Monday, November 28, 2022

Infection Control For Healthcare Professionals

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Updates Added May 21 2021

CJD Infection Control and Patient Care for Healthcare Professionals

PHAC is updating its interim guidance on infection prevention and control in acute healthcare settings to consider the rollout of COVID-19 vaccines and emerging data on SARS-CoV-2 variants of concern.

PHAC will continue to consider new evidence as it becomes available. The following statements summarize the current knowledge used to inform updates to the guidance:

  • SARS-CoV-2 variants of concern:
  • Viruses naturally mutate or change over time. Mutations do not always result in increased transmissibility or virulence, or lead to suboptimal immune or therapeutic responses compared to non-variant virus
  • Multiple SARS-CoV-2 variants that have emerged in recent months have shown increased transmissibility when compared with non-variant SARS-CoV-2. These have been labeled variants of concern
  • The mechanism for the increased transmissibility of some SARS-CoV-2 variants has not been fully determined, though it may be related to changes in receptor binding or viral load
  • Some VOCs have demonstrated ability or potential to escape immune responses from previous SARS-CoV-2 infection or vaccines the risk of reinfection or superinfection and influence on vaccine effectiveness for all known and future variants is uncertain
  • Vaccination:
  • Multiple vaccines have shown clinical trial efficacy and real-world effectiveness against COVID-19 disease and serious outcomes, and there is growing data on the real-world effectiveness of some vaccines against infection with SARS-CoV-2
  • Vaccination:

    Cover Your Nose And Mouth When Coughing And Sneezing

    When you cough and sneeze, germs and diseases spread through the air. Germs can travel up to one meter or further if you do not cover your mouth and nose when you cough or sneeze.

    You can prevent spreading your germs to other people or onto surfaces around you

    • Keep tissues handy and use a clean one to cover your mouth when you cough and sneeze.
    • Do not reuse tissues. After use, discard it in a trash container immediately.
    • Clean your hands immediately with soap and water or alcohol-based hand sanitizer.
    • If you do not have a clean tissue available, turn away from other people and cough or sneeze into the bend of your arm and not your hand. If you do cough or sneeze into your hand, clean immediately before touching anything.

    What’s Unique To The 2022 Multi

    During the multi-country 2022 outbreak, not all cases are presenting in the typical fashion described above. Some individuals may initially present with exclusively oral, genital or perianal lesions, which may or may not be accompanied by symptoms of proctitis. Systemic symptoms characteristic of the prodromal stage could occur prior to or after the appearance of lesions. Some, but not all, may develop a more generalized rash, which may evolve asynchronously.

    This content will be updated as new evidence becomes available about the clinical manifestations seen in this outbreak.

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    Hand Hygiene & Infection Prevention

    Healthcare-associated infections, which can occur in the blood, surgical sites, lungs or urine, are a major but preventable threat to patient safety. Protecting our patients, visitors and staff is a top priority for UCLA, and our goal is to have zero healthcare-associated infections. To ensure we do our best to prevent infections in patients, staff and visitors, we take several precautions. We invite you to partner with us and participate in these prevention efforts.

    How To Obtain An Exemption

    What is the Role of an Infection Control Nurse?

    Graduates from New York State medical schools and/or residency programs are automatically credited with having completed the initial requirement as part of their coursework. Four years after graduating from a New York medical school and/or residency program, the affected professionals will be required to complete the infection control and barrier precautions course prior to licensure renewal.

    Professionals who have received equivalent training , those who are not actively practicing in New York State , and those who do not provide direct patient care or oversee individuals or programs where others are responsible for providing patient care or reprocessing patient care equipment may apply for exemption from training.

    As of November 3, 2008, all exempted providers will be required to renew their exemption every four years.

    Physicians, physician assistants and specialist assistants should apply to the NYSDOH for exemption.

    The Department is pleased to announce paperless exemption applications for physicians, physician assistants, and specialist assistants interested in applying for exemption from NYS-mandated Infection Control and Barrier Precautions Training. As of 5/13/2019, these professionals can access the on-line application at:

    Dentists, dental hygienists, licensed practical nurses, registered nurses, optometrists, and podiatrists should apply to the State Education Department for exemption. NYSED can be contacted at 518-474-3817 ext. 360 or by e-mail at .

