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Infection Prevention & Control Standard IPC precautions refresher Amanda Jackson September 2023 AIM To provide information relating to Standard Infection Control Precautions Objectives By the end of the session you should be able to: • State the chain of infection • Highlight the 10 standard infection control precautions • Indicate the importance of hand hygiene, personal protective equipment, waste management and zoningLearning content: This session is intended to create an understanding of the need to apply infection prevention and control measures to reduce potential risk factors to both patients and the dental team. GDC Development Outcome: CWhat is out there? COVID 19 HIV MRSA Hep c Nora Virus Flu To survive a microorganism needs: Time Heat food moisture Group discussion: What micro organisms concern us & why? What does Infection prevention & control mean to us? What can survive outside the body? Longest: • COVID-19 • MRSA: over 6mths • HIV • Nora virus: weeks HS/12dys fabric • HBV • HCV: 3 weeks • HCV • COVID-19 72 hour(3 days on steel, plastic) • FLU • HBV: approx 7 days • Herpes • Flu: 24 hours • Nora virus • HIV: few hours • MRSA • Herpes: few hours Infection Invasion of the body by microbes Main Concern in dental practice: • Direct: Contact from Patients blood/saliva • Indirect: Instruments & equipment • Airborne droplets: Water spray/aerosol/Flying particles (AGP: aerosol generating procedures)Chain of infection Susceptible Infectious host agent Portal of Reservoir entry Mode of Portal of transmission exit Break the chain Dental Professional Noro virus Mouth Gastrointestinal Via hands / Tract eating Hands Vomit or poo Wash hands Infection Prevention & Control How do we break the chain of infection and prevent or control infection from spreading? • Adhere to legislation, local guidance, policy & procedures: HTM 01/05 & Minimum Standards • Use Standard Infection Control Precautions • Have an Infection control policy & follow procedures within your practiceInfection Prevention & Control is collectively all the measures taken to prevent the transfer of infectious agents that have the potential to cause harm. It can be the small things that make the difference! Standard Infection Control Precautions • 10 in total • Must be used on all patients when there is a possibility of contact with: • Blood • All other body fluids (except sweat) • Non intact skin • Mucous membranes • Used at all times in the care setting, whether an infection is known to be present or not • Additional transmission based precautions (TBP) applied in conjunction with SICPs Standard Infection Control Precautions • Cough etiquette • Patient placement • Hand hygiene • Personal protective equipment • Prevent occupational exposure • Management of blood and body fluids • Patient care equipment • Control of the environment • Safe handling of waste • Linen Transmission Based Precautions (TBPs) • Applied when SICPs alone are insufficient to prevent cross infection • Are additional IPC precautions required when caring for a patient with a known or suspected infectious agent • Categorised by the route of transmission of the infectious agent: > Contact precautions: to prevent and control transmission via direct or indirect contact e.g. environment /equipment. Most common route of infection transmission > Droplet precautions: to prevent and control transmission over short distances via droplets (≤ 5µm) from the respiratory tract of someone directly onto a mucosal surface or conjunctivae of another: Approx. 2 metre around the infected individual considered area of risk > Airborne precautions: To prevent and control transmission via aerosols (≤ 5µm) from the respiratory tract of someone directly onto a mucosal surface or conjunctivae of another Cough Etiquette In the clinical environment: • Cough into your elbow If you can: • ‘Catch it, kill it, bin it! Always perform hand hygiene Preparing for work: Steps you should take before starting work in the surgery • Vaccinations: R U up2date • Hep B • Rubella • Tetanus • Occupational Health Assessment (for all new clinical dental staff) • Hair off collar/ long, tie up / clip back • Nails short, no polish or false nails • Jewellery – bare below the elbow, no dangly earrings • Uniform (Linen SICP) • Must be clean everyday, for example scrubs • Washed separately at suitable temperature for the fabric / tumble dry or ironed • Bare below the elbow • Closed in flat shoes that you can wipe Scottish check list for back to work