HS unit 7

Rules when dealing with a sterile field

-All sterile equipment is double wrapped. If tape used to close the sterile package has not changed color after autoclaving, it should be considered contaminated. -All sterile packages must bear an expiration date. When opening a sterile package, only clean hands should touch the outside of the package. -The inside of sterile packages can be touched only with sterile gloves. Only sterile surfaces may contact sterile surfaces. -Commercially prepared sterile packages will be sealed. If the package is in poor condition, consider the items to be non-sterile. -When opening a sterile package, never reach across the sterile area. Open by walking around the sterile area. -Barriers must be used to keep field sterile once opened, i.e. sterile gloves, gowns, drapes, and masks. -Your hands must be always kept in front and above the waist. Below the waist is considered contaminated. -Do not cough or sneeze over sterile field. Sterile fields must remain dry, if wet it is no longer sterile. -Never leave the sterile field unless it is first covered with a sterile drape. -Consider 1½ inches around the edge of a sterile field to be contaminated. DO NOT PLACE ANYTHING STERILE IN THAT AREA. -Special rooms might be used to reduce contamination. -Transfer forceps are like sterile fingers. Do not tilt tip upward, keep downward and touch sterile items only with the tip. -Never turn your back on a sterile field.

Sterile Field

-Any area that is used when doing a sterile procedure. -Materials used in the procedure are placed within the sterile field. -Area where the sterile field is placed must be clean and dry. -The area of sterility is covered by a sterile drape.

MRSA transmission

-Direct contact between healthcare workers and patients. -Healthcare workers are the main carriers of MRSA. -Colonization vs. Infection: -Colonization means that the organism is present or in the body, but is not causing illness. -Infection means that the organism is present and causing illness. -MRSA is not usually spread through the air.

Gram stuff

-Gram-Negative Bacteria (stain pink) -Gram-negative bacteria are those bacteria that do not retain crystal violet dye in the Gram staining protocol. -Gram negative bacteria associated with nosocomial infections include Acinetobacter baumanii, which cause bacteremia, secondary meningitis, and ventilator-associated pneumonia in intensive care units of hospital establishments. -Acinetobacter is a group of bacteria commonly found in soil and water. -It can also be found on the skin of healthy people, especially healthcare personnel. One of the several unique characteristics of Gram-negative bacteria is the structure of the outer membrane. This outer membrane protects the bacteria from several antibiotics, dyes, and detergents which would normally damage the inner membrane or cell wal

Role of healthcare workers in prevention of VRE

-Hand-washing helps stop the spread of VRE. Wash before caring for a patient. After removing gloves. Before leaving the patient's room. -Follow facility protocol for standard precautions.

Pathogenesis of VRE

-Opportunistic. -Bacteria transmitted between patients and healthcare workers. Colonized vs. infected persons.

MRSA (Methicillin resistant Staphylococcus aureus)

-Resistant to most antibiotics. -Found in health care facilities: Hospitals. -Long term care facilities. -Other care facilities. -Not a threat to a healthy individual.

Process of sterilization

-Steam under pressure. -Gas autoclave for heat sensitive items. -Includes the use of special tape that changes color when sterilization is complete.

Preparing a patient

-Sterile drapes may be used, depending on the procedure. -Antiseptic agents might be used to prepare the patient's skin. -Removal of hair might also be done

Basic concepts to keep in mind when determining the correct procedures to follow

-Sterile to Sterile = Sterile -Sterile to Unsterile = Unsterile -Sterile to Unsure = Contaminated -If during a procedure, sterile technique is breached by breaking one of the rules, tell the person(s) involved. A patient's health and well being is at stake. -The health care provider must be aware of all needles and sharps during procedure. Account for them at the finish. -Wear gloves when cleaning after procedure; dispose of needles and sharp items in proper containers.

MRSA risk factors

-Surgery. -Devices used in invasive procedures. -Burn wards or intensive care units (ICU). -Age. -Treatment with multiple antibiotics. -Severe illness or disability. -Prolonged or repeated hospital stays. -Compromised immune system.

VRE (Vancomycin resistant enterococcus) concerns

-VRE is hard to treat. -VRE can pass on their drug-resistant genes.

