Learning Experience of Infection Prevention and Control Module

Learning experience in this Infection prevention and Control module (IPC).

 

Entry 1 30/08/17

Expectations of the module, my personal expectations, and the expected outcomes. Including how I feel and will contribute to this outcome.

Entry – My expectations of this module are that it will be full on involving a lot of hard work. As with all modules I will be personally giving my all and hoping to obtain the highest possible percentage. I will achieve this by listening carefully to instructions as regards tasks, this journal and skills demo.

I will be honest and forthright with this journal and hopefully catch snapshots of where I am as this module progresses. I would hope to see progression in my understanding of Infection Prevention and Control (IPC) illustrated in my journal.

I will spend the time preparing for the skills demonstration so I can go into it with confidence, experience and the knowledge required to achieve the highest possible standard.

As regards the examination, I will research the essential content, as guided by the tutor, make notes on same, ensure I understand it and study it with a view to being able to answer any possible question that may be asked.

As the weeks progress I would hope that my expanding knowledge of this module will assist me in both my work placement and allow me expand any points I might make in my journal this week.

Information or skills learned, including learning outcomes.

Entry – While studying care skills we learned some aspects of IPC. I look forward to studying these in greater measure.

IPC measures we touched on in Care Skills include using PPE in various environments, how micro-organisms thrive in damp conditions, hand hygiene, the three cleaning standards (cleaning, disinfection and sterilisation), precautions around client’s body fluids and exposure to blood. I will expect that we will go into all these in much greater detail in this module.

Reflection on difficulties encountered and positive experiences i.e. with course work, the classroom setting, your interaction with others.

Entry – I have found very little negatives as regards course work, classroom settings and my interaction with other students and our tutors. One classmate does seem to have an issue with me but I am experienced enough to carry on, be mannerly and not let it affect me. My interaction with everyone else and them to me has been excellent.

The rest of this course has been a hugely positive experience and I would expect that to continue during this module.

I may find difficulty with the scientific terms but will employ the system of learning I used in Anatomy and Physiology which worked very well in that module.

Reflection on how the information is used in the work/clinic setting. If you already have experience in the workplace, use this.

Entry – I already wash my hands continually after learning the importance of doing so in the last module.

I would expect that on completion of this module I will have many more tools in my possession to assist in IPC at a much greater level.

The understanding of how infection spreads will be a great assistance in this regard. I feel it will assist me greatly and ensure I will be a better healthcare assistant by improving the environment, not only for me but for any clients and staff I will be dealing with in the future.

It will also ensure that I will always use best possible practice in any contact I will have with clients and staff.

Entry 2 – 1/09/17

Learning experience in this Infection prevention and Control module.

Expectations of the module, my personal expectations, and the expected outcomes. Including how I feel and will contribute to this outcome.

Entry – 30/8/16 – My expectations for this week is that I will get a good start into understanding IPC.

As with the start of any study program I am unsure what to expect. Will there be too much information thrown at me? Will it be too scientific? Will I make sense of it? Will it relate to my work placement? Will it help in my work placement? The questions go on and on.

The best way I can contribute to any learning outcome is to fully engage. Listen to what the tutor is saying, ask if I need clarification, take good notes and research essential content. I also think listening to class-mates questions and views is important as interpretation can vary from person to person and it is always interesting and helpful to understand other people’s views on what’s being discussed.

I would also expect by the end of this week to understand and know how to implement some of the module learning outcomes.

Information or skills learned, including learning outcomes.

Entry – I think the best way for me to fully address skills learned and learning outcomes in a cohesive manner is to head paragraphs with the relevant learning outcomes and then explain why and what I have learned that is relevant to that outcome.

To achieve this I will put in sub headings which are numbered and titled as they are in the ‘Award Specific Learning Outcomes’ document as supplied by the tutor. The headings from this document are not in order as I will use them when they are relevant to this week’s learning.

1 – Explain the basic principles of infection and the application of standard precautions in relation to infection control, to include the significance of an area of infection control.

Micro-organisms that can cause infections are known as pathogens and are classified in various groups and can all cause infection and disease, examples of a relevant disease is included in brackets. The groups are Bacteria (Staphylococcus Aureus), Viruses ( Hepatitus B), Fungi (Thrush), Protozoa (Giardia lamblia), Parasites (Threadworm) , Ectoparasites (scabies) and Prions (Creutzfeldt-Jakob disease).

Healthcare associated infections (HCAI) are infections that are acquired in healthcare facilities or as a result of healthcare interventions. They are a major problem for patient safety and can lead to serious illness, prolonged hospital stays, long term disability and even death. Three examples of HCAI infections are MRSA, C. Diff, Norovirus.

The Health Information and Quality Authority (HIQA) are the independent statutory body in Ireland with responsibility for developing and monitoring standards.

They have issued elements of Standard precautions which consist of eleven precautions as follows,

1. Staff immunisation
2. Hand hygiene
3. Personal protective equipment (PPE)
4. Respiratory hygiene and cough etiquette
5. Safe injection practices
6. Management of sharps injury/contamination
7. Decontamination of reusable medical equipment
8. Decontamination of the environment
9. Management of spillages of blood and body fluids
10. Management of laundry
11. Safe management of healthcare risk waste

These precautions are developed to break the chain of infection (the chain of infection will be fully explained later in this document).

