Session 1 09000945 or 13001345 HAI SICP PPE Session 2 10151115 or 13451445 Recognising and Managing the Deteriorating Patient with Viral SepsisOrgan Failure ID: 1048081
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1. Pandemic-Enhanced Care Skills for Ward Based Staff Session 1 09:00-09:45 or 13:00-13:45 - HAI, SICP (PPE)Session 2 10:15-11:15 or 13:45-14:45- Recognising and Managing the Deteriorating Patient with Viral Sepsis/Organ Failure Session 3 11:20-12:45 or 15:15-16:45 – Airway & Respiratory Management
2. Title – Infection Prevention and Control ID –INDCOVID19v5Author – original version Susan Malone; updated by Carol Calder (Lead IPCN Edinburgh North)Category 2 – Teaching PPDocument – Version 5Status Draft/Final - Final Review Date – Authorizer –Anna Monro, Lindsay Guthrie and Carol Calder IPCT LeadsDate Authorization -19/03/20Date added to intranet N/A Key Words – N/AComments – induction session, COVID19
3. HAI, SICP (PPE) andCOVID19CET March 2020
4. Aims To have an awareness (and in the context of a pandemic) of the importance of hand hygiene, respiratory etiquette, patient placement, and enhanced environmental and equipment cleaning in preventing the spread of infection Awareness and importance of PPE and how to put it on and off, effectively and safely. Awareness of where to go to get the latest COVID19 updates and guidance
5. Respiratory infections NHS staff deal with respiratory infections every year:Colds (Coronavirus)Seasonal Flu Prior Pandemics:SARS (Coronavirus)MERS (Coronavirus)Flu (Avian flu, Swine flu)Current Pandemic - COVID 19 (Coronavirus)
6. Standard Infection Control Precautions (SICPs)SICP1: Patient placementSICP 2: Hand hygiene SICP 3: Respiratory etiquette & cough hygieneSICP 4: Personal Protective Equipment (PPE)SICP 5: Patient Care EquipmentSICP 6: Control of the Environment SICP 7: Management of Linen SICP 8: Management of Blood and Bodily Fluid spillagesSICP 9: Waste DisposalSICP 10: Occupational Exposure Management
7. Patient placement Mild/Moderate: Cohort ward or isolation roomSevere: Critical Care/RIDUThe majority of people who develop Covid19 infection will present with mild/moderate symptoms
8. Hand Hygiene
9. Why Is Hand Washing Important?The most common way that micro-organisms, particularly bacteria, are spread and cause infection is by being carried on people’s hands.Hand hygiene is one of the most effective ways to reduce the spread of micro-organisms such as MRSA, Clostridium difficile, Salmonella, flu virus and COVID19
10. When Should I Clean My Hands?Regular and thorough hand hygiene is essential in an environment where healthcare is providedHand hygiene is also necessary before and after you have been wearing gloves ie: hands can still become contaminated upon removal of glovesThere are five other important moments when hand hygiene must be performed:
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12. Importance of Hand HygieneEnsure hands and forearms up to elbow level are fully exposedRemove all hand/wrist jewellery (a single plain metal ring is permitted but should be removed or moved up during hand hygiene)Keep nails clean and short - No varnish or false nailsCover all cuts or abrasions you have with a waterproof dressingPay attention to thumbs, finger tips, palms and between fingers when washing (These areas are the most frequently missed) Dry hands with paper towels and dispose of in a domestic waste binApply enough soap to cover all hand surface- process should take at least 20 secondsReport any skin problems to the Occupational Health Service
13. Hand Washing Procedure
14. Alcohol rubsAlcohol based hand rubs can be used except when:Hands are visibly soiledThe patient is experiencing vomiting and/or diarrhoeaThere is direct hand contact with any body fluids eg: if gloves have forgotten to be wornThere is an outbreak of norovirus, C. difficile or other diarrhoeal illnessesAlcohol based hand rubs are not effective against thethe infections outlined aboveIn these instances hands should always be washed withliquid soap and warm water and dried thoroughly.
