How to implement and monitor infection prevention and control standards, policies and procedures within our practice.
MAT Health Clinic (MHC) is a General Practice which provides a wide range of medical services to all age groups. A specialised team of male and female general practitioners (GP’s) work at the clinic along with allied health service providers, nursing staff and an administration team.
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UNDERSTANDING INFECTION
Commonly Used Terms and Terminology
| Additional precautions | Where standard precautions may be insufficient to prevent transmission of infection (e.g. airborne transmission). |
| Antiseptics | Solutions that kill, retard or prevent the growth of bacteria and can be used on the skin |
| Arthropods | Insects |
| Asepsis | The absence of disease producing micro-organisms |
| Aseptic technique | Aseptic technique is an effort to keep the client as free from exposure to infection-causing pathogens as possible |
| Asymptomatic | There are no symptoms |
| Bacteria | Unicellular organisms that do not require living tissue to survive |
| Biocidal | Biocidal products are products which, through their chemical or biological properties, act against harmful organisms or prevent damage caused by harmful organisms |
| Bloodborne pathogens | Disease-causing bacteria or viruses carried through the body in blood or body fluids |
| Catheterisation | To introduce a catheter into a body cavity to inject or remove fluid. |
| Causative agent | Causative agents in infection are pathogens |
| Colonisation | Refers to the presence and growth of a micro-organism on the skin or mucous membrane without any evidence of infection |
| Commensalism | The term is normally used to describe the relationship between the human host and the many and varied micro-organisms that reside in or on the human body normal flora |
| Competency | This is the ability to demonstrate the skills, knowledge and attitudes expected in the industry. |
| Cross-contamination | Occurs from travelling from contaminated areas to clean areas |
| Disinfection | A process that eliminates almost all pathogenic organisms on objects, with the exception of bacterial spores. |
| Fungi | Large diverse group of organisms |
| Germ | A one celled micro-organism |
| HAV | Hepatitis A Virus |
| HBV | Hepatitis B Virus |
| HCV | Hepatitis C Virus |
| HIV | Human Immunodeficiency Virus |
| Hazardous Waste | Waste containing chemical compounds that are dangerous to human health and/or the environment |
| Helminths | Multi-cellular organism, worms |
| Hepatitis | A disease caused by a bloodborne virus and marked by inflammation of the liver |
| Infection | The condition where body tissue is invaded by disease-causing bacteria |
| Medical Asepsis | Refers to clean techniques that inhibit the growth and spread of pathogenic micro-organisms |
| Medicament | An agent that promotes recovery from injury or ailment; a medicine |
| Microbiology | Microbiology is the study of microbes: bacteria, yeasts, fungi, algae, protozoa and viruses. |
| Mode of transmission | Is where the organism is transmitted from the reservoir or source to another person |
| MRO | Multi Resistant Organism |
| MRSA | Methicillin Resistant Staphylococcus Aureus |
| Mutualism | Refers to a situation where two independent organisms live together to their mutual benefit |
| Mycosis | An infection caused by a fungus |
| Norovirus | Noroviruses are a group of viruses that frequently cause intestinal infection. They are highly infectious and may cause outbreaks in settings such as schools, child care centres, aged care facilities, cruise ships, restaurants and hospitals. |
| Nosocomial infection | Is one that is acquired in a hospital/ practice or service or other health care facility |
| Occupational disease | Illnesses resulting from contact with products or ingredients in the workplace |
| Parasites | Organisms that live on other organisms and derive nutrients from that host i.e. worms |
| Pathogen | A Pathogen is anything that can produce disease. |
| pH | The pH scale measures how acidic or basic a substance is. The pH scale ranges from 0 to 14 |
| Portal of entry | Micro-organisms enter the body the same pathway that they used for exit via the respiratory tract (breathing in), genitourinary tract (on urine catheters) gastrointestinal (eating contaminated food), Skin (broken skin from laceration and wounds, ulcers, stepping on a nail, injections, insect bites). |
| Portal of exit | Micro-organisms leave the body via the respiratory tract |
| PPE | Personal Protection Equipment |
| Protozoa | Unicellular organisms with no cell wall, larger than bacteria with visible organelles |
| Reservoirs (sources) | A reservoir is any person, animal, plant, soil, or substance (or combination of these) in which an infectious agent normally lives and multiplies. |
| Residential flora | Residential organisms are naturally found in or on the body, which do not cause disease (‘colonising’). |
| Risk | A risk means the probability and consequences of injury, illness or damage resulting from exposure to a hazard. |
| Risk controls | Are the devices and methods to, where practicable, eliminate the hazard or, where this is not practicable, minimise the risk associated with the hazard |
