Clinical Matters - Infection Control Awareness
We shall cover:
Methods of spreading infections
Points of entry for infection
Why older people are susceptible to infection
Ways to control infection
Universal infection control procedures
To enable Care Workers to:
- Understand what infection is and how it spreads.
- Understand the Universal Infection Control Procedures.
- Understand the management of Infectious Diseases.
What is infection?
Infection is caused by pathogens ('bugs') such as bacteria, viruses, or fungi getting into or onto the body. It can take some time before the microbes multiply enough to trigger symptoms of illness, which means an infected person may unwittingly be spreading the disease during this incubation period. Infection control in the workplace aims to prevent pathogens from coming into contact with a person in the first place. Employers are obliged under the Occupational Health and Safety Act (2004) to provide a safe workplace for their employees, including the provision of adequate infection control procedures and the right equipment and training.
Community living, such as Care Homes, provide an ideal breeding ground for infective organisms because large numbers of people live in close proximity to each other, sharing living and eating accommodation in a warmly heated environment.
What is infestation?
This is invasion of the body by parasites, e.g. scabies, or by fungi, e.g. ringworm.
Infestation can also lead to infection from the parasite or through an open wound or sore.
These are living cells, which are found everywhere. Not all of them are harmful. Pathogenic bacteria form toxins or poisons in the body and can cause food poisoning outbreaks. Staphylococcus Aureus is the most common bacteria and is found on skin, hair and in nostrils.
Bacteria require 4 elements to multiply:
These are smaller than bacteria and can only grow in living cells. They are responsible for causing influenza, measles, poliomyelitis, foot and mouth disease covid 19 and many other illnesses.
Methods of spread
Physical – Direct and Indirect Contact
Skin-to-skin contact - the transfer of some pathogens can occur through touch, or by sharing personal items, clothing or objects.
The single most important aspect of controlling infection is by frequent thorough hand washing.
b. Wounds and Moist Skin Conditions
These provide an ideal site for bacteria to multiply – food, warmth, moisture, and often time.
c. Failure to Wear Clean Gloves between each Procedure
Bacteria picked up from one procedure can either be transferred to another part of the body or to another client.
d. Body Fluids
Pathogens in saliva, urine, faeces or blood can be passed to another person's body via cuts or abrasions, or through the mucus membranes of the mouth and eyes. Failure to dispose of clinical waste correctly, Incorrect laundering of soiled linen.
e. Contaminated Items
The pathogens in a person's faeces may be spread to food or other objects, if their hands are dirty.
Incorrect cleaning and disinfection of surfaces and commonly used shared equipment can cause spread of infection. Any items used by an infected client.
Airborne - coughs or sneezes release airborne pathogens, which are then inhaled by others.
Over food or in the vicinity of susceptible people.
From an infected person.
d. Toilet Flushing
Splash back from toilet used by an infected person.
Can contain skin cells, bacteria and spores/
Through poor food hygiene practices.
Through poor hand washing practices.
a. Sharps Injury
Accidental injury or due to poor sharps disposal practices.
Insects or pets.
Self-infliction, e.g. poor sharps disposal practices.
Failure to cleanse the skin area correctly prior to an injection in immuno-compromised clients.
1. Respiratory – acquired by inhalation of droplets from sneezing and coughing. Larger droplets can settle as dust and remain active for several weeks or even months. Responsible for:
- Open pulmonary tuberculosis.
- Chicken pox, shingles, measles, mumps and rubella.
- Influenza and some other viral infections.
Infection Control Measures
Strict hand washing procedures before and after contact/treatment.
Staff personal immunity if open TB, chicken pox, shingles, measles, mumps and rubella.
Use of disposable plastic apron, which is removed immediately following contact with the client and disposed of in Clinical Waste bag.
Use of disposable gloves when handling secretions.
All laundry should be treated as infected.
2. Gastro-intestinal – acquired through ingestion and spread by contact with body fluids. Responsible for:
- All diarrhoeal illnesses such as viral gastro-enteritis and salmonella.
- Hepatitis A.
- Hepatitis B.
- Human Immunodeficiency Virus (HIV)
- Other blood borne viruses.
Infection Control Measures
Safe handling and disposal of waste and body fluids.
Wearing of disposable gloves and aprons at all times. Removal and disposal immediately after contact with client.
Careful hand washing before and after using gloves.
Client should have single room with toilet.
All laundry should be treated as infected.
