TABLE OF CONTENTS Winnipeg Regional Health Authority Introduction Page Number 1. Purpose of the WRHA Infection Prevention and Control Manual 2.1 and approval process 2. WRHA Infection Prevention and Control Program 2.2 2.1 Site Specific Infection Prevention & Control Program 2.3 2.2 After Hours Coverage 2.5 3. Chain of Infection 2.6 3.1 Links in the Chain of Infection 2.6 3.2 Breaking the Chain of Infection 2.8 3.3 Transmission of Microorganisms 2.9 WRHA Infection Prevention and Control Policies & Operational Directives 1. Nursing Foot Care Infection Prevention & Control Management 3.1 2. Routine Practices for Reducing the Risk of Infection Transmission 3.5 3. Gels, Ultrasound and Medical 3.10 4. Admission Screening of Patients for Antibiotic Resistant Organisms 3.13 (MRSA & VRE) 5. Cleaning of Non-Critical, Reusable Items 3.15 6. Cleaning and Disinfection of Non-Critical Reusable Equipment/Items 3.18 for Patients in Hospital 7. Outbreak Management for Infection Prevention & Control in Hospitals, 3.26 Long Term Facilities and Personal Care Homes 8. Outbreak Management for Infection Prevention & Control in Hospitals 3.29 9. Reporting of a Communicable Disease to Manitoba Health by Infection 3.37 Prevention & Control in Hospitals 10. Upper Extremity Supportive Devices 3.42 Routine Practices 1. Introduction 4.1 2. Hand Hygiene 4.3 2.1 Important Factors in Hand Hygiene 4.3 2.2 When to Perform Hand Hygiene 4.4 2.3 Agents Used for Hand Hygiene 4.5 2.4 How to Perform Hand Hygiene 4.5 2.5 Patient/Visitors 4.6 1.1
3. Personal Protective Equipment 4.7 3.1 Gloves 4.7 3.2 Gowns 4.8 3.3 Masks 4.8 3.4 Eye Protection 4.8 3.5 Face Protection 4.9 4. Respiratory Etiquette 4.9 5. Patient Management 4.9 5.1 Accommodation 4.9 5.2 Equipment 4.10 5.3 Environmental Control 4.11 5.4 Specimen Collection 4.11 5.5 Visitors 4.12 5.6 Education 4.12 5.7 Postmortem Care 4.12 Additional Precautions 1. Introduction 5.1 2. Implementation of Additional Precautions 5.1 3. Discontinuation of Additional Precautions 5.2 4. Airborne Precautions 5.3 4.1 Introduction 5.3 4.2 Indications for Airborne Precautions 5.3 4.3 Accommodation 5.3 4.4 Healthcare Workers 5.4 4.5 Hand Hygiene 5.5 4.6 Personal Protective Equipment 5.5 4.7 Patient Transport 5.6 4.8 Patient/Family 5.6 4.9 Visitors 5.7 5. Contact Precautions 5.9 5.1 Introduction 5.9 5.2 Indications for Contact Precautions 5.9 5.3 Accommodation 5.10 5.4 Hand Hygiene 5.10 1.2
5.5 Personal Protective Equipment 5.10 5.6 Patient Transport 5.11 5.7 Equipment and Environment 5.11 5.8 Patient/Family 5.12 5.9 Visitors 5.12 6. Droplet Precautions 5.13 6.1 Introduction 5.13 6.2 Indications for Droplet Precautions 5.13 6.3 Accommodation 5.13 6.4 Hand Hygiene 5.14 6.5 Personal Protective Equipment 5.14 6.6 Patient Transport 5.15 6.7 Patient/Family 5.15 6.8 Visitors 5.16 7. Airborne/Contact Precautions 5.18 7.1 Introduction 5.18 7.2 Indications for Airborne/Contact Precautions 5.18 7.3 Accommodation 5.18 7.4 Healthcare Workers 5.19 7.5 Hand Hygiene 5.19 7.6 Personal Protective Equipment 5.20 7.7 Patient Transport 5.21 7.8 Equipment and Environment 5.22 7.9 Patient/Family 5.23 7.10 Visitors 5.23 8. Droplet/Contact Precautions 5.25 8.1 Introduction 5.25 8.2 Indications for Droplet/Contact Precautions 5.25 8.3 Accommodation 5.25 8.4 Hand Hygiene 5.26 8.5 Personal Protective Equipment 5.26 8.6 Patient Transport 5.28 8.7 Equipment and Environment 5.28 8.8 Patient/Family 5.29 8.9 Visitors 5.30 Clinical Presentation/Microorganism/Infectious Disease Table 6.1 1.3