| Sharps container | Is a container that is filled with used medical needles (and other sharp medical instruments, such as an IV catheter) |
| Standard Operating Procedures (SOPs) | Detailed, written instructions to explain how a policy is to be implemented |
| Standard precautions | Applied as the first line of approach to infection control |
| Sterilisation | A process that eliminates or destroys all forms of microbial life. |
| Surgical asepsis | Refers to sterile techniques that destroy all micro-organisms and their spores |
| Susceptible host | The host (also called the susceptible host) is the human body |
| Symbiosis | The biological term to describe two organisms living together |
| Transient flora | Organisms that are acquired during hand contact with clients, or contaminated equipment |
| UTI | Urinary Tract Infection |
| Vector | A vector is any agent (person, animal or microorganism) that carries and transmits an infectious pathogen into another living organism. – insects, ticks |
| Viral infection | A type of infection that is caused by a virus. |
| Viruses | Very small intracellular parasites that require a living host for replication |
| VRE | Vancomycin Resistant Enterococcus |
| VZV | Varicella Zoster Virus |
Microorganism
A microorganism, or microbe, is an organism of microscopic size, which may exist in its single-celled form or as a colony of cells. These microorganisms are often called “infectious agents” ‘bugs’ or ‘germs’.
Microorganisms which can cause infections in humans are known as pathogenic organisms. When a pathogenic organism lodges into human tissue and starts to multiply, an infection occurs.
Infections can either be local or systemic
Local infection is confined to a specific area of the body (such as a wound infection).
Systemic means affecting the entire body, rather than a single organ or body part. An infection that is in the bloodstream is called a systemic infection. Systemic infections are not necessarily more severe than local infections. They just affect a larger proportion of the body. For example, the common cold is a systemic infection.
Infectious Disease
A variety of microorganisms can cause disease. Pathogenic organisms are of five main types: Bacteria, Viruses, Fungi, and Parasites.
Infectious diseases can be viral, bacterial, parasitic or fungal infections.
| Type of infectious disease | Description |
| Bacterial infections (Bacteria) | Bacteria are single-celled organisms with their instructions written on a small piece of DNA. Bacteria are all around us, including inside of our body and on our skin. Many bacteria are harmless or even helpful, but certain bacteria release toxins that can make you sick. To cause disease, pathogenic bacteria must gain access into the body. The range of access routes for bacteria includes: • Cuts • Contaminated food or water • Close contact with an infected person • Contact with the faeces of an infected person • Breathing in the exhaled droplets when an infected person coughs or sneezes • Indirectly, by touching contaminated surfaces – such as taps, toilet handles, toys and nappies. |
| Viral infections (Viruses) | A viral infection is any type of infection that is caused by a virus. • Viruses are made up of the genetic material known as DNA or RNA, which the virus uses to replicate • Viruses are not living organisms and need a “living” host in order to reproduce-otherwise it cannot survive • They cannot multiply on their own, so they have to invade a ‘host’ cell and take over its machinery in order to be able to make more virus particles • In order for a virus to survive, it must invade and attach itself to a living cell. It will then multiply and produce more virus particles • When a virus enters your body, it invades some of your cells and takes over the cell machinery, redirecting it to produce the virus, and in so doing causes disease. Tissue cells usually degenerate and die (releasing viral particles) • In some instances the cells survive and result in latent infections – e.g. herpes simplex Viruses can be transmitted in numerous ways, such as through contact with an infected person, swallowing, inhalation, or unsafe sex. Factors such as poor hygiene and eating habits can increase your risk of contracting a viral infection. |
| Fungal infections (Fungi) | Like bacteria, there are many different fungi. Fungi can live on your body and when they multiply they become harmful. All fungi can enter the body through the mouth, nose or cut in the skin and make you sick. Common examples of fungal conditions include: · Tinea pedis (athletes foot) · Tinea cruris (jock itch) · Tinea corporis (ringworm) · Candida albicans – of the nail, of the genitourinary system (thrush), oral thrush, enteric candida · Onychomycosis -Toenail fungal infections |
| Parasitic infections (Parasites) | Parasites use the bodies of other organisms to live and reproduce. Parasites include worms (helminths) and some single-celled organisms (protozoa). |
The spread of infection involves three factors:
- A source of infectious agent
- A Susceptible host
- A mode of transmission
Non-Infectious Disease
Non-infectious diseases are not caused by pathogens and therefore cannot be spread from one person to another. Instead, non-infectious diseases are caused by factors such as genetics, malnutrition, environment and lifestyle. Examples of non-infectious diseases include cancer, Alzheimer’s disease and epilepsy.
