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www.hlthss.gov.nt.ca The NWT Infection Prevention and Control Manual 2012

March 2012

1 "The Chief Executive Officer of a Board of Management for a hospital or health care facility shall take measures to ensure compliance with standards approved by the

Minister

for the control of infections in hospitals and health care facilities."

Section 59 of the Northwest Territories

HOSPITAL AND HEALTHCARE FACILITY STANDARDS REGULATION, 2009 (R-036-2005) The NWT Infection Prevention and Control Manual 2012

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TABLE OF CONTENTS

HOSPITAL AND HEALTHCARE FACILITY STANDARDS REGULATION, 2009 (R-036-2005) 1

TABLE OF CONTENTS..............................................................................................................................2

ACKNOWLEDGEMENTS ..........................................................................................................................7

PURPOSE ....................................................................................................................................................8

UPDATES FROM 2004 MANUAL ........................................................................................................ 10

SECTION 1

- INTRODUCTION ............................................................................................................. 11

Infection Prevention and Control in Healthcare Facilities.............................................................. 12

Roles and Responsibilities for Infection Prevention and Control in Healthcare

Facilities . 12

Infection Control Practitioners ................................................................................................................. 13

Certification and Training ........................................................................................................................... 14

CHICA-Canada Endorsed Infection Prevention & Control Courses .............................................. 15

Infection Prevention and Control Committees .................................................................................... 16

SECTION-2-PRINCIPLES OF INFECTION PREVENTION AND CONTROL .................................. 17

Transmission and Chain of Infection ...................................................................................................... 17

Elements of Routine Practices ................................................................................................................... 18

Interaction Controls ...................................................................................................................................... 19

Risk Assessment ............................................................................................................................................. 19

Hand hygiene ................................................................................................................................................... 19

SECTION-3-PERSONAL PROTECTIVE EQUIPMENT ...................................................................... 23

Gloves ................................................................................................................................................................. 23

Masks .................................................................................................................................................................. 25

Eye Protection ................................................................................................................................................. 26

Putting on PPE ................................................................................................................................................. 27

Taking off PPE ................................................................................................................................................. 27

N95 Respirator ................................................................................................................................................ 27

Environmental Controls .............................................................................................................................. 27

Administrative Controls .............................................................................................................................. 29

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SECTION-4-ADDITIONAL PRECAUTIONS ....................................................................................... 31

General ............................................................................................................................................................... 31

Clinical Syndromes requiring Additional Precautions ..................................................................... 32

Cohorting ........................................................................................................................................................... 33

Initiation and Discontinuation of Precautions .................................................................................... 33

Contact Precautions ...................................................................................................................................... 34

Droplet Precautions ...................................................................................................................................... 35

Airborne Precautions ................................................................................................................................... 36

Reverse isolation/Protective Environments ....................................................................................... 38

SECTION- 5-INFECTION PREVENTION AND CONTROL PRECAUTIONS .................................. 39

Patient placement .......................................................................................................................................... 39

Patient transport ............................................................................................................................................ 39

Food and Nutrition ........................................................................................................................................ 40

Laboratory Transport ................................................................................................................................... 41

Visitors ............................................................................................................................................................... 41

Pet visitation .................................................................................................................................................... 42

Environmental Controls by Area .............................................................................................................. 42

SECTION-6-ENVIRONMENTAL CLEANING ...................................................................................... 44

General ............................................................................................................................................................... 44

Routine Cleaning ............................................................................................................................................ 44

Double Cleaning .............................................................................................................................................. 49

Terminal Cleaning.......................................................................................................................................... 49

Linen and Laundry Services ....................................................................................................................... 50

Waste Management ....................................................................................................................................... 51

Sharps Disposal ............................................................................................................................................... 54

Blood/Body Substance Spills

..................................................................................................................... 55

Contaminated Medical Records ................................................................................................................ 56

SECTION-7-MEDICAL REPROCESSING/STERILIZATION ............................................................ 57

General Requirements ................................................................................................................................. 57

Selection of Equipment/Devices ............................................................................................................... 57

General Reprocessing Requirements ..................................................................................................... 58

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Reusable Medical Equipment/Devices ................................................................................................... 60

Cleaning ............................................................................................................................................................. 60

Disinfection ...................................................................................................................................................... 61

Sterilization ...................................................................................................................................................... 64

Endoscopic Devices ....................................................................................................................................... 67

CJD........................................................................................................................................................................ 67

Dental ................................................................................................................................................................. 68

Breaks in Infection Control ........................................................................................................................ 70

SECTION-8-OCCUPATIONAL HEALTH AND SAFETY .................................................................... 71

Immunization .................................................................................................................................................. 71

Tuberculosis Surveillance........................................................................................................................... 73

