INFECTIOUS DISEASE IN HEALTHCARE AND THE WORK PLACE; INFECTION CONTROL

Question 1

PRINCIPLES OF INFECTION CONTROL (HOST FACTORS, ENVIRONMENTAL FACTORS, AGENT FACTORS)

Answer 1

HOST FACTORS: DIRECT PROTECTION OF HOST BY IMMUNISATION, PROPHYLACTIC TREATMENT, IMPROVED NUTRITION AND GENERAL HEALTH

ENVIRONMENTAL FACTORS: PREVENT/REDUCE CONTACT BETWEEN AGENT AND HOST BY USING BARRIERS (PPE, CONDOMS, BED NETS) AND REDUCING THE NUMBER OF AGENTS REACHING THE POTENTIAL HOST (HAND WASHING, REDUCED OVERCROWDING, FOOD HYGIENE MEASURES, SEWAGE DISPOSL, WATER TREATMENT, CONTROL OF VECTOR NUMBERS)

AGENT FACTORS: REDUCE THE AMOUNT OF AGENT RELEASED BY TRETING CASES TO REDUCE INFECTIOUS PERIOD, ISOLATING CASES, ELIMINATING/REDUCING ENVIRONMENTAL RESERVOIR

Question 2

WHY ARE WORKPLACES A SITE SUSCEPTIBLE TO PATHOGENIC CONTAMINATION AND TRANSMISSION?

Answer 2

• NUMEROUS PEOPLE IN A CONFINED SPACE
• HIGH INTERACTION
• SHARED RESOURCES AND EQUIPMENT
• SPACE VENTILATION?

Question 3

FOMITES?

Answer 3

FOMITE IS ANY INANIMATE OBJECT THAT CAN CARRY AND SPREAD DISEASE AND INFECTIOUS AGENTS (E.G. TOUCH SCREENS, MONEY, ELEVATOR BUTTONS, HANDLES…)

Question 4

GERBA (2014) PATHOGEN TRANSMISSION IN THE WORKPLACE EXPERIMENT?

Answer 4

• GERBA USED A TRACER VIRUS (A HARMLESS VIRUS THAT IS TRACEABLE) TO STUDY HOW QUICKLY AND EFFECTIVELY FOMITE TRANSMISSION OCCURS IN AN OFFICE
• HE APPLIED VIRUS SAMPLES TO 1-2 COMMONLY TOUCHED SURFACES (DOOR KNOB AND TABLE TOP)
• LATER TOOK SAMPLES OF OTHER SURFACES IN THE OFFICE SPACE
• WITHIN 2-4 HRS, 40-60% OF THE REMAINING SURFACES WERE CONTAMINATED WITH THE VIRUS
• IN THE INTERVENTION PHASE OF THE STUDY, EMPLOYEES WERE PROVIDED WITH DISINFECTANT CONTAINING VIBE AND INSTRUCTED ON PROPER USE ( AT LEAST ONCE DAILY)
• THE NUMBER OF FOMITES ON WHICH VIRUS WAS DETEVTED WAS REDUCED BY 80% OR MORE
• THE CONCENTRATION OF THE VIRUS WAS REDUCED BY 99% OR MORE

Question 5

EXAMPLES OF ADAPTATIONS TO REDUCE TOUCHING SURFACES IN THE WORKPLACE?

Answer 5

• MOST SINKS IN BRITISH HOSPITAL HAVE ELBOW OPERATED TAPS
• ‘NO TOUCH DOOR OPENERS’ ON DOOR HANDLES/KNOBS USED IN SOME WORKPLACES (MANY MADE FROM COPPER THAT HAS ANTI VIRAL PROPERTIES)
• A HAND-FREE 3D PRINTED DOOR OPENER (COMPANY THAT PRODUCED IT MADE IT AVAILABLE FREE OF CHARGE)

Question 6

CHAIN OF INFECTION?

Answer 6

1) INFECTIOUS AGENT (BACTERIUM, VIRUS, FUNGUS, PROTOZOAN, PRION)
2) THE RESERVOIR (HUMANS, ANIMALS, ENVIRONMENT)
3) PORTAL OF EXIT (E.G. RESPIRATORY, ALIMENTARY, GENITOURINARY..)
4) MODE OF TRANSMISION (DIRECT, E.G. DROPLETS/INDIRECT, E.G. VIA INANIMATE OBJECTS, FOOD)
5) PORTAL OF ENTRY (INHALATION, INGESTION, ABSORPTION….)
6) SUSCEPTIBLE HOST (AGE, MALNUTRITION, IMMOBILITY, UNDERLYING ILLNESS, MEDICATION, GENETICS AND OTHER FACTORS..)