Healthcare workers are responsible for implementing these standard precautions at all times. They must attend induction and on-going training on standard precautions, report deficits in knowledge or resources to the line manager, report any illness as a result of an exposure, inform occupational health department if they know or suspect they have an infection and advise visitors of infection prevention and control requirements such as hand hygiene and cough etiquette.

Managers of healthcare facilities also have an important role to play in IPC.

These include an IPC control service, an occupational health service, an IPC induction program for new staff, PPE, cleaning equipment, physical infrastructure and development of an action plan to address any non-compliance with Standard Precautions identified by regular audits.

IPC staff are responsible for providing education on Standard Precautions to all staff, ensuring local and national guidelines on Standard and transmission based Precautions are in place and regularly reviewed, surveillance of epidemiology important organisms and notifiable diseases, providing on-going advice to staff and auditing and reporting of same.

Hand hygiene (HH) is one of the most effective means of preventing HCAI’s. I will further explore HH later in this reflective journal as it is learning outcome 9.

Immunisation is one of the most effective healthcare interventions under the safety, health and welfare act 1998. It must be seen as one part of a wider policy to prevent transmission to workers and patients. It can never be used as a substitute for good IPC practices. It will minimise the risk to workers acquiring or spreading infection and also reduces the burden of disease, shrinking treatment costs and reducing sick leave. Diseases involved in immunisation programs are Hepatitis B, Influenza, Measles, mumps, rubella and Varicella.

The SARI guidelines for hand hygiene (HH) in Irish care settings (2005) allow for three levels of HH.

These are,

Social HH- Remove dirt and organic material, dead skin and most transient micro-organisms from the hand.

Antiseptic HH – a higher level of cleanliness is required. Eg. If a client is immune compromised.

Surgical HH – before all surgical procedures and removes all transient and resident micro-organisms.

Although these in themselves differentiate between social, antiseptic and surgical HH there is, however, a lot more to HH than these three levels. The World health Organisation (WHO) in their five moments of HH 2012 recommends that HH be carried out when there is a perceived or actual risk of a micro-organism transmission from one surface to another via hands.

The five moments of HH are,

1. Before touching a patient
2. Before clean/antiseptic procedures
3. After body fluid exposure risk
4. After touching a patient
5. After touching patient surroundings

HH is the most important and effective method of prevention of the spread of infection. Inadequate HH technique increases the risk of transmitting micro-organisms which can be acquired through contact with patients, staff, equipment and the environment.

Proper HH technique is as follows,

Run water over hands.

Apply 5ml of liquid soap and rub all over hands.

Rub palms up and down. Rub both hands 5 times.

Rub fingers up and down with one hand on the back of the other. Rub back of both hands 5 times.

Rub finger pads both ways, 5 times for each hand.

Rub palm at end of thumb. Rub both palms 5 times.

Rub thumbs by wrapping hands around them. Rub both thumbs 5 times.

Rub both wrists 5 times.

HH can be carried out three ways

1. Using an alcohol rub foam/gel, this is a preferred method for HH when the hands are not soiled and are physically clean (not effective on patient with C Diff. or Norovirus)
2. Wash with plain soap
3. Wash with an antiseptic hand wash

Although the HH technique described above is for HH using water and soap the same technique is used for all three ways of completing HH.

There are also important points as regards care of hands for healthcare workers which are as follows, nails should be kept short and cut smoothly, nail varnish/false nails should not be worn, all wrist and hand jewellery/watches should be removed ( an exception is made for a plain wedding band but special care has to be taken when decontaminating same), sleeves should be rolled up to the elbow, cover any abrasions with waterproof dressing and Healthcare workers HCWs with damaged hand skin (eg. Weeping dermatitis) should not carry out direct patient care and should seek occupational health advice.

General care of hands also include,

Cover cuts with an impermeable waterproof dressing, wet hands before applying soap, use preparations containing emollients, always rinse hands and pat thoroughly, apply emollient hand cream or barrier cream regularly, communal jars/tubs of hand cream should not be used as the contents may become contaminated and seek professional advice for sensitivity/allergy to disposable gloves and skin problems.

Patients and visitors should be reminded and encouraged to decontaminate their hands regularly.

I must also add that the five points of contact are not the only times HCWs should use HH. Other times will include before and after each work shift, when hands are visibly contaminated, before putting on and after removing PPE, before eating and drinking food, after handling waste and after cleaning clinical areas.

Finally the 2005 “guidelines for hand hygiene in Irish care settings” apply to all healthcare facilities including the community setting.

They state that,

Mandatory attendance (at least two yearly) at HH education and practice is required for all HCWs involved in clinical areas.

Audit of compliance with HH guidelines and HH facilities is required in all healthcare settings.

2 – Discuss the importance of infection prevention and control in the healthcare area, in providing a healthy environment for patients, staff and visitors.

To discuss this I must first point out what Healthcare-associated infections (HCAI’s) are. These are infections that are acquired in healthcare facilities or as a result of healthcare interventions and are a major problem for patient safety. HCAI’s can lead to serious illness, prolonged hospital stays, long term disabilities and patient deaths.

