Infection Control in The Outpatient Clinic 6 th Borneo International - - PowerPoint PPT Presentation

Infection Control in The Outpatient Clinic

6th Borneo International Infection Control Congress 20-21th September 2018

Definition: Outpatient Facilities or Ambulatory Care

• Facilities where patients do not remain
• vernight
• Gain popularity in recent years – reduces

admission, cost of healthcare

• Poses unique challenges to infection control

Outpatient

Outpatient or Ambulatory Care

DIAGNOSIS OBSERVATION CONSULTATION TREATMENT INTERVENTION REHABILITATION

Outpatient or Ambulatory Care

• Comprises

– Outpatient clinic : Hospital vs non-Hospital – Specialized clinic – Hemodialysis – Physiotherapy, Rehabilitation – Radiotherapy – Radiology – Day care center- oncology, Thalassaemia, surgery (endoscopy, day care surgery)

Definition

• Healthcare personnel (HCP)
• All persons (paid or unpaid)
• Working in outpatient settings
• Who has potential for exposure to patients

and /or to infectious materials, including body substances, contaminated medical supplies, devices, contaminated environmental surfaces,

• r contaminated air
• (includes clerical, house keeping, volunteers)

Definition – Healthcare personnel

Outbreaks reported

HONG KONG

Fundamen tal Elements

Dedicat ed resourc es (admin) Educate & Train HCP Monitor & Report HCAI Standar d

Precautio n

Dedicate resources (administrative)

• Develop & maintain IP programs
• Sufficient and appropriate equipment &

supplies e.g. HH products, PPE, injection

• At least one IP trained personnel (HR)
• Written IP policies & procedures

– Tailor according to services provided and patients populations – Prioritize & focus

Local Challenges

• OPD IP policy still lacking
• Lack of infection control trained HCP
• ICN – multi-tasking e.g. administrative and

nursing

• Old building structure  inadequate sink,

ventilation, dedicated rooms for isolation

• Lack awareness among HCW, Administrations
• Lack of funding or administrative support

The administration

• May not necessary to central government
• Local head of unit eg Family medicine in-

charge of unit, Matron or sister in-charge, head of radiology unit  aware the importance of infection prevention

Education and Training in OPD

• Job & Task-specific Education & Training
• Focus on both HCP safety and patient safety
• Provided upon hire & repeat, when policies

revised

• Competencies - documented

Local Scenario

• Workshop on outpatient infection control
• Head of unit to send relevant HCP to attend

workshop OR post basic training

• Retain trained HCW in IP

HAI Surveillance & Reporting

• Educate patients signs & symptoms of

infection, notify the facilities

• Local and National requirement of HAI

surveillance

• Regular audit of HCP adherence

Need National Policy Local audit

• local project
• Understands local

issue

HH PPE Environment Cleaning Equipment sterilization & disinfectant Linen and Waste Handling Safe Injection Practice Cough & Respiratory Etiquette

Standard precaution

$$$$ ?? STANDARD PRECAUTION

Prioritize is the KEY

Patient Triage - OPD

• Experience or trained staffs – TRIAGE
• Besides severity, potentially infectious patients
• identified. Examples:

– Respiratory symptoms

• Traveling : Middle East, Africa
• TB
• Pertussis (vaccination history)
• Diarrhea

– Fever + rash + 3 C = conjunctivitis, coryza, cough) measles

Triage

Registration Triage area

• Visual alert – Banners, Poster, video, make

announcement

• HCP : Active Advice (BRIEF) / pamphlet

– Cough etiquette/ Hand Hygiene

• Equipment : Surgical mask , Alcohol hand rub

at counter

• Offer surgical mask, tissue to respi cases
• Suspect

– Measles ( fever, rash with 3 ”C” isolation ) – Chronic cough >3 weeks TB ( facilitate process)

Waiting Area

• To provide reading material, pamphlets
• To give a short CME or medical talk on relevant

topics e.g. cough etiquette, hand hygiene, disease transmission eg TB

• To provide educational video in waiting area
• To provide alcohol hand rub (waiting & clinic)

