Contamination

Back to: Linking to Care, Point of Care Testing (POCT). Aotearoa Edition

For this lesson, please take your time. This is a lot of information and opportunity to learn for you, whanau and friends, The provided links and materials are available for self-paced learning with key messaging and expected take home learnings well indicated. This is a consolidation of many areas of learning and a complex minefield of information. Health Network Collective would really appreciate your spending time in better understanding contamination risk and possible outcomes as a result of contamination. Especially when it comes to your health and wellbeing, and having the learned confidence to deal with possible contamination scenarios that may occur at some stage. This is not to scare you or cause fear. This is to empower you with preventative measures and assurance that following best practice most often leads to good outcomes. A 2023 study conducted at the peak of the COVID epidemic showed a rate of 2.79 needle stick injuries (see needle stick injuries below) per 100,000 injections, up from some 0.79 per 100,000 pre COVID. Health Network Collective is not conducting mass vaccinations at the time of writing, we are conducting controlled calm finger prick tests. Smaller needles calmer environment and not as pressured as the COVID time has been.

Contamination is a broad word in terms of definition and meaning. A succinct and broad definition can be found in the Cambridge Dictionary;

noun [ U ]; UK  /kənˌtæm.ɪˈneɪ.ʃən/ US  /kənˌtæm.əˈneɪ.ʃən/

the process of making something dirty or poisonous, or the state of containing unwanted or dangerous substances

In the context of Health Network Collective activities and procedures this is not the best of definitions in that it contributes to enforcing stigmas and untoward perceptions of HCV and similar conditions. In the context of your safety and wellbeing this is appropriate to help you understand that contamination and risk of contamination may result in your un-wellness or the risk of un-wellness for those that we seek to help.

In Tabers Medical Dictionary the definition related to medical and clinical contamination is more appropriate; 1. The act of contaminating, esp. the introduction of pathogens or infectious material into or on normally clean or sterile objects, spaces, or surfaces.

It is also important to recognize the difference between contamination and infection in our context. Especially in the narrative you will develop for any conversations or education you may enter into with colleagues, wai ora; or anyone.

Contamination is the non-intended or accidental introduction of infectious micro-organisms to any environment. This includes however is not limited to bacteria, yeast, fungi, protozoans, virus and prions. It can also include contamination by toxins such as endotoxins, exotoxins and any of their by by-products.

Infection is the invasion of our body tissues by microbes. Possibly as a result of contamination. This may be from injection, ingestion, inhalation or absorption.

• Nose, mouth (respiratory), we breath the microbe in from someone breathing sneezing or coughing it out. These are airborne Pathogens.
• Infected wounds, eye discharge. This may be direct or indirect contamination (wound to wound, or eye to hand to surface to hand…)
• Contaminated surfaces, to skin
• Contaminated food, water or associated systems
• Antibiotic-resistant pathogens (such as MRSA)

So, consider in very broad terms, contamination is cause leading to effect, the effect is infection. Even the best of procedure, education and process can result in inadvertent contamination. And the same can be said for infection. For you it is important to understand risk of contamination can be minimized, hopefully reducing the risk of infection. All Health Network Collective needs you to understand is that contamination is spreading nasties, largely by accident, and infection is getting unwell or sick.

For interest, contamination can also apply to radiation, stress responses to environmental contamination, psychological effect (words running together into non-sensical meanings), land and environment contamination… and the list goes on… A decent google search produces many results, Health Network Collective does not recommend “Dr Google” based assumptions or diagnosis in the absence of qualified opinion.

Prevention is better than cure. In previous lessons we have looked at

• Overview and Learning Agreement
• People Centered Practice and Personal Safety
• Hepatitis C (HCV)
• Basic Hygiene; including the 5 Moments of Hand Hygiene, Use of Hand Sanitizer and this lesson on Contamination.

All of these are contributors to reducing or mitigating the risk of contamination. As we have mentioned, there is never a guarantee of eliminating the risk of contamination. There is no one single act that is the magic solution, hence our best defense is to be diligent, take our time and follow best practice at all times. In saying that, our 5 moments of hand hygiene with good hand washing / hygiene technique really can help.