Patients, staff and visitors need to be reassured that health services in Ireland are following best practice in order to minimise the risk of HCAI’s in Irish care practices.

In Ireland, The Health Information and Quality Authority (HIQA) is the independent statutory body responsible for developing and monitoring standards for health and social care services. HIQA has prioritised standards for the prevention and control of HCAI’s as healthcare environments should safe, clean and the risk of acquiring an infection, whether patient, staff or visitor should be kept as low as possible.

I will also point out, before I go any further, that there can be huge costs as a result of infection outbreaks. Apart from the chances of legal action there can be other losses, examples being sick leave or treatment infected patients.

As a result of the dangers Standard Precautions (evidence based clinical work practices published by the Centre of Disease Control (CDC) in 1996 and updated in 2007) have being introduced. They are designed to prevent the transmission of micro-organisms from person to person either by direct or indirect contact.

These Standard Precautions are to be used at all times whether or not we know someone is or isn’t infected.

On the three groups of people mentioned in the learning outcome they all have an expectation that healthcare facilities are clean and do their utmost to prevent the spread of infections.

Reflection on difficulties encountered and positive experiences i.e. with course work, the classroom setting, your interaction with others.

Entry – I find while I’m learning new material it takes a while to sink in. I love the technique used by our tutors where we go through the manual and discuss the contents, while relating it to our experiences in work practice.

I then research the manual and break down the information, writing out the bones of the information in a way that I can follow and elaborate on. It takes a lot of reading from there for the information to fully sink in.

Learning in this manner has become my favourite part of this course and I would have never expected to say that.

Reflection on how the information is used in the work/clinic setting. If you already have experience in the workplace, use this.

Entry – This information is hugely important in work placement. It appears to me that with the introduction of HIQA IPC is being taken to a new level as regards regulation and implementation in Irish healthcare and, as a result, is not fully bedded in yet but is being improved daily.

I think people, like me, on work placement can help with that bedding in by simply taking on board what we have learnt and using that knowledge in our placements.

An example of this is the more people decontaminate their hands the more people will decontaminate their hands and it will become an ever growing habit. This is a small measure of how we can use knowledge gained to assist in improving our workplace as regards IPC.

Entry 3 – 8/09/17

Learning experience in this Infection prevention and Control module.

Expectations of the module, my personal expectations, and the expected outcomes. Including how I feel and will contribute to this outcome.

Entry –  6/9/17 – On the safe use of sharps I would expect that on completion of this chapter I will know how to risk assess (health, welfare at work  act 2005) sharps (needles etc.). I will know how to handle, dispose, store and transport them in a way that will reduce the risk of injury to me and others.

I would expect spills management is the correct procedure for dealing safely with spills and we will also learn proper cleaning protocol.

We did a bit of laundry management in Care Skills. By the end of this chapter I would expect to know the regulations and how these are enforced and how laundry in handled for Infection Prevention Control (IPC) in various types of healthcare facilities.

I would expect I will know the procedure and reasons for that procedure for waste management in the healthcare environment.

As regards decontamination I expect I will know cleaning agent to use for different equipment and why that agent is used. Also I should know about different cleaning methods.

As there will be some cross over with the Care Skills module I believe what I learned in that module will assist me in completing this section of this module.

As regards safe injection practices I would expect to know how it is carried out in a safe manner and who is actually allowed perform an injection.

I will also learn about single use devices, why they are used and how they are disposed of.

How isolation rooms are cleaned and approached, or exited from to prevention the spread of infection is something I should know by the end of this week.

Information or skills learned, including learning outcomes.

Entry – As with last week the best way for me to fully address skills learned and learning outcomes in a cohesive manner is to head paragraphs with the relevant learning outcomes and then explain why and what I have learned that is relevant to that outcome.

To achieve this I will once more put in sub headings which are numbered and titled as they are in the ‘Award Specific Learning Outcomes’ document as supplied by the tutor. The headings from this document are not in order as I will use them when they are relevant to this week’s learning.

6 Investigate the terms ‘cleaning’, ‘disinfection’ and ‘sterilisation’ to include cleaning standards, procedures and frequencies while paying special attention to decontamination of equipment, including patient care equipment.

There are three levels of decontamination of equipment and environment recognised in healthcare facilities. These are,

Cleaning, this isthe process that physically removes soiling, including large numbers of micro-organisms and the organic material on which they grow. This is usually carried out using neutral detergent and warm water. Detergent wipes may be used provided they have not dried out.

Disinfection, this is a process that eliminates many or all pathogenic micro-organisms from inanimate objects, with the exception of bacterial spores, e.g. disinfection of environmental surface with a sodium hypochlorite solution. The use of disinfectant wipes is not advised.

Sterilisation, this is a physical or chemical process that completely kills all forms of viable micro-organisms from an object, including spores. This is usually carried out in an autoclave.

I will add that proper PPE be worn at all times when cleaning the environment or equipment. HH should also be carried out at appropriate times and in the appropriate manner. HH is already discussed in an earlier entry and I will be discussing PPE learning outcome 4. As a result I will not elaborate on either at this particular juncture.

