Presenters at the Cleaning & Disinfection Symposium held during the 2023 IPAC Canada annual meeting were ( seated from left ) Natalie Bruce , Michelle Alfa , Victor Leung and Jim Gauthier .
Remind your staff to consistently apply precautions . Remind them if they have a patient that doesn ’ t have any skin , feces or mucous membranes and you ’ re just working with a skeleton in the bed , fine , do what you want , but generally speaking , there ’ s a potential for infection in front of you every time , otherwise .” no contact droplet sign . I asked her about it and she said , ‘ Well , there ’ s nothing in it ( the sputum ).’ Now you know where this talk came from .”
During his presentation , Gauthier referred to a modified diagram of horizontal infection prevention practices derived from Wenzel and Edmond ( 2010 ).
He pointed to hand hygiene on the diagram . “ Let ’ s start with handwashing ,” he said . “ We do worry about hand hygiene among healthcare personnel and how well we teach it to them . What are your rates like ? I really don ’ t think we should be auditing our staff for hand hygiene because after all , they are by and large trained professionals , many of whom have a degree . So , why am I standing in a hallway to make sure they actually do this ? They know when to wash their hands . Instead , where do I want to put that time ? I say patient hand hygiene . In the time that I spent in the hallway with my iPad to record hand hygiene moments among staff , I could have explained to patients , “ Please don ’ t touch the environment and then eat something that was brought into your room . Please don ’ t touch a dressing and then touch your face , as that ’ s a portal of entry .’ ‘ Patients pick up microbes from their environment and are self-Inoculating because we either don ’ t tell them to wash their hands or we make it almost impossible to perform hand hygiene , or they just don ’ t have the capability to perform hand hygiene due to their illness .”
Gauthier continued . “ We could do also do a better job of cleaning and disinfecting the environment . Microbes get deposited on surfaces , and with biofilms , it ’ s very easy to pick it up and move it to other surfaces . We need better elbow grease by staff . However , how many of you in the past two years have heard that your EVS department has had to cut its budget ? The pandemic apparently was very expensive , so we ’ re going to save money by cutting cleaning and disinfecting efforts . Sorry , run that past me again . It should be , ‘ Let ’ s increase EVS by 20 percent , get more people out there cleaning and disinfecting .’”
Gauthier addressed high-touch surface cleaning and disinfection . “ In the paper that we published , we outlined five moments of environmental disinfection before you put something on a patient ’ s over-bed table . Why don ’ t we disinfect it before and after an aseptic procedure ? After anything to do with feces or respiratory secretions in the patient ’ s bed space , be sure to disinfect . Any patient bathing within the patient ’ s bed space , something needs to be wiped down . Anything used by or used on a patient that touches the floor needs to cleaned . How many times a day do you think someone comes into the room and sees the cell phone , cell phone charger , or call bell button on the floor , picks it up and hands it to the patient without cleaning it ?”
He then pivoted to personal protective equipment ( PPE ). “ We need to perform certain procedures while always wearing PPE , the first one being any patient care involving feces . I don ’ t care how good you are , if you ’ re changing your patients out of an incontinence product , if you ’ ve had a patient who was incontinent in bed and you need to change the bed , the first thing staff always do is look at the door , thinking , ‘ It does not say contact precautions so I don ’ t need PPE .’ I think we need to be very , very aware of how and when we use PPE . There are certain situations for which we need to don PPE , and soiling in the patient environment is the big one , or working with something that has gazillions of bacteria in it . So , if I ’ m suctioning a patient , I should have something covering my face because I ’ m creating this little aerosol that if I collected it all , it would have trillions of microorganisms in it . So , yeah , you probably should have face protection on when suctioning a patient .”
Gauthier alluded to the current debate over what constitutes aerosol-generating procedures .
“ We ’ re going to see a lot more research post-COVID as to what is truly an aerosol-generating procedure
24 july 2023 • www . healthcarehygienemagazine . com