MRSA prevention

-proper hand-washing. Before caring for each patient. After removing gloves. Before leaving the patient's room. Follow facility protocol for standard precautions.

Experimental vaccine

A number of innovative vaccines are also in development and in use Experimenting combining?

Widespread use of antibiotics has been associated with the emergence of drug resistant microorganisms. According to the CDC, more than ____ of the bacteria now causing hospital-acquired infections are resistant to at least one of the drugs most commonly used to treat them. All health-care workers play a role in preventing the spread of these nosocomial infections.

70%

If an unvaccinated child is exposed to a disease germ, the child's body may not be strong enough to fight the disease

Before vaccines, many children died from diseases that vaccines now prevent, such as whooping cough, measles, and polio. Those same germs exist today, but because babies are now protected by vaccines, we do not see these diseases nearly as often.

Procedures with high risk for infection

All surgeries. Insertion of urinary and other catheters. Dressing of wounds. Caring for patients at great risk for infection: -Burns. -Transplants. -Newborns. -Those with suppressed immune systems (for example cancer victims, elderly, patients with some autoimmune diseases, transplant patients, victims of AIDS, etc.).

Traits of an infection

An infection is what causes illness. The immune system then has to fight the infection. Once it fights off the infection, the body is left with a supply of cells that help recognize and fight that disease in the future.

Conjugate vaccine

Certain bacteria have polysaccharide outer coats that are poorly immunogenic. Conjugate vaccines link these outer coats to proteins, like toxins, that the immune system can be led to recognize the polysaccharide as if it were a protein antigen. Examples include Haemophilus influenzae type B vaccine.

Killed vaccine

Contain killed, but previously virulent, microorganisms that have been destroyed with chemicals, heat, radioactivity, or antibiotics. Examples include influenza, cholera, bubonic plague, polio, Hepatitis A, and rabies vaccines.

Why immunize

Diseases are becoming rare due to vaccinations. Some diseases (like polio and diphtheria) are becoming very rare in the U.S. mostly because we have been vaccinating against them. It is still reasonable to ask whether it's really worthwhile to keep vaccinating.

Contact

Diseases spread by contact with infected skin or objects. Examples include herpes, impetigo, diphtheria, scabies, AIDS, and MRSA.

Droplet

Diseases spread by droplets, as in a sneeze or cough. Examples include certain types of meningitis and pneumonia, pertussis, influenza, mumps, and German Measles

What if we stopped vaccinating?

Diseases that are almost unknown would stage a comeback Before long we would see epidemics of diseases that are nearly under control today More children would get sick and more would die.

Airborne

Diseases that are spread through the air. Examples include chickenpox, measles, and TB.

Signs of infection for VRE

Drainage from a wound. Fever and chills. Elevated white blood count

Uses for PPE

Gloves: Use when touching blood, body fluids, secretions, excretions, contaminated items; for touching mucous membranes and nonintact skin. Gowns: Use during procedures and patient care activities when contact of clothing/ exposed skin with blood/body fluids, secretions, or excretions is anticipated. Mask and goggles or a face shield: Use during patient care activities likely to generate splashes or sprays of blood, body fluids, secretions, or excretions.

These are applied to all patients/residents at all times because not all diseases are readily observable.

Gloves should be worn at all times; hands should be washed for a minimum of 10 seconds and gloves changed when moving from one patient to another. Depending on the activity performed on the patient, the nature of the patient's illness, and the amount of exposure to blood and body fluids, other protective equipment should be worn. For example, gown and goggles if patient is coughing, bleeding, or has drainage from wounds or body orifices. Needles should never be capped. All sharps (needles, razors, etc.) should be disposed of immediately in biohazard puncture proof sharps containers located in each room. Never carry needles or sharps from one location to another. If necessary to do so, never point toward another person or yourself. KEEP POINT TOWARD THE FLOOR OR CEILING. All unknown spills or waste should be treated as potentially hazardous.