I will now take these one at a time. Routine cleaning is required to minimise the number of micro-organisms in the environment. It starts with removing visible dust and dirt. It is also important to make sure to dry thoroughly as dampness is an ideal condition for the growth of micro-organisms. Routine cleaning is usually carried out with neutral detergent and warm water.

There is a growing body of evidence linking the environment with outbreaks of specific HCAI’s such as VRE, C Diff etc.

The technique used in routine cleaning is also important, sweeping brushes are not advised as they can spread infections and dirt by literally sweeping it into the air. Mops also can be a problem as they can leave damp spots which micro-organisms can quickly multiply in. as a result dust collecting brushes, dry mops and vacuuming are the preferred cleaning options. Cleaning should be done from the top down and from clean to dirty to ensure it is of utmost efficiency.

In relation to equipment, as it passes from one patient to another, it would be cleaned and then disinfected either by disinfectant wipes or a disinfectant. Routine cleaning breaks the chain of infection progressing.

Disinfection is the next level of cleaning and is extremely important if a patient or the environment becomes infected. Disinfectant wipes are not advised for this level of cleaning. Chlorine or bleach based solutions are necessary. It is extremely important that such products are locked away when not in use and used in line with the manufacturer’s instructions.

If a patient becomes infected all equipment must be disinfected. Also the environment must be disinfected. As I will be dealing with isolation rooms and outbreak management in learning outcome 10 I will further elaborate on the techniques and systems of disinfection in that entry.

Disinfection reduces micro-organisms to a safer level and kills bacteria you can’t see.

The final level of cleaning is sterilisation, this is usually carried out in an autoclave and kills all micro-organisms. It is used to clean equipment for surgical procedures.

As larger equipment will not fit in autoclaves they cannot be sterilised and, as a result, if they cannot be decontaminated they must be destroyed.

11 Apply appropriate management of blood and body fluid spillages, to include policies for dealing with clean and soiled linen, the disposal of sharps and the correct management following inoculation, injury or accidental exposure to blood and body fluids.

The first thing to be mentioned as regards blood or body fluid spills is HH. As per the WHO 5 moments of HH hands must be decontaminated, even if there was a risk of such spillages.  The second thing to be mentioned is PPE. On coming across a spillage PPE in the form of an apron and gloves must be donned in the correct manner and worn.

The soiled linen should be placed in an alginate bag at point of contact. The bag should be sealed immediately, placed in the appropriate laundry sack (only to be filled to 1/3 capacity) and sent to the laundry. The bag will be put straight into the washing machine without the seal being broken.

Normal run of the mill dirty linen will be put in the white laundry sack at point of contact (also only to be filled to 2/3 capacity).

If there are such spillages on the floor the area must be cordoned off and warning sign/s ‘cleaning in progress’ placed adjacent. Collect all the necessary equipment to fully clean and dispose of spillage (in some facilities a spillage kit will be available). It is important to keep other people away until area is decontaminated.

Any cuts or abrasions on skin must be covered with waterproof plasters. Disposable gloves and plastic apron must be worn and must be donned and doffed using the correct procedure (this procedure will be fully explained in learning outcome 10).

The contaminated area should be sprinkled with a chlorinating agent (e.g. Klorosept, Presept). It should be covered in paper towels and left for a few minutes in line with manufacturer’s instructions.

Remove sodden material and dispose of as per waste segregation policy. As there is blood present it must be placed in ‘risk’ waste because of the danger of blood borne virus’s (BBV’s). Upon completion of the task PPE must be doffed in the appropriate manner and also placed in the ‘risk’ waste.

As regards sharps, which include, needles, scalpels, stich cutters, glass ampoules/vials, lancets and broken glass it is important in order to avoid unnecessary exposure to potentially infectious agents, particularly those micro-organisms that can be found in blood and other body fluids, precautions are essential while providing care.

Sharps should be disposed of in special sharps containers that are provided, they must never be placed in a bag. If the item has contacted blood or being used on an infected patient it must be placed in the ‘risk’ container.

However, in the event of an inoculation injury the following sequence of events should occur.

• bleeding of the wound should be encouraged immediately
• wash wound with soap and warm running water
• cover wound with waterproof dressing
• report incident and fill accident form
• as with local policy, see doctor or go to A&E
• blood sample marked ‘urgent inoculation injury’ sent immediately to laboratory
• investigation of the injury should be done
• retest at 6 weeks and 6 months

In the event of accidental exposure to blood or body fluids it is essential to decontaminate the affected area straight away. If the spillage in on your clothes you must change your clothes and place contaminated clothes in an alginate bag, seal and wash.

Injections must only be carried out by competent people trained to do so. All equipment for injections must be handled correctly and disposed of in the appropriate waste.

10 implement the local terminal cleaning procedure in a range of settings, such as an isolation room, single use items and outbreak management.

Cleaning of an isolation room after an infected patient has left it would be as follows. The cleaner must wear the appropriate PPE for the task (in this example apron and gloves are sufficient). The cleaner must decontaminate their hands, don the apron, decontaminate their hands again and then don their gloves.

