Infection control: General knowledge

At the end of this chapter, you will be able to:

• identify strategies to prevent infections
• describe signs and symptoms of a respiratory infection
• demonstrate proper hand hygiene
• review how to maintain a clean environment

To control infections, it is very important to practise good hand hygiene, keep your child's hands, tracheostomy tube and equipment clean and make sure the air at home is free of pollution (e.g., dust, cigarette smoke, fragrances from household cleaners).

Because your child already has a condition that requires a tracheostomy tube, preventing infection is even more important for their health.

How can I prevent my child from getting an infection?

• Always wash your hands properly. (link to AKH hand hygiene AND section below)
• Have a smoke-free home.
• Ask visitors to stay away if they are sick (for example, if they have a cough, fever or runny nose).
• Make sure anyone who is sick – but needs to be around your child to help care for them – cleans their hands often.
• It is advisable for the individual who has symptoms to wear a mask.
• If the person needs to cough, sneeze, or touch their face, they should step away from your child and turn their head to avoid coughing or sneezing on your child or anything in your child’s immediate environment.
• Before the person returns to your child's side, they should clean their hands.
• Keep your child’s stoma and surrounding dressings (if required) clean and dry.
• Clean equipment and other surfaces regularly.
• Provide good mouth care for your child.
• Routine vaccinations for the child and family members such as pneumococcal, annual influenza (flu) and COVID-19 vaccines.
• COVID-19 vaccine for children and adolescents
• HINT: When to worry and how to assess for symptoms of COVID-19 in congregate/community settings? from Connected Care @ SickKids
• Respiratory syncytial virus (RSV) prophylaxis, as recommended by your child’s healthcare team
• Follow protocols for masking, personal protective equipment (PPE), aerosol generating medical procedures (AGMP’s).

What is an AGMP?

• An AGMP is an aerosol generating medical procedure.
• Tracheostomies have the potential to generate aerosols and it is important to use appropriate PPE when doing any tracheostomy care.
• Non-family caregivers, for example home or school nurses, must consider appropriate PPE. This will depend on practices directed by public health and employer policies.

How do I provide good mouth care for my child?

• Provide good mouth care for your child. Good dental care and regular visits to the dentist can prevent infections that affect the entire body.
• Reduce the risk of future dental problems such as cavities and gingivitis.

Cleaning your child’s mouth

• All children require oral hygiene.
• Start cleaning your child's gums and teeth early.
• Wipe a newborn baby’s gums with a soft, clean, damp cloth after feeding.
• At around 3 months old, wipe your baby’s gums with a damp cloth after every feeding. When the first tooth appears, you can start using a baby toothbrush.
• For more information on mouth care, visit the Canadian Dental Association or the Canadian Paediatric Society websites.

Tooth brushing

• As soon as your child’s teeth poke through the gums, you and your child should clean them with a toothbrush.
• Take your child to their first dentist appointment within six months of the eruption of their first tooth or by 12 months of age.
• If, for example, your child is unable to tie their own shoelaces and cut food with a knife and fork on their own, you will need to assist your child with brushing their teeth. When a child is ready to start brushing their own teeth, it is important that you check that they do a good job brushing.
• To avoid excessive swallowing of toothpaste by young children, children developmentally younger than 6 years of age should be supervised during brushing and only use a small amount of toothpaste.
• Brush with only water or use a small amount of fluoride toothpaste (less than the size of a grain of rice for children younger than 3 years old; a pea sized amount for children aged 3 to 6 years old).
• Talk to your child’s dentist about balancing your child’s risk for swallowing toothpaste with their risk for dental decay.
• Speak to your child’s dentist about modified tooth brushing if you feel your child requires this.

Flossing

Get your child to start flossing early. In most cases, it is a good idea to start when your child's back teeth touch each other. This usually occurs around age three. Flossing is important because a toothbrush cannot clean between teeth.

What are the signs that my child has an infection?

Your child may have an infection if they:

• have signs of respiratory distress
• are coughing more
• are sleepy and/or irritable
• feel unwell
• are not tolerating feeds and/or are vomiting
• have a fever or chills
• are more short of breath than usual
• have chest tightness

Your child may have an infection if their mucus:

• is thick
• has increased
• is yellow or green
• is tinged with blood
• has an unpleasant smell

Your child might have an infection if their stoma:

• is red, swollen and/or painful
• has excoriation (skin breakdown)
• has increased secretions accompanied by other signs of infection
• has coloured discharge
• has granulation tissue (extra tissue growth, called a granuloma)

Finally, your child may have an infection if:

• they start to need oxygen or need more oxygen than usual
• they need to be suctioned more often
• they need to use inhalers (puffers) more often
• they otherwise look unwell
• their ventilator’s high pressure or low volume al​arms​ are going off more than usual

What should I do if I think my child has an infection?

If you think your child might have an infection:

• call your child's health-care team
• follow instructions provided by your child’s health-care team on giving your child medications, such as antibiotics

For severe respiratory infections (e.g., COVID-19, flu), follow advice from:

• your child’s health-care team
• your local, provincial or federal public health department

Hand hygiene

When should I wash my hands?

Wash your hands:

• before and after every suction
• before and after every tracheostomy tube change
• before and after stoma care
• after handling dirty equipment
• when your hands are dirty, especially if you can see dirt
• before, during and after you prepare food
• before you eat, feed a child or give medication
• after you use the bathroom
• after you change your child’s diaper or help them use the bathroom
• after you touch blood or other body fluids such as saliva, vomit and/or mucus
• after sneezing, coughing or blowing your nose
• after you touch animals or pick up their waste
• after you handle garbage
• immediately after returning home from work or any outing outside of the household

How should I wash my hands?

1. Wet your hands thoroughly with warm water.
2. Apply enough liquid, foam, or clean bar soap to cover the entire surface of the hand (the palm and the back).
3. With your hands away from the water, rub your hands vigorously together.
4. Scrub all surfaces.
5. Make sure to get between the fingers and under the fingernails.
6. Wash the wrists and lower arms, if necessary.
7. Continue for at least 15 seconds or about the length of time it takes to hum a short song such as Happy Birthday twice. Both the soap and the scrubbing action help dislodge and remove germs.
8. Rinse well, removing all soap residue.
9. Dry your hands on a clean towel or paper towel.
10. Use the towel to turn the tap off.

Can I use hand sanitizer instead of soap and water?

Yes, you can use hand sanitizer if your hands are not wet, greasy, or visibly dirty. Rub your hands with the sanitizer until they become dry. To make the hand sanitizer effective against germs, make sure that it contains at least 70 per cent alcohol (ethanol or isopropyl alcohol [isopropanol]).

Although hand sanitizer can be more convenient at times, use soap and water if your hands are wet, greasy, or visibly dirty.

For more information on using hand sanitizer, please see the section “More information about the treatment” in the page “Hand hygiene”.