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    Changes In Recent Updates

    The Public Health Agency of Canada develops evidence-informed infection prevention and control guidance to complement provincial and territorial public health efforts in monitoring, preventing, and controlling healthcare-associated infections. Guidance will necessarily shift with the benefit of new scientific findings and their replication, as well as with thoughtful consideration of implications for practice in areas of uncertainty. National-level guidance should always be read in conjunction with relevant provincial, territorial and local policies and regulations.

    Active Screening And Notification

    Prompt identification of all individuals with signs or symptoms of infection should occur via active screening.

    • Signs and symptoms of COVID-19 can vary from person to person. They may also vary according to age group
    • Reported symptoms include but are not limited to:
    • new or worsening cough
    • conjunctivitis
    • feeling very unwell
  • Older and frail adults may experience chest pain, dizziness, loss of appetite, changes in cognition, behavior, or functional status, increased frequency of falls, or delirium
  • All confirmed cases of COVID-19 are to be reported to the relevant jurisdictional public health authorities.

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    Infection Prevention And Control In Long

    Key Messages

    • Break the chain of infection.
    • Detect, diagnose, and treat infections quickly and effectively.
    • Do not rush to use antibiotics.
    • Carefully follow facility policies and procedures to prevent infections.

    Basic Background

    Every LTC facility has policies and procedures to prevent infection and keep residents safe. Infection prevention and control practices help residents avoid getting infections from health care workers, other residents, family members, and visitors. These practices can also help prevent health care workers from getting infections from residents. It’s important that health care workers are familiar with these policies and procedures and follow them closely to reduce the risk of infection. Residents also can play an active role in maintaining their health and preventing infection.

    Practice Tips

    Health care workers can reduce the risk of infection byâ

    • Cleaning hands with an alcohol-based hand rub or soap and water, also known as practicing hand hygiene.
    • Wearing gloves and other personal protective equipment per facility policy.
    • Keeping the environment clean and properly disinfecting surfaces and medical equipment.
    • Handling waste safely.
    • Covering mouths and noses when sneezing or coughing.
    • Not coming to work when sick.
    • Staying up to date on all recommended vaccinations.
    • Practicing standard precautions for all residents.

    Help residents play a role in reducing risk of infection by encouraging them toâ

    Communication Tips

    Masking And Eye Protection For The Full Duration Of Shifts Or Visits

    Webinar: COVID-19 Infection Prevention and Control for Regulated Health Professionals

    Given ongoing community spread of COVID-19 within Canada and evidence that transmission occurs from those who have few or no symptoms, masking for the full duration of shifts or visits for all acute healthcare setting staff and visitors is recommended. The rationale for full-shift or visit masking of all staff and visitors is to reduce the risk of transmitting COVID-19 from staff or visitors to others, at a time when no symptoms of illness are recognized, but the virus can be transmitted. Staff should support visitors to ensure appropriate use of medical masks.

    Use of eye protection for the full duration of HCW shifts is also recommended in all acute healthcare settings, based on local epidemiology. This applies to all staff working within 2 metres of patients.

    HCWs should refer to provincial and territorial guidance and facility policies on specific recommendations for use of medical masks, eye protection and other PPE, as well as PPE conservation strategies. When medical masks for HCWs and visitors are recommended for the full duration of shifts or visits, HCWs and visitors should:

    When an N95 or equivalent respirator is deemed necessary based on the HCW’s PCRA, they should follow facility procedures for taking off a medical mask and eye protection then put on the N95 or equivalent respirator and replace their eye protection, with meticulous hand hygiene performed at all steps.

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    Infection Prevention And Control Practices At A Glance

    Employers must ensure that:

    • Organizational risk assessments are completed to determine potential risks for contamination and transmission of COVID-19 to HCWs, other staff, patients and visitors in the acute healthcare setting
    • A PCRA is conducted by all HCWs prior to any interaction with a patient or visitor
    • Routine Practices, including hand hygiene, are in place for the care of all patients
    • Adequate triage and facility access points are in place
    • Active screening activities are in place ensuring:
    • A limited number of access points designated for active screening of all HCWs and others working in the facility
    • A limited number of entry points for active screening of patients and visitors
    • Controls are in place to limit traffic, and to ensure physical distancing and that medical masks are worn by staff, visitors, and patients on entry to acute care facilities
    • Screeners are protected with transparent barriers that allow for communication between themselves and patients or others who present at screening
    • Where the above controls and transparent barriers are not in place, screeners are provided with appropriate PPE to be selected based on a PCRA
  • All staff and visitors put on a medical mask at entry and while in the healthcare facility to reduce the risk of transmitting COVID-19 infection to other staff, visitors or patients, which may occur even when signs or symptoms of illness are not apparent
  • Processes are in place to manage HCW exposures to COVID-19 and HCW illness
  • Infection Prevention And Control