http://www.sdcep.org.uk/wp-content/uploads/2020/05/SDCEP-Dental-Practice-Reopening-Following-COVID-19-checklist-250520.docx Hand Hygiene Hand hygiene is essential to reduce the transmission of infection in health and other care settings. https://www.dreamstime.com/royalty-free-stock-photos-woman-pushing-up-her-glasses-image10243528 Preparation Checklist • Keep nails short. • Avoid wearing rings with ridges/stones. • Do not wear artificial nails/polish. • Remove wrist watches etc. • Select the correct cleaning agent. • Use a designated sink. Products • Liquid soap •plain •uncoloured •unperfumed • Alcohol rubs (at least 60% alcohol) • Antimicrobial hand wash (only for surgical) • chlorhexidine, videne • No decanting of dispensers • No standard use of nail brushes Alcohol-based Preparations (ABHR) Benefits Limitations • Cannot be used if hands are visibly soiled • Rapid and effective anti- microbial action • Build up may occur and hands still need to be washed once ‘stickiness’ occurs • Improved skin condition • Needs to have minimum 60% • More accessible than sinks alcohol content • Should not be used when spore forming organisms are present, e.g. Clostridium difficile, or when a patient/client has viral gastroenteritis e.g. Norovirus8 Step Technique The “My 5 moments for Hand Hygiene” approach 2 Before a clean/aseptic 4 After patient procedure Contact 1 Before patient Contact 5 After contact with patient surroundings 3 After body fluid exposure risk Personal Protective Equipment • A major component of standard infection control precautions • Specialist clothing or equipment worn to protects the skin and mucus membranes from exposure to infectious materials in spray/spatter • Should be removed when leaving treatment areas • Additional transmission based precautions applied in conjunction with SICPs (e.g. TB or Coronavirus, specific type of mask and full gown) Single Use: Use once and bin Considerations • Gloves • Aprons • Gowns (sterile for surgical procedures) • Masks • Goggles/visors/disposable options All Single usePutting on PPE (Donning)Removing (Doffing) PPEBad Habits? Control of the Environment We can control the environment in two ways: > Zoning > Cleaning Zoning in the Surgery Aim: To separate areas likely to be contaminated with direct splatter or touch with PPE - ‘dirty zones’ - from those less likely to be contaminated - ‘clean zones’ Advantage: Minimizes the contamination of clean equipment, areas, instruments and materials. Simplifies and speeds up the cleaning/disinfection process between patients Clinical Contact Surfaces High potential for contamination from spray or splatter or by hand contact Clinical Contact Surfaces High potential for contamination from spray or splatter or by hand contactTreatment Planning A Patient treatment list will assist you in being prepared: • Collect correct instrumentation for each session • Only put out what is required for each patient treatment • Streamline your work (where possible)What’s in your drawers? REFLECT • Where are your burs stored? • What do you put out? • Are the clinical areas tidy and free from clutter • Do these items get the same standard as other instruments?National colour coding scheme for cleaning equipment Red – Wash rooms Blue – Offices Green – Kitchens Yellow – Clinical & decontamination areasVisible contamination must be CLEANED To clean we use detergent To kill micro organisms we use disinfectant Dental Unit Water Lines • Legionella risk assessment • Combination of methods of maintenance and cleaning will help reduce risk of bio contamination Daily maintenance: • Flush through hand piece for at least 2 mins before and at the end of each session • Flush for 30 secs between each patient • Use of good quality water in your unit bottles • Daily dosage system: ensure correct dosage to water / follow manufacturers instructions • Empty water bottle, clean according to manufacturers instructions and leave inverted to dry • Dental equipment with potential for backflow should have anti- retraction valve NB Always refer to manufacturers guidelines Periodical disinfection: • HTM states ‘this should be done periodically not specific on how often’ • There are a number of effective products • In all cases the manufacturers instructions should be consulted • Aids the removal of Bio-film • Ensure lines are flushed for at least 3 mins after disinfection before return to clinical use NB Always refer to manufacturers guidelines • For surgical procedures sterile water or saline from a separate single source should be used