Statewide Program for Infection Control and Epidemiology SPICE UNC School of Medicine Module C Objectives Discuss the infectious process Review methods for controlling transmission of infection in outpatient settings ID: 730290
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Slide1
Epidemiology and Risk of Infection in outpatient Settings
Statewide Program for Infection Control and Epidemiology (SPICE)UNC School of Medicine
Module
CSlide2
Objectives
Discuss the infectious processReview methods for controlling transmission of infection in outpatient settings
Standard Precautions
Transmission-based Precautions
Describe steps for detecting and controlling outbreaksSlide3
CHAIN OF INFECTIONSlide4
Infectious Agent or “The Harmful Germ”
Bacteria (MRSA, VRE)
Viruses (Influenza,
Norovirus
)
Fungi (
Candida
, Aspergillis)Parasites (Giardia, pinworms)
Arthropods (mites)
Infestations, not infectionsSlide5
Reservoir or “Hiding Places”
Where germs live, grow, and increase in numbers
A person
Environment/Fomite
An animalSlide6
People as Reservoirs
BloodSkin
Digestive tract
Mouth, stomach, intestines
Respiratory tract
Nose, throat, lungs
Urinary tractSlide7
Portals of Exit and Entry
Exit or “The Way Out”Entry or “The Way in”
Nose and
mouth
Allows
germs to
leave
in mucous droplets, and saliva or spitGastrointestinal tractAllows for germs to leave
in stool and/or vomit
Skin
Allows for germs to leave
through direct contact, in blood, pus, or other liquids that come from the body.
Nose and
mouth
Allows
germs to
enter
in
mucous droplets, and saliva or spit
Gastrointestinal
tract
Allows
for germs to
enter
via ingestion
Skin
Allows for germs to enter through direct contact, with blood, pus, or other liquids that come from the body.Slide8
Susceptible Person
AgeStress
Fatigue
Poor Nutrition
Chronic Illnesses
Not properly vaccinated
Open cuts, skin breakdown
MedicationsSlide9
Person to Person
Environmental sourceSlide10
Modes of TransmissionContact
Direct Contact
Indirect Contact
Person to person contact
and physical transfer of organisms
Contact
with a contaminated surface or deviceSlide11
Modes of TransmissionDroplet
Droplets may arise from speaking, coughing or sneezing
Droplets are heavy and travel short distance (usually 3 feet)
Need to be relatively closeSlide12
Modes of TransmissionAirborne
Droplet nuclei are very small (1-5 micron)
Suspended in air for extended periods of time
May spread thru ventilation systemsSlide13
Knowledge Check
A disease or condition of the body when harmful germs get into the body and cause pathology:Host
Infection
Reservoir
Portal of exitSlide14
Knowledge Check
Germs can be spread via indirect contact through:Shared medical equipment
Bloody gauze
Needlesticks
A and B only
All of the aboveSlide15
Standard Precautions
Transmission-Based Precautions
Controlling transmission of infection
As long as
there is a means of transmission,
infection will spread to others.Slide16
Safe Injection Practices
Respiratory Hygiene/Cough Etiquette
Personal Protective Equipment (PPE)
Hand Hygiene
Standard Precautions
Hand hygiene
Use of personal protective equipment
Respiratory hygiene/cough etiquette
Safe injection
practices
Use of a mask when injecting the epidural space
Safe handling of potentially contaminated equipment
Standard Precautions
The minimum infection prevention practice that applies to all patient care.
CONTROLLING TRANSMISSION Slide17
What is the Best Way to Stop the Spread of Infection?
Hand HygieneSlide18
Personal Protective Equipment (PPE)
Gloves
Gowns
Masks
Goggles
Face
ShieldsSlide19
Use of Personal protective equipment(PPE)
Three overriding principals related to personal protective equipment (PPE)
Wear PPE when the nature of the anticipated patient interaction indicates that contact with blood or body fluids may occur
Prevent contamination of clothing and skin during the process of removing PPE
Before leaving the patient’s room or cubicle, remove and discard PPE Slide20
Safe work practices (PPE Use)
Keep hands away from face
Work
from clean to dirty
Limit
surfaces touched
Change
when wet, torn or
heavily contaminated
Perform
hand hygieneSlide21
Gloves:
Wear gloves to reduce risk of contamination or exposure to blood/other body fluidsClean hands before donning sterile gloves
Cleans hands after removing gloves
Cleans hands and change gloves between task (moving from one body site to another)
Make sure gloves correct type and fit
Follow facility policy
DO
Type equation here.