Infection vs. Colonisation
Infection is the presence of microorganisms causing damage to body tissues, usually in the presence of acute inflammation (pain, swelling, redness, heat and loss of function). For example Staphylococcus aureus on intact skin does not cause a problem; it is the normal flora for skin. However if you cut your skin, Staphylococcus aureus can cause infection in the cut.
Germs can also be in or on the body, but not make you sick. This is called colonisation. Colonisation describes when bacteria grow on body sites exposed to the environment, without causing infection. This is a normal process. People who are colonised will have no signs or symptoms. They feel fine.
Who are Most Susceptible to Infection?
Any member of the general public can contract an infection, however in healthcare settings, the most common susceptible hosts are patients and healthcare workers.
Healthcare workers may be exposed to infectious agents from infected or colonised patients, instruments and equipment, or the environment. The level of risk relates to the type of clinical contact healthcare workers have with potentially infected or colonised patient groups, instruments or environments, and the health status of the healthcare worker (e.g. immunised or immunocompromised).
All healthcare facilities will have infection control policies and procedures in place and staff are required to take every precaution to avoid infections. However the risk of infection can never be completely eliminated and some patients and staff have a higher risk of acquiring an infection than others.
Patients may be exposed to infectious agents from themselves (endogenous infection) or from other people, instruments and equipment, or the environment (exogenous infection). The level of risk relates to the healthcare setting (specifically, the presence or absence of infectious agents), the type of healthcare procedures performed and the susceptibility of the patient.
Some individuals are more susceptible to infection than others. These include:
• Very young people – premature babies and very sick children
• Very old people – the frail and the elderly
• People who are already ill
• People with open wounds
• People with defective immunity – people with diseases that compromise their immune system or people who are being treated with chemotherapy or steroids
• People on inadequate diets – more likely to be deficient in certain vitamins and minerals
Chain of Infection
The chain of infection, if we think of it as an actual chain, is made up of six different links: pathogen (infectious agent), reservoir, portal of exit, modes of transmission, portal of entry, and the susceptible host. Each link has a unique role in the chain, and each can be interrupted, or broken, through various means.
Infectious Agent – Causative agents in infection are pathogens. Pathogens are micro-organisms that are capable of causing diseases or infections. Micro-organisms causing the infection are viruses, bacteria, parasites and fungi.
Reservoirs (sources) – A reservoir is any person, animal, plant, soil, or substance (or combination of these) in which an infectious agent normally lives and multiplies. Sources of infection can be the hands of a health care worker, other residents, residents own body, health care equipment e.g.: washers or towels; catheters, nebuliser masks, bedpans, contaminated food, water, soil, birds/animals and mosquitoes.
Portal of exit – this is how or where the pathogen leaves the reservoir. In the body this is through cavities or openings such as cuts. Micro-organisms may leave the body via the respiratory tract (cough, sneeze), genitourinary tract (urine, genital secretions), gastrointestinal (faeces, vomit), Skin (touching the skin, holding hands, touching mucus membrane (nose and mouth).
Modes of transmission of infection – is where the organism is transmitted from the reservoir or source to another person. The common ways organisms can be transmitted are via direct contact, through the air or by way of insects or animals. There are several modes of transmission.
