Infection Prevention and Control Practice Handbook V2 Updated 1 Sep 2017 PDF

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INFECTION PREVENTION AND CONTROL PRACTICE HANDBOOK

Not controlled if printed – Last updated 28 August 2017

© Clinical Excellence Commission 2016 All rights are reserved. In keeping with the NSW Government's commitment to encouraging the availability, dissemination and exchange of information (and subject to the operation of the Copyright Act 1968), you are welcome to reproduce the information which appears in this publication, as long as the user of the information agrees to: • use the document for information only • save or print a single copy for personal use only and not to reproduce any major extract or the entire document except as permitted under Copyright Act 1968 (as amended) without the prior written permission of the State of New South Wales • acknowledge the source of any selected passage, table diagram or other extract reproduced • not make any charge for providing the Information to another person or organisation without the prior written consent of the State of New South Wales and payment of an agreed copyright fee • not modify the Information without the express prior written permission of the State of New South Wales include this copyright notice in any copy made: © - Copyright – Clinical Excellence Commission for and on behalf of the Crown in right of the State of New South Wales. National Library of Australia Cataloguing-in Publication entry Title: Infection prevention and control practice handbook. Principles for NSW public health organisations ISBN: 978-1-76000-381-4 SHPN: (CEC) 160031 Suggested citation Clinical Excellence Commission, 2016, Infection prevention and control practice handbook. Principles for NSW public health organisations. Clinical Excellence Commission, Sydney, Australia. Any enquiries about or comments on this publication should be directed to: Clinical Excellence Commission Locked Bag 8 Haymarket NSW 1240 Phone: (02) 9269 5500 Email: [email protected]

Not controlled if printed – Last updated 28 August 2017

ACKNOWLEDGEMENTS Contributors Jan Gralton, Iain Crawford, Evette Buono, Kate Callaghan, Ronald Govers, Nina Muscillo, Anne Axam, Paul Smollen, Paul Curtis - Clinical Excellence Commission Jane Rothman - HAI Steering Committee, Clinical Excellence Commission Catriona Furlong - Health Protection NSW Amanda Elliott - Health and Education Training Institute Nicky Gilroy - Agency for Clinical Innovation (BMT Network) Kate Hipsley - NSW Ambulance Bruce Sanderson - Central Coast LHD Wendy Hamilton - Justice Health and Forensic Mental Health Network Louise Bright, Alison Shoobert, John Ferguson - Hunter New England LHD Beth Bint, Annmaree Wilson - Illawarra Shoalhaven LHD Chris Fraser - Nepean Blue Mountains LHD Leigh Boivin, Julie Hunt, Shayne Larymore - Northern Sydney LHD Melainie Ison, Barbara May, Poonam Nagrani, Lindy Ryan - Mid North Coast LHD Sharon Maher - Murrumbidgee LHD Margaret Evans, Fiona Law, Kate Clezy- South Eastern Sydney LHD Genevieve Maguire - Southern NSW LHD Helen McCarthy, Jennifer Morrison, Donna Schmidt, Ravi Srinivas - South Western Sydney LHD Margaret Barker, Marilyn Harris, Jeana Nurmeiyati, Helen Parker- Sydney LHD Dianne Dalton - Sydney Children’s Hospitals Network Meegan Connors - Western NSW LHD Kathy Dempsey, Jo Tallon, Tracey Worthington, Lyn Gilbert - Western Sydney LHD

i IPC Practice Handbook v2 – Update 1 Sep 2017

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CONTENTS INTRODUCTION PURPOSE ............................................................................................................................................................................... 1 OTHER RELEVANT POLICIES .................................................................................................................................................. 1 DEFINITIONS AND ABBREVIATIONS ........................................................................................................................................ 2 SECTION 1 - HEALTHCARE ASSOCIATED INFECTIONS 1.1 THE RISK OF HEALTHCARE ASSOCIATED INFECTIONS ............................................................................................ 12 1.2

MODES AND ROUTES OF TRANSMISSION................................................................................................................ 13 1.2.1 CONTACT TRANSMISSION ROUTES....................................................................................................................... 13 1.2.2 DROPLET TRANSMISSION ROUTE ......................................................................................................................... 13 1.2.3 AIRBORNE TRANSMISSION ROUTE .......................................................................................................................14 1.2.4 COMMON SOURCE ROUTE.................................................................................................................................... 14 1.2.5 SIMULTANEOUS TRANSMISSION ROUTES ............................................................................................................. 14

1.3

COLONISATION........................................................................................................................................................ 15

1.4

INFECTION ............................................................................................................................................................... 15