3. Direct Contact – acquired through skin/mucous membrane contact.
4. Percutaneous – acquired through the skin, i.e. needle stick injuries.
5. Vertically – infection passed from mother to child either while in the womb or during the birth process.
Points of Entry into the Body
1) Natural Orifices
e.g. mouth, nose, vagina, urethra, ear, rectum.
2) Artificial Orifices
i.e. tracheotomies, ileostomies, colostomies.
3) Mucous Membranes
These form a lining of most natural and artificial orifices.
4) Skin Breaks
Accidental or surgical incision.
Why are older people so susceptible to infection?
The immune system becomes less efficient as age increase, especially in those over the age of 80.
- There may be chronic medical conditions, like heart disease, lung disease, diabetes.
- There may be a change in mental ability.
- Diminishing of physical fitness.
- Lack of mobility and physical frailty.
- Long-term smoking.
- Long-term intrusive devices such as urinary catheter.
Ways to control infection
Personal hygiene practices
Infection control procedures relating to good personal hygiene include:
- Hand washing - the spread of many pathogens can be prevented with regular hand washing. You should thoroughly wash your hands with water and soap for at least 15 seconds after visiting the toilet, before preparing food, and after touching clients or equipment. Dry your hands with disposable paper towels.
- Unbroken skin - intact and healthy skin is a major barrier to pathogens. Any cuts or abrasions should be covered with a waterproof dressing.
- Gloves - wear gloves if you are handling body fluids or equipment containing body fluids, if you are touching someone else's broken skin or mucus membrane or performing any other invasive procedure. Wash your hands between each client and use fresh gloves for each client where necessary.
- Personal items - don't share towels, clothing, razors, toothbrushes, shavers or other personal items.
Cleanliness in the workplace
Infection control procedures relating to cleanliness in the workplace include:
- Regularly wash the floors, bathrooms and surfaces - such as tables and bench tops - with hot water and detergent.
- Wash - walls and ceilings periodically.
- Mops, brushes and cloths should be thoroughly washed and dried after every use. Drying mops and cloths is particularly important, since many pathogens rely on moisture to thrive.
- Use disinfectants to clean up blood and other spills of bodily fluids.
- When using disinfectants - always wear gloves, clean the surfaces before using the disinfectant, and always follow the manufacturer's instructions exactly.
- Spot clean when necessary.
Dealing with spills of body fluids
Examples of body fluids include blood, saliva, urine and faeces. When dealing with spills of body fluids, infection control procedures should be followed carefully. You should always:
- Isolate the area.
- Wear gloves, a plastic apron and eye protection, such as goggles.
- Soak up the fluid with disposable paper towels, or cover the spill with a granular chlorine releasing agent for a minimum of 10 minutes. Scoop up granules and waste using a piece of cardboard (or similar), place in a plastic bag and dispose of appropriately.
- Mix one part bleach to10 parts water and apply to the area for 10 minutes.
- Wash with hot water and detergent.
- Dry the area.
- Dispose of paper towelling and gloves appropriately.
- Wash your hands.
- Rinse any contaminated clothing in cold running water, soak in bleach solution for half an hour, then wash separately from other clothing or linen with hot water and detergent.
To dispose of infectious waste that has been contaminated with blood or other body fluids, you should:
- Wear gloves
- Place waste in plastic bags marked 'infectious waste'
- Dispose of waste in accordance with EPA regulations.
- In the handling of Clinical waste personal protective clothing PPE should always be worn.
- Foot operated bag holders should be provided inappropriate areas.
- Only Yellow bags should be used for clinical waste and should be kept separate from general waste in black bags.
- When the bag is three quarters full it should be securely tied and labelled. Overfilling will lead to spillage/splitting of the bag and inevitably contamination.
- A specific area must be designated for the storage of secured bags, and collection for disposal only made by licensed contractor for incineration.
- All areas where yellow bags are used should be thoroughly cleaned at least weekly using appropriate disinfectants. Any spillages should be dealt with immediately.
- All sharps, needles, syringes, broken glass ad ampoules should be disposed of in a sharps box not a yellow bag.
Universal Infection Control Procedures
It is not always possible to detect when clients are infectious. These precautions must be taken every day for each client you come into contact with.
1. Hand Hygiene
Why is hand hygiene so important?
Hand hygiene removes or reduces the number of any germs picked up by the hands and also reduces the numbers that normally live on the skin. The purpose of hand hygiene is to afford protection to you and to prevent transfer of germs to other people. Good hand hygiene (including the technique employed) is more important than the type of cleanser used.
When should hands be washed?
Before and after each shift or break.
Before and after contact with each client.
After contact with all body fluids (e.g. urine and faeces).