Re-use or wash gloves (except for utility gloves)
Substitute glove use for hand hygiene
Use non-approved hand lotions
Use gloves if damaged or visible soiled
Touch your face when wearing gloves
Wear the same pair from one patient to another
Wear gloves in the hall
Forget to remove and dispose of appropriately
DON’TSlide22
gowns
Wear a gown, that is appropriate to the task, to protect skin and prevent soiling or contamination of clothing during procedures and patient-care activities when contact with blood, body fluids, secretions, or excretions is anticipated
Wear a gown for direct patient contact if the patient has uncontained secretions or excretions
Remove gown and perform hand hygiene before leaving the patient’s environment
Do not reuse gowns, even for repeated contacts with the same patient Slide23
Mouth, nose, eye protection
Use PPE to protect the mucous membranes of the eyes, nose and mouth during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions and excretions.
Select masks, goggles, face shields, and combinations of each according to the need anticipated by the task performed
Remember:
Prescription eye glasses do not protect the eyes unless they have side shieldsSlide24
Donning PPESlide25
Doffing PPE
GlovesGrasp outside of glove with opposite gloved hand, peel off
Hold removed glove in gloved hand
Slide fingers of ungloved hand under remaining glove at wrist
Goggles/Face Shield
To remove, handle by “clean” head band or ear pieces
Place in designated receptacle
GownUnfasten neck, then waist tiesRemove gown using a peeling motionGown will turn inside out
Hold away from body, roll into a bundle and discard
Mask
Grasp ONLY bottom then top ties/elastics and remove
DiscardWash hands or use an ABHR immediately after removing PPE
ORSlide26
Respiratory Hygiene/Cough Etiquette
Post signs at entrancesProvide tissues and no-touch trash cans for disposal in waiting areas
Provide hand hygiene product in waiting areas
Offer mask to symptomatic patients
Encourage ill patients to sit away from others
Process must be in place year round and not just during influenza seasonSlide27Slide28
TRANSMISSION
BASED PRECAUTIONS
CONTROLLING
TRANSMISSION
Airborne
Droplet
ContactSlide29
Direct ContactIndirect Contact
Droplet Airborne (Aerosol)
Routes of TransmissionSlide30
Private room or Cohort
Gown and gloves
before
or “upon entry”
Hand hygiene
Dedicate equipment
Disinfect shared equipment
Limit patient movementSlide31
Special
enteric precautions for C. difficile and Norovirus
And
Routine handwashing with soap and water or ABHR
Slide32
Surgical mask prior to entry
No special ventilation
Private room or Cohort
Hand hygiene
Patients/Residents
use mask outside of roomSlide33
Private room only
Room requires negative airflow pressure
Doors must remain closed
Visual air monitors
Everyone must wear an N-95 respirator or higher
Limit the movement and transport of the patientSlide34
Tuberculosis
Facility does not have a dedicated negative pressure room:
Place a mask on the individual and move to an exam or
patient room
immediately.
Keep the door to the room closed
Transfer individual to a facility capable of managing and evaluating individual (leave mask on patient during transport)
Be sure policy is included in your plan
Facility does have
negative
pressure room:
Follow Airborne PrecautionsSlide35
Chickenpox and Shingles
Non-immune healthcare personnel should not care for patients/residents with Chickenpox or Shingles
Disease
/Condition
Type and Duration
of Isolation
Chickenpox
(varicella)
Airborne and Contact until lesions are dry and crusted
Shingles (Herpes zoster. Varicella zoster)
Localized in patient with intact immune system with lesions that can be contained/covered
Standard Precautions
Disseminated disease in any patient
Airborne and Contact
precautions for duration of illness
Localized disease
in immunocompromised patient until disseminated infection ruled out
Airborne and Contact precautions for duration of illnessSlide36
Knowledge Check
What is the single most effective way to prevent the spread of infections?
Using PPE
Cleaning patient care equipment
Hand Hygiene
Coughing into the crook of elbow or tissueSlide37
Knowledge Check
For patients that require the use of airborne precautions, they should be allowed to sit in the waiting room?
True
FalseSlide38
Determine contributing factors
Implement measures to
stop the outbreak
prevent future outbreaks
OUTBREAK INVESTIGATIONSlide39
Outbreaks Steps
Verify diagnosisEstablish case definition
Review for cases – case search
Create a line listing
Make an
epi
-curve
Develop hypothesis
Test hypothesis
Control measures
Evaluate control measures
Disseminate informationSlide40
Determine contributing factors
Implement measures to
stop the outbreak
prevent future outbreaks
Know Who to Call for Assistance
Your Supervisor/Manager
Local Health Department
North
Carolina
Division of Public Health
919-733-3419
Statewide Program for Infection Control and Epidemiology (SPICE)
spice@unc.edu
919-966-3242
OUTBREAK INVESTIGATIONSlide41
Knowledge Check
Who should be notified of a suspected or known communicable disease outbreak?
Risk Management
Administration/Director
Local Health Department
All of the aboveSlide42
Questions?