Infection control

Infection control is the prevention of the spread of micro-organisms from client to client, client to employee and employee to client. Infections can spread through contact with body fluids that are airborne, ingested, on the skin, or on other surfaces.

Mode of transmission

Common ways infections spread include:

• airborne droplets

coughing and sneezing, even talking or singing, produce airborne droplets that can fall on surfaces or be breathed in

• throat and nose discharge

infection can spread if infectious organisms are present in body fluid when it is on hands, other parts of the body, clothes or surfaces such as toys, walls and tables

• faecal-oral

any virus, bacteria or parasite present in the faeces of infected people can be passed directly to the mouth from hands, or indirectly onto other surfaces or food. The sites most frequently contaminated with faeces are hands, tap handles, nappy changing areas, toilet flush handles, toys and tabletops. Toothbrushes and reusable towels also are potential sources of infection

• skin contact

some conditions can be spread by skin-to-skin contact or contact with contaminated items or surfaces

• blood/body fluids

viruses, bacteria and parasites in blood or body fluids may be spread through contact with these fluids

Standard precautions

When dealing with any blood or body substances, use ‘standard precautions’. Standard precautions treat all clients the same way regardless of their infectious status.

Standard precautions are work practices that are required for a basic level of infection control. They include:

• personal hygiene practices such as hand washing

• use of protective apparel which may include gloves, aprons, gowns, overalls, masks/face shields and eye protection

75 • appropriate handling and disposal of sharp instruments and clinical waste • correct cleaning and disinfecting of non-disposable equipment

• appropriate use of cleaning agents

• environmental controls such as design and maintenance of premises, cleaning and spills management.

Standard precautions are used in health care settings. Not all of the precautions listed need to be applied all of the time in community service organisations. For many community service employees and volunteers the type of exposure with clients is non-clinical and protective equipment such as gloves are only required for circumstances where the employee/volunteer has direct contact with blood (including dried blood), other body fluids,

secretions and excretions (eg faeces, saliva, mucus) and non-intact skin. This sort of exposure may occur during cleaning of bathrooms, nappy

changing, disposal of waste, cleaning of body fluid spills or administration of first aid. The most common means of infection control in the community services workplace are hand washing, gloves, immunisation, and the use of cleaning agents.

Additional precautions

Additional precautions should be applied with some infectious diseases transmitted by airborne or droplet transmission of respiratory secretions such as tuberculosis, chickenpox, measles, rubella, pertussis and influenza. In cases such as these, the infected clients, volunteers, or employees should be quarantined from attending workplaces or receiving home services (other than acute health care) until after the period of acute infection has passed. In some cases, such as chicken pox, clients can have continued care if employees and volunteers are immune.

If your service provides residential care, isolate the client in a separate room and provide them with separate toilet and bathroom facilities if possible. Some infections will require a health care institution that has specialist facilities for infectious diseases where additional precautions are required. Additional precautions are not usually required for patients with blood borne viruses such as HIV, hepatitis B, or hepatitis C, unless there are complicating infections such as pulmonary tuberculosis.

In the case of outbreaks of rare infectious disease such as meningococcal disease or SARS, the Public Health Unit of your Area Health Service should be contacted for instructions and help with coordinating the response, including notification of people who have had significant contact with the infected person.

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Step 1 – Think – identify and assess the problem

Observationof practices and workplace inspectionswill assist you identify

potential causes of infection in the workplace. For example, hand washing patterns of staff and volunteers, adequacy of hygiene facilities and food handling practices.

Your injury and illnessrecords will help you identify employees and

volunteers who may have been exposed to infectious diseases and the common diseases experienced.

Step 2 – Talk – consult with employees and volunteers

Consult your employees and volunteersto get their opinion on the possible

causes of infections in the workplace and how they can be avoided.

Once you have identified the infection hazards in your organisation, you then need to assess the risk arising from them.

Assessment means answering two questions.

• how likely is it that this hazard will cause injury or illness

• consider the level of an employees’ exposure to the hazard. For example, working with young children everyday will increase your likelihood of contracting an infectious disease

• how severe is the injury or illness if it does occur

• consider the extent of the injury or degree of harm that may be caused by a hazard. For example, contracting Hepatitis C may permanently affect the immune system of the employee/volunteer.

The Risk management worksheetin Checklists and tools Section 2can assist

with assessing risk and assigning priorities for action.