    Infection Prevention and Control refers to evidence-based practices and procedures that, when applied consistently in health care settings, can prevent or reduce the risk of transmission of microorganisms to health care providers, clients, patients, residents and visitors.

    We provide public health professionals with expertise, support and resources for infection prevention and control. For information and resources related to specific topics or services, see the list below.

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    Summary Of Recent Changes

    Due to concerns about increased transmissibility of the SARS-CoV-2 Omicron variant, this guidance is being updated to enhance protection for healthcare personnel, patients, and visitors and to address concerns about potential impacts on the healthcare system given a surge in SARS-CoV-2 infections. These updates will be refined as additional information becomes available to inform recommended actions.

    • Empiric use of Transmission-Based Precautions is recommended for patients who have had close contact with someone with SARS-CoV-2 infection if they are not up to date with all recommended COVID-19 vaccine doses.
    • In general, quarantine is not needed for asymptomatic patients who are up to date with all recommended COVID-19 vaccine doses or who have recovered from SARS-CoV-2 infection in the prior 90 days potential exceptions are described in the guidance. However, some of these patients should still be tested as described in the testing section of the guidance.
  • A test-based strategy and consultation with infectious disease experts is now recommended for determining the duration of Transmission-Based Precautions for patients with SARS-CoV-2 infection who are moderately to severely immunocompromised.
  • Included additional examples when universal respirator use could be considered
  • Additional updates that will have implications for healthcare facilities were made in the following guidance documents:
  • Healthcare Workers As A Source Of Transmission

    Nurse Hand Washing
    Chapter Editor: Ziad A. Memish, MD, FRCPC, FACP

    KEY ISSUES

    Within the hospital, healthcare workers are often exposed to infections. Any transmissible disease can occur in the hospital setting and may affect HCWs. HCWs are not only at risk of acquiring infections but also of being a source of infection to patients. Therefore, both the patient and the HCW need to be protected from contracting or transmitting hospital-acquired infections by using recommended infection control measures.

    KNOWN FACTS

    Infectious Diseases Transmitted by Healthcare Workers

    A short overview of some of the most important infectious diseases transmitted by HCWs is presented below.

    SUGGESTED PRACTICE

    General PrinciplesIn a recent review, 152 hospital-acquired infection outbreaks with a HCW as a source were identified. These outbreaks were mainly associated with surgery, neonatology, and gynecology departments. The most frequently encountered pathogens were hepatitis B virus, Staphylococcus aureus, and Streptococcus pyogenes.

    In general, the most important infection prevention measure is adequate hand hygiene. Hand disinfection as defined by the WHO guidelines specifies 5 moments of hand hygiene. In short this comprises

  • before touching a patient
  • after body fluid exposure risk
  • after touching a patient
  • Hepatitis AHepatitis A occurs rather infrequently as a hospital acquired infection. Prevention of transmission is through maintaining personal hygiene, especially through hand washing.

    REFERENCES

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    What We Are Doing

    Hand hygiene

    The most important way we prevent healthcare-associated infections is by washing our hands. Healthcare workers and visitors should wash their hands on entering and after leaving the patient room. Hand washing may be done with alcohol hand rub or antibacterial soap and water both are acceptable.

    Handling Patient Care Equipment

    All reusable equipment and supplies, along with toys, electronic games, personal belongings, etc., should be dedicated to the use of the patient who is suspected or confirmed to have COVID-19. If reuse with other patients is necessary, the equipment and supplies should first be cleaned, and disinfected with a hospital-grade disinfectant for the recommended contact time.

    Upon patient transfer or discharge, items that cannot be appropriately cleaned and disinfected should be discarded. Patient-owned items should be taken home by the patient, and unwanted items discarded.

    Single-use disposable equipment should be discarded into a no-touch waste receptacle after use.