Specific Disease Protocols-Alpha Listing 7.1.1 Specific Disease Protocols 1. Antibiotic Resistant Organisms 7.2.1 1.1 Extended Spectrum Beta Lactams (ESBLs) 7.2.1 1.2 Methicillin-Resistance Staphlococcus Aureus (MRSA) 7.2.10 1.3 Vancomycin Resistant Enterococci (VRE) 7.2.20 1.4 Vancomycin-Resistant Intermediate Staphylococcus Aureus 7.2.31 (VISA) 1.5 Vancomycin-Resistant Staphlococcus Aureus (VRSA) 7.2.34 2. Diarrhea 7.3.1 2.1 Bacterial 7.3.1 2.2 Clostridium difficile associated diarrhea (CDAD) 7.3.4 2.3 Other infectious microorganisms 7.3.6 2.4 Viral 7.3.8 3. Tuberculosis (TB) 7.4.1 4. Varicella Zoster Virus (VZV) 7.5.1 Chickenpox (Varicella) 7.5.1 Shingles (Herpes Zoster) 7.5.5 5. Influenza (Seasonal) 7.6.1 6. Acquired Immunodeficiency Syndrome (AIDS) Human Immunodeficiency Virus 7.7.1 7. Creutzfeldt-Jakob Disease (CJD) 7.8.1 8. Group A Streptococcus 7.9.1 9. Hepatitis 7.10.1 9.1 Hepatitis A (HAV) 7.10.1 9.2 Hepatitis B (HBV) 7.10.5 9.3 Hepatitis C (HCV) 7.10.10 10. Immunocompromised Condition 7.11.1 11. Measles/Rubeola 7.12.1 12. Meningitis 7.13.1 1.4
12.1 Hemophilus meningitis 7.13.1 12.2 Meningococcal meningitis 7.13.3 12.3 Pneumococcal meningitis 7.13.6 12.4 Viral meningitis 7.13.9 13. Mumps 7.14.1 14. Pediculosis (Lice) 7.15.1 15. Pertussis 7.16.1 16. Rubella (German Measles) 7.17.1 17. Scabies 7.18.1 18. Severe Respiratory Illness 7.19.1 19. Cimex Lectularius (Bed Bugs) 7.20.1 20. Pandemic Influenza P1 Specific Infection Prevention and Control Practices 1. 4% Chlorhexidine to 2% Chlorhexidine for hand antisepsis and 8.1 cleansing. 2. Infection Prevention & Control Management of solution and equipment 8.3 for wound irrigation. 3. Reuse of electrical razors for personal hygiene. 8.5 4. Sharing of personal items. 8.7 5. String cords and call bells in patient care areas. 8.9 6. Infection Prevention & Control Wound Management Principles 8.11 Individual Site Specific Protocols, Policies & Information Refer to Table of Contents located in this section 1.5
Medical Device Reprocessing 1. Single-use Medical Devices 10.1 2. Event Notification Process - Event Notification Process 10.5 3. Sterilizer Quality Assurance Monitoring 10.8 4. Endoscopes, Reprocessing (undergoing High Level Disinfection) 10.13 Definitions 11.1 Appendix 1. Hand Hygiene Quick Reference Chart 12.1 2. Hand Hygiene Procedure: Using an Alcohol-Based Hand Rub 12.2 3. Hand Hygiene Procedure: Using Plain Soap or Antimicrobial Soap 12.3 4. Personal Protective Equipment Criteria for Respiratory Infections 12.4 5. Donning Personal Protective Equipment (PPE) 12.5 6. Removing Personal Protective Equipment (PPE) Prior to Exiting 12.6 Patient Room 7. Removing Personal Protective Equipment (PPE) Immediately After 12.7 Exiting Patient Room 8. Air Changes for Removal of Airborne Contaminants 12.8 9. Cover Your Cough 9.1 Cover Your Cough Pamphlet English 12.9 9.2 Cover Your Cough Poster #1 English 12.11 9.3 Cover Your Cough Poster #2 English 12.12 9.4 Cover Your Cough Bilingual 12.13 10. Additional Precautions Signs English 10.1 Airborne Precautions Sign 12.14 10.2 Airborne/Contact Precautions Sign 12.15 10.3 Contact Precautions Sign 12.16 10.4 Droplet Precautions Sign 12.17 10.5 Droplet/Contact Precautions Sign 12.18 11. Additional Precautions Signs Bilingual 12.19 1.6