The person cleaning should then gather the required equipment to properly clean the room and disinfect it. The room must be cleaned first with soap and water, starting from the top down and clean to dirty. This will remove viable dirt. The room must then be dried.

If at any stage the cleaner has to leave the room the PPE must be removed using the correct technique, gloves first, decontaminate hands, then remove apron by breaking the neck band and allowing it fall away from the body, then breaking the waist band and roll it up only touching the inside of it, then decontaminating hands again. The PPE should be placed in a risk bin as the patient had an infection and the environment has been touched.

On re-entering the room the PPE must be again fitted in the same manner described above. The PPE is hugely important to prevent micro-organisms harbouring on the cleaners clothes and hands.

The room should now be disinfected with an approved disinfectant. This must be applied in accordance with the manufacturer’s instructions. This will remove most transient and resident micro-organisms bring them to a safer level.

All equipment must also go through the procedures outlined above and some may require being sterilised, if so it should be packaged correctly and sent to be sterilised.

All linen should be placed in an alginate bag and sent to the laundry in the correct sac, only fill up to 2/3’s.

When the room is completed it should be dried as micro-organisms thrive in damp conditions. The cleaner must once again remove their PPE in the correct fashion remembering to decontaminate their hands at the appropriate times. The PPE should be placed in a risk bin as the patient had an infection.

Single use items should be placed in the appropriate bins, if it is a needle it should be placed in a sharps bin point down. These should never be cleaned for re-use and must be disposed of after use to prevent any infection from spreading.

When there is an outbreak of an infection the area should be cordoned off. The patient should be moved to an isolation room. The technique described earlier in this section should be used to decontaminate the area including correct use of PPE.

Once the patient is in the isolation area PPE must be used at all times while attending to their needs. The ICT must be alerted and local procedures put in place. These will include the WHO five moments of hand washing, decontamination of equipment, visitors being informed of procedures and supplied with PPE and shown how to put it on and remove it, or be assisted in same.

When the patient recovers and is removed from the isolation room it should be disinfected as outlined above.

At all times we should all strive to break the chain of infection.

Reflection on difficulties encountered and positive experiences i.e. with course work, the classroom setting, your interaction with others.

Entry – Firstly I loved the group work which we used to recap on last week’s learning. It is always interesting, and sometimes slightly frustrating, to get different ideas and infuse different ways of doing things into a cohesive, well presented and informative poster.

There is a lot of information in this module and, although most of it is ‘common sense’ and very logical, the biggest difficulty I have is getting it all in the right order and under the correct topics.

My interactions with my fellow learners have been wholly positive this week. That includes the person who has had difficulties with me in the past. I have opened dialogue with that person and the response has been good. I don’t think we’ll be going on holidays together but the improvement certainly eases pressure on me during the day.

So, to be honest, it has been another very enjoyable and positive week. I need to get my head in my notes and cement the information learned so I can continue to attain high scores as this course progresses.

Reflection on how the information is used in the work/clinic setting. If you already have experience in the workplace, use this.

Entry – My workplace experience thus far has been in a day care centre for intellectually challenged people with challenging behaviour. As a result some of the learning has not been relevant to that particular setting.

It is not my intention to criticise others as I embark on my healthcare journey. I think, in this country, it is a road we take too easily.

In my work placement the staff work hard and the setting is kept clean and the service users are extremely well looked after.

Could things be improved? The answer to that has to always be a yes. The real question is, how can I improve things as regards IPC? The answer to that is a little bit more complicated than a simple yes.

The best way for me to improve any working environment is to simply hold myself to the highest standard. If I conduct myself properly at all times I will be setting an example for others to follow. Institutional change or mind-set change can be extremely difficult to enforce. I am but one man, but if I do things right and others do the same, after a while the mind-set on IPC may indeed be one of full compliance with guidelines. This might be a bit of an idealistic idea but I believe that’s always where true change starts.

In my view, education in the workplace can come from people implementing new standards and this can be as efficient as expensive advertising campaigns.

Entry 4 – 15 /09/17

Learning experience in this Infection prevention and Control module.

Expectations of the module, my personal expectations, and the expected outcomes. Including how I feel and will contribute to this outcome.

Entry – 13/9/17 – In this part of the module I would expect, come Friday, I will have an understanding of Microbiology, pathogens and opportunistic pathogens.

I will also understand types of micro-organisms, bacteria and viruses, how they produce/spread and create the chain of infection. Knowing of the existence of the chain of infection I assume I will have a greater knowledge on how to break the chain of infection.

With this knowledge my understanding of transmission based precautions and airborne based precautions should be supplemented as understanding the spread of infection will obviously assist my understanding of preventing them.

This logic should, I imagine, also help with HCAI’s as the more I get to understand them, the risk factors, how they spread, how it’s prevented etc. the more I will understand the breaking of the chain of infection.

My expectations of this part of the module are that it will bring together all the previous learning and enhance it. Understanding the differing types of infection will assist me in understanding how to prevent these infections. This will also mean I will have more learning outcomes to discuss in this entry as opposed to the other three because all  the learning outcomes are coming together in my thought process.

Information or skills learned, including learning outcomes.