Mask fit testing ................................................................................................................................................ 74

Blood-borne Exposures ............................................................................................................................... 74

Education .......................................................................................................................................................... 75

Section-9-Reportable Diseases and Special Cases ..................................................................... 76

List of reportable diseases .......................................................................................................................... 76

Special Cases

of Reportable Diseases ..................................................................................................... 79

Respiratory Infections .................................................................................................................................. 79

Tuberculosis (TB) .......................................................................................................................................... 81

Meningitis ......................................................................................................................................................... 83

Antibiotic Resistant Organisms ................................................................................................................ 84

Antibiotic Stewardship................................................................................................................................. 85

MRSA ................................................................................................................................................................... 85

VRE ...................................................................................................................................................................... 88

ESBLs and CREs ............................................................................................................................................... 91

Clostridium difficile....................................................................................................................................... 93

SECTION-10-OUTBREAK MANAGEMENT ....................................................................................... 97

Acute Respiratory Outbreak ...................................................................................................................... 98

Gastrointestinal/Enteric Outbreak

......................................................................................................... 99

Correctional Facilities .................................................................................................................................. 99

Child Care Facilities ....................................................................................................................................... 99

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SECTION-11-CARE OF THE DECEASED ..........................................................................................100

SECTION-12-CONSTRUCTION AND DESIGN OF HEALTHCARE FACILITIES .........................102

SECTION-13-REFERENCES ................................................................................................................105

SECTION-14-APPENDICES ................................................................................................................107

APPENDIX-1-The NWT Infection Control Committee (ICC) Terms of Reference .................. 107

APPENDIX-2-Audits ..................................................................................................................................... 110

APPENDIX- 2a)- Hand Hygiene Monitoring Tool .............................................................................................................. 110

APPENDIX -2b)- Hand Hygiene Structural Audit .............................................................................................................. 112

APPENDIX -2c)- NWT Infection Control Cleaning Audit ................................................................................................ 113

APPENDIX-3-Hand Hygiene ...................................................................................................................... 116

APPENDIX- 3a)-Using an Alcohol Based Hand Rub (ABHR) ........................................................................................ 116

APPENDIX-3b)-Using Plain Soap .............................................................................................................................................. 117

APPENDIX-4-PPE Types ............................................................................................................................. 118

APPENDIX-4a)-Medical Gloves.................................................................................................................................................. 118

APPENDIX-4c)-Eye Protection .................................................................................................................................................. 119

APPENDIX-4d)-Masks and N95 Respirators ....................................................................................................................... 120

APPENDIX-5-Personal Protective Equipment (PPE) ....................................................................... 121

APPENDIX-5a)-Putting on PPE .................................................................................................................................................. 121

APPENDIX-5b)-Removing PPE .................................................................................................................................................. 122

APPENDIX-5c)-N95 Respirator Protocol .............................................................................................................................. 124

APPENDIX-5d)-Care of Reusable PPE .................................................................................................................................... 125

APPENDIX-6-Communicable Disease Reference Chart

.................................................................. 126

APPENDIX-7-Cleaning ................................................................................................................................. 142

APPENDIX-7a-Checklist for Discharge/Transfer Cleaning of all Rooms ................................................................ 142

APPENDIX-7b)-Special Cleaning for MRSA, VRE and C. difficle .................................................................................. 144

APPENDIX-7c)-Cleaning Recommendations Clinic Rooms .......................................................................................... 145

APPENDIX-7d)-Bed and Stretcher Cleaning ........................................................................................................................ 148

APPENDIX-7e)-Blood Spill Floor .............................................................................................................................................. 149

APPENDIX-7f)-Blood and Body Fluid Carpet Stain Cleaning ....................................................................................... 150

APPENDIX-7g)-Commode Cleaning ........................................................................................................................................ 151

APPENDIX-7h)-Damp mopping of floors .............................................................................................................................. 152

APPENDIX-7i)-Damp Wiping of Surfaces ............................................................................................................................. 153

APPENDIX-7j)-Tub and Shower Cleaning ............................................................................................................................ 154

APPENDIX-7k)-Wheelchair Cleaning ..................................................................................................................................... 155

APPENDIX-7l)-Exam Table Cleaning ...................................................................................................................................... 156

APPENDIX-7m)-Toy Cleaning .................................................................................................................................................... 157

APPENDIX-7n)-Routine Washroom Cleaning ..................................................................................................................... 158

APPENDIX-7o)-Sample Terminal Cleaning Protocol for Routine Precautions (PIDAC) .................................. 159

APPENDIX-7p)-Laundry Handling ........................................................................................................................................... 161

APPENDIX-7q)-Handling Garbage ........................................................................................................................................... 162

