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401006 Bioscience 2: Week 4

Healthcare Associated Infections This module provides an overview of health care associated infections (HAI or HCAI) together with terminology associated with health care associated infections. You will also review the NSW Government Infection control policy on precautions nurses must take to ensure standard and additional precautions procedures are followed in healthcare settings and the legal responsibilities of nurses in the areas of infection control. During week 4 vUWS village in PPE 1 last semester you were introduced to standard precautions and WHO’s five moments for hand hygiene. This module will reinforce and extend your understanding of these concepts in an applied way using a case study. Completing the various activities in this module will allow you to achieve the following Learning Objectives: 1. Become familiar with vocabulary used in the areas of infection. 2. Review and discuss the concepts involved in the Infection Control Policy and its application to nursing practice. 3. Describe the terms Standard Precautions and Additional Precautions and relate to infection control in a health care facility. 4. Differentiate exogenous and endogenous sources of infectious microorganisms 5. Discuss the main sources of infection acquired in health care facilities. 6. Explain the risk factors associated with methicillin-resistant Staphylococcus aureus (MRSA) in the health care setting

LESSON 1: OVER VIEW OF H EALTHCARE ASSOCIATED IN FECTION S

Overview

LESSON 2: TER MINOLOGY AND DEFIN ITIONS

Terminology and denitions

LESSON 3: NSW GOVERN MEN T INF ECTION CONTROL POLICY

Infection Control Policy

How well do you know the policy pertaining to infection control?

LESSON 4: EMMIE HAS APPEN DICITIS

Understanding disease transmission

Rodriguez family case study

LESSON 5: HEALTH CAR E ASSOCIATED IN FECTIONS (HAIS)

Healthcare Associated Infections

LESSON 6: INTRODUCTION TO MRSA (METHICILLIN -RESISTANT STAPHY LOCOCCUS AUREUS)

Introduction to MSRA

CON GRATULATIONS

Congratulations!

References

Lesson 1 of 10

Overview

HAIs are an ever-present factor in every health system, are varied and complex, many caused by multi-resistant organisms (MROs) that can be difficult to detect and treat. HAIs can cause significant mortality, morbidity and stress to the patients and could also result in prolonged hospital admissions, increased costs of care and increased drug use (particularly antibiotics). The Australian Commission on Safety and Quality in Health Care (ACSQHC, 2010) released the Australian Guidelines for the Prevention and Control of HAIs. The aim was also to lead and coordinate national improvements in safety and quality in health care across Australia.

A Healthcare Associated Infection (HAI) occurs when a patient acquires an infection as a result of receiving healthcare. They occur more than 48 to 72 hours after admission and within 10 days after hospital discharge (Centre for Disease Control and Prevention, 2004). They include central line-associated bloodstream infections, catheterassociated urinary tract infections, ventilator-associated pneumonia and infections at surgery sites.

Please proceed through all the learning activities as we explore the concepts involved in Health Care Associated Infections (HAI or HCAI)

Please watch the following Lecture PowerPoint presentations Microorganisms and infection control in health care settings Part 1 and Part 2 before starting this week’s module activities:

Microorganisms and infection control in healthcare settings Part 1.pptx 17.7 MB

Microorganisms and infection control in healthcare settings Part 2.pptx 8.8 MB

Now watch a short video on Infection control in healthcare by clicking on the following link. Whilst watching be sure to jot down a few notes about the:

