Infection prevention and control in paediatric office settings Flashcards
3 principles to prevent transmission
- assume all bodily fluids contain pathogens
- screen for sx
- source containment
Give the precaution type and duration: MRSA
contact; if pts assessed at risk to transmit
Give the precaution type and duration: bird flu
droplet + contact; 14 days from onset
Give the precaution type and duration: enterovirual infection (supsected or diagnosed)…including HAND FOOT MOUTH
contact; for duration of illness
Give the precaution type and duration: gasteroenteritis
contact; for duration or symptoms or until infectious cause ruled out
Give the precaution type and duration: Hep A or E (diagnosed or suspected)
contact until viral infection ruled out OR if hep A diagnosed: 7days after onset of hepatitis
Give the precaution type and duration: measles (diagnosed
airbrone; 4 days after onset of rash…if immunocompromised for whole duration of illness
Give the precaution type and duration:
measles CONTACT who is non-immune and in the incubation period
airbone; 5 days after first day of exposure- 21 days after last day of exposure
Give the precaution type and duration: meningitis (bact, vir) suspected or diagnosed
DROPLET until 24 hours after receiving antibx
CONTACT for whole illness
Give the precaution type and duration: mumps
droplet; 9 days after onset of swelling
Give the precaution type and duration: mumps contact who’s nonimmune and in incubation period
droplet: from 10 days after first day of exposure–> 26 days after last day of expsoure
Give the precaution type and duration: pertussis (dx or supsected)
droplet until 5 days of appropraite antibx received or pertussis ruled out
Give the precaution type and duration: petechial or ecchymotic rash with fever (suspected meningococcemia)
droplet until 24 h of antibx received or meningococcus ruled out
Give the precaution type and duration: contact who is nonimmune and in incubation period
droplet; From 7 days after the first day of exposure to 21 days after last day of exposure
Give the precaution type and duration: SARS MERS-CoV
droplet + contact + N95
To 10 days after resolution of fever
Give the precaution type and duration: scabies
Contact Until initial therapy applied
Give the precaution type and duration: skin infection with extensive lesions/abscess/drainage not covered or contained
contact; for duration of drainage or until exudative lesions are healed
Give the precaution type and duration:GAS impetigo lesions not covered
contact; until 24 h of appropraite therpay
Give the precaution type and duration:invasive GAS (pharyngitis, pneymonia, scarlet fever)
droplet until 24 hours antibx
Give the precaution type and duration: TB (dx or suspected)
airbone until assessed as non infectoius
Give the precaution type and duration: varicella
airbone plus contact until lesoisn crusted and dried or varicella is ruled out
Give the precaution type and duration:varicella contact who is nonimmune and incubation pateint
airbone; from 8 days until fisrt day of expos–> 21 days after last day of exposure….to 28 days if given VZIG
Give the precaution type and duration:viral resp tract infection
drop + contact for duartion or illness or until viral inection ruled out
Give the precaution type and duration: zoster not covered
airbone plus contact until lesiosn crusted adn dried or zoster ruled out
contact precautions: how?
gloves, gowns, distinfection of surfaces…most common
give 3 egs of dx’s needed droplet precuations (surgical mask)
H flu
N meningitidis
B pertussis
Give 3 egs of dx’s needing droplet + contact precautions
TSV influenza parainfluenza rhinovirus adenovirus SARS coronarvirus
3 egs of dx’s requiring airborne precuations
varicella, measles, TB, smallpox
which dx’s can go from contact-> airbone precautions with bronchoscopy, intubation
SARS coronavirus
MERS
avian flu
viral hemorrahgic fever
medical equipment: explain cirtical vs semicritical vs nonccritial
crtiical : must be sterile because –> sterile body space (eg: needle); semicritical: requires high level infection to remove everything except bacterial sports (touches mucous membranes or nonintact skin or thorugh whihc isnpired air flows, eg: laryngoscope; noncritical: low-level disinfection b/c only in contact with intact skin (eg stethoscope)
ways to sterilize equipment?
Steam, dry heat, chemical sterilants
ways for high-level disinfection?
Pasteurization, 2% glutaraldehyde, 0.55% ortho-phthalaldehyde, 6% to 7.5% hydrogen peroxide with or without peracetic acid*
ways to intermediate-level disinfect?
70% to 90% ethyl or isopropyl alcohol (immersion >5 min), sodium hypochlorite 5.25% diluted 1:50 to 1:500 (immersion >10 min), 3% hydrogen peroxide, 0.5% accelerated hydrogen peroxide, quaternary ammonium products, iodine, iodophors, phenolics, disinfectant wipes *,†
clean surfaces, knobs in office how?
detergent + water or disninfectant wipes
what if stethoscope has blood on it?
use sodium hypochlorite diluted 1:10 to 1:100 or 70% to 90% alcohol.
need to know what about phenolics?
should not be used for items that will be in direct contact with the skin of newborns.
give 2 suggested admin policies
develop infection control policy and review every 2 years; ongoing education for personel; establish system fo communcation with public health
3 things to incoproate in office design
avoid carpeting; ensure sinks + soap and waterless hand hygiene products avaialbe in all pt areas; signs with resp etiquette; ventilation at least 6 air changes per hour
how can you triage pts?