Question 7

COMMON CHALLENGES WHEN IT COMES TO BREAKING THE CHAIN OF INFECTION IN HEALTHCARE ENVIRONMENTS?

Answer 7

• HIGH USE OF ANTIMICROBIAL AGENTS
• COMPARATIVELY HIGH PREVALENCE OF ANTIMICROBIAL RESISTANT ORGANISMS
• HIGH USE OF INVASIVE DEVICES/PROCEDURES
• PATIENTS WHO ARE FREQUENTLY IMMOBILE
• PATIENTS WHO ARE UNDERNOURSIHED

Question 8

KEY AREAS FOR PREVENTION OF HEALTHCARE-ASSOCIATED INFECTIONS (HAIs)?

Answer 8

1) HAND HYGIENE
2) PERSONAL PROTECTIVE EQUIPMENT (PPE)
3) ENVIRONMENTAL CONTROL

Question 9

HOW LONG SHOULD HAND WASHING TAKE?

Answer 9

20 SECONDS

Question 10

IN ABSENCE OF HAND WASHING OPPORTUNITY, ALCOHOL GELS CAN BE USED, EXCEPT IF?

Answer 10

THE HANDS ARE VISIBLY DIRTY

Question 11

HAND WASHING INSTRUCTIONS?

Answer 11

• WASH SYSTEMATICALLY
• ALL PARTS OF HANDS AND WRISTS SHOULD BE RUBBED WITH SOAP AND WATER
• INCLUDES AREAS THAT ARE FREQUENTLY MISSED (NAILS AND THUMBS!!!!!!!!!!)

Question 12

5 MOMENTS FOR HAND HYGIENE IN A HEALTHCARE SETTING?

Answer 12

1) BEFORE TOUCHING A PATIENT
2) BEFORE A PROCEDURE
3) AFTER A PROCEDURE OR BODY FLUID EXPOSURE RISK
4) AFTER TOUCHING A PATIENT
5) AFTER TOUCHING A PATIENT’S SURROUNDINGS

Question 13

COUGH ETIQUETTE?

Answer 13

• WHEN COUGHING/SNEEZING USE A TISSUE OR YOUR SLEEVE
• BIN YOUR TISSUE AFTER USE
• WASH YOUR HANDS

Question 14

PPE DEFINITION?

Answer 14

ALL EQUIPMENT THAT IS INTENDED TO BE WORN OR HELD BY A PERSON AT WORK AND WHICH PROTECTS THEM AGAINST ONE OR MORE RISKS TO HEALTH AND SAFETY

Question 15

CONTAMINATION RISKS PPE SAFEGUARDS HEALTHCARE WORKERS AGAINST?

Answer 15

• AEROSOLS (PARTICLES IN AIR THAT CAN TRAVEL LONG OR SHORT DISTANCE DEPENDIG ON SPEED WITH WHICH THEY ARE GENERATED), I.E. COUGH OR SNEEZE
• DROPLETS (LARGER THAN AEROSOLS; CAN REMAIN SUSPENDED IN AIR FOR SEVERAL MINUTES BUT ARE NOT INFECTIOUS OVER LONG DISTANCE)
• SPLASHES AND SPRAYS (CAUSED BY BLOOD AND BODY FLUIDS BEING EXPELLED VIOLENTLY, MAY BE GENERATED DURING SURGICAL PROCEDURES)

Question 16

EXAMPLES OF TYPES OF PPE USED IN A HEALTHCARE SETTING?

Answer 16

• APRONS AND GOWNS (PROTECT THE UNIFORM/CLOTHING, THE LEVEL OF COVERAGE DEPENDS ON THE SEVERITY OF INFECTION RISK
• GLOVES (DO NOT NEGATE THE NEED FOR HAND HYGIENE, DO NOT ELIMINATE ALL RISK AS INTEGRITY CANNOT BE GUARANTEED, COULD BE TORN BY E.G. JEWELLERY)
• FACE PROTECTION (FULL FACE VISORS OR SHIELDS: PROTECT FROM SPLASHES AND SPRAYS, SURGICAL FACE MASKS: PROTECT FROM DROPLETS AND SPLASHES, RESPIRATOR FILTERING FACE PIECE (FFP) MASKS; PROTECT FROM AEROSOLS!!!!!!!!!!!!!!!!!!!!!, COME IN 3 DIFFERENT LEVELS OF FILTERING CAPABILITY

Question 17

WHY SHOULD PPE BE DONNED (PUT ON) AND DOFFED (REMOVED) IN THE CORRECT/SPECIFIC ORDER?

Answer 17

• TO MINIMISE THE RISK OF CROSS-INFECTION ACROSS PATIENTS

- TO MINIMISE THE RISK OF/ PREVENT INADVERTENT SELF-CONTAMINATION OF THE HEALTHCARE WORKER

Question 18

DECONTAMINATION DEFINITION?