Waste Guidance HTM 07-01 Your statutory duty of care, is to ensure: • Correct segregation, store safely/securely on premises • Packaged appropriately for transport • Described accurately/fully on the accompanying documentation when removed • Transferred to an authorised person for transport to an authorised waste site • Appropriately registered for hazardous waste, records & returns on premises • Staff are trained Documentation Needs to be complete and accurate Waste transfer documentation: Consignment notes: for hazardous - Tracks movement - Ensures safe disposal - New note for each collection of waste Waste transfer notes: for non-hazardous - Describes the waste and can cover a 12 month period Top Tips • Always use foot pedal on bins • Always dispose directly into the bin • Do not overfill • Minimal handling • Swan neck and tag bags if full Sharps Medical instruments or other objects that are necessary for carrying out healthcare work and could cause an injury by cutting or pricking the skin or a splash to the eye. • 1 million injuries per annum across Europe • 100, 000 injuries per annum in UK • Since 1997 20 Hepatitis C cases 5 HIV cases Medical and dental professions reported a similar number of occupational exposures as nursing professions in 2011 Dental sharps Discuss the different types of sharps used in dentistry and highlight concerns Risk of transmission of blood-borne viruses from patient to healthcare work.r Hepatitis B: up to 30% Hepatitis C: 1-3 % HIV: 0.3% Percutaeous injury /non vaccinated Ref: Bloodborne viruses: Eye of the needle - GOV.UK (www.gov.uk)SHARPS AWARENESS Lock when Close contents temporary reach the closure when fill line not in use Assemble it Identify correctly. your Snap lid on all practice on round label Place on Never go into bracket, the sharps box securely to retrieve an fitted to wall item or trolley Dispose at point of Keep hands use behind You use it sharps You bin it Correctly Safer use sharps No boxes Sharps recapping Managing an injury • Deal with immediately • First aid • Encourage wound to bleed • Rinse under cold running water • Apply a covering • Risk assessment • Source (If source unknown risk assess clinical session) • Injury & vaccine status of recipient • Item causing injury • Svirus lab)rred to GMP for BBVs blood screening (sent to regional • Contact local occupational Department immediately with above information and follow advice • Complete all necessary documentation Audit tool Complete every 6 months retain for 2 yearsACTION PLAN • Keeps focus so improvements are implemented • Electronic version of IPS audit tool indicates HTM guidelines • Re audit every 6 months Turning theory into practice • Consistency with an experienced Dental Nurse • Embedding good practice • Feedback on where to improve • Safer sharps Can you identify anything you need to practice? To do: • Check the Infection Prevention and Control (IPC) Policy and Procedures for your practice • Ask your Dental Nurse for feedback on your use of PPE. • Complete the Infection prevention society IPC audit attached for your surgery • Have a go at cleaning/running through the suction and filling the water bottle attached to your chair and let the handpiece attachment run for 2 minutes References • NHS England • HSC doc: Management of https://www.england.nhs.uk/clinaudit/ sharps incidents in Dental Practice and GP Practice • Pel 13 13 • Minimum standards for • Preparation for the Re- establishment of the dental care and treatment General Dental Services - Operational Guidance • Infection Prevention society http://www.hscbusiness.hscni.net/pdf/Preparation% 20for%20the%20Re- 2022%20June%202020.pdfhe%20GDS%20Updated%https://assets.publishing.service.gov.uk/government/uploads/syste m/uploads/attachment_data/file/881489/COVID- 19_Infection_prevention_and_co ntrol_guidance_complete.pdf https://www.publichealth.hscni.net/news/covid-19-what-situation- northern-ireland https://www.gov.uk/government/publications/covid-19-personal- protective-equipment-use-for-non-aerosol-generating-procedures https://www.gov.uk/government/publications/covid-19-personal- protective-equipment-use-for-aerosol-generating-procedures Personal Protective Equipment https://www.gov.uk/government/publications/covid-19-personal-protective- equipment-use-for-non-aerosol-generating-procedures equipment-use-for-aerosol-generating-proceduresd-19-personal-protective- https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/ file/910885/COVID-19_Infection_prevention_and_control_guidance_FINAL_PDF_20082020.pdf