CHARISSA FAY BORJA-TABORA, MD, FPPS,FPIDSP
CHAIR, INFECTION PREVENTION AND CONTROL COMMITTEE
RITM
Objective
•
•
Understand the importance of infection control in preventing healthcare-associated
infection
Know basic infection control practices such as standard precautions and Hand Hygiene
•
Suggested Reading:
–
–
–
•
WHO Aide-Memoire: Infection Prevention
WHO Aide-Memoire: Standard Precautions
WHO Aide-Memoire: Hand Hygiene
Hand out/materials
–
–
–
–
–
–
How top Hand Rub poster
How to Hand Wash poster
Competency Checklist (x 1each person) (photocopy)
Hand Hygiene Quiz (x 1each person) (photocopy)
Water-Based Paint
Sterile Gloves (Exam Gloves acceptable; 1 set for each person)
RESEARCH INSTITUTE FOR TROPICAL MEDICINE
2
Chain of Infection
Certain conditions must be met in order for a microbe or infectious disease to
be spread from person to person.
Infection occurs when all six links in the chain are intact.
Source: OSHA
RESEARCH INSTITUTE FOR TROPICAL MEDICINE
3
Ebola and the
Chain of Infection in Healthcare Facilities
• Pathogenic Microorganism:
– Ebola virus
• Reservoir:
– Patient infected with Ebola
• Means of Escape:
– Blood and body fluids (blood, saliva, urine, sperm etc.)
• Mode of Transmission:
– Direct contact with blood and body fluids of infected person
– Contact with contaminated surfaces/equipment
• Means of Entry:
– Non-intact skin, mucous membranes, sharps injury
• Host Susceptibility:
– Poor nutrition, stress, exhaustion, non-intact skin
RESEARCH INSTITUTE FOR TROPICAL MEDICINE
4
Infection Control
• What? Breaking the chain of infection
• Why? Prevent infections within health facilities
• How? Consistent practice of protocols that
prevent an infectious agent moving from one
host to another
• Who? Protects:
–
–
–
–
Patients
HCWs
Visitors
Other staff
RESEARCH INSTITUTE FOR TROPICAL MEDICINE
5
“If carefully implemented, Infection
Prevention and Control measures will reduce
or stop the spread of the [Ebola] virus and
protect health-care workers (HCWs) and
others.”
-WHO 2014
Interim Infection Prevention and Control Guidance for Care of Patients with Suspected
or Confirmed Filovirus Haemorrhagic Fever in Health-Care Settings, with Focus on
Ebola
RESEARCH INSTITUTE FOR TROPICAL MEDICINE
6
Infection Control can:
• Stop/reduce the spread of Ebola
• Protect Health care workers
• So how strong is infection
control at your facility?
RESEARCH INSTITUTE FOR TROPICAL MEDICINE
7
Core Components for Infection Prevention
& Control (IPC) Programs
Checklist
Organization of IPC program
Technical guidelines
Human resources (training, staffing,
occupational health)
Surveillance of diseases and
monitoring of practices
Microbiology laboratory support
Clean and safe environment
Monitoring and evaluation of IPC
program
Links with public health and other
services
Slide adapted and used with permission from World Health Organization
INFECTION CONTROL PREPAREDNESS CHECKLIST
Done and
completed
FACILITY
Review triage and placement procedure and ensure that treatment
and isolation areas have been identified
x
Inspect identified treatment areas to check if they meet IPC
recommendations (floor plan, adequate ventilation, electricity and
water, comfort room etc/)
x
Ensure that all Airborne Infection Isolation Rooms (AIIR) are
functioning correctly and are appropriately monitored for airflow
and exhaust handling. (Calibration of measuring devices, check
HEPA filter status)
x
Ensure that healthcare personnel have ready access, including via
telephone, to medical consultation.
Post appropriate signage alerting healthcare personnel to isolation
status, PPE required, proper hygiene, and handling/management
of infected patients and contaminated supplies.
x
Develop contingency plans for staffing, logistics, budget,
procurement, security, and treatment.