15. Cough Etiquette1) If sneezing or coughing use a disposable tissue to cover your face2) Immediately dispose of tissue as clinical waste3) Decontaminate hands with soap & water or alcohol gel
16. Current PPE & advice for managementSuspected or known case: Fluid repellent Surgical Mask, Disposable Apron Non-sterile Gloves (eye protection if required)Covid19 positive patients in high risk areas (ITU/RIDU): Additional PPE for AEGTransmission – DROPLET and Contact (2 meter recommendation for non care givers. Enhanced cleaning of surfaces)Aerosol Generating Procedures require additional PPE
17. Procedures requiring fluid repellent surgical mask/visor & disposal apron, gloves Non-Aerosol generating proceduresNebulisersOxygen therapy via nasal cannulaHigh flow oxygen via Venturi mask (high flow humidified O2 via face mask)Labour/delivery of pregnant womenEntonoxViral Sampling for COVID-19
18. Procedures requiring FFP3 Mask, Gloves & Disposal Gown Respiratory proceduresIntubation, extubation ‘and related procedures’ Tracheostomy proceduresManual ventilationOpen suctioningBronchoscopyNon invasive ventilation e.g. BIPAP and CPAP (use of ‘Bird’)High frequency oscillating ventilation (HFOV) High flow nasal oxygen (humidified only)Induced specimen of sputumNon-Respiratory proceduresSome dental procedures (e.g. high speed drilling) Surgery and post mortem procedures using high speed devices (e.g. drills)
19. Viral Sampling for COVID-19 TestingIndications to swab, must follow the current guidance for secondary carehttps://hpspubsrepo.blob.core.windows.net/hps-website/nss/2936/documents/1_covid-19-guidance-for-secondary-care.pdf
20. Viral Sampling for COVID-19 TechniqueExplain, discuss, consentHand hygiene, PPERemove swab from outer packageIf patient has capacity and no physical restrictions, ask the patient to open mouth wide. A tongue depressor may need to be used otherwise. Gently roll the swab over the area between uvula and in front of the tonsils. Remove from mouth carefully and insert swab into the medium and be careful to snap swab and hold open. Take a new swab and gently insert inside the anterior nares with the tip directed upwards and gently rotate. Put swab into the same medium & snap swab off and put lid on.
21. Sampling for COVID-19 Testing
22. PPECorrect ways to put on (Donning) and take off (Doffing) PPE:https://youtu.be/5s0zQ5U19KE
23. PPE RemovalNon AGP’s –(Standard DROPLET TBP’s) gloves/ aprons/ masks/ visors/ goggles all PPE including the mask/visor should be removed within the patient’s room and before leaving the isolation cubicle or patient care environment. AGP -Staff wearing FFP 3 mask, virus particles will be airborne, so staff should remove all PPE in the room, except their FFP mask staff should exit the room/cubicle still wearing mask. Remove, then hand hygiene.
24. Cleaning/Decontamination Chlorclean 1:1,000 strength
25. Cleaning blood/bodily fluid spillagesChlorclean1:10,000strength
26. Sources of Important Information:Local: NHS Lothian Intranet COVID BASE http://intranet.lothian.scot.nhs.uk/COVID19/Pages/default.aspxInfection Prevention & Control Team (IPCT)NHSL COVID-19 Staff Advice Line: 0131 537 8530National NHS Inform - https://www.nhsinform.scotHealth Protection Scotland - https://www.hps.scot.nhs.uk/
27. Infection prevention and Control SupportIntranet – Infection Prevention and Control pagesFor COVID 19 specific enquiries, Intranet/Internet and HelplineDuty Nurse – anything other enquiries not answered through these routes: Monday – Sunday, 08.30 – 16.000131 536 3373 (63373)
28. Any Questions?