Patients

▪ Accompanying family member or friends



Elements of Respiratory Hygiene/CoughEtiquette

3) source control measures▪ covering the mouth/nose with a tissue when coughing

▪ prompt disposal of used tissues

▪ using surgical masks on the coughing person whentolerated




4) hand hygiene▪ after contact with respiratory secretions




5) spatial separation

>3 feet

< 3 feet : risk for transmission▪ N. meningitidis

▪ group A streptococcus



Effective in decreasing the risk of transmission of pathogens contained in

large respiratory droplets▪ influenza virus

▪ Adenovirus

▪ B. pertussis

▪ Mycoplasma pneumoniae



Covering sneezes and coughs and placing masks

on coughing patients are proven means of source

containment that prevent infected persons fromdispersing respiratory secretions into the air.





Injection Safety proper use and handling of supplies for administering

injections and infusions

▪ (e.g., syringes, needles, fingerstick devices, intravenous tubing,medication vials, and parenteral solutions)

intended to prevent transmission of infectious diseases

during preparation and administration of parenteralmedications



A survey of US healthcare workers whoprovide medication through injection found

that 1% to 3% reused the same needleand/or syringe on multiple patients . (CDC)



Outbreaks related to unsafe injection practices indicate

that some healthcare personnel are unaware of, do not

understand, or do not adhere to basic principles of

infection control and aseptic technique.

Outbreaks (CDC)

4 large outbreaks of HBV and HCV (USA)▪ private medical practice, a pain clinic, an endoscopy clinic, and a

hematology/oncology clinic

define and reinforce safe injection practices



OUTBREAK

Primary breaches in infection control practice

1) reinsertion of used needles into a multiple-dose vial or

solution container (e.g., saline bag)

2) use of a single needle/syringe to administer

intravenous medication to multiple patients.



These and other outbreaks of viral hepatitis could have

been prevented by adherence to basic principles of

aseptic technique preparation and administration of

parenteral medications

use of a sterile & single-use disposable needle & syringe

for each injection







prevention of contamination of injection equipment and

medication







use of single-dose vials

▪ especially when medications will be administered to multiple

patients





1. Use aseptic technique▪ when preparing and administering medications

2. Cleanse the access diaphragms of medication vials with 70% alcohol

▪ before inserting a device into the vial



3. Never administer medications from thesame syringe to multiple patients

▪ even if the needle is changed or the injection isadministered through an intervening length of intravenous tubing

4. Do not reuse a syringe to enter amedication vial or solution



5. Do not administer medications from single-dose or single-use vials, ampoules, or bags or

bottles of intravenous solution to more than one

patient

6. Do not use fluid infusion or administration sets

(e.g., intravenous tubing) for more than one

patient



7. Dedicate multidose vials to a singlepatient whenever possible.

If multidose vials will be used for more than onepatient

▪ they should be restricted to a centralized medication

area▪ should not enter the immediate patient treatment

area (e.g., operating room, patient room/cubicle)



8. Dispose of used syringes and needles at thepoint of use in a sharps container

▪ closable, puncture-resistant, and leak-proof





Cleaning

removal of visible soil and organic contaminationfrom a device or environmental surface

using the physical action of scrubbing

with a surfactant or detergent and water, or anenergy-based process (e.g., ultrasonic cleaners)

with appropriate chemical agents.▪ This process removes large numbers of microorganisms

from surfaces and must always precede disinfection.



Disinfection

less lethal process of microbial inactivation(compared to sterilization)

eliminates virtually all recognized pathogenicmicroorganisms but not necessarily all microbialforms (e.g., bacterial spores).



traditional approach that has been used todetermine the level of disinfection or sterilization

for reusable medical devices based upon the degree of risk for transmitting infections

if the device is contaminated at the time of use



Critical items (e.g., surgical instruments)

objects that enter sterile tissue or the vascularsystem

sterilization



Semi-critical items (e.g., endoscopes used forupper endoscopy and colonoscopy)

contact mucous membranes or non-intact skin

high-level disinfection



Noncritical items (e.g., blood pressure cuffs)

come in contact with intact skin but not mucousmembranes

low- or intermediate-level disinfection



Environmental surfaces (e.g., floors, walls)

do not contact the patient during delivery of care

cleaning

if disinfection is indicated

▪ low-level disinfection





1. Establish policies and procedures forroutine cleaning and disinfection of environmental surfaces

a. Focus on those surfaces in proximity to the

patient and those that are frequently touched

▪ bedrails

▪ doorknobs



1. Facilities should ensure that reusablemedical equipment is cleaned andreprocessed

prior to use on another patient



2. Reusable medical equipment must becleaned and reprocessed (disinfection orsterilization) and maintained according tothe manufacturer’s instructions.

If the manufacturer does not provide such

instructions▪ the device may not be suitable for multi-patient use



3. Assign responsibilities for reprocessing of medicalequipment to HCP with appropriate training

a. Maintain copies of the manufacturer’s instructions for reprocessing of equipment in use at the facility▪ post instructions at locations where reprocessing is performed

b. Observe procedures to document competencies of HCP

responsible for equipment reprocessing on an ongoingperiodic basis (e.g., quarterly)▪ upon assignment of those duties

▪ whenever new equipment is introduced



4. Assure HCP have access to and wearappropriate PPE

▪ when handling and reprocessing contaminatedpatient equipment



2. Select EPA-registered disinfectants or

detergents/disinfectants▪ with label claims for use in healthcare

3. Follow manufacturer’s recommendations for

use of cleaners and EPA-registered

disinfectants▪ (e.g., amount, dilution, contact time, safe use, and

disposal)



Documents

Basic Infection Control for Outpatient Oncology Setting