ROI COVID-19 Guidance - Infection prevention in hospitals (02)

Standard Infection Control Precautions (SICPs)

  • Acts as the basic infection prevention & control measure necessary to reduce the risk of transmission of infectious agents
  • Interrupts the transmission of COVID-19 by stopping the route of transmission via contact & droplets

Use of PPE

  • As part of standard precautions, it is the responsibility of every worker to undertake a risk assessment prior to performing a clinical task as this will inform the level of IPC precautions needed, including the choice of appropriate PPE for those who need to be present.
  • The table below shows the personal protective equipment requirements by precaution.
PrecautionContact DropletAirborne
GlovesYesAs per standard precautionsAs per standard precautions
Gown/Apron (impermeable)When workers clothing is in substantial contact with the patient, items in contact with the patient and their immediate environmentAs per standard precautionsAs per standard precautions
Surgical maskWhen in close contact (less than 1m)YesNo
P2/N95 respiratorNot requiredNot requiredYes
Googles / Face shieldNot requiredAs per standard precautionsAs per standard precautions
Donning and doffing PPE
Source: HSE.
  • NB that in outbreak situations or other circumstances where extended use of one set of PPE (other than gloves) when moving between residents with a diagnosis of COVID-19, it is important to make every effort to avoid generalised use of PPE throughout the facility without considering the level of risk
  • In the event of extended use of PPE define clean and contaminated zones. PPE should be donned before entering the contaminated zone and doffed and hand hygiene competed before entering clean zones.
  • Transiting through the hallway of a contaminated zone without providing resident care does not require the use of PPE if the residents are in their rooms and there is no physical contact with staff wearing PPE

Source: HSE

Transmission-based precautions for COVID-19
  • Transmission based precautions are IPC measures which are implemented in addition to standard precautions. They include contact, droplet and airborne precautions.
  • In general COVID-19 is spread by respiratory droplets – transmission may be direct, through contact with the respiratory secretions of someone with COVID-19 or indirect through contact with a contaminated surface/object. Less commonly airborne spread may occur during AGP.
  • Transmission based precautions should be applied immediately to all suspected cases of COVID-19

Further information can be found here.


Aerosol Generating Procedures

The current AGPs in the nursing/residential care setting are:

  • Tracheostomy procedures – insertion, removal or open suction
  • Non-invasive ventilation (BiPAP or CPAP)
  • Ventilation via a tracheostomy
  • Cough Assist

Further information on the PPE requirements can be found here.

 

Hand Hygiene
  • Hand hygiene is the single most important action to reduce the spread of infection in health and other social care settings and is a critical element of standard precautions
  • Facilities must provide ready access for staff, residents and visitors to hand hygiene facilities and alcohol-based hand rub
  • Hand hygiene must be performed immediately before every episode of direct resident care and after any activity or contact that potentially results in hands becoming contaminated, including the removal of PPE, equipment decontamination, handling of waste and laundry
  • Residents should be encouraged to wash their hands after toileting, after blowing their nose, before and after eating and when leaving their room
  • The use of gloves is not a substitute for hand hygiene – hand hygiene is required before putting on gloves and immediately after they have been removed.
  • Staff should adhere to the WHO five moments for hand hygiene
  1. before touching a patient
  2. before clean/aseptic procedures
  3. after body fluid exposure/risk
  4. after touching a patient, and
  5. after touching patient surroundings.
Source: WHO

Follow the protocol below when washing hands – don’t forget to include your exposed forearms:

Hand hygiene guide
Respiratory hygiene and cough etiquette
  • Respiratory hygiene and cough etiquette refer to measures taken to reduce the spread of viruses via respiratory droplets produced when a person coughs or sneezes
  • Disposable single-use tissues should be used to cover the nose and mouth when sneezing, coughing or wiping and blowing the nose
  • Used tissue should be disposed of promptly in the nearest foot-operated waste bin
  • Some residents may need assistance with the containment of respiratory secretions. Hands should be cleaned with soap and water or an alcohol-based hand rub after coughing, sneezing, using tissues or after contact with respiratory secretions and contaminated objects
  • Staff and residents should be advised to keep hands away from their eyes, mouth and nose
Safe management of linen
  • All towels, clothing, or other laundry used in the direct care of residents with suspected or confirmed COVID-19 should be managed as ‘infectious’ linen.
  • Linen must be handled, transported and processed in a manner that prevents exposure to the skin and mucous membranes of staff, contamination of their clothing and the environment
  • Disposable gloves and apron should be worn when handling linen
  • All linen should be handled inside the resident room/cohort area. A laundry trolley should be available as close as possible to the point-of-use for linen deposit.
  • When handling linen the worker should not:
  • Rinse, shake or sort linen on removal from beds/trolleys
  • Place used/infectious linen on the floor or any other surfaces
  • Handle used/infectious linen once bagged
  • Overfill laundry receptacle or
  • Place inappropriate items in the laundry receptacle
  • When managing infectious linen the worker should:
  • Place linen directly into a water-soluble/alginate bag and secure
  • Place the alginate/water-soluble bag into the appropriately coloured linen bag (as per local policy)
  • Store all used/infectious linen in a designated, safe area pending collection by a laundry service
  • If there is no laundry service, laundry should be washed using the hottest temperature that the fabric can withstand and standard laundry detergent
  • Laundry should be dried in a dryer in a not setting
Management of waste
  • Dispose of all waste from residents with confirmed or suspected COVID-19 as healthcare risk waste
  • When removing waste, it should be handled as per usual precautions for healthcare risk waste
  • The external surfaces of bags/containers do not need to be disinfected
  • All those handling waste should wear appropriate PPE and clean their hands after removing PPE
  • Hands-free health-care risk waste bins should be provided in isolation rooms and cohort areas
  • If healthcare risk waste service is not available in the facility then all consumable waste items that have been in contact with the individual, including used tissues, should be put in a plastic rubbish bag, tied placed in a second bag and left for 72hrs. This should be put in a secure location prior to collection
  • Waste such as or faeces from individuals with possible or confirmed COVID-19 does not require special treatment and can be discharged into the sewage system.
Environmental hygiene
  • The care environment should be kept clean and clutter-free in so far as is possible bearing in mind this is the resident’s home
  • Residents observation charts, medication prescription and administration records and healthcare records should be taken into the room to limit the risk of contamination.
Use of clothing at work
  • Do not travel to work in your uniform that you will be wearing during your shift
  • If possible, change into your uniform on commencement of shift
  • Use different footwear when at work – this prevents the spreading of the virus outside of the working environment
  • Prior to leaving the shift, change back into travelling clothes, place your uniform and footwear into a plastic bag
  • Once you have returned home, wash your uniform immediately at 90°c (Avoid shaking them out prior to putting them into the washing machine)

You can read the full guidance here.

Stay up to date with the latest HSE advice here.