On
going
x
x
Not
Started
INFECTION CONTROL PREPAREDNESS CHECKLIST
Done and On
completed going
ADMINISTRATIVE GUIDANCE
Review your hospital’s infection control procedures to ensure
x
adequate implementation for preventing the spread of Ebola.
Review consistency with DOH, WHO, CDC guidelines.
Review policies and procedures for screening, minimizing
x
healthcare personnel exposure, isolation, medical consultation
appropriate for Ebola exposure and/or illness, and monitoring
and management of potentially exposed healthcare personnel
Review roles of the infection control practitioner to:
x
 Ensure appropriate infection control procedures are being
followed, including for lab, food, environmental services,
and other personnel, and
 Maintain updated case definitions, management,
surveillance and reporting recommendations.
Not
Started
INFECTION CONTROL PREPAREDNESS CHECKLIST
Done and
completed
ADMINISTRATIVE GUIDANCE
Review and distribute the Guidelines for Environmental
Infection Control in Health-Care Facilities.
On going Not
Started
x
Review laboratory procedures for appropriate specimen
collection, transport, and testing of specimens from
patients who are suspected to be infected with Ebola
virus.
x
Review policies and procedures for screening and work
restrictions for exposed or ill healthcare personnel, and
develop sick leave policies for healthcare personnel that
are flexible and consistent with recommendations,
Review protocols for sharps injuries
x
Ensure all HCP handling EVD patients proper medical
clearance
x
x
INFECTION CONTROL PREPAREDNESS CHECKLIST
Done and On
Not
completed going Started
TRAINING
Review ICP training status of all personnel. All training
requirements in PPE and infection control should be met
Educate and train HCP on the following areas:
 Management and exposure precautions for suspected or
confirmed Ebola cases
 Proper use of PPE (donning and doffing)
 Hand Hygiene
 Respiratory fit test
 Sick leave policies
 Safe sharp practices
 Waste Management
x
Review environmental cleaning procedures and provide
education/refresher training for cleaning staff
x
Conduct education and refresher training with healthcare
personnel on Ebola for special pathogen handling in the
laboratory.
Review plans for special handling of linens, supplies, and
equipment
Provide education/refresher training for healthcare personnel
responsible for cleaning.
x
x
x
x
INFECTION CONTROL PREPAREDNESS CHECKLIST
Done and
completed
On going
SUPPLIES
Ensure an adequate supply, for all healthcare personnel,
of:
• Impermeable gowns (fluid resistant or impermeable),
• Gloves,
• Shoe covers, boots, and booties, and
• Appropriate combination of the following:
o Eye protection (face shield or goggles),
o Facemasks (goggles or face shield must be worn
with facemasks),
o N95 respirators (for use during aerosolgenerating procedures)
• Other infection control supplies (e.g. hand hygiene
supplies).
Conduct a detailed inventory of available supply of PPE
suitable for standard, contact and droplet precautions.
x
Ensure Ebola PPE supplies are maintained in triage, ED,
and all patient care areas.
x
x
Not Started
INFECTION CONTROL PREPAREDNESS CHECKLIST
Done and
completed
On going
ASSESS
Conduct spot checks and inspections of triage staff to
determine if they are incorporating screening procedures
and are able to initiate notification, isolation, and PPE
procedures for your hospital.
Spot-check frequently to be sure standard, contact and
droplet infection control and isolation guidelines are
being followed, including safe putting on and removing
PPE.
x
x
Not Started
How will you strengthen your IPC?
• Administrative support
• Checklists/Audit
• Ebola coordinator:
– Appointed staff member to oversee adherence
to the infection control measures in your facility
– The professional in charge of infection control in
the facility
– The focal person to coordinate Ebola activities
and advise
-WHO 2014
RESEARCH INSTITUTE FOR TROPICAL MEDICINE
15
Breaking the Chain of Infection
Activity/Discussion:
In what ways can we break the chain of infection
for Ebola in healthcare?