APPENDIX-7r)- Sharps Handling .............................................................................................................................................. 163

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APPENDIX 8 Precautions Requirements and Signage..................................................................... 164

APPENDIX-8a)-Contact Precautions ....................................................................................................................................... 164

APPENDIX-8b)-Droplet Precautions....................................................................................................................................... 166

APPENDIX-8c)-Airborne Precautions .................................................................................................................................... 168

APPENDIX 9 Disinfectant ........................................................................................................................... 170

APPENDIX-9a)-Uses/Advantages/Disadvantages ........................................................................................................... 170

APPENDIX-9b)-Preparing Household Bleach as a Disinfectant .................................................................................. 174

APPENDIX-9c)-Antimicrobial Activity of Disinfectants ................................................................................................. 175

APPENDIX 10 Reprocessing...................................................................................................................... 176

APPENDIX-10a)-Reprocessing Area Set Up Chart ............................................................................................................ 176

APPENDIX-10b)-Cleaning, Disinfection and Sterilization ............................................................................................. 177

APPENDIX-10c)-Sample Autoclave Maintenance Record ............................................................................................ 182

APPENDIX-10d)-Sample Biological Indicator Record .................................................................................................... 183

APPENDIX-10e)-Sample Biological Indicator Failure Record ..................................................................................... 184

APPENDIX-11-Infection Control Information for Homecare Workers ..................................... 185

APPENDIX-12-Post-exposure Prophylaxis Protocol ....................................................................... 186

APPENDIX-13-Glossary .............................................................................................................................. 186

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ACKNOWLEDGEMENTS

The Office of the Chief Public Health Officer would like to thank all participants for their valuable contributions to the development of this manual with special consideration to:

NWT Regional Infection Control Practitioners

Medical Health Officers (MHOs)

NWT Nurse Managers

NWT Dental Association

Canadian Hospital Infection Control Association (CHICA) Ontario's Provincial Infectious Disease Advisory Committee (PIDAC) First Nations and Inuit Health Branch, Health Canada ( FNIHB)

Infection Control Practitioners

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PURPOSE

Infection prevention and control is a mandatory component of all healthcare facilities and offices for reducing the risk of infections in patients, health care providers, other staff and volunteers and visitors. The purpose of this Manual is to:

1. Provide information on the principles, practice and tools of infection prevention

and control in healthcare facilities and offices.

2. Set Territorial standards and best practices regarding infection prevention and control practices within healthcare facilities and offices.

3. Serve as an adjunct to infection prevention and control training and education.

4. Provide a framework that NWT healthcare facilities can use to develop processes to ensure compliance with Accreditation Canada infection prevention and control standards. The standards are divided into four subsections:

Investing in infection prevention and control

Keeping all people safe from infections

Providing a safe and suitable work environment

Being prepared for outbreaks and pandemics

5. Provide foundational information that individual healthcare facilities can use to develop facility-specific infection prevention and control policies and

procedures.

6. Provide a list of resources and links to additional and/or more detailed infection

prevention and control information.

7. Serve as a repository for the systematic collection of new information that can be

used to form the next revision of the NWT Infection Prevention and Control

Manual.

8. Provide a place where individual healthcare facilities can retain facility-specific

infection prevention and control information with the result that all necessary information will be together. The NWT Infection Prevention and Control Manual 2012

March 2012

9 Overall, infection control is a regional responsibility as per the NWT Hospital and

Health Care Facility Standards

Regulations (R-036-2005). Therefore, the

information in the Manual is intended to provide guidance on best practices, but is not intended to replace the need for healthcare facilities to develop facility-specific policies and procedures. The information in the Manual is based on best practices published by a variety of facilities, including: Health Canada, Public Health Agency of Canada, provincial jurisdictions and institutions, the Center for Disease Control and organizations such as the Community and Hospital Infection Control Association - Canada. The Manual serves as a resource of comprehensive information and planning documents that include specific information about infection prevention and control available in the NWT.

Additional Resources

Northwest Territories Severe Infections Disease Contingency (SIDC) Plan gency_plan.pdf

Communicable Disease Control Program-Tuberculosis

/tuberculosis/default.htm

NWT Pandemic Influenza Contingency Plan

pandemic_influenza_contingency_plan.pdf Pan -Territorial Pandemic Planning Project Environmental Scan Report

Northwest Territories Communicable Disease Manual

Northwest Territories HIV/AIDS Manual for Health Professionals Guidelines for the Management of Biomedical Waste in the Northwest