12. Patient and Family Information Sheets for Additional Precautions - English 12.1 Airborne Precautions 12.20 12.2 Airborne/Contact Precautions 12.21 12.3 Contact Precautions 12.23 12.4 Droplet Precautions 12.24 12.5 Droplet/Contact Precautions 12.25 13. Patient and Family Information Sheets for Additional Precautions 12.27 Bilingual 14. Hand Hygiene Signs 14.1 Wash Your Hands Sign 4.25 x 5.5 12.28 14.2 Please Use the Hand Rub Provided Sign 4.25 x 5.5 12.29 14.3 Please Use the Hand Rub Provided Sign 8.5 x 11 12.30 14.4 Hand Hygiene Signs Bilingual 12.31 15. Fact Sheets 15.1 Extended Spectrum Beta Lactamase (ESBL) Producing 12.32 Bacteria Fact Sheet for Patient, Family & Visitors 15.2 Methicillin Resistant Staphylococcus aureus (MRSA) 12.34 Fact Sheet for Patient, Family & Visitors 15.3 Vancomycin Intermediate Resistant Staphylococcus aureus (VISA) 12.37 and Vancomycin Resistant Staphylococcus aureus (VRSA) Fact Sheet for Patient, Family & Visitors 15.4 Vancomycin-Resistant Enterococci (VRE) Fact Sheet 12.40 for Patient, Family & Visitors 15.5 Extended Spectrum Beta Lactamase (ESBL) Producing 12.42 Bacteria Fact Sheet for Healthcare Workers 15.6 Methicillin Resistant Staphylococcus aureus (MRSA) 12.45 Fact Sheet for Healthcare Workers 15.7 Vancomycin Intermediate Staphylococcus aureus (VISA) 12.48 and Vancomycin Resistant Staphylococcus aureus (VRSA) Fact Sheet for Healthcare Workers 15.8 Vancomycin-Resistant Enterococci (VRE) Fact Sheet 12.51 for Healthcare Workers 15.9 Testing for Methicillin Resistant Staphylococcus aureus (MRSA) 12.54 Fact Sheet for Patient & Family 15.10 Testing for Vancomycin-Resistant Enterococci (VRE) 12.56 Fact Sheet for Patient & Family 1.7
16. Infection Prevention & Control Signs 16.1 Price List 12.58 16.2 Ordering Process 12.59 References 13.1 1.8
Additional Precautions TABLE OF CONTENTS ALPHA LISTING Page Number Airborne Precautions 5.3 Introduction 5.3 Indications for Airborne Precautions 5.3 Accommodation 5.3 Healthcare Workers 5.4 Hand Hygiene 5.5 Personal Protective Equipment 5.5 Patient Transport 5.6 Patient/Family 5.6 Visitors 5.7 Airborne/Contact Precautions 5.18 Introduction 5.18 Indications for Airborne/Contact Precautions 5.18 Accommodation 5.18 Healthcare Workers 5.19 Hand Hygiene 5.19 Personal Protective Equipment 5.20 Patient Transport 5.21 Equipment and Environment 5.22 Patient/Family 5.23 Visitors 5.23 Contact Precautions 5.9 Introduction 5.9 Indications for Contact Precautions 5.9 Accommodation 5.10 Hand Hygiene 5.10 Personal Protective Equipment 5.10 Patient Transport 5.11 Equipment and Environment 5.11 Patient/Family 5.12 Visitors 5.12 Discontinuation of Additional Precautions 5.2 DATE ISSUED: REVISION DATE: 1.9
