AUSTRALIAN GUIDELINES FOR THE Prevention and Control of Infection in Healthcare WORKING TO BUILD A HEALTHY AUSTRALIA © Australian Government 2010 Electronic documents This work is copyright. You may download, display, print and reproduce this material in unaltered form only (retaining this notice) for your personal, non-commercial use, or use within your organisation. Apart from any use as permitted under the Copyright Act 1968, all other rights are reserved. Requests for further authorisation should be directed to the Commonwealth Copyright Administration, Attorney-General’s Department, Robert Garran Offices, National Circuit, Canberra, ACT, 2600 or posted at www.ag.gov.au/cca. ISBN Online: 1864965223 © Australian Government 2010 Paper-based publication This work is copyright. Apart from any use permitted under the Copyright Act 1968, no part may be reproduced by any process without written permission from the Commonwealth available from the Attorney-General’s Department. Requests and inquiries concerning reproduction and rights should be addressed to the Commonwealth Copyright Administration, Attorney-General’s Department, Robert Garran Offices, National Circuit, Canberra, ACT, 2600 or posted at www.ag.gov.au/cca. ISBN Print: 1864965282 This document should be cited as: NHMRC (2010) Australian Guidelines for the Prevention and Control of Infection in Healthcare. Commonwealth of Australia. Acknowledgements Infection Control Guidelines Steering Committee The production of a document such as this requires a considerable effort over a long period. Special thanks and acknowledgment are due to the Infection Control Guidelines Steering Committee members for their generous donation of time, their technical advice and ongoing commitment to the project. Dr Ann Koehler (Chair); Dr Nick Demediuk; Prof Chris Baggoley; Ms Sylvia Gandossi; Clinical Prof Keryn Christiansen; A/Prof Tom Gottlieb; Dr Liz Coates; Mr Brett Mitchell; Prof Peter Collignon; Assoc Prof Peter Morris; Dr Celia Cooper; Ms Claire Boardman NHMRC—ICG Project Team, Canberra Tanja Farmer; Cathy Mitchell; Stephanie Goodrick; Kay Currie Technical writers—Ampersand Health Science Writing Elizabeth Hall; Jenny Ramson Australian Commission for Safety and Quality in Health Care Marilyn Cruickshank; Susanne Panasko; Sue Greig Disclaimer This document aims to combine a review of the best available evidence with current clinical and expert practice. It is designed to provide information based on the best evidence available at the time of publication to assist in decision-making. The members of the Infection Control Guidelines Steering Committee, the Australian Commission for Safety and Quality in Health Care and the National Health and Medical Research Council give no warranty that the information contained in this document and any online updates available on the NHMRC website is correct or complete. Infection prevention and control guidelines are necessarily general and are not intended to be a substitute for a healthcare professional’s judgment in each case. The members of the Infection Control Guidelines Steering Committee, the Australian Commission for Safety and Quality in Health Care and the National Health and Medical Research Council shall not be liable for any loss whatsoever whether due to negligence or otherwise arising from the use of or reliance on this document. This document can be downloaded from the NHMRC website: http://www.nhmrc.gov.au AUSTRALIAN GUIDELINES FOR THE PREVENTION AND CONTROL OF INFECTION IN HEALTHCARE Contents Contents Summary of recommendations . .1 Introduction . .7 Part a BaSICS of InfeCtIon PreventIon and Control 15 a1 Infection prevention and control in the healthcare setting . .17 A1.1 Risks of contracting a healthcare-associated infection. ................... 17 A1.2 Standard and transmission-based precautions . 21 a2 Overview of risk management in infection prevention and control . .23 A2.1 Risk-management basics. ............................................ 23 A2.2 Risk-management process . .......................................... 25 a3 A patient-centred approach . .29 A3.1 Patient-centred health care . ......................................... 29 A3.2 How does patient-centred care relate to infection prevention and control? . ............................................ 30 Part B Standard and tranSmISSIon-BaSed PreCautIonS 31 B1 Standard precautions . .33 B1.1 Hand hygiene . ..................................................... 34 B1.2 Personal protective equipment. ...................................... 46 B1.3 Handling and disposing of sharps . 62 B1.4 Routine management of the physical environment . 68 B1.5 Reprocessing of reusable instruments and equipment . .................. 78 B1.6 Respiratory hygiene and cough etiquette . 