Territories

The NWT Infection Prevention and Control Manual 2012

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UPDATES FROM 2004 MANUAL

The 2012 NWT Infection Prevention and Control Manual is a revised version of the

2004 Manual. The current version is formatted to highlight the

various components involved in preventing infections in health care settings. The components are grouped by: Administrative support and responsibilities for the provision and implementation of infection control practices and policies Focus on the provision of education and training for infection prevention and control practices Focus on the need for ongoing monitoring and evaluation of infection prevention and control practices, including the use of audit tools The importance of engineering controls in preventing the transmission of infections The importance of properly delivered and monitored environmental cleaning and reprocessing practices

The responsibility of each individual who works at a health care centre to be aware of and implement infection control Precautions

Other changes include:

"Infection prevention and control" replaces "infection control" "Routine Precautions" replaces "Standard Precautions" o Additional Precautions refers to Contact, Droplet and Airborne

Precautions

Healthcare setting is the general term that includes hospitals, healthcare centres and community health settings "Patient" is used as a general term to include patients, clients and residents of hospitals, community health facilities and long-term care facilities "Staff" refers to all employees of a healthcare facility including nurses, medical and non -medical practitioners and support staff including administrative staff and housekeeping services. The NWT Infection Prevention and Control Manual 2012

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SECTION 1

- INTRODUCTION Healthcare associated infections (HAIs) have gained rapid status as being important and preventable events that result in significant morbidity, mortality and economic costs to the health care system.

One in nine hospital patients in Canada will

develop an HAI. This results in 220,000 HAIs per year in Canada, with 8,500-12,000 associated deaths. The estimated direct costs of these HAIs in Canada are $1 billion annually. This does not include additional costs borne by patients, caregivers and the programming costs of home and community care. The Canadian Committee on Antibiotic Resistance estimates that

30% of HAIs can be

prevented. However, t he incidence of HAIs is increasing in Canadian hospitals.

Methicillin

-resistant Staphylococcus aureus (MRSA) has increased by 17-fold between

1995 and 2006, and there has been a five

-fold increase in Clostridium difficile between 1991
-2003. In the Northwest Territories, a similar pattern has been seen in terms of increasing numbers of HAIs and antibiotic resistant specimens. Annual cases of MRSA, C difficile and Extended-spectrum beta-lactamase enterobacteriaciae (ESBL) have all increased significantly over the past five years. Environmental services of cleaning, laundry and other support services have been recognize d as being a vital component of infection prevention and control strategies.

Many microorganisms such as

C difficile, MRSA and norovirus can remain in the

environment for extended periods of time. Preventing the transmission of infection requires careful cleaning of these areas, proper hand hygiene, and controls to ensure that these are being carried out. "Breaking the chain of infection" requires well-resourced, well-trained infection prevention and control teams and dedicated staff with proper training to interrupt the links of transmission and prevent HAIs.

SECTION-1-INTRODUCTION

The NWT Infection Prevention and Control Manual 2012

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12 Infection Prevention and Control in Healthcare Facilities

Infection preven

tion and control (IPAC) aims to prevent and/or control the introduction, acquisition, transmission and dissemination of HAIs and other communicable diseases.

IPAC programs ensure the systematic development,

implementation and monitoring of processes and activities to achieve these goals. HAIs have a significant impact on the health of patients and contribute to health care costs in terms of prolonged hospital stays, readmissions and occasionally legal and litigation costs. IPAC programs have been shown to effectively reduce the burden of

HAIs and to be cost

-effective. The NWT Infection Prevention and Control Manual provides the best practice standards of infection control for health care settings in the NWT. Users may create their own policies and procedures for their settings and utilize the resources provided in this

Manual.

Roles and Responsibilities for Infection Prevention and Control in Healthcare Facilities The Government of the Northwest Territories (GNWT) requires each hospital to have a Health Service Committee that will: Consider every case of HAI including the post-operative infection of wounds and the post -partum infection of mothers and advise the hospital authority as to what measures must be taken to control the infection.

Health Care Facility

Standards Regulation, 2009

Form subcommittees deemed necessary for further consideration of these issues (e.g., infection prevention and control committee, transfusion sub-committee)

Oversee infection prevention and control within all healthcare facilities of the responsible authority

The Office of the Chief Public Health Office (OCPHO) requires that:

Each Health Authority designate an individual with appropriate education and training as its Infection Prevention and Control Practitioner

This person should report to a senior administrator with authority to oversee the implementation of processes to ensure that medical, nursing and other staff

comply with infection prevention and control directives as appropriate The senior administrator forwards the name and qualifications of the Infection

Prevention and Control Practitioner to the

OCPHO each time that there is a staffing change. The NWT Infection Prevention and Control Manual 2012

March 2012

13 Infection Prevention and Control Activities in Healthcare Facilities: Regular Infection Prevention and Control Committee meetings (minimum quarterly)quotesdbs_dbs42.pdfusesText_42

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