Infection control in clinics
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Standard precautions
o First tier
o Apply to all clients, regardless of their diagnosis and infectious status
o STU staffs and students should follow standard precautions
Transmission-based precautions
o 2nd tier
o extra steps that are used in addition to the standard precautions
o Apply where the suspected or confirmed presence of infectious agents
Standard Precautions
 define all the steps that should be taken to prevent spread of infection/
contamination
 when there is anticipated contact with blood, body fluid, secretions, excretions, nonintact skin and nucleus membranes
 application of this is determined by nature of contact, interaction with patient,
extent of fluid exposure
 Perform hand hygiene
 Use of personal protective equipment (PPE)
 Clean and disinfect environment appropriately
 Waste management
 more related to clinical contacts in STU
 Follow safe injection practices
 Follow respiratory hygiene and cough etiquette
 Reprocessing of reusable medical devices/instruments properly
Hand hygiene
 5 moments for hand hygiene (critical to reduce spread of infections) (steps by WHO)
o Before touching a patient
o Before clean and aseptic procedures, e.g. before the feeding procedure in
swallowing assessment
o After body fluid exposure risk, e.g. after touching client’s saliva
o After touching a patient (at the end of encounter/ when the encounter is
interrupted)
o After touching patient surroundings e.g. client’s wheelchair
 Do not wear artificial nails, rings and other jewelries
 How to achieve?
o Rubbing hands with 70-80% alcohol-based formulation (ABHR)
 Apply a palmful of ABHR (around 3-5ml) and cover all surfaces of the
hands including palms, back of hands, between fingers, thumbs, finger
tips and wrists
 Rub all hand surfaces for at least 20 seconds until hands are dry
 ABHR can be found in all clinic rooms in STU
 if hands are not visibly soiled, this is preferred
o Washing hands with liquid soap and water
 Wet hands with water and apply enough amount of liquid soap
necessary to cover all hand surfaces
 Rub all surfaces of the hands for at least 20 seconds before rinsing
under running water
 Dry hands thoroughly with disposable paper towel
 Do not touch the water tap directly again when the hands are cleaned
 turn off tap by using paper towel to wrap the faucet
 used paper towels should be discarded to bin with lid
 The whole procedure usually takes about 40-60 seconds
 Avoid using hot water for hand washing because repeated exposure
to hot water may increase the risk of dermatitis
 preferred after using the toilet/ visibly dirty (with blood)
Personal protective equipment (PPE)
 Upper face
o all CTs must wear surgical mask, goggles, face shield
o contact lens and glasses are not adequate for eye-protection
 Extra precautions
 Gloves (worn when there is anticipated risk of contacting the above liquids and
potentially infection material)
o e.g. During oral motor assessment & treatment and during swallowing
assessment & treatment
o use of gloves doesn’t replace need for hand hygiene
o Remove after caring for a patient
o don’t wear the same glove for care for more than 1 patient
o Remove promptly after clinical procedures or before touching noncontaminated items e.g. handling clinical notes
o hand hygiene should be performed right after removal of gloves
o selection of powder-free gloves recommended  avoid interaction with
alcohol-based hand rub and gritty feeling on hands
 Gowns: to protect skin and clothing, during procedures that generate splash and
sprays of blood, excretions and secretions
Principles of PPE removal (protect from contamination)
 Remove PPE before leaving clinic room: shouldn’t be brought to non-clinic areas
 Perform hand hygiene after removal of PPE or when hands get contaminated
 Discard PPE in lidded waste receptacles after use
 Decontaminate reusable PPE properly according to the manufacturer instruction
Environment Cleaning and Disinfection
 Routine cleaning and disinfection after each clinical session
• Furniture
• Computers
• Toys
• Treatment materials
 Use towels soaked with 1:99 diluted household bleach (to clean and disinfect env
appropriately)
• Put in designated container after use
 Put on appropriate PPE (mask and gloves)
 Inform clinical supervisor and customer service officer in case of contamination of
blood, secretions, vomitus or excreta (should be disposed to plastic waste bag)
 Use bleach on metals  70% alcohol
 Use bleach together with other household detergents (reduce effectiveness in disinfection
+ cause dangerous chemical reactions)
 Prepare extra detergents for environmental cleaning
Waste Management
 Put in the lidded rubbish bin inside the clinic room
• Gloves
• Surgical masks
• Tongue depressors
• Used tissues
• Used wet wipes
 Inform customer service officer if the rubbish bin in the clinic room is full
Standard Precautions (follow all these in CP5)
 Perform hand hygiene
 Use of personal protective equipment (PPE)
 Clean and disinfect environment appropriately
 Waste management
 Follow safe injection practices
 Follow respiratory hygiene and cough etiquette
 Reprocessing of reusable medical devices/instruments properly