Droplet Precautions 5.13 Introduction 5.13 Indications for Droplet Precautions 5.13 Accommodation 5.13 Hand Hygiene 5.14 Personal Protective Equipment 5.14 Patient Transport 5.15 Patient/Family 5.15 Visitors 5.16 Droplet/Contact Precautions 5.25 Introduction 5.25 Indications for Droplet/Contact Precautions 5.25 Accommodation 5.25 Hand Hygiene 5.26 Personal Protective Equipment 5.26 Patient Transport 5.28 Equipment and Environment 5.28 Patient/Family 5.29 Visitors 5.30 Implementation of Additional Precautions 5.1 Introduction 5.1 Appendix Additional Precautions Signs English Airborne Precautions Sign 12.14 Airborne/Contact Precautions Sign 12.15 Contact Precautions Sign 12.16 Droplet Precautions Sign 12.17 Droplet/Contact Precautions Sign 12.18 Additional Precautions Signs Bilingual 12.19 Air Changes for Removal of Airborne Contaminants 12.8 ARO Fact Sheets - Extended Spectrum Beta Lactamase (ESBL) Producing Bacteria 12.32 Fact Sheet for Patient, Family & Visitors Methicillin Resistant Staphylococcus aureus (MRSA) Fact Sheet 12.34 for Patient, Family & Visitors Vancomycin Intermediate Resistant Staphylococcus aureus 12.37 1.10 DATE ISSUED: REVISION DATE:
(VISA) and Vancomycin Resistant Staphylococcus aureus (VRSA) Fact Sheet for Patient, Family & Visitors Vancomycin-Resistant Enterococci (VRE) Fact Sheet for Patient, 12.40 Family & Visitors Extended Spectrum Beta Lactamase (ESBL) Producing Bacteria 12.42 Fact Sheet for Healthcare Workers Methicillin Resistant Staphylococcus aureus (MRSA) Fact Sheet 12.45 for Healthcare Workers Vancomycin Intermediate Resistant Staphylococcus aureus 12.48 (VISA) and Vancomycin Resistant Staphylococcus aureus (VRSA) Fact Sheet for Healthcare Workers Vancomycin-Resistant Enterococci (VRE) Fact Sheet for 12.51 Healthcare Workers Testing for Methicillin Resistant Staphylococcus aureus (MRSA) 12.54 Fact Sheet for Patient & Family Testing for Vancomycin-Resistant Enterococci (VRE) Fact 12.56 Sheet for Patient & Family Cover Your Cough Cover Your Cough Pamphlet English 12.9 Cover Your Cough Poster #1 English 12.11 Cover Your Cough Poster #2 English 12.12 Cover Your Cough Bilingual 12.13 Donning Personal Protective Equipment (PPE) 12.5 Hand Hygiene Procedure: Using an Alcohol-Based Hand Rub 12.2 Hand Hygiene Procedure: Using Plain Soap or Antimicrobial Soap 12.3 Hand Hygiene Quick Reference Chart 12.1 Hand Hygiene Signs Wash Your Hands Sign 4.25 x 5.5 12.28 Please Use Alcohol-Based Hand Rub Sign 4.25 x 5.5 12.29 Please Use Alcohol-Based Hand Rub Sign 8.5 x 11 12.30 Hand Hygiene Signs Bilingual 12.31 Infection Prevention & Control Signs - Infection Prevention & Control Signs Price List 12.58 Infection Prevention & Control Signs Ordering Process 12.59 1.11 DATE ISSUED: REVISION DATE:
Patient and Family Information Sheets for Additional Precautions - English Airborne Precautions 12.20 Airborne/Contact Precautions 12.21 Contact Precautions 12.23 Droplet Precautions 12.24 Droplet/Contact Precautions 12.25 Patient and Family Information Sheets for Additional Precautions 12.27 Bilingual Personal Protective Equipment Criteria for Respiratory Infections 12.4 Removing Personal Protective Equipment (PPE) Prior to Exiting 12.6 Patient Room Removing Personal Protective Equipment (PPE) Immediately After 12.7 Exiting Patient Room Clinical Presentation/Microorganism/Infectious Disease Table 6.1 Definitions 11.1 Individual Site Specific Protocols, Policies & Information Refer to Table of Contents located in this section Introduction After Hours Coverage 2.5 Breaking the Chain of Infection 2.8 Chain of Infection 2.6 Links in the Chain of Infection 2.6 Purpose of the WRHA Infection Prevention and Control Manual 2.1 Site Specific Infection Prevention & Control Program 2.3 Transmission of Microorganisms 2.9 WRHA Infection Prevention & Control Program 2.2 Medical Device Reprocessing Medical Device Reprocessing - Event Notification Process 10.5 Single-use Medical Devices 10.1 Sterilizer Quality Assurance Monitoring 10.8 1.12 DATE ISSUED: REVISION DATE:
References 13.1 Routine Practices Hand Hygiene 4.3 Important Factors in Hand Hygiene 4.3 When to Perform Hand Hygiene 4.4 Agents Used for Hand Hygiene 4.5 How to Perform Hand Hygiene 4.5 Patient/Visitors 4.6 Introduction 4.1 Patient Management 4.9 Accommodation 4.9 Equipment 4.10 Environmental Control 4.11 Specimen Collection 4.11 Visitors 4.12 Education 4.12 Postmortem Care 4.12 Personal Protective Equipment 4.7 Gloves 4.7 Gowns 4.8 Masks 4.8 Eye Protection 4.8 Face Protection 4.9 Respiratory Etiquette 4.9 Specific Disease Protocols Acquired Immunodeficiency Syndrome (AIDS) Human Immunodeficiency Virus 7.7.1 Antibiotic Resistant Organisms 7.2.1 Extended Spectrum Beta Lactams (ESBLs) 7.2.1 Methicillin-Resistance Staphlococcus Aureus (MRSA) 7.2.10 Vancomycin Resistant Enterococci (VRE) 7.2.20 Vancomycin-Resistant Intermediate Staphylococcus Aureus 7.2.31 (VISA) Vancomycin-Resistant Staphlococcus Aureus (VRSA) 7.2.34 1.13 DATE ISSUED: REVISION DATE:
Creutzfeldt-Jakob Disease (CJD) 7.8.1 Diarrhea 7.3.1 Bacterial 7.3.1 Clostridium difficile associated diarrhea (CDAD) 7.3.4 Other infectious microorganisms 7.3.6 Viral 7.3.8 Group A Streptococcus 7.9.1 Hepatitis 7.10.1 Hepatitis A (HAV) 7.10.1 Hepatitis B (HBV) 7.10.5 Hepatitis C (HCV) 7.10.10 Immunocompromised Condition 7.11.1 Influenza (Seasonal) 7.6.1 Measles/Rubeola 7.12.1 Meningitis 7.13.1 Hemophilus meningitis 7.13.1 Meningococcal meningitis 7.13.3 Pneumococcal meningitis 7.13.6 Viral meningitis 7.13.9 Mumps 7.14.1 Pandemic Influenza P1 Pediculosis (Lice) 7.15.1 Pertussis 7.16.1 Rubella (German Measles) 7.17.1 Scabies 7.18.1 Severe Respiratory Illness 7.19.1 Tuberculosis (TB) 7.4.1 1.14 DATE ISSUED: REVISION DATE:
Varicella Zoster Virus (VZV) 7.5.1 Chickenpox (Varicella) 7.5.1 Shingles (Herpes Zoster) 7.5.5 Specific Infection Prevention and Control Practices 4% Chlorhexidine to 2% Chlorhexidine for hand antisepsis and 8.1 cleansing Infection Prevention & Control (IP & C) Wound Management Principles 8.11 Infection Prevention & Control Management of solution and equipment 8.3 for wound irrigation Reuse of electrical razors for personal hygiene 8.5 Sharing of personal items 8.7 String cords and call bells in patient care areas 8.9 WRHA Infection Prevention and Control Policies & Operational Directives Admission Screening of Patients for Antibiotic Resistant Organisms (MRSA & VRE) 3.13 Cleaning of Non-Critical, Reusable Items 3.15 Gels, Ultrasound and Medical 3.10 Nursing Foot Care Infection Prevention & Control Management 3.1 Routine Practices for Reducing the Risk of Infection Transmission 3.5 1.15 DATE ISSUED: REVISION DATE: