Project Overview

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Project Overview

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1. If this is to be presented as an in-service, the presenter should insert their name and title in the spaces providedIf this is to be presented as an in-service, the presenter should insert their name and title in the spaces provided

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3. 2 Standard Precautions Tier 1 These are the minimum standard of precautions to be applied to all people accessing health care services regardless of their diagnosis or presumed infectious status, there-by reducing the risk of transmission of organisms from both recognised and unrecognised sources. These precautions apply to blood and all body substances (except sweat) acutely or chronically non-intact skin and mucous membranes including eyes Sweat is excluded because it has not been implicated in disease transmission – not because it does not carry micro-organisms. Acutely non intact skin includes – cuts, lacerations abrasions and burns (skin that will usually heal to be intact in a short time) Chronically non-intact skin includes – acne, exfoliating skin conditions, dermatitis, psoriasis (conditions that may be long lasting and not easily treated or able to be covered) When considering protection of mucous membranes – always remember the eyes Sweat is excluded because it has not been implicated in disease transmission – not because it does not carry micro-organisms. Acutely non intact skin includes – cuts, lacerations abrasions and burns (skin that will usually heal to be intact in a short time) Chronically non-intact skin includes – acne, exfoliating skin conditions, dermatitis, psoriasis (conditions that may be long lasting and not easily treated or able to be covered) When considering protection of mucous membranes – always remember the eyes

4. 3 Standard Precautions must be considered when Providing direct patient care Handling blood or body substances Performing invasive procedures including cannulation or catheterisation Risk of splash or splatter to mucous membranes Providing care that can induce coughing Handling and disposal of waste or sharps Handling or preparation of food

5. 4 Additional Precautions Tier 2 These precautions are designed for patients known or suspected to be infected with pathogens for which Additional Precautions, in addition to Standard Precautions, are needed to interrupt transmission of those pathogens in health care facilities. Additional Precautions are implemented for pathogens spread by airborne or droplet or contact with people or with contaminated surfaces, or by any combination of these routes.

6. 5 Additional Precautions Apply Additional Precautions on clinical suspicion, pending confirmation with regular review and maintain precautions until evidence of pathogen is no longer present or effective treatment has been implemented and continued for a specified time or effective treatment time has elapsed Additional Precautions may be combined to target multiple means of transmission of certain conditions/diseases. When applying Additional Precautions, they need to be implemented as soon as possible to minimise potential exposure of others to a transmissible infection or disease. Do not wait for pathology results or further clinical reviews to be completed as more people will be exposed to potential risks.When applying Additional Precautions, they need to be implemented as soon as possible to minimise potential exposure of others to a transmissible infection or disease. Do not wait for pathology results or further clinical reviews to be completed as more people will be exposed to potential risks.

7. 6 Additional Precautions - Tier 2 Droplet Precautions In point 2 facial protection includes fluid resistant face mask and face shield or eye protection. For consistency in terminology – Perform hand hygiene immediately by either a 15 second hand wash or using a water-free alcohol based skin cleanser In point 2 facial protection includes fluid resistant face mask and face shield or eye protection. For consistency in terminology – Perform hand hygiene immediately by either a 15 second hand wash or using a water-free alcohol based skin cleanser

8. 7 Droplet Precautions Respiratory droplets are generated when a person coughs, sneezes, speaks or during a procedure that generates aerosols eg. suctioning, chest physiotherapy Droplet transmission involves contact of the conjunctivae or the mucous membranes, of the nose or mouth, of a susceptible person with large particle droplets (larger than 5 µm in size) containing micro-organisms generated from a person who has a clinical disease, or who is a carrier of the micro-organism.

9. 8 Droplet Precautions Examples of pathogens spread by droplet route Adenovirus pneumonia (combined with contact transmission) Haemophilus influenzae Seasonal Human Influenza (combined with contact transmission) Mumps Meningococcal disease Pertussis Rubella

10. 9 Droplet Precautions – the room Patients requiring Droplet Precautions need to be placed into a Single Room with the door closed, access to this room must be restricted for equipment, visitors and non-essential staff. No special ventilation or air handling is required. If several patients with the same suspected infection/pathogen require hospitalisation then cohort together. This should only be implemented following consultation with Infection Control or Infectious Diseases experts. If patients are being cohorted, separation of at least 1 metre between patients is required. En-suite bathroom facilities should also be available for patient use. If not available then a dedicated bathroom should be made available for the patient/cohort group to utilise. Staff should be aware that appropriate PPE will need to be available outside the room and this should be restocked regularly, but not overstocked. Patients should be fully informed of what droplet precautions entail and how they are to be implemented. An effective way to restrict access is to close the door of the room. If cohorting is to be considered this must be done in consultation with the Infection Control or Infectious Diseases experts as patients need to have the same organism, and be at a similar stage of illness or infection. 1 metre between patients bed units has been identified to reduce the opportunity for infections to spread easily from person to person. Staff should be aware that appropriate PPE will need to be available outside the room and this should be restocked regularly, but not overstocked. Patients should be fully informed of what droplet precautions entail and how they are to be implemented. An effective way to restrict access is to close the door of the room. If cohorting is to be considered this must be done in consultation with the Infection Control or Infectious Diseases experts as patients need to have the same organism, and be at a similar stage of illness or infection. 1 metre between patients bed units has been identified to reduce the opportunity for infections to spread easily from person to person.