- put immunocompromised pts in exam room right away
- parents should tell receptionist right away if suspect child contangious
- segregate symptomatic infectoius children ASAP
- if travel alert for resp infectoius, ask about rravel ouside canada in past 21 days before sx (ask the same thing for household ocntacts)
options for toys in waiting rooms:
- don’t keep toys unless they can be appropiattely cleaned
- ask parents to bring toys from home
- provided only toys with smooth solid surfaces
- ask parents to supervise kids and place used toys in designated bin for cleaning
- provide books taht kids can take home or dispose of after use
give 4x when personell should clean hands
- immed before/after pt contact
- before moving to a clean body site from a contaminated body site during care of same pt
- after contact with blood, body fluids
- after directly touching a live vaccine
- after touching a surface likely to be contaminated
- before invasive procedures
- after removing gloves
alchohol based hand risnses should contain what % isopropyl or ehtyl alcohol
60-90% isopropyl or ethyl alchohol
are gloves needed for giving vaccines?
no
3 times when gloves are needed
If anticipating direct hand contact with blood, body fluids, secretions or excretions, or with items contaminated by any of these substances.
For direct hand contact with mucous membranes or nonintact skin.
For direct hand contact with a patient when the health care provider has an open lesion on the hand.
how should spills be cleaned?
promptly and cleaned with detergent followed by bleach (a 1:10 to 1:100 dilution of household bleach, using the higher concentration for larger spills
clean stethoscopes, otoscope handles how?
alcohol, disinfectant wipes, or soap and water
pulse oximetry, base of thermoeter should be cleaned how often?
daily and when soiled
computer mice and keyboards should be cleaned how often?
daily; consider these contaminated
if examining table soiled with body fluids clean how?
1:100 bleach solution
clean exam tables, tx chairs, sinks, door knobs how often?
daily
washrooms could be cleaned how often?
daily
clean surfaces taht are not usually an infection risk (eg: floors) how often?
weekly; but cupboards, walls, windows, air vents can be cleaned yearly
disinfect toys how?
1:100 bleach + soap and water + air dry…or dishwasher
toys should be cleaned how often?
between pts= ideal; otherwise, at end of the end
preferred agent to clean skin for venipuncture and vaccines?
70% alcohol
clean skin how for inserting IV catheter or doing invasive procedure or taking blood cultures?
2% chlorhexidine, chlorhexidine in 70% alcohol, 10% povidone-iodine or an alcoholic tincture of iodine should be used. Povidone-iodine should be left to dry for 2 minutes [2
antiseptics should ideally be SINGLE use. if multi-use, do what?
label them with the date and discard after 28 days of use
do what for pts with suspected measles, varicella, disseminated zoster or contagious TB?
- place directly in exam room
- use a negative pressure room
- keep exam room door closed
for suspected measles or varicella (airborne precautions, NOT TB!), personnel should do what?
- no mask needed if immune
- if not immune, do not enter room
after airborne-dx patient leaves room, do what?
- leave room for 70 min for air ventilation if 6 air changes/hour
- or, if air exchange rate not known, only use room for immune pts for remainder of the day
do what for droplet precuations (meningitis, pertussis, rubella, mumps, meningococcal infection)
- place in room immediately or separate from other pts from 1-2 m
- have pt wear surgical mask when outside of the room (same for any resp infection); if infant, cover their nose with mouth and tissue
for droplet transmission, when is eye protection needed?
should be considered for care of patients with respiratory tract infections (RTIs) who are coughing at the time of the interaction or if a procedure is performed that may result in coughing [1][5][6]. When eye protection is not available, wear gloves and keep hands away from the eyes during patient care.
who needs contact precautions? (4)
Infectious diarrhea.
Extensive, skin lesions which are not covered (e.g., varicella, zoster), or wound drainage not contained by dressings.
Selected patients colonized with antibiotic-resistant organisms (AROs), such as MRSA and VRE (see below).
Children with a documented or suspected viral RTI who cannot control their respiratory secretions adequately.
how to manage antibiotic resistant organism?
-usually hand hygiene enough; consider contact precautions (case by case)
do what for pts with suspected ebola?
- contact public health
- if low risk (early stage or healing): droplet + eye + contact precuations
- if advanced disease (bleeding, vomiting, incontiennce): more extensive protective apparel to cover ALL exposed skin. use airborne precautions for aerosol-generating procedures.
5 things HCPs should be immune to
measles, mumps, rubella, varicella, hep B, polio
what should HCP do if have cold
- go to work
- no contact with high-risk pts
- wear surgical mask
- wash hands after contact with resp tract secretions and before every contact with pt/pt care equipment
personnel with blood-borne viral infections should do what
not perform procedures with high risk of transmission of blood
infections where not allowed to come to work
influenza, measles, mumps, pertussis, TB(active), varicella
infections where restrictions in place until symptoms resolves/ lesiosn healed/crusted?
colds, gastroenttisi (or deemed not contagoius), HSV. herpetic whitlow, influena,MSSA (unless lesions covered), MRSA (and assessed for risk fo trnasmission), varicella,
infections where can’t work with pts
conjunctivitis, gastro, hep A, herpetic whitlow, pediculosis, scabies, MSSA if lesions on hands/can’t be covered, MRSA, GAS, zoster if not covered
infections where HCPS are exclused from working with high risk pts only
colds, HSV (if lesions not covered, includes babies adn nonimmune peopel), Zoster (even if lesions covered– for babies, preg women, and nonimmune immunocomp pts)
when can people with conjunctivitis work with pts again?
when exudates resolves
when can ppl with hep A work with pts again?
1 week after onset of jaundice
when can people iwth measles return to office?
4 days after onset of rash
when can people iwth mumps return to office?
9 days after onset of parotitis
when can people with pediculosis work with pts again?
when one treatment completed (<24h)
when can people with pertussis return to work?
after antibx x 5 days
when can ppl with rubella return to work?
7 days after onset of rash
when can people with scabies return to pt care?
after one tx completed <24 h
when can people with GAS return to pt care?
once treated for 24 h
when can people dx’ed with active tb return to office?
when assessed as non-infectious
who is considered a high risk pt?
hemodynamically significant congenital heart disease or chronic lung disease, neonates and immunocompromised patients.
