National Infection Prevention and Control Guidelines for ...

1 THE National . Infection Prevention AND Control . Guidelines . FOR ACUTE HEALTHCARE FACILITIES. 2017. Foreword _____. The National Infection Prevention and Control Committee (NIPC) was appointed by the Singapore Ministry of Health in 2014 and charged with a number of tasks including reform and consolidation of National Guidelines . It is with great pleasure therefore that I present the 2017 National Infection Prevention and Control Guidelines for the acute care setting. This version is built on many previous publications from sources including Singapore's Ministry of Health (MOH), the Infection Control Association of Singapore (ICAS), and international sources including Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO) and peer-reviewed literature.

2 Specifically in this version, we have excluded sections dedicated to the non-acute sectors, and we will compile this in a separate document. We have also brought in and modified pre-existing standalone documents related to multi-drug resistant organisms and environmental cleaning. These Guidelines can be used as a reference for healthcare professionals, management and operations staff to ensure protocols and processes for Infection Prevention and Control are appropriately adapted and in place in all of Singapore's acute healthcare settings. The NIPC committee and secretariat welcome feedback, particularly in areas for improvement which will as a matter of course be considered for future editions. Finally, I would like to give particular acknowledgement to the writing committee (see acknowledgement page) and all Infection Prevention and Control specialists who provided expert input to the drafting of these Guidelines .

3 Dale Fisher Chairperson, National Infection Prevention and Control Committee National Infection Prevention Control Guidelines for Acute Healthcare Facilities, 2017 Page | 2. Part I. Specific Precautions Acknowledgement _____. The National Infection Prevention and Control Guidelines 2017 has been endorsed by the National Infection Prevention and Control Committee (NIPC). The composition of the NIPC is provided in Table 1. Table 1. Composition of NIPC. S/N Name Role Designation NIPC members 1 Prof Dale Fisher Chairperson Head and Senior Consultant, Infectious Disease, National University Hospital 2 Dr Brenda Ang Member Senior Consultant, Infectious Disease, Tan Tock Seng Hospital 3 Dr Hsu Li Yang Member Head and Senior Consultant, Infectious Disease, Tan Tock Seng Hospital 4 Ms Lee Lai Chee Member Assistant Director, Nursing Division, Singapore General Hospital 5 Dr Ling Moi Lin Member Director, Infection Prevention and Control , Singapore General Hospital 6 Dr Kalisvar Member Consultant, Department of Infectious Marimuthu Disease, Tan Tock Seng Hospital MOH Representatives and NIPC Secretariats 7 Dr Lim Eng Kok MOH Director, Clinical Quality.

4 Performance Representative and Technology Division, MOH. 8 Dr Yvonne Koh MOH Deputy Director, Patient Safety and Representative Quality Improvement Branch, Clinical Quality, Performance and Technology Division, MOH. 9 Dr Felicia Hong Secretariat Assistant Director, Patient Safety and Quality Improvement Branch, Clinical Quality, Performance and Technology Division, MOH. 10 Ms Suhana Secretariat Senior Manager, Patient Safety and Solhan Quality Improvement Branch, Clinical Quality, Performance and Technology Division, MOH. 11 Ms Kelly Liew Secretariat Manager, Patient Safety and Quality Improvement Branch, Clinical Quality, Performance and Technology Division, MOH. National Infection Prevention Control Guidelines for Acute Healthcare Facilities, 2017 Page | 3.

5 Part I. Specific Precautions The MOH would like to acknowledge Dr Ling Moi Lin (Director, Infection Prevention and Control , Singapore General Hospital) for leading the various groups of experts in the writing and revision of the Guidelines . The experts who contributed in their individual capacity to the revision of the Guidelines are listed in Table 2. Table 2. Experts who contributed to the revision of the Guidelines (in alphabetic order). Name Designation Dr Brenda Ang Senior Consultant, Infectious Diseases, Tan Tock Seng Hospital Ms Gabrielle Chia Staff Nurse, Infection Control , Tan Tock Seng Hospital Ms Tenny Chow Assistant Director, Operations, Changi General Hospital Ms Chua Gek Hong Chief Infection Control Officer & Assistant Director Nursing, Parkway Pantai Ltd Dr Chuan Lee Ren, Associate Consultant, Infectious Diseases, Department of Leyland Medicine, Ng Teng Fong General Hospital and Jurong Community Hospital, Jurong Health Services Pte.