1. Principles of infection 2. Standard precautions 3. Transmission based precautions

Transcript

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INFECTION CONTROL IN HEALTHCARE Principles of infection control Standard precautions Transmission based precautions Organizational support JULIE SANTALL The prevention and control of infection within a healthcare setting is critically important. As nurses and healthcare professionals, we have a legal duty of care to protect the health and safety of patients. The following chapters will outline the principles of infection control, standard precautionsused to control infection, transmission based precautions, and then how organizational support can be used to help nurses control infection. 00:30Principles of infection control 00:35[music] Julie Santall Clinical Nurse/Educator Merck Serono Principle 1: everyone is potentially infectious JULIE SANTALL Healthcare facilities are potentially dangerous places. As healthcare professionals, we need to be well aware of basic infection control procedures in order to keep ourselves, the patients, and others safe. Infection control starts with the assumption that everyone is potentially infectious. This includes nurses, doctors, support staff, patients, and visitors. Just because we can't actually see infections happening, we can never assume they are not happening. 01:10Magali De Castro Prevention & Early Intervention Project Officer, Southcity GP Services MAGALI DE CASTRO Health professionals are also responsible for making sure that their, the actual procedures and infection control standards are being observed on a regular basis and also to make sure that we, um, evaluate how they're going and evaluate where the barriers are that are, um, causing, um, issues, so that we can actually improve them. 01:30Principle 2: anyone can be infected Principle 3: implement adequate precautions and practices based on risk management JULIE SANTALL Infection occurs when a parasite species, like a virus or bacterium, colonizes a host organism. Infection can occur across differenttransmission pathways, such as direct contact, droplets of patient bodilyfluids, or through the air. Just as we need to assume everyone is potentiallyinfectious, we must also assume that anyone can be infected. Nurses and doctors are just as susceptible to infection as anybody else in a healthcarefacility. In fact, probably more so, because of the nature of their work. So, we must implement adequate precautions and practices based on risk identification and management.

02:10MAGALI DE CASTRO The soonest you implement, uh, um, an infection control procedure, you have actually a standard or a policy that is consistent across all health professionals and across all staff in a, in a facility. So, it actually, um, allows you for something to, um, to measure against, to see if you're actually meeting the goals that you're wanting or if you're, um, or if there are things that could be improved. 02:35standard precautions transmission based precautions Principle 4: everyone is responsible JULIE SANTALL All organizations have a set of standard precautions that outline the minimum level of infection control required. Precautions are designed to prevent or reduce the transmission of infection between healthcare workers and patients. Transmission based precautions are used in addition to standard precautions when a particular infection is known to exist and the specific root of transmission is known. Everyone is responsible for infection control in a healthcare setting. This includes nurses, doctors, and other healthcare professionals, as well as carers and patients. 03:05MAGALI DE CASTRO An infection control practitioner could play many roles. Um, one of them could be the development of policy, um, around infection control for a special facility. Um, it could be making sure that the, um, the staff and everybody involved in that facility is actually up to date, in terms of their level of education. It could also be, um, making sure that people are observing the standards that have been set for that facility. 03:30involve the patient in their infection control Summary Principles of infection control everyone is potentially infectious anyone can be infected implementing adequate precautions and practices risk management, hazard assessment Summary Principles of infection control everyone is responsible patient focused approach JULIE SANTALL Involving the patient in their infection control has many benefits. It can give the patient some ownership of their situation and also demystify infection control procedures that may make the patient feel isolated. Being diagnosed with an infectious, life-threatening disease can be a stressful time for patients. Also take a caring, sensitive, and patient focused approach. Principles of infection control include an awareness that everyone is potentially infectious and that anyone can be infected. Implementing adequate precautions and practices is critical, based on risk management and hazard assessment. Within the healthcare organization, everyone is responsible for infection control and always remember to take a patient focused approach. 04:20Standard precautions 04:25[music] JULIE SANTALL Standard precautions are the primary set of procedures used by nurses and healthcare professionals in the control of infection. They are used at all times, regardless of whether an immediate threat of infection is recognized or not. 04:45MAGALI DE CASTRO PREVENTION & EARLY INTERVENTION PROJECT OFFICER, SOUTHCITY GP SERVICES MAGALI DE CASTRO When we're working in healthcare facilities, we use standard precautions and additional precautions. Now, you'd have your standard precautions, which is essentially the things that we use for all patients, regardless of whether we think they might be infectious or not, um, and they will include things like washing hands, using personal protective equipment, or, um, disinfecting surfaces, and then we have things like additional precautions, which we use when we believe that the standard precautions may not be enough to, um, prevent the, the spread of pathogens. 05:15Standard 1: hand hygiene wet hands liquid soap rub hands for 15 seconds rinse hands thoroughly pat dry with single use towels 1 - before touching a patient