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    Patient Flow And Activity

    Patients who are suspected or confirmed to have COVID-19 should be restricted to their room until they have met criteria for discontinuation of Additional Precautions in accordance with facility IPC protocols and provincial or territorial public health guidance. Patient movement or transport should also be restricted to essential diagnostic tests and therapeutic treatments. Transfer within and between facilities while patients are suspected to be infectious should be avoided unless medically necessary.

    If patients must leave their room for medically necessary care or treatment, they should:

    • Be accompanied by an HCW
    • Wear a medical mask, as tolerated
    • Be instructed to perform respiratory and hand hygiene
    • Be provided with clean clothes and bedding before leaving their room
    • Minimize touching or contact of surfaces or items outside of their room

    Any surfaces that may have been touched by the patient while out of their room should be cleaned and disinfected.

    A minimum of Droplet and Contact Precautions should be maintained by HCWs during patient transport, and communicated along with relevant clinical information to the transferring service and receiving unit ahead of transfer.

    How To Use This Guide

    Guidelines for Infection Control for Regulated Health Professionals

    This guide is divided into four sections, some of which have multiple subsections. Each section and subsection is arranged into four categories:

    Key Messages are high-level takeaways for each topic.

    Basic Background provides general information about each topic. It is designed to give simple “what” and “why” know-how.

    Practice Tips are actions to take to reduce the risk of infections in long-term care facilities.

    Communication Tips offer ways to talk with residents, families, coworkers, and others about infection prevention.

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    Ii Standard Precautions: Infection Prevention Basics

    Key Messages

    • Practice standard precautions for the care of all residents all the time.4
    • Observe the standard precautions of not touching blood, body fluids, mucous membranes, cuts, wounds, or rashes with bare handsâand not letting these touch your skin, face, or clothes.
    • Use personal protective equipment when contact is possible with blood, body fluids, mucous membranes, or nonintact skin.
    • Practice hand hygiene.
    • Use safety needles and sharps.
    • Practice respiratory etiquette by covering coughs in sleeves and wearing masks when recovering from coughs or colds.

    Basic Background

    Standard precautions are basic steps that every health care worker should take to prevent the spread of germs. Standard precautions include keeping hands clean, not touching the face, covering coughs in sleeves, and using safety needles and sharps.

    Practice Tips

    • Make sure PPE are available at all times.
    • Keep PPE supplies close to resident care locations.
    • Use only safety engineered needles, including lancets for testing blood sugar and safety needles for insulin pens.
    • Practice the motto “one needle/syringe, one resident, one time.”
    • Always cough into sleeves, and wear a mask when recovering from a cough or cold.

    Communication Tips

    Key Messages

    • Practice hand hygiene when moving among residents and from soiled to clean spaces.
    • Wash hands with soap and water for at least 20 seconds, or use an alcohol-based hand rub or alcohol hand wipe, covering all surfaces of the hands.

    Basic Background

    Practice Tips

    Recommended Infection Prevention And Control Practices When Caring For A Patient With Suspected Or Confirmed Sars

    The IPC recommendations described below also apply to patients with symptoms of COVID-19 and asymptomatic patients who have met the criteria for empiric Transmission-Based Precautions based on close contact with someone with SARS-CoV-2 infection. However, these patients should NOT be cohorted with patients with confirmed SARS-CoV-2 infection unless they are confirmed to have SARS-CoV-2 infection through testing.

    Patients placed in empiric Transmission-Based Precautions based on close contact with someone with SARS-CoV-2 infection should be maintained in Transmission-Based Precautions for the following time periods.

    • Patients can be removed from Transmission-Based Precautions after day 10 following the exposure if they do not develop symptoms. Although the residual risk of infection is low, healthcare providers could consider testing for SARS-CoV-2 within 48 hours before the time of planned discontinuation of Transmission-Based Precautions
    • Patients can be removed from Transmission-Based Precautions after day 7 following the exposure if a viral test is negative for SARS-CoV-2 and they do not develop symptoms. The specimen should be collected and tested within 48 hours before the time of planned discontinuation of Transmission-Based Precautions

    Patient Placement

  • Limit transport and movement of the patient outside of the room to medically essential purposes.
  • Personal Protective Equipment

    Aerosol Generating Procedures

    Visitation

    Duration of Transmission-Based Precautions

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