After handling clinical waste (soiled dressings, clothes, linen, washing equipment, emptying the bin, etc.).
Before and after dealing with urinary catheter bags.
Before handling food.
Before eating and drinking.
After using or cleaning the toilet.
After removing protective clothing (gloves and aprons).
After blowing or wiping your nose.
Before preparing and giving medications.
After contact with animals.
When hands look or feel dirty.
After touching hair or face.
After handling money.
Dry, chapped skin, cuts and abrasions all harbour bacteria.
Regular use of hand creams in tubes (not tubs) will help to prevent hands from becoming chapped and sore.
All cuts and abrasions should be covered with a waterproof dressing.
WEARING OF DISOSABLE GLOVES DOES NOT ELIMINATE THE NEED FOR EFFECTIVE HAND HYGIENE.
NEVER WASH AND RE-USE DISPOSABLE GLOVES.
2. Personal protective clothing (PPE)
Contaminated clothing can spread infection. Disposable plastic aprons, if used correctly, can prevent the spread of infection and protect the wearer.
Disposable aprons should be used for all activities that may result in contamination of clothing by blood, fluids or excreta. The apron must be discarded, and hands washed between dealing with different clients and before any other activity.
Gloves are required when dealing with infected materials, clinical waste, wounds, or blood and body fluids. They should also be used when using any caustic cleaning agent.
All gloves should be single use, well fitting and waterproof.
Hands should be washed before putting on gloves, following the advised procedure. Before removing, wash gloves in soap and water, remove carefully to avoid puncturing and discard into yellow clinical waste bag.
If a disposable apron has been used, remove this and dispose into yellow bag before washing and removing gloves.
How should you wash your hands?
Remove excessive jewellery (e.g. rings with stones) and wrist watch to allow for effective hand washing.
Keep fingernails short and clean and avoid using nail varnish.
Use warm running water.
Always wet hands before applying cleanser.
Work elbow/wrist operated taps appropriately – DO NOT USE HANDS. If using hand operated taps use a clean paper towel to turn tap off to avoid contaminating hands.
Apply sufficient cleanser to produce a good lather. Pay particular attention to fingertips, areas between fingers and thumbs.
Rub cleanser evenly over all areas of hands.
Rinse off every trace of lather under running water.
Dry hands and wrists with a clean paper towel. This helps to prevent dry, chapped skin, which can harbour bacteria, and damp hands, which encourage bacteria to grow.
NB Avoid hand re-contamination from bin when disposing of paper towel. (Use pedal or open top bins and not ‘flip-top’.
What should you wash your hands with?
Use liquid soap from wall-mounted dispenser for routine staff hand washing. Residents’ own bar soap can become contaminated with skin bacteria and gram-negative bacilli, so must never be used by staff.
Palm to palm.
Right palm over back of left hand and vice versa.
Interlace fingers of right hand over left and vice versa.
Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa.
Rotational rubbing of right thumb clasped in left palm and vice versa.
Grasp left wrist with right hand and work cleanser into skin, then vice versa.
Rub hands and wrists for 30 seconds, then rinse and dry thoroughly.
People are more vulnerable to infection at certain stages of their life, for example, when very young, when the immune system is not fully developed and when elderly, when the immune system is declining. It is vital, therefore, that good standards of hygiene are maintained when caring for these resident groups.
Washing and bathing
Is avoiding sharing items for washing and bathing important?
Yes. Residents should have their own soap, razors and toiletries, which should never be shared.
Face cloths and towels must never be shared between launderings. Labelling personalised face cloths and towels is good practice but not necessary if laundry temperatures are adequate to disinfect after each use. Paper towels, preferably of the individual sheet type, in dispensers, should be provided for hand drying in all communal areas such as toilets. If bathmats are required they should be disposable or a dry towel may be used instead.
Is hand hygiene for clients important?
Staff must be aware of the importance of hand washing and drying for residents in care environments. Some clients will require staff to undertake or assist them in this procedure.
What do I need to know about bathing a resident?
A daily bath, shower, or full body wash is the best way to prevent an accumulation of dirt and bacteria on the skin. Good hygiene is particularly important for those who are incontinent. When a resident is incontinent the skin should be cleaned without delay. The resident should be dried gently and carefully to prevent fungal disease particularly under the breasts. Any persistently red or problematic areas should be brought to the attention of the GP.
N.B. Antiseptics or salt should not be added to bath water, as they have no beneficial properties. Baths should be cleaned thoroughly, with neutral general-purpose detergent after each resident use.