2 - before a procedure 3 - after touching a patient 4 - after a procedure 5 - after touching a patient's surroundings Standard 2: personal protective equipment (PPE) Standard 3: handling and disposing of sharps Standard 4: maintenance of physical environment Standard 5: reprocessing of reusable instruments and equipment cleaned disinfected sterilized Standard 6: respiratory hygiene Standard 7: aseptic technique Standard 8: waste management Standard 9: handling of linen JULIE SANTALL One of the most important standard precautions is hand hygiene. It may look simple, but the actual technique is critical. Start by taking off any jewelry and wetting your hands under tepid water. Next, apply the recommended amount of liquid soap, and then rub your hands together for a minimum of 15 seconds, so that all surfaces of the hands are cleaned. Pay special attention to the tips of your fingers and thumbs, and the areas between your fingers. Next, rinse hands thoroughly under running water and finally, pat them dry with single use towels. It's also important to know when to wash your hands. There are five key times: before touching a patient, before a procedure, after touching a patient, after a procedure, and after touching a patient's surroundings. Another important standard precaution is the use of personal protective equipment, or PPE, including aprons, gowns, masks, gloves, and protective eyewear. Other precautions include the correct handling and disposing of sharps. Reinforcement around handling and disposal is really important. I've come across needles accidentally left in a patient's bed that could easily have caused a needle stick injury to any other carer, nurse, visitoror patient. Maintenance of the physical environment, such as surface cleaning and spill management is vital. The reprocessing of reusable instruments and equipment is also critically important. Hospitals and healthcare facilities reuse many things and the risk of disease transmission can be high. Any usedinstrument must first be cleaned, either manually or with an automated cleaner, like an ultrasonic cleaner or washer. The instrument must then be disinfected, using heat, chemicals, or both. It must then be sterilized. Another important standard precaution in a healthcare facility is respiratory hygiene. Always cover your mouth when coughing and sneezing, and make sure you wash your hands afterwards. Further critical standard precautions include aseptic technique, or non-touch technique, when handling patients, waste management, and the correct handling of linen. 07:35Magali De Castro Prevention & Early Intervention Project Officer, Southcity GP Services MAGALI DE CASTRO In terms of the aseptic, the aseptic technique, what we would look at is we, we observe standard precautions, which we do all the time, and then we also look at using the, the equipment that we use has to besterile. We look at creating sterile fields, and we look at minimum contact or, ideally, no contact between practitioner, direct contact between practitioner and patient. 07:55Summary Standard precautions applied at all times threat of infection or not make sure patients understand in place to protect everyone JULIE SANTALL Standard precautions must be applied at all times, whether there is an immediate threat of infection or not. Nurses should make sure patients understand why standard precautions are being used. Standard precautions are in place to protect everyone from infection. 08:15Transmission based precautions 08:20[music] 1 - contact transmission