Portal of entry – micro-organisms enter the body. They may use the same entry point that they used for exit of the previous host. e.g. via the respiratory tract (breathing in), gastrointestinal (eating contaminated food), Skin (broken skin from laceration and wounds, ulcers) or may be through another way e.g. contaminated instruments.
Susceptible host – the host (also called the susceptible host) is the human body: someone who is at the risk of infection. Infections do not necessarily occur when pathogens enter the body of the person whose immune system is functioning normally. Whether or not a pathogen will result in infection depends upon several factors related to the host (the person exposed), the pathogen itself, and the environment.
ONE TO ONE CONTACT
| Types of infections | Infections that can be passed on this way | How to prevent possible infection being passed on in this way |
| Direct infections are passed on by direct contact with people | Chickenpox Meningitis Whooping cough Gastroenteritis Influenza (flu) Sexually transmitted diseases MRSA HIV HEP B | Good hand washing Avoid direct contact with an infected person Use PPE for contact with infected skin and bodily fluids if you, or the person you are caring for has a respiratory illness like a cold or flu |
| Indirect infections are passed on by contact with objects such as door handles, caps, cutlery, soiled bedding and clothing | Chickenpox Colds Gastroenteritis Skin infections Athletes foot Conjunctivitis Head lice Threadworm MRSA | Frequent hand washing Use gloves when handling soiled bedding clothing Disinfect items that may be contaminated Don’t share personal items such as cups, cutlery, towels, hairbrushes |
| Droplet occurs when droplets containing microorganisms from an infected person are propelled through the air and land on the mouth, eyes, or nose of another person. | Meningococcal Whooping cough Influenza Respiratory viruses (sneezing, coughing) German measles | Use masks Good hand washing Cover mouth when coughing or sneezing Single room is preferred |
NON CONTACT
| Types of infections | Infections that can be passed on this way | How to prevent possible infection being passed on in this way |
| Airborne infections are passed on by contact with infected droplets of moisture in the air e.g. sneezing Diseases transmitted via the airborne route involve small airborne droplets/particles that can remain suspended in the air for long periods. | Flu Colds Rubella Tuberculosis Chickenpox Meningitis Whooping cough Mumps Measles | Avoid close contact with infected person Cover your mouth or nose when coughing, sneezing Isolation Wear a mask vaccination |
| Vehicle refers to contaminated items such as food, water, medications, devices, and equipment. | Contaminated medicines Food poisoning Medical equipment | Use of tamper proof containers Refrigerate food to keep at required temperature Hand washing prior to handling food Use of clean utensils Disinfection standards |
| Vectors – common examples of vectors are mosquitos, flies and ticks | Malaria Dengue fever Yellow fever | If travelling overseas use insect repellents to reduce risk Get vaccinated or take tablets to protect against some vector-borne infections e.g. Yellow fever, malaria |
Sources of Infecting Microorganisms
Everyday items at the home, in the workplace and in public places can easily become contaminated with virus (such as flu), including food, door handles, remote controls, handrails, telephone handsets and computer keyboards. A common way for infectious diseases to spread is through the direct transfer of bacteria, viruses or other germs from one person to another. This can occur when an individual with the bacterium or virus (a carrier) touches, kisses, coughs or sneezes on or around someone who isn’t infected.
Breaking the Chain of Infection
In a healthcare setting infections may pass between (either to or from) the following:
- Clients / patients
- Health care workers
- Instruments and equipment
- The health care environment
There are many different germs and infections inside and outside of the healthcare setting. Despite the variety of viruses and bacteria, germs spread from person to person through a common series of events. Therefore, to prevent germs from infecting more people, we must break the chain of infection.
No matter the germ, there are six points at which the chain can be broken and a germ can be stopped from infecting another person.
| The 6 links | The best ways to break the link are |
| Infectious Agent | preventative treatment – for those who may be exposed rapid identification prompt treatment – for those infected good health and hygiene |
| Reservoirs | immunisation environmental cleaning good health and hygiene disinfection/sterilisation hand hygiene |
| Portal of exit | Hand hygiene PPE Control of body fluids Effective waste disposal |
| Mode of transmission | Isolation Food handling precautions Airflow control Sterilisation Hand hygiene |
| Portal of entry | Effective wound care practices Catheter care aseptic technique |
| Susceptible host | Recognition of high risk patients Early mobilisation Treatment of underlying diseases |
STANDARDS AND GUIDELINES
POLICIES AND PROCEDURES
ROLES AND RESPONSIBILITES
STAFF TRAINING
All staff have an individual responsibility to identify any potential infection risks within the practice and to be familiar with and implement the relevant infection control procedures of our practice.