SECTION 2 - CLINICAL GOVERNANCE 2.1 NATIONAL STANDARDS ........................................................................................................................................... 16 2.2 2.3

RISK MANAGEMENT FRAMEWORK........................................................................................................................... 17 INFECTION PREVENTION AND CONTROL PROGRAM ................................................................................................ 18 2.3.1 ROLES AND RESPONSIBILITIES OF THE HEALTHCARE WORKER ........................................................................... 19

2.4

PREVENTATIVE MAINTENANCE AND ASSET MANAGEMENT ..................................................................................... 19 2.4.1 PURCHASING NEW EQUIPMENT ............................................................................................................................ 19 2.4.2 REVIEW AND MAINTENANCE OF EXISTING EQUIPMENT ........................................................................................ 20 2.4.3 DEMOLITION, REFURBISHMENT AND CONSTRUCTION .......................................................................................... 20

2.5

STAFF HEALTH AND HAI RISK................................................................................................................................. 21 2.5.1 RISK ASSESSING HCWS ...................................................................................................................................... 21 2.5.2 MANAGING HCWS ............................................................................................................................................... 22 2.5.3 EXPOSURE PRONE PROCEDURES (EPPS) .......................................................................................................... 23 2.5.4 HCW SCREENING AND VACCINATION .................................................................................................................. 23 2.5.5 HCW S WITH CYSTIC FIBROSIS ............................................................................................................................. 23 2.5.6 HCW S WITH HERPES SIMPLEX VIRUS .................................................................................................................. 23

2.6

HEALTHCARE WORKER EDUCATION ....................................................................................................................... 24 2.6.1 MANDATORY REQUIREMENTS .............................................................................................................................. 24 2.6.2 LOCAL EDUCATION AND TRAINING ....................................................................................................................... 24

2.7

CONSUMER EDUCATION ......................................................................................................................................... 25 2.7.1 EVALUATING THE DELIVERY OF INFORMATION TO CONSUMERS .......................................................................... 27

2.8

COMMUNICATION BETWEEN PROVIDERS ................................................................................................................ 27

SECTION 3 - RISK IDENTIFICATION OF HEALTHCARE ASSOCIATED INFECTIONS 3.1 RISK ASSESSING THE PATIENT ...............................................................................................................................30 3.2

RISK ASSESSING THE FUNCTIONAL AREA ............................................................................................................... 31 ii

IPC Practice Handbook v2 – Update 1 Sep 2017

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3.2.1 HOSPITAL ENVIRONMENTS ................................................................................................................................... 31 3.2.2 COMMUNITY SETTINGS......................................................................................................................................... 31 3.2.3 AMBULANCE SETTINGS......................................................................................................................................... 33 3.2.4 PATIENT TRANSPORT SETTINGS ..........................................................................................................................33 3.3

RISK ASSESSING VISITORS ..................................................................................................................................... 33

SECTION 4 - RISK MITIGATION: STANDARD PRECAUTIONS 4.1 HAND HYGIENE ....................................................................................................................................................... 36 4.1.1 HAND HYGIENE PRINCIPLES ................................................................................................................................. 36 4.1.2 HAND HYGIENE PRODUCT SELECTION .................................................................................................................38 4.1.3 ‘BARE BELOW THE ELBOWS’................................................................................................................................. 38 4.1.4 JEWELLERY .......................................................................................................................................................... 39 4.1.5 HAND CARE AND SKIN INTEGRITY......................................................................................................................... 41 4.1.6 FINGERNAILS ........................................................................................................................................................ 41 4.1.7 HAND HYGIENE IN ORAL HEALTH SETTINGS ......................................................................................................... 41 4.1.8 HAND HYGIENE IN COMMUNITY AND HOME SETTINGS.......................................................................................... 41 4.1.9 HAND HYGIENE IN JUSTICE AND FORENSIC MENTAL HEALTH SETTINGS............................................................ 42 4.1.10 PATIENT AND VISITOR HAND HYGIENE ............................................................................................................... 42 4.2

PERSONAL PROTECTIVE EQUIPMENT .....................................................................................................................42 4.2.1 GLOVES ................................................................................................................................................................ 43 4.2.2 FACIAL PROTECTION ............................................................................................................................................ 44 4.2.3 GOWNS AND APRONS........................................................................................................................................... 45

4.3

USE OF ASEPTIC TECHNIQUE.................................................................................................................................. 46 4.3.1 INVASIVE DEVICES ................................................................................................................................................ 47 4.3.2 LUMBAR PUNCTURE AND INTRA-ARTICULAR INJECTION PROCEDURES ............................................................... 47 4.3.3 SKIN ANTISEPSIS .................................................................................................................................................. 48 4.3.4 ASEPTIC TECHNIQUE IN ORAL HEALTH ................................................................................................................. 48

4.4

SAFE USE AND DISPOSAL OF SHARPS .................................................................................................................... 48 4.4.1 BLOOD GLUCOSE MONITORING DEVICES ............................................................................................................. 49 4.4.2 SHARPS IN COMMUNITY AND HOME SETTINGS..................................................................................................... 49

4.5

SAFE INJECTION PRACTICES................................................................................................................................... 49 4.5.1 APPLYING ASEPTIC TECHNIQUE ........................................................................................................................... 49 4.5.2 SHARP INJECTING DEVICES.................................................................................................................................. 50 4.5.3 INTRAVENOUS SOLUTIONS ................................................................................................................................... 50 4.5.4 FLUSHING ............................................................................................................................................................. 50 4.5.5 MEDICATION VIALS AND AMPOULES ..................................................................................................................... 51 4.5.6 MULTI-DOSE VIALS ............................................................................................................................................... 51

4.6 4.7

ENVIRONMENTAL CLEANING ................................................................................................................................... 52 PATIENT EQUIPMENT - REPROCESSING ................................................................................................................. 52 4.7.1 SINGLE USE OR SINGLE PATIENT USE EQUIPMENT .............................................................................................. 52

4.8

RESPIRATORY HYGIENE AND COUGH ETIQUETTE................................................................................................... 53 iii

IPC Practice Handbook v2 – Update 1 Sep 2017

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4.9

SAFE HANDLING AND DISPOSAL OF STOCK, LINEN AND WASTE ............................................................................. 54 4.9.1 STORAGE OF STERILE, CLEAN AND REPROCESSED STERILE STOCK AND EQUIPMENT ....................................... 54 4.9.2 CLEAN LINEN ........................................................................................................................................................ 55 4.9.3 HANDLING AND DISPOSAL OF USED LINEN ........................................................................................................... 55 4.9.4 PATIENT ZONE PRIVACY CURTAINS ...................................................................................................................... 56 4.9.5 DEDICATED WINDOW HUNG CURTAINS AND BLINDS IN CLINICAL AREAS.............................................................. 56 4.9.6 W ASTE DISPOSAL ................................................................................................................................................. 56 4.9.7 W ASTE DISPOSAL IN COMMUNITY HEALTH SETTINGS .......................................................................................... 57

4.10

SAFE HANDLING AND TRANSPORT OF PATIENT SPECIMENS ................................................................................... 57

4.10.1 TRANSPORT BETWEEN LOCATIONS ................................................................................................................... 57 4.11

OTHER CONTROLS REQUIRED IN ALL PATIENT SETTINGS....................................................................................... 58

4.11.1 FOOD.................................................................................................................................................................. 58 4.11.2 FLOWERS AND PLANTS ...................................................................................................................................... 59 4.11.3 STAFF ATTIRE..................................................................................................................................................... 60 SECTION 5 - RISK MITIGATION: TRANSMISSION-BASED PRECAUTIONS 5.1 CONTACT PRECAUTIONS ........................................................................................................................................62 5.1.1 CONTACT PRECAUTIONS IN SPECIFIC SETTINGS ................................................................................................. 63 5.2 5.3

DROPLET PRECAUTIONS......................................................................................................................................... 63 AIRBORNE PRECAUTIONS ....................................................................................................................................... 63 5.3.1 AIRBORNE PRECAUTIONS IN SPECIFIC SETTINGS ................................................................................................ 64

5.4

PERSONAL PROTECTIVE EQUIPMENT (PPE) REQUIREMENTS ..............................................................................65 5.4.1 SURGICAL MASKS................................................................................................................................................. 66 5.4.2 P2/N95 MASKS .................................................................................................................................................... 66 5.4.3 POWERED-AIR PURIFYING RESPIRATORS ............................................................................................................ 67

5.5

TRANSMISSION-BASED PRECAUTIONS IN ORAL HEALTH SETTINGS ........................................................................ 67

SECTION 6 - RISK MITIGATION: PATIENT PLACEMENT 6.1

PATIENT PLACEMENT IN A SINGLE OR ISOLATION ROOM ........................................................................................ 70

6.2

PATIENT PLACEMENT IN A COHORT OR MIXED INPATIENT AREA............................................................................. 71

SECTION 7 - RISK MITIGATION: PRECAUTIONS FOR MULTI-RESISTANT ORGANISMS AND CLOSTRIDIUM DIFFICILE 7.1 CLOSTRIDIUM DIFFICILE .................