Infection control

• 30 -50% of infections resulting from exposure in healthcare facilities are preventable, and are primarily caused by problematic patient care practices, such as poor hand washing¹.
  • Recent data from the World Health Organization (WHO) shows that 1 in 10 patients get an infection while receiving healthcare²
  • About 8% of children and 10% of adults in Canadian hospitals have a hospital acquired infection (HAI) at any given time³
• The Public Health Agency of Canada (PHAC) and the WHO recommend that all healthcare facilities put an efficient infection control program into place to prevent the spread of disease^4,5,6.
  • Effective infection prevention and control in healthcare settings reduces infections by at least 30%
  • Full participation in infection control is the responsibility of every health care worker
  • Good infection control practices instil confidence in patients⁷
  • Education (for healthcare professionals, patients and hospital visitors) is an important component of infection control

• Routine practices should be the minimum level of precautions used when providing care for all patients⁸.
• Routine practices are an element of best practice followed by all MRTs, including proper hand hygiene according to the guidelines set out by their facility⁹.
• MRTs’ duty to their patients include compliance with institutional procedures and policies regarding standard and special precautions (contact, droplet or airborne), including the proper use of personal protective equipment¹⁰.

Hand hygiene

• Hand hygiene is a major component of routine practices* and one of the most effective methods to prevent transmission of pathogens associated with healthcare⁸.
• Like all healthcare professionals, MRTs are expected to learn and adhere to hand hygiene techniques⁸.
• Five moments for hand hygiene include¹¹:
  • Before touching a patient
  • Before clean aseptic procedure
  • After body fluid exposure risk
  • After touching a patient
  • After touching patient surroundings
• The two predominant methods of removing microorganisms on the hands are¹²:
  • Alcohol-based hand rub (ABHR) (this is the preferred method unless the hands are visibly soiled)
  • Hand washing with soap and water (best when hands are visibly soiled; the mechanical action of washing, rinsing and drying aids in the removal of microorganisms)
• Barriers to proper hand hygiene include¹²:
  • Long, artificial nails or nails with chipped polish (difficult to clean, and may harbour microorganisms)
  • Rings, hand jewelry, bracelets and wrist watches (hides bacteria and may compromise glove integrity)
• Gloves are not a replacement for hand washing — hands should be washed prior to putting on, and after removing gloves
  • MRTs should be aware of the appropriateness of gloves in clinical situations
    • To reduce the risk of exposure to blood and other body fluids
    • To reduce the risk of germ dissemination and transmission¹³

• Depending on the route of transmission (airborne, contact or droplet) a different set of additional precautions is employed for people with documented or suspected infection¹⁴.

Additional airborne precautions

• Examples of diseases which are transmitted via the airborne route include¹⁴:
  • Measles (rubeola)
  • Varicella (including disseminated herpes zoster)
  • Tuberculosis
• Additional airborne precautions include^4,14,15:
  • Using N95 masks for MRTs, where fit-testing has been completed
  • Using surgical masks for patients, MRTs without N95 fit-testing, and others coming into contact with the infectious agent
  • Instructing patients to observe respiratory hygiene/cough etiquette
  • Limiting the movement and transport of patients
  • Keeping doors to rooms closed
• Airborne pathogens stay suspended in the air for long periods of time – ventilation of the environment may be required¹⁵.

Additional contact precautions

• Examples of diseases which are transmitted via contact include:
  • Methycillin-resistant staphylococcus aureus (MRSA)
  • Vancomycin-resistant enterococcus (VRE)
  • Clostridium difficile (C. difficile)
• Contact transmission may occur directly (infected person to person) or indirectly (contaminated equipment, etc.)¹⁴.
• Additional contact precautions include^4,14,15:
  • Strict hand hygiene for all those who come into contact with the patient
  • Using  personal protective equipment such as gloves and gowns
  • Carefully disposing of gloves and other items that come into contact with the patient
  • Proper cleaning of equipment, according to facility policy

Additional droplet precautions

• Examples of diseases which are transmitted via the droplet route include¹⁴:
  • Influenza virus
  • Neisseria meningitidis
  • Bordetella pertussis (whooping cough)
• Additional droplet precautions include^4,14,15:
  • Using a surgical mask (patient, MRT and others coming into contact with the patient)
  • Using gloves and gowns
  • Instructing patients to observe respiratory hygiene/cough etiquette
  • Using eye protection when within 1-2 meters of patient
  • Limiting the movement and transport of patients

• Good housekeeping in the workplace helps to reduce the prevalence of pathogens and discourage the growth of microorganisms¹⁶.
• Equipment is wiped with disinfectant between patients⁸.
• Fresh linens are used for each new patient and used linens are handled and transported in a way that avoids exposure to other patients or staff⁸.
• Safe waste management techniques are employed⁸.
  • Some waste may be disposed of in the regular garbage
  • Biomedical waste is disposed of according to established guidelines and standards
• Infectious patients are scheduled for the end of the day where possible.
  • This allows a thorough cleaning of the room (while it remains unoccupied over a prolonged period of time), allowing the air filtration system to remove any airborne contaminants
  • Airborne precautions often include a period of time where a room is left empty after an infectious patient followed by thorough cleaning

• An effective infection control program requires good communication with patients and education regarding the importance of institutional practices¹⁷.
  • MRTs explain the importance of hand washing when entering and leaving the facility and hand hygiene awareness information is available to patients
  • Family and visitors are also given instructions regarding hand hygiene and the appropriate use of Personal Protective Equipment as appropriate¹⁴
• Patients who require additional precautions should have the importance of these measures explained to them¹⁸.
• Effective communication between staff is also essential¹².
  • Precaution patients are clearly identified and recorded
  • Additional precautions are communicated at every patient handover