11. 10 Droplet Precautions – hand hygiene Hand hygiene facilities include A dedicated handwashing sink with liquid soap or anti-microbial soap solution, disposable paper hand towel and general waste bin Water free alcohol-based skin cleaner Perform hand hygiene immediately before or on entry into the room

12. 11 Droplet Precautions – Personal Protective Equipment (PPE) PPE should be placed in the anteroom or immediately outside the room on a trolley for staff to utilise. PPE must include Fluid resistant surgical face mask Protective face shield, eyewear/goggles Single use disposable gloves * If contact precautions are combined then an impervious gown is added to PPE and is donned first before the face mask. When stocking the trolley or the anteroom with PPE it is important to ensure it is not overstocked and only items required for the patient are located there. Restock regularly with PPE Ensure that the size and type of PPE is appropriate for the precautions being implemented. Ensure that staff using the PPE are trained and assessed on how to fit PPE correctly – refer to Module on Donning and Doffing of PPE. When stocking the trolley or the anteroom with PPE it is important to ensure it is not overstocked and only items required for the patient are located there. Restock regularly with PPE Ensure that the size and type of PPE is appropriate for the precautions being implemented. Ensure that staff using the PPE are trained and assessed on how to fit PPE correctly – refer to Module on Donning and Doffing of PPE.

13. 12 Droplet Precautions – when HCWs are leaving the patients room Remove gloves (if used) Perform hand hygiene by either, washing hands or by using water free alcohol skin cleanser. Remove face shield or protective eye wear * If contact precautions are combined then an impervious gown is removed before the face mask (refer to donning and removal of PPE) Remove the mask taking care not to touch the mask but to remove and hold the mask by the ties. Dispose of the mask into the general waste bin Perform hand hygiene by either, washing hands or by using water free alcohol skin cleanser. If any of the PPE removed is contaminated with blood or body substances then it should be placed into Clinical Waste otherwise, General Waste is the appropriate waste stream from used PPE. If any of the PPE removed is contaminated with blood or body substances then it should be placed into Clinical Waste otherwise, General Waste is the appropriate waste stream from used PPE.

14. 13 Droplet Precautions – the patient Fluid resistant surgical mask to be placed onto the patient if they need to leave the room for tests or treatment. If oxygen therapy is required then it should be administered by using nasal prongs placed under a surgical mask for transport (if medical condition allows). Advise transport staff of level of precautions to be maintained and ensure they have appropriate PPE available. Educate patient on respiratory hygiene for coughing and sneezing patients suspected of having an infectious respiratory illness. Notify area receiving patient of the precautions to be implemented. Patient notes and Medical Records must not be taken into the patients room.

15. 14 Droplet Precautions - visitors Visitors must see nursing staff before entering a restricted access room with Droplet Precautions in place wear a fluid resistant surgical mask and protective eyewear when entering the patients room remove the mask and eyewear on exiting the room and discard into general waste bin perform hand hygiene on entry and exit from the room Visitors must be instructed on how to apply and remove PPE before entering the patients room. Visitors need to be minimised where possible. Children should be restricted and access determined on a case by case basis.Visitors must be instructed on how to apply and remove PPE before entering the patients room. Visitors need to be minimised where possible. Children should be restricted and access determined on a case by case basis.

16. 15 Where do I go for more information? Check local Infection Control Policy Manual Check with facility or Area Infection Control Nurse NSW Health Website http://www.health.nsw.gov.au/quality/hai/

17. 16 Points to remember Standard Precautions apply to all patients Additional Precautions apply to specific diseases/conditions not effectively controlled by Standard Precautions Additional Precautions include airborne, droplet and contact precautions OR a combination of these. Always refer to the Additional Precautions posters before entering a room where Additional Precautions are in place and follow the instructions. With Droplet Precautions the door of the room to remain closed at all times. Fluid Resistant surgical face masks to be worn by all HCW and visitors when entering the room. Eye shields or protective eyewear is to be worn by all HCW and visitors when entering the room. Educate patients on respiratory hygiene for coughing and sneezing.

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