Answer 18

A COMBINATION OF PROCESSES THAT REMOVE OR DESTROY CONTAMINATION SO INFECTIOUS AGENTS CANNOT REACH A SUSCEPTIBLE SITE IN SUFFICIENT QUANTITIES TO INITIATE INFECTION

Question 19

LEVELS OF DECONTAMINATION?

Answer 19

1) CLEANING (PHYSICAL REMOVAL OF SOIL, DIRT, DUST… USING A SOLVENT) —> WILL NOT COMPLETELY ELIMINTE MICROORGANISMS
2) ENHANCED CLEANING (AS ABOVE BUT WITH INCREASED FREQUENCY AND USE OF ADDITIONAL CLEANING EQUIPMENT, USUALLY IN RESPONSE TO INFECTION AND CONTROL REQUIREMENTS
3) DISINFECTION (FOR BLOOD AND BODY FLUID SPILLAGES, BU NOT ALWAZS PRACTICAL AT IT IS TIME CONSUMING, LESS EFFECTIVE THAN STERILISATION)
4) STERILISATION (A PROCESS USED TO RENDER AN OBJECT FREE FROM VIABLE INFECTIOUS AGENTS)

Question 20

ISOLATION OF PATIENTS AS A MEASURE OF INFECTION CONTROL?

Answer 20

• ISOLATION OF ‘COLONISED’ OR INFECTED PATIENTS IN A SINGLE ROOM IS GENERALLY CONSIDERED TO BE BEST PRACTICE IN PREVENTING AND CONTROLLING THE SPRED OF INFECTION TO OTHER PATIENTS AND HEALTHCARE STAFF
• CAN HAVE ADVERSE PSYCHOLOGICAL EFFECTS ON PATIENTS
• BEFORE ISOLATION, THERE ARE RISK ASSESSMENT CONSIDERATIONS (DEPENDS ON THE NATURE OF THE COLONISATION/INFECTION, AS DIFF INFECTIONS POSE DIFF RISK TO PH
• NEGATIVE PRESSURE ISOLATION MIGHT BE USE

Question 21

SOURCE (STANDARD) VS PROTECTIVE ISOLATION?

Answer 21

SOURCE: ISOLATION IN A SINGLE SIDE ROOM, PREFERABLY WITH EN-SUITE FACILITIES
PROTECTIVE: PATIENTS WHO ARE SEVERELY IMMUNOCOMPROMISED THROUGH ILLNESS ARE PARTICULARLY SUSCEPTIBLE TO INFECTION AND MAY REQUIRE SPECIALIST, PROTECTIVE ISOLATION

Question 22

NEGATIVE PRESSURE ISOLATION?

Answer 22

• AIR CURRENTS CAN TRANSPORT BACTERIA AND VIRUSES WIHIN BUILDINGS AND ROOMS, INCREASING THE RISK OF INFECTION TO OTHER PATIENTS AND STAFF
• IN STANDARD (SOURCE) ISOLATION ROOMS, THE AIR CHANGES WITHIN THE ROOM BY PASSING UNDER THE DOOR OR WHENEVER A DOOR OR WINDOW IS OPENED, MIXING WITH THE AIR IN CORRIDORS
• IMPORTANT TO PREVET CONTAMINATED AI FROM MIXING WITH ‘CLEAN’ AIR
• ACHIEVED BY A VENTILATION SYSTEM WHICH EXPELS THE AIR FROM THE ROOM AND AWAY FROM OTHER AREAS, VENTING IT TO THE OUTSIDE SO IT IS NOT SUCKED BACK INTO THE BUILDING —> HAVING A NEGATIVE PRESSURE ISOLATION ROOM

Question 23

COHORT NURSING?

Answer 23

COHORT NURSING IS UNDERTAKEN IN SITUATIONS WHERE THERE ARE NOT ENOUGH SINGLE ROOMS TO ISOLATE PATIENTS
- PATIENTS ARE EITHER COHORTED WITH THE SAME ORGANISM (E.G. MRSA) OR IF THEY HAVE THE SAME SYMPTOMS

Question 24

WHAT SHOULD HEALTHCARE WORKERS DO IF THEY’RE FEELING UNWELL?

Answer 24

• HEALTHCARE WORKERS NEED TO MONITOR THEIR ‘FITNESS TO WORK’
• THEY MUST REPORT EPISODES OF ILLNESS AND INFECTION TO THEIR LINE MANAGER (AND CONTINUE TO KEEP THE LINE MANAGER FULLY UPDATED)
• CAN ONLY RETURN TO WORK WHEN FIT TO DO SO
• MUST TAKE PRECAUTIONS NOT TO TRANSMIT INFECTIONS TO OTHERS