Entry – Once more I will put in sub headings which are numbered and titled as they are in the ‘Award Specific Learning Outcomes’ document as supplied by the tutor. The headings from this document are not in order as I will use them when they are relevant to this week’s learning.

3 Summarise the various types of micro-organisms, the elements required for growth, spread and subsequent infection process, to include direct and indirect contact, knowledge of the chain of infection and the need for vigilance and safe practice at all times.

There are various types of micro-organisms including Bacteria, Fungi, Viruses, Protozoa and Algae.

Favourable conditions for growth of bacteria are time, warmth, moisture, food and oxygen. In a ten hour period with favourable conditions one single cell can become one billion cells. Each species has a definite temperature range in which they multiply. Examples being some grow at room temperature while others grow at body temperature. Some can survive without oxygen (anaerobic) while some need oxygen (aerobic). Bacteria require food to thrive. They also need moist conditions to multiply, they will not multiply on dry surfaces or equipment. Bacteria can be killed with antibiotics but some are mutating to be resistant to same.

Viruses are smaller than bacteria and cannot be seen under a microscope. They do not respond to antibiotic and thus are more difficult to kill. They also differ in that they cannot reproduce themselves and can only inside a living cell, hence depending on a host cell for growth. They reproduce in the host cell filling it until it bursts, then entering the bloodstream and spreading. Blood borne viruses (BBV) will be discussed in the next heading (no 7).

Micro-organisms can be transmitted in three ways, contact, droplet or airborne.

There are two types of contact,

Direct contact, the infection travels directly from person to person through blood, bodily fluids or sexual contact. (examples being chicken pox, tuberculosis, sexually transmitted infections (STI’s).

Indirect contact, a carrier is involved in the spread of pathogens. This carrier can be hands, equipment and inanimate objects, airborne particles, vectors or food and water.

Micro-organisms can also be carried in food. In poultry and eggs salmonella can exist. In meat and water E coli can be present. In soft cheese and pate Listeria can thrive and Campylobacter can grow in chicken and turkey.

There are also opportunistic pathogens. An opportunistic pathogen is “an organism that is capable of causing disease only when the host’s resistance is lowered, for example, by other diseases or drugs”. (dictionary, 2017)

To battle the spread of pathogens it is important to understand the chain of infection. This is the route through which infection spreads. Proper IPC systems break this chain, thus preventing the spread of infection.

There are six links in the chain of infection and they are,

1. Infectious agent, any micro-organism that will cause an infection.
2. Reservoir, the place where the micro-organism resides, thrives and reproduces.
3. Portal of exit, the place where the micro-organism leaves the reservoir (examples being respiratory tract, intestinal tract, urinary tract or blood and other bodily fluids).
4. Mode of transmission, the means by which a micro-organism passes from one body to another, either by direct or indirect transmission.
5. Portal of entry, the opening where an pathogen enters the hosts body (examples being mucus membranes, open wounds, tubes inserted into body cavities or feeding tubes).
6. Susceptible host, the person at risk, several factors determine how at risk a person may be including age (younger people and elderly people are generally more at risk), underlying chronic diseases, weakened immune system, invasive devices and malnutrition.

 

Understanding the chain helps understand how good infection control measures, as discussed elsewhere throughout this document, can prevent the spread of infections by putting barriers between the links in the chain.

7 Identify the main blood borne viruses which pose a threat and the methods that prevent the spread of infections

Blood borne viruses (BBV’s) are carried in the blood. Some people infected with a BBV may show little or no symptoms of serious disease while others may be very ill. BBV’s include human immunodeficiency virus, hepatitis B and hepatitis C.

BBV’s can be spread by various routes,

The more common routes of transmission include:

• sexual intercourse (common for HBV, HIV; inefficient for HCV);
• sharing injecting equipment;
• skin puncture by blood-contaminated sharp objects (eg needles, instruments or glass); and
• childbirth (ie the mother infects the child either before or during birth, or through breast-feeding).

Less common routes of transmission are:

• contamination of open wounds (eg blood injuries during sporting activities);
• contamination of skin lesions (eg eczema);
• splashing of the mucous membranes of the eye, nose or mouth; and
• human bites when blood is drawn (this may be more of a problem in certain occupations, eg prison and police service, where front line workers may be exposed to violent behaviour). (HSE, 2017)

Standard precautions should always be used in healthcare settings which will minimise the risk of infection spreading.

If, however, we know a patient has a BBV we must use contact precautions in addition to standard precautions. These precautions are used to stop infection spreading either by direct or indirect contact. An apron and gloves must be worn for all interactions with the patient, proper HH must be used at all relevant times (I have explained HH earlier in this document) and an isolation room should be provided.

4 Analyse the predisposing factors to the development of healthcare acquired infections to include contact precautions, respiratory precautions and enteric precautions 

The predisposing factors to the development of healthcare acquired infections (HCAI’s) are a setting that is not cleaned to a good standard, a setting where staff do not take adequate precautions to break the chain of infection, a setting where spills are not cleaned, where moisture is not dried, where bed linen is mixed whether clean, dirty or fouled, the building is not ventilated, equipment is not cleaned and I could go on and on.