84 B1.7 Aseptic technique . ................................................. 85 B1.8 Waste management . 89 B1.9 Handling of linen . 90 B2 Transmission-based precautions . .91 B2.1 Application of transmission-based precautions . 92 B2.2 Contact precautions . ............................................... 94 B2.3 Droplet precautions . 97 B2.4 Airborne precautions . ............................................. 100 B2.5 Putting it into practice . 105 B2.6 Resources . ....................................................... 108 B2.7 References . 108 National Health AND Medical RESEARCH COUNCIL i AUSTRALIAN GUIDELINES FOR THE PREVENTION AND CONTROL OF INFECTION IN HEALTHCARE Contents B3 Management of multi-resistant organisms and outbreak situations . .109 B3.1 Management of multi-resistant organisms. ............................ 112 B3.2 Outbreak investigation and management . 121 B3.3 Putting it into practice . 129 B3.4 Resources . ....................................................... 129 B3.5 References . 130 B4 Applying standard and transmission-based precautions during procedures . .133 B4.1 Taking a risk-management approach to procedures . 134 B4.2 Therapeutic devices . 137 B4.3 Surgical procedures. ............................................... 148 B4.4 Putting it into practice . 153 B4.5 Resources . ....................................................... 155 B4.6 References . 156 B5 Supplementary information . .159 B5.1 Recommended routine cleaning frequencies for clinical, patient and resident areas in acute settings . 159 B5.2 Type and duration of precautions for specific infections and conditions . 165 B5.3 Exposure prone procedures (EPP). .................................. 179 B5.4 Examples of how to perform aseptic non-touch technique . ............. 184 B5.5 General infection control resources. ................................. 188 Part C OrganISatIonal SuPPort 191 C1 Management and clinical governance . .193 C1.1 Clinical governance in infection prevention and control . ................ 193 C1.2 Roles and responsibilities . .......................................... 194 C1.3 Infection prevention and control program . 196 C1.4 Risk management . 199 C1.5 Taking an organisational systems approach to infection prevention quality and safety. ....................................... 200 C2 Staff health and safety . .203 C2.1 Roles and responsibilities . .......................................... 203 C2.2 Health status screening and immunisation . 205 C2.3 Exclusion periods for healthcare workers with acute infections . 209 C2.4 Healthcare workers with specific circumstances . 211 C2.5 Exposure-prone procedures . 213 C2.6 Occupational hazards for healthcare workers . 215 C3 Education and training . .215 C3.1 Universities and training colleges . 215 C3.2 Healthcare worker education . ...................................... 216 C3.3 Education strategies . 217 C3.4 Example of education in practice — hand hygiene . .................... 218 C3.5 Patient engagement . 219 C3.6 Compliance and accreditation. ...................................... 220 ii National Health AND Medical RESEARCH COUNCIL AUSTRALIAN GUIDELINES FOR THE PREVENTION AND CONTROL OF INFECTION IN HEALTHCARE Contents C4 Healthcare-associated infection surveillance . .221 C4.1 Role of surveillance in reducing HAI. ................................. 221 C4.2 Types of surveillance programs . ..................................... 222 C4.3 Data collection and management . ................................... 224 C4.4 Outbreak surveillance. ............................................. 225 C4.5 Disease surveillance in office-based practice . 226 C4.6 Notifiable diseases . 227 C5 Antibiotic stewardship . .227 C5.1 Background . 227 C5.2 Antibiotic stewardship programs . ................................... 228 C5.3 Antibiotic stewardship surveillance methods . ......................... 230 C6 Influence of facility design on healthcare-associated infection . .231 C6.1 Facility design and its impact on infection prevention and control . 231 C6.2 Mechanisms for influencing healthcare-associated infection through environmental design . 232 C6.3 The benefits of single-bed rooms for patient isolation . 237 C6.4 Construction and renovation . 238 C7 Resources . .239 C7.1 Management and clinical governance . ................................ 239 C7.2 Staff health and safety. ............................................. 239 C7.3 Education and training . 240 C7.4 Surveillance. ...................................................... 241 C7.5 Antimicrobial Stewardship . ......................................... 241 C7.6 Facility design . .................................................... 241 C8 References . .243 aPPendICes 247 1 Membership and terms of reference of