New staff, including contracted staff and casuals, are familiarised with our infection control policies that are appropriate to their duties as part of their induction to our workplace and are educated about their role in preventing the spread of infection.
All staff must:
- understand relevant infection risks and modes of transmission of common pathogens
- know when personal protective equipment is required and what type
- know who is responsible for ensuring that essential procedures (e.g. environmental cleaning) are performed and be aware of the cleaning schedule
- know what to do if there is an accident or incident that risks exposure to infection.
All staff must be trained in the following competencies, and demonstrate competency within a reasonable time after starting their duties at the practice:
- hand hygiene
- respiratory hygiene and cough/sneeze etiquette
- when and how to perform the appropriate level of precautions (standard precautions and transmission-based precautions)
- selection and use of personal protective equipment
- aseptic technique
- managing blood and body substance spills
- managing blood or body substance exposure (appropriate to their role)
- principles of environmental cleaning and reprocessing reusable medical devices (appropriate to their role)
- where to find information on other aspects of infection prevention and control in the practice.
Mechanisms are in place to ensure ongoing education and competency occur on a regular basis or when changes occur to our procedures. All training is recorded in our staff training log.
HOW TO MANAGE WORK HEALTH AND SAFETY RISKS
How to Manage Work Health and Safety Risks
How to Assess Work Health and Safety Risks
PERSONAL HYGIENE PRACTICES
Good personal hygiene is one of the most effective ways to protect ourselves and others from many illnesses, such as gastroenteritis.
Clothing and other wearable items
Staff should avoid wearing lanyards, long chains and neckties as evidence indicates they may facilitate transmission of infection.
Our clinical staff (doctors and nurses) wear normal clothing to work and then change into a uniform when they enter their sterile work environments. This is to decrease the chance of contaminating other surfaces, causing more infections than necessary.
Where there is a risk of clothing splash by blood and other body substances, it is recommended that our administration staff wear uniforms or sensible clothing as well as the appropriate personal protective equipment.
Healthcare workers who wear uniforms should wear a clean uniform for each shift. If work attire has been contaminated with blood or body substances, it should be changed immediately and laundered appropriately.
Our clinic uses an external managed uniform laundering service who guarantee that uniforms will be laundered to the highest standards.
Any staff who launder their own uniforms need to take care to wash them separately to other clothing. When soiled uniforms are washed with other sterile items, bacteria may survive, and contaminate the other items.
LEVELS OF PRECAUTIONS
Standard precautions
Transmission based precautions
Additional Precautions
SHARPS HANDLING
STEPS FOR MANAGING AN EXPOSURE INCIDENT
Blood or body substance exposure must be assessed and managed immediately to reduce the risk of infection.
Response to an exposure incident includes both care of the exposed person, and actions directed
towards the person whose blood or body substances were involved in the incident (source person), if known.
Recommended steps include:
- immediate decontamination of the exposed area and treatment of any wounds
- immediate reporting of the exposure to the infection prevention and control coordinator or designated responsible person
- immediate assessment of the risk of transmission of infection. The practice may choose to refer the exposed person to an occupational health physician or transfer them to a hospital emergency department for this assessment and counselling.
- prompt treatment if indicated, eg post-exposure prophylaxis against a known or suspected blood-borne virus, tetanus vaccination or immunoglobulin, as required. If the exposed person is referred for assessment, treatment is administered or arranged by the hospital or consulting physician. (Post-exposure prophylaxis is not delayed while waiting for results of testing of the source person but is administered immediately when indicated on the basis of the assessment.)
- confidential counselling for the source person and testing for hepatitis B virus, hepatitis C virus and HIV (or verifying documented carrier status). The practice may choose to refer the source person to an infectious disease physician for counselling and testing.
- documentation of the exposure incident
- testing the exposed person for blood-borne viruses.
Some steps must be done within the practice. These include decontamination, documentation, analysis, risk reduction and staff education.