To combat such lethargy precautions have being introduced, the first level is standard precautions which have been discussed in an earlier entry.

The next level is contact precautions, these are to be used in addition to standard precautions should a patient be infected.

• The contact route can be direct or indirect.
• Wear a disposable apron and gloves for all interactions that may involve direct contact with the patient.
• Wear gloves if there is a risk to exposure to blood or bodily fluids.
• Perform HH after patient contact/removal of gloves. Note; from my learning on this module HH should be used before donning each item of PPE as well as after doffing each item and the PPE should be disposed of in the risk waste bin.

Respiratory/droplet precautions are for infections such as influenza and meningococcal meningitis which can be transmitted by droplets that are generated by the patient during coughing, sneezing, talking or while performing cough inducing procedures. These are to be used in addition to standard precautions

• Wear a disposable plastic apron, gloves and surgical facemask for all interactions that may involve direct contact with the patient or bring you within 3 feet of the patient.
• Wear gloves if there is a risk of exposure to blood or bodily fluids.
• Perform HH after patient contact/removal of gloves. Note; from my learning on this module HH should be used before donning each item of PPE as well as after doffing each item and the PPE should be disposed of in the risk waste bin.
• Respirator masks may be required for specific suspected or confirmed infections during aerosol generating procedures.
• Isolation room preferred, if unavailable isolate patient with curtains and minimum of 3 feet space.

Enteric precautions are used for patients who have an active infection of C Diff, rotovirus or norovirus.

These are to be used in conjunction with standard and contact precautions.

• HH to be performed properly and at all appropriate times by attendants, doctors nurses, visitors etc. and by the patient..
• Patient must use a flush toilet, if they have to use a bed pan PPE must be worn when handling it.
• Towels must not be shared.
• The toilet and bathroom must be disinfected at least daily.
• All equipment must be disinfected after use.

5 Discuss the role and functions of the local infection control team members, to include local policy in relation to dress, staff health and travel associated infections.

The local infection control team (ICT) consists of various members of staff whom have specialist knowledge that are trained in IPC. They also have senior staff, whom can influence change in practice and finance.

Their functions are to monitor, advise and plan services to reduce the risk of the spread of infection. Ensure each ward/department has a proactive infection control nurse. They will also ensure each department has a communication system in situ to inform staff and visitors of infection control information. They should also monitor infection rates and trends and participate in local and national audits by collecting data and providing reports on the findings. They should also participate in national initiatives to raise awareness around IPC. It is also incumbent on them to ensure IPC policies are based on current research and best practice.

The ICT should consist of the following members, membership may vary in different establishments as per local standards.

A consultant micro-biologist, senior nurse representative, general or deputy manager, IPC nurse, surveillance scientist/manager, ward management representation.

It is important these people are on the committee as it must have the ability to access finance, push through change and ensure best possible practice.

The ICT are not an island in each hospital working away off their own agenda. HIQA has developed National Standards for the Prevention and Control of Healthcare Associated Infections. There are twelve of these standards and they provide guidelines for local ICT’s to follow.

Everybody has a role to play in implementing these standards including the HCA. The HCA can assist by following the following guidelines.

• Always have good personal hygiene
• Use the WHO five moments of HH
• Always use correct HH technique
• Handle and dispose of sharps correctly
• Ensure correct linen storage and segregation
• Report when ill in a timely manner
• Correct use and disposal of PPE
• Adherence to waste management policy
• Ensure correct decontamination of equipment

8 Examine the role of antibiotics and the importance of correct and safe antibiotic use to avoid antibiotic resistance.

Antibiotics are a group of medicines that are used to treat infections caused by germs, bacteria and certain parasites. They do not work against viral infections.

They are generally used for more serious bacterial infections, an example being pneumonia. It is important that the full course of antibiotics is run so as to prevent resistance developing to that antibiotic. There can be side effects to antibiotics but most of these are not serious, maybe a stomach upset or diarrhoea. Some people can be allergic to antibiotics but this is rare.

Antibiotics come in various brands and are usually grouped together based on how they work. Different antibiotics are used to treat different types of infection.

Some bacteria have mutated and can be highly resistant to antibiotics. A ‘sensitive’ micro-organism is one which will be controlled or killed by the antibiotic being used, a ‘resistant’ bacteria is one that will not be affected by the antibiotic being used.

Over use of antibiotics has been recognised as a worldwide problem for many years. It has contributed to antibiotic resistance being built up by certain bacteria’s.

As a result it is very important that the correct antibiotic is used on bacterial infections and the correct course of that antibiotic is prescribed by the doctor and taken in full by the patient.

Antibiotics are hugely important in controlling infections in patients and allowing that patient make a full recovery.

Reflection on difficulties encountered and positive experiences i.e. with course work, the classroom setting, your interaction with others.

Entry – This has been a very intense module so far. There is a lot of information and a lot of routines which, while are logical and step by step, require a lot of learning.

Unlike Anatomy and Physiology, which is basically fact driven and study of real visible items (heart, kidneys etc.), IPC is subjective and more like preventive maintenance. Coming from a trades background this is something I can relate to and enjoy seeing procedures put in place to prevent infection spreading.