RESEARCH INSTITUTE FOR TROPICAL MEDICINE
16
Breaking the Chain of Infection
Reservoir: Patient infected with Ebola
•
•
•
•
Signage and screening at entrances to healthcare settings
Early identification of possible cases
Separation: Isolation or cohorting of possible cases
Care and monitoring of people exposed
Means of Escape from the patient: Blood and body
fluids
• Safe handling of human remains
• Symptomatic treatment of patients
RESEARCH INSTITUTE FOR TROPICAL MEDICINE
17
Breaking the Chain of Infection
Mode of Transmission: Direct contact with blood and body
fluids of or contaminated surfaces/equipment
•
•
•
•
•
Decontamination of equipment
Regular and rigorous environmental cleaning
Linen and waste management
Spatial separation
Strategies to reduce aerosols
Means of Entry: Non-intact skin, mucous membranes, sharps injury
•
•
•
•
•
•
Hand hygiene
Standard Precautions including respiratory etiquette
PPE: correct use of physical barriers for care
Sharps safety
Safe processing of lab samples
Safe handling of body fluids
Host Susceptibility:
•
Future - Vaccines?
RESEARCH INSTITUTE FOR TROPICAL MEDICINE
18
STANDARD PRECAUTIONS
When are Standard Precautions Needed?
• Basic essential component of
infection control
• Applied to every patient
• 1st line of protection from Ebola
transmission in health facilities
– Ebola symptoms are non-specific
– Apply to ALL patients
RESEARCH INSTITUTE FOR TROPICAL MEDICINE
20
Standard Precautions Include
• Hand hygiene
• Gloves before anticipated contact with body fluids,
mucous membrane, non-intact skin and
contaminated items
• Gown and Eye protection before procedures and
patient-care activities likely to involve contact with or
projection of blood or body fluids.
• Best practices for injection safety
• Safe handling and disposal of sharp instruments
• Safe cleaning and disinfection of the environment
• Correct re-processing of reusable equipment
• Adequate laundry and waste management
WHO 2014
RESEARCH INSTITUTE FOR TROPICAL MEDICINE
21
KEY PRINCIPLES FOR EBOLA
• Prior to working with Ebola patients, all healthcare
workers involved in the care of Ebola patients must have
received repeated training and have demonstrated
competency in performing all Ebola-related infection
control practices and procedures, and specifically in
donning/doffing proper PPE.
• While working in PPE, healthcare workers caring for
Ebola patients should have no skin exposed.
• The overall safe care of Ebola patients in a facility must
be overseen by an onsite manager at all times, and
each step of every PPE donning/doffing procedure must
be supervised by a trained observer to ensure proper
completion of established PPE protocols.
http://www.cdc.gov/vhf/ebola/hcp/index.html
RESEARCH INSTITUTE FOR TROPICAL MEDICINE
22
How well are standard
Precautions per WHO
standards currently
implemented in your
facility?
http://www.who.int/csr/resources/publication
s/EPR_AM2_E7.pdf
“Ebola is an unforgiving and a frightening disease. But
it can be defeated if we work together in solidarity and
with effective coordination”
UN Deputy Secretary General Jan Eliasson
Resources
• WHO 2014 Interim Infection Prevention and Control Guidance for
Care of Patients with Suspected or Confirmed Filovirus Haemorrhagic
Fever in Health-Care Settings, with Focus on Ebola
http://apps.who.int/iris/bitstream/10665/130596/1/WHO_HIS_SDS_20
14.4_eng.pdf?ua=1&ua=1
• WHO 2011 Aide-Memoire Infection Control: Core components of
infection prevention and control programmes in health care
http://www.who.int/csr/resources/publications/AM_CoreCom_IPC.pdf
• WHO Standard Precautions in Health Care
http://www.who.int/csr/resources/publications/EPR_AM2_E7.pdf
RESEARCH INSTITUTE FOR TROPICAL MEDICINE
25