6 Ltd. Prof Dale Fisher Head, Infectious Diseases, National University Hospital Ms Molly How Senior Nurse Clinician, Infection Prevention & Control , Singapore General Hospital Dr Koh Tse Hsien Head, Diagnostic Bacteriology, Pathology, Singapore General Hospital Ms Lam Fong Kim Senior Nurse Clinician, Infection Control , Institute of Mental Health Ms Lily Lang Nurse Manager ( Infection Control Dental), National Healthcare Group Polyclinics Ms Lee Ewe Choon Assistant Director, Environmental Services, Singapore General Hospital Ms Lee Lai Chee Assistant Director, Nursing ( Infection Prevention and Control ), Singapore General Hospital Ms Lee Shu Lay Infection Control Manager, Nursing Administration, Thomson Medical Centre Ms Lim Siok Hong Assistant Director, Infection Control , KK Women's and Children's Hospital Mr Razali Mahdi Nurse Clinician, Infection Control , National University Hospital Ms Ng Kim Sim Senior Nurse Manager, Infection Control , Ng Teng Fong General Hospital Dr Surinder Kaur Pada Senior Consultant and Director, Infectious Diseases, Ng Teng Fong General Hospital, Jurong Health Services Dr Sharon Salmon Assistant Director of Nursing ( Infection Prevention and Control ), National University Hospital Prof Paul Professor of Medicine, Yong Loo Lin School of Medicine, National Anantharajah University of Singapore.

7 And Tambyah National Infection Prevention Control Guidelines for Acute Healthcare Facilities, 2017 Page | 4. Part I. Specific Precautions Senior Consultant, Infectious Diseases, National University Hospital Ms Tan Kwee Yuen Senior Nurse Clinician, Infection Prevention & Control , Singapore General Hospital Dr Nancy Tee Head, Department of Pathology and Laboratory Medicine, KK. Women's and Children's Hospital Ms Cathrine Teo Senior Nurse Clinician, Infection Prevention , National University Hospital Ms Caroline Wong Senior Manager, Environmental Services, Singapore General Hospital Ms Hernie Nurse Clinician, Infection Control , KK Women's and Children's Mohommad Yunos Hospital National Infection Prevention Control Guidelines for Acute Healthcare Facilities, 2017 Page | 5.

8 Part I. Specific Precautions Content _____. Foreword .. 2. 3. 6. PART I. SPECIFIC PRECAUTIONS .. 10. Chapter 1. Standard Precautions .. 11. 1 Chain of Infection .. 11. 2 Rationale for Standard Precautions .. 13. 3 Components in Standard Precautions .. 14. 4 Recommendations .. 19. 5 Glossary .. 20. 6 References .. 21. Chapter 2. Droplet Precautions .. 22. 1 Patient Placement .. 22. 2 Signage .. 22. 3 Personal Protective Equipment (PPE) / Hand Hygiene .. 23. 4 Environmental Control .. 23. 5 Patient-care equipment and linen .. 23. 6 Patient transport .. 23. 7 Communication .. 24. 8 Recommendations .. 24. 9 Glossary .. 24. 10 References .. 25. Chapter 3. Contact Precautions .. 26. 1 Patient Placement .. 26. 2 Personal Protective Equipment.

9 26. 3 Environmental Control .. 27. 4 Patient care equipment and linen .. 27. 5 Patient Transport .. 27. 6 Communication .. 28. 7 Recommendations .. 28. 8 Glossary .. 29. 9 References .. 29. Chapter 4. Airborne Infection Isolation 30. 1 Patient Placement .. 30. 2 Aerosol-generating procedures .. 31. 3 Personal Protective Equipment (PPE) .. 31. 4 Equipment /Consumables .. 32. 5 Dishware and eating utensils .. 32. 6 Environment cleaning .. 32. 7 Personnel Restriction .. 32. 8 Visitors .. 33. 9 Patient transport .. 34. 10 Communication .. 34. 11 Recommendations .. 34. 12 Glossary .. 35. 13 References .. 35. Chapter 5. Protective Environment .. 36. 1 Patient Placement .. 36. 2 Ventilation/Environmental Control .. 36. 3 Personal Protective Equipment (PPE).

10 37. 4 Equipment /Consumable .. 37. 5 Environment cleaning .. 37. 6 Staff Restriction .. 38. National Infection Prevention Control Guidelines for Acute Healthcare Facilities, 2017 Page | 6. Part I. Specific Precautions 7 Visitors .. 38. 8 Patient transport .. 38. 9 Communication .. 39. 10 Recommendations .. 39. PART II. STANDARD Infection Prevention AND Control PRACTICES 41. Chapter 6. Hand Hygiene .. 42. 1 Concept of hand hygiene for inpatients and outpatient .. 42. 2 Indications for hand hygiene .. 44. 3 Sequence of care .. 48. 4 Methods of hand hygiene .. 49. 5 Hand Care .. 50. 6 Evaluation of hand hygiene products .. 51. 7 Factors to consider when selecting hand hygiene products .. 55. 8 Hand hygiene program .. 57. 9 Evaluation of hand hygiene program.