Standard Precautions; to reiterate, 5 moments of hand hygiene and good hand washing techniques combined with always following best practice. We can support this with personal preparedness measures of ensuring our vaccinations are up to date and we are maintaining good or better personal hygiene at all times.

• Hand hygiene, as discussed in previous sections
• Appropriate Personal Protective Equipment, as discussed below
• Cough etiquette, coughing or sneezing into the crook of you elbow or tissue. If using tissues, they go in the bin followed by hand washing
• Safe use of needles and other sharps, again we will discuss in detail in following sections.
• Aseptic “no touch” techniques where ever possible, we will explore this further when cover our POCT procedures in a following section.
• No reusing of disposable or single use equipment or items.
• Safe waste management and good environmental hygiene practice.

Personal Protection Equipment (PPE); we will discuss masks, gloves and other forms of PPE in the following sections. For now, consider that any risk of respiratory conditions, such as COVID or Influenza in the community would be extremely suggestive of wearing masks, for both kaiawhina or health worker, and for wai ora or person seeking health. Use of gloves is not compulsory, however, as we are testing blood there is a risk of blood contamination so glove use is recommended. We will discuss this further in a following section.

Body Fluid Spills; cleaning and appropriate first aid is essential.

• Ensure you and the patient are safe, for example bleeding control if required. Simply put; – all persons have air going in and out, and blood going around and around – within the body.
• Reassure our wai ora, and yourself. Take your time, be purposeful not rushed or panicked.
• Avoid further contamination, this may be distancing yourself from the risk.
• Apply suitable further first aid as required and indicated.
• Clean the affected areas thoroughly. Soap and water with good washing technique is best, although sanitizers are suitable if the situation dictates use of sanitizer(s). Obvious visible contaminate must be cleaned and removed followed by a thorough efficient clean of the affected and surrounding areas.
• Dress any wounds appropriately.
• Seek medical advice in all cases. Document and report as appropriate to your local health professional, they will inform you of the pathways for further actions, tests and requirements.
• We will discuss needle stick injury (NSI) in further detail below.

Needle Stick Injury (NSI). Follow the steps as described in body fluid spills above and SEEK PROFESSIONAL MEDICAL ADVICE

• If you pierce, puncture or even suspect a needle scraped or pierced your skin, see a health professional immediately or seek professional medical advice as soon as possible.
• Any needle injury, regardless of where or how the needle has been used, must be considered a risk of infection from hepatitis B & C, HIV and other viruses.
• The risk is dependent on several factors such as whether the person(s) the needle pierced have infection and their viral load, or number of viruses in the blood. Let your medical professional be the judge of this supported by their recommended tests and follow-ups.

The Waiting Room,

• keep it simple with chairs and surfaces having non-porous surfaces. This allows more efficient cleaning of surfaces and reduces spaces for nasties to hide.
• Keep in mind children’s toys may be a nice distraction for parents seeking care, they are very efficient at hiding and transmitting microbes.
• If the room can be well ventilated with fresh moving air, all the better.
• Spacing is preferred and maintaining a reasonable schedule to minimize the number(s) of persons waiting where possible should be adhered to.
• Clean frequently. The area should appear clean and tidy to any persons arriving at any time.
• In times of respiratory conditions being prevalent in the community have masks available at the entrance
• Where possible have clean rest rooms with hand washing facilities available
• Place hand sanitizers strategically in and around entrances and waiting areas
• Waiting rooms are a great education opportunity, place posters and awareness materials in the area so they are visible and accessible.

The Real Risk of HCV HBC HIV contamination.

For the purpose of this lesson, and Health Network Collective activities, we will consider the risk as very real and subject to discussion, testing and confirmation by seeking further medical advice from a health professional such as a doctor.

Please download the file “Contamination and Exposure Recommendations, BPAC NZ” from the course materials available for this lesson for further information and reference in your workplace.

Summary; Best practice with frequent hand washing, and following the 5 moments of hand hygiene, is a great step towards mitigating the risk of contamination. We can’t absolutely remove the risk of contamination so in the event of perceived or real contamination (for example when you are not sure) follow contamination procedure as we have discussed in this section, and seek professional medical advice as soon as possible. Preferably immediately.