Audiology Infection Control Practices

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AudiologyInfection Control Practices

• Bruce Gamage, BSN CIC
• Infection Control Consultant
• BCCDC

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Outline

• Basic risk factors in patients
• Risk of cross-contamination
• Chain of Infection
• Spaulding classifications
• Scope of practice
• Routine
• High risk procedures
• Routine Practices
• Employee Health
• BBF exposure

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Patient Risk Factors

• All treatment offered should minimize potential
  disease transmission
• Patients may have underlying disease
• May be immunosuppressed
• Drug related
• Leads to increase risk of infection from
  opportunistic organisms

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Chain of infection
Agent
Environment
Transmission
Host
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Agent

• Infectiousness
• Pathogenicity
• Source
• Period of infectivity
• Portal of exit

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Transmission

• Contact spread
• Common vehicle spread
• Airborne spread
• Vectorborne spread

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Host

• Portal of entry
• Non specific defense mechanisms
• Skin, tears, mucous membranes, stomach acid,
  inflammatory response
• Specific Immunity
• Natural immunity, vaccinations
• Host response

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Environment

• Dont over emphasize!
• Temperature
• Humidity
• Cleanliness

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Risk of cross-contamination

• Patients and technicians
• Variety of contacts with environment and objects
• Direct or indirect contact with multiple patients

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Spauldings Classifications

• Critical items
• Penetrate the skin, contact blood, unintact
  mucous membranes require sterilization
• E.g. curettes, wax loops, imittance and
  autoacoustic emissions probe tips, ear impression
  syringes and otoscopic specula
• Many of these items are available as disposables

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Spaulding's Classifications

• Semi-critical
• Contact intact mucous membranes - require
  high-level disinfection
• Non-critical
• Contact intact skin only - sterilization not
  required
• Require cleaning and disinfection

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Cleaning

• Remove gross contamination
• Most important step to disinfection or
  sterilization as soil will inhibit the process
• Accomplished with brush, wipe or ultrasonic
  machine

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Disinfection

• Kills specific organisms depending on chemical
  used
• QAC, Phenolic will kill vegetative bacteria,
  enveloped viruses (e.g. Hep B, C, HIV)
• Aldehydes, Concentrated Hydrogen peroxide,
  chlorine (bleach) will kill fungus, and enveloped
  viruses dependent on contact time. Not bacterial
  spores
• Prolonged contact time can provide sterilization.
  (must follow manufacturers recommendations for
  concentration and contact time)

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Disinfection

• Disinfection is acceptable for non-critical items
  items that do not penetrate the skin, touch
  mucous membranes
• Noncritical items
• Earmolds,
• in the ear hearing aids
• Supra-aural headphones
• Otoscope specula
• Probe tips
• Electrodes
• All items should be cleaned and disinfected
  between patients

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Disinfecting the Environment

• Surfaces in work areas should be disinfected
  regularly
• Disinfectant wipes/squirt bottle
• Waiting room toys
• Your saliva is my saliva

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Sterilization

• Kills all microbes, including spores
• Autoclaves
• Uses moist heat
• Must be used correctly
• Must be monitored
• Cold Sterilization
• Usually accomplished soaking in a chemical
  sterilant (e.g. 2 gluteraldehyde, 7.5 hydrogen
  peroxide)
• Requires correct contact time and concentration
• Solutions should be monitored

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Disposables

• Many items involved in cross-contamination are
  available as disposables
• Otoscope specula, probe tips, earmold impression
  syringe tips, insert receivers, probe microphone
  tubes.
• May be cleaned and reused on same patient
• Re-use of disposables between patients
• Dont go there!

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Scope of Practice

• Routine procedures
• More invasive procedures
• Exposure to body fluids
• Interoperative monitoring of cranial nerves
• Sensory evoked potentials
• Insertion needle electrodes
• Vestibular procedures (vomiting)
• Cerumen

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Routine Practices

• Aimed at controlling exposure between people and
  the environment/objects
• Varies with the nature of the contact from simple
  cleaning sterilization
• Responsibility of Clinician to provide a safe
  work environment for themselves, their colleagues
  and their patients
• Assume that every patient is potentially
  infectious

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Routine Practices

• Handwashing
• Soap
• Antibacterial soap
• Alcohol based hand rubs
• Equivalent to a handwash as long as hands are not
  visibly soiled

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Routine Practices

• Gloves
• Should be worn for all procedures where risk of
  exposure to body fluids ( e.g. cerumen
  management, draining ear, lesions present,
  cleaning spills and disinfecting)
• Single use
• Task specific
• Vinyl vs. Latex
• Utility Gloves for handling chemicals

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Routine Practices

• Protective apparel
• Safety glasses and masks should be worn is risk
  of splash or spatter of body fluids
• Cerumen removal
• Working with grinding or buffing wheel
• Masks for potential TB patients
• Disposable headphone covers for mass screenings

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Waste Disposal

• Waste that is contaminated with blood , body
  fluids (ear drainage, cerumen) can go in regular
  garbage unless dripping
• Saturated materials, tissue, etc. must be placed
  in biohazardous waste bags
• Proper sharps disposal
• GVRD regulations require that biohazardous
  waste/sharps must be picked up and processed
  (either sterilization or incineration)

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Employee Health

• Vaccinations
• Hepatitis B Vaccine
• MMR
• Diphtheria/tetanus (every 10 years)
• Influenza
• Varicella
• Hepatitis A? If working with high-risk population

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BBF exposure

• Blood or other potentially infectious body fluids
• Intact skin
• No risk wash with warm soapy water
• Splash to mucous membrane or sharps injury
• High risk flush with NS, water
• Dont squeeze or soak in bleach
• Report to nearest emergency department for
• Assessment type of exposure/status of source
• Baseline blood work
• Possible ART

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Summary

• Cross-contamination
• Cleaning, disinfection and sterilization
• Routine practices

Wash Your Hands