It suits my logical way of thinking. It’s tough going but I love it.

Reflection on how the information is used in the work/clinic setting. If you already have experience in the workplace, use this.

Entry – this whole module is something that appears to require more education in the work setting. If I am honest practice in my work setting could be improved. However, the knowledge I have gained is something I now use on a daily basis, as I go further into a career in healthcare I am sure I will get opportunities to implement IPC and assist in it getting the respect it deserves.

As a footnote I must add that I have also brought the knowledge learned into my home environment, especially around laundry and the kitchen area.

Entry 5 /09/17

Learning experience in this Infection prevention and Control module.

Expectations of the module, my personal expectations, and the expected outcomes. Including how I feel and will contribute to this outcome.

Entry – my expectations of the skills demonstration is that I will be given a task or tasks to plan, organise and act out.

I would expect that I will have done my homework and be able to adapt to whichever skill/s I am requested to perform. As always I will be looking for maximum marks in this demo.

Previous experience of skills demonstrations should be of assistance to me as I complete the task/s laid out.

Information or skills learned, including learning outcomes.

Entry – I think a skills demonstration is an accumulation of learnings and putting them into practice.

Learning categorises subjects into chapters, neatly laying out the how and why of the subject. In real life however two or more learning categories can overlap.

An example of this would be where HH (which is in learner outcome 9) is a huge part of local terminal cleaning procedures (which is in learner outcome 10). While the overlapping of learner outcomes in practical use can be a lot more complicated than this example I think it is a perfect example to illustrate the point.

This overlap of learning is where skills demonstrations are very helpful.

The presentation of learning in a skills demonstration is always a challenge, as trying to remember everything, put everything in correct chronological order, using the correct technique and demonstrating same in front of an examiner and witness can be nerve racking.

Even though I have experience of presenting and talking to groups I think it is human nature to be nervous.

This demonstration was another piece of the jigsaw that makes up this course. Learning by doing is probably the oldest form of learning on this planet.

Wearing of PPE has been mentioned throughout this document and explained in certain circumstances. As it is such an important part in breaking the chain of infection as PPE helps prevent the spread of germs in the healthcare setting  I feel it is necessary, at this point, to go through the correct procedure for donning and doffing of standard PPE.

To don PPE,

• Decontaminate hands correctly
• Don apron using the correct technique
• Decontaminate hands correctly
• Don face mask/goggles if required
• Decontaminate hands correctly
• Don gloves

To doff PPE,

• Remove gloves using the correct technique
• Dispose of gloves in the correct waste
• Decontaminate hands correctly
• Remove apron using the correct technique
• Dispose of apron in correct waste
• Decontaminate hands correctly
• Remove face mask/goggles if used, correctly
• Dispose of mask/goggles in correct waste
• Decontaminate hands correctly

Reflection on difficulties encountered and positive experiences i.e. with course work, the classroom setting, your interaction with others.

Entry – first off, I love presentations, which is what a skills demo is. I enjoy an audience and, although nervous at the start, generally relax and roll along in a timely manner through whatever the task may be.

On this day we were presented with 2 tasks. The first was to demonstrate the SARI hand washing technique used in a healthcare setting. The second was wearing and removal of PPE.

For task 1 I prepared my hands before entering the exam hall by cutting my nails, removing all jewellery and my wrist watch, ensuring I had no cuts and so did not need a water proof plaster, I do not wear nail varnish or false nails and hence did not need to remove them and as I wore short sleeves I did not need to roll my sleeves up beyond my elbow.

I also have no skin diseases so did not need an occupational therapist.

As I did all this to prepare for the demonstration before I entered the room I should have told the examiner I had completed all the tasks above. I omitted to say that to her and as a result that part of my preparation was not recognised by the examiner. This frustrated me as such a simple slip of the mind could have consequences down the road.

However, aside from that omission the demonstration went extremely well, I planned the hand hygiene (HH) correctly by having the correct equipment available and in situ and I decontaminated my hands correctly. I did mention SARI and the WHO five moments and was very happy with my timing and demonstration with the obvious exception of the omission mentioned above.

As regards the PPE I did go to put a glove on before my apron but stopped, removed the glove, reset and completed the task correctly from start to finish, including full and proper HH at all relevant times and disposal of PPE in a ‘risk’ bin (as PPE is worn where infections are known or suspected it should be disposed of in a ‘risk’ bin).

After the skills demonstration I was annoyed at my slip up as I always strive for perfection in these things and I felt a bit hard done by because of this oversight. But it has strengthened my resolve to do my utmost to get every available point I can from here on in to ensure I get a distinction in this module.

Reflection on how the information is used in the work/clinic setting. If you already have experience in the workplace, use this.

Entry – Life in the work place is a constant skills demonstration. Every time we are looking after a patient/client/service user we are, in effect, putting our learning into a real working situation which is what a skills demonstration is.

Quite often, if not always, in work tasks we carry out are witnessed by colleagues, bosses, service users amongst others and we have to be competent in applying skills we have learned, both on this course and at work experience.

I think skills demonstrations are very beneficial in the preparation of the application of skills before and during work placement.