Hand Hygiene

Personal Protective Equipment

Prioritize - understand

• wn usage

Cough & Respiratory Etiquette

Others

• Separate : Diabetic clinic and TB clinic and

OPD clinic

• Well child clinic/ vaccination clinic  screen

and separate or expediate from sick children from vulnerable group eg severe premature, congenital heart disease, chronic lung disease

Environment Cleaning

• One of the most important steps of infection

control

• Ensure Hospital Support Service Staffs (HSS) are

being trained for environment cleaning & understand their important role

• Emphasize on high touch area
• Immediate Spillage control – eg vomitus, blood,

stool

Equipment Sterilization and Disinfection

• Equipment : common fomite, transmits disease
• BP cuff thermometer, otoscopy, keyboard,

ultrasound machine/ probes

• Disposable set – dressing, suturing set, vaginal

speculum

• Nebulization, oxygen delivery apparatus
• Digital thermometer
• Laryngoscope
• Emergency delivery set

Disinfection

• NON– CRITICAL equipment

– Eg BP cuff, pulse oximeter, nebulization set, auriscope nozzle, digital thermometer – Low level disinfection

• Semi-critical Equipment

– laryngoscope – high level disinfection

Safe Injection Practice

• Aseptic, cleanse diaphragm
• Single versus Multiple vial – vaccines
• NO reuse syringe
• NO same syringe for multiple patients
• Sharps disposable bin – convenient area, not
• verfilled
• NO RECAPPING
• Regular audit

Transmission-based precaution

Tuberculosis - airborne

• MDR & XDR TB – major public health threat
• Lack of effective treatment of MDR & XDR 

infectious for longer period

• HIV and TB  infectious
• Prevention of nosocomial TB to patients and

HCW : paramount

HCW TB Infection Rate in Sabah

Years HCW (number) Pulmonary TB Smear Positive Smear Negative 2013 31 29 2 2014 28 22 6 2015 24 17 7 2016 46 30 16 2017 29 22 7 Total 158 120 38

Unpublished data, JKNS Tb unit

Infection Control in Tuberculosis in OPD setting

• Organisational Activities

– Policy, Training, Research, Public Education, Surveillance, monitoring, Evaluation

• Administration Activities
• Environmental Control
• Respiratory Protection

– Respirator, HCW care & prevention

Which are the MOST feasible and important components?

Infection Control in Tuberculosis in OPD setting

• A. Organisational Activities
• A. Policy, Training, Research, Public Education,

Surveillance, monitoring, Evaluation

• B. Administration Activities
• C. Environmental Control
• D. Respiratory Protection
• A. Respirator, HCW care & prevention

Administration Activities

• 1. Screen
• Early recognition during Triage
• 2. Educate
• Educate cough hygiene, safe distance
• Provide mask
• 3. Separate
• Separate from other patients
• Waiting in well ventilated area
• 4. Provide HIV services
• 5. Investigate for TB
• Prompt investigation for TB including CXR

Environmental control

• After administrative controls
• Reduce the concentration of infectious

respiratory aerosols in the air

– Mechanical ventilation – Enhancing natural ventilation – Filtration – Ultraviolet germicidal irradiation units

Ventilation

• Simplest and least expensive technique

– removes and dilutes the air from areas with TB patients – channeling it away from other patients and HCW without TB

• 1. Natural
• 2. Mechanical ventilation

TB infection control in Eastern Cape of South Africa

• Training of HCW – TB infection prevention
• Open-window stickers
• Reminder HCW to screen for TB

Droplet precaution

• Cough etiquette + respiratory hygiene + HH +

Environmental Cleaning

• Keep safe distance: 3 meters

Examples:

• Avian flu /H1N1
• MERS Cov
• SARS
• Adenovirus

Contact precaution

• MRO ( bacteria)

– MRSA – Carbapenemase resistant Enterobactericaeae – Vancomycin resistant enterococcus – Clostridium difficile with toxin

• Virus

– Rotavirus – Norovirus – Astrovirus – Hand foot mouth (enterovirus)

Summary

• Infection Prevention is important in OPD
• Feasible infection control activities despite

limitation of resources and financial constraint

• TB / Droplet – administrative activities  can

be done