JULIE SANTALL Transmission based precautions are used, as well as standard precautions, when the threat of a particular infection is known. The type of transmission based precaution used depends on the way the infection spread and there are three broad types. Contact transmission is when the infection need direct physical contact to spread. Diseases like MRSA or Golden Staph are known to spread this way, as well as various types of skin infection. 08:50Magali De Castro Prevention & Early Intervention Project Officer, Southcity GP Services MAGALI DE CASTRO To, in terms of additional precautions for diseases through contact, again, you, with all additional precautions, you still wouldobserve standard precautions and then, on top of that, you would use things like making sure that all surfaces and the environment is actually disinfected, um, in accordance to, um, the, the policies, um, of that facility. You would also use things like gloves, um, goggles, if there's any, any risk of splash injury, mask, a gown if there's any, any, um, likelihood of you, of your, your body coming in contact with the patient or any infected surfaces. 09:252 - droplet transmission JULIE SANTALL Droplet transmission happens when a disease is spread through respiratory droplets that are released when somebody talks, sneezes,or coughs. Illnesses like measles, rubella, and influenza are spread this way. 09:35MAGALI DE CASTRO For diseases transmitted by droplets, we would also use things like masks, um, ideally, you would use a mask on the patient, um, so that when they're coughing, um, all of that is being contained. You would also observe cough etiquette, so make sure that your teaching your patientsthat, if they're coughing, to please cover their mouth. Ideally, not with their hand, because their hand is the first point of contact for everything else, so they'd be spreading those droplets or those pathogens everywhere, so you try and teach them to cough either into their upper, um, upper arm or using tissues and then disposing of those tissues.

Lesson 2 of 10

Terminology and definitions

As health care professionals you will need to be familiar with the common terminology associated with infections. In order to enable you to achieve this familiarity please attempt the following activity.

Match the following infection control terms with their correct definitions

Infection

Growth of pathogenic microorganisms in the body, overwhelming body defences.

Contamination

Unwanted presence of bacteria without proliferation.

Colonization

Proliferation of microorganisms without a host response.

Delayed healing

Delayed healing will occur from contamination and colonisation of bacteria in a wound.

Host

Person with infection. Cell for virus.

Pathogen

Organism that is able to produce disease.

Carrier

A person who harbours and continually sheds a pathogen without signs or symptoms.

Sub clinical infection

Infection not producing any recognisable sign & symptoms but elicits an immune response.

Clinical infection

An infection that does present recognisable sign & symptoms,

SUBMIT

Sterilisation is the complete removal of all living microorganisms including What is the difference between disinfection and sterilisation?

spores. Disinfection is to reduce the number of microorganisms to

an acceptable level.

1 of 5

Both used to reduce the number of microorganisms to acceptable levels.

How is a disinfectant and an antiseptic similar?

2 of 5

Antiseptic is mild enough to use on skin or mucous membranes. Disinfectants are too harsh

How are a disinfectant and an antiseptic different?

and do damage skin if not handled carefully. Would not use in place of antiseptic on skin.

3 of 5

Infections caused by organisms that do not normally cause disease, but Opportunistic infection

can become pathogenic under certain conditions, such as depression of the immune system.

4 of 5

An infection occurring in a patient in a hospital or other healthcare facility in whom

Health-care associated infection (HAI)

the infection was not present or incubating at the time of admission.

5 of 5

Lesson 3 of 10

Infection Control Policy

The skin acts as a natural barrier and usually bars invading microorganisms unless it is physically disrupted (e.g., by injury, IV catheter, or surgical incision). NSW hospitals and clinicians actively participate in national and local programs to minimise the risk of acquiring a HAI and also maintain high infection control standards. Clinical care staff and other health care workers are the frontline defence for applying daily infection control practices to prevent infections and transmission of organisms to themselves and other patients.

The Infection Control Policy describes the importance of standard and additional precautions in healthcare settings and the legal responsibilities of nurses in the areas of infection control.

Please open the Infection Control Policy document by clicking the link below:

NSW Health - Infection Prevention and Control Policy.pdf 699.1 KB

How well do you know the policy pertaining to infection control? Look up the policy directive to answer the following questions (read page 7 section 6.1 on Standard Precautions and see the summary table on page 27)

C O NT I NU E TO QU E S T I O NS O N I NFE C T I O N C O N T R OL PO L I C Y

Lesson 4 of 10

How well do you know the policy pertaining to infection control?

Look up the policy directive to answer the following questions (read page 7 section 6.1 on Standard Precautions and see the summary table on page 27) before flipping the card to see if you are correct.

Standard Precautions apply to all patients receiving care in health organisations, What do Standard Precautions apply to?

regard...