PPE used in healthcare settings

Gloves: protect hands. Mask: protect mouth/nose. Respirator: protect respiratory tract from airborne infectious agents. Goggles: protect eyes. Face shields: protect face, mouth, nose, and eyes. Gowns: protect skin/clothing. Cap: protects head

Application of personal protective equipment

Hands must be washed prior to application, according to protocol. This equipment is clean, not sterile. Order of application: -Gown. -Cap. -Mask. -Gloves: sterile gloves might be required depending on what care is to be given (e.g. assisting with some sterile procedure) Order of removal: -Gloves first by never touching the outside of the glove ( Remove the first one by grabbing a place on the glove and removing Remove the second by hooking the finger inside the glove and removing ) - Hook the finger inside the cap and pull cap off -Reach behind the gown and untie, pulling the gown off and touching only the inside of the gown; roll it inside out as removing - Finally pull ties of mask and removes, being careful to avoid touching the hair. - In airborne transmission, the mask should be removed just before leaving the room (or if there is a outside foyer for application and removal of protective equipment it should be removed there) - Lastly, hands should be washed according to protocol.

Community acquired MRSA

MRSA infections that are acquired by persons who have not been recently (within the past year) hospitalized or had a medical procedure (such as dialysis, surgery, catheters) are known as CA-MRSA infections. -Staph or MRSA infections in the community are usually manifested as skin infections, such as pimples and boils, and occur in otherwise healthy people.

MRSA

MRSA is becoming more prevalent in healthcare settings. According to CDC data, the proportion of infections that are antimicrobial resistant has been growing. In 1974, MRSA infections accounted for two percent of the total number of staph infections; in 1995 it was 22%; in 2004 it was 63%.

Japan reduced pertussis vaccinations, and an epidemic occurred

In 1974, Japan had a successful pertussis (whooping cough) vaccination program, with nearly 80% of Japanese children vaccinated. That year only 393 cases of pertussis were reported in the entire country, and there were no deaths from pertussis. In 1976, rumors began to spread that pertussis vaccination was no longer needed and that the vaccine was not safe. Therefore, only 10% of infants were getting vaccinated. In 1979, Japan suffered a major pertussis epidemic, with more than 13,000 cases of whooping cough and 41 deaths. In 1981, the government began vaccinating with acellular pertussis vaccine and the number of pertussis cases dropped again.

MRSA concerns

MRSA is difficult to contain. MRSA is easily spread.

Toxoid Vaccine

Made from inactivated toxic compounds that cause illness rather than the microorganism. Examples include tetanus and diphtheria vaccines.

Surgical Asepsis

Involves keeping the clinical setting and objects as free from microorganisms as possible. Used in operating rooms and in other conditions that are similar to surgical procedures. Involves the use of physical barriers: Gowns. Gloves. Masks. Drapes Involves extraordinary control measures so contamination does not occur. Involves use of autoclave to kill microorganisms from objects.

Attenuated vaccine

Many of these are active viruses that have been cultivated under conditions that disable their virulent properties, or that use closely related but less dangerous organisms to produce a broad immune response. Typically provoke more durable immunological responses and are the preferred type for healthy adults. May not be safe for use in immunocompromised individuals, and may rarely mutate to a virulent form and cause disease. Most attenuated vaccines are viral; some are bacterial in nature. Examples include the viral diseases yellow fever, measles, rubella, and mumps, and the bacterial diseases typhoid and tuberculosis (BCG) vaccines.

How contact precautions work

May be private or have people with same diseases together. Everyone entering the room must wear gloves and change them whenever soiled. Gowns, mask, goggles, hair covering, should be worn depending on length of contact and activity. All must wash their hands and avoid touching objects before leaving the room. Patients should leave the room as little as possible and avoid contact with other people or objects. Use biohazard waste bags to dispose of any trash or items leaving the room. Equipment such as thermometer, blood pressure equipment should remain in the room, and disinfected properly when precautions have been discontinued.

Valence

Monovalent: protects against a single microorganism. Multivalent (polyvalent): designed to immunize against two or more strains of the same microorganism, or against two or more microorganisms

Why are childhood vaccines so important?

Newborn babies are immune to many diseases because they have antibodies they got from their mothers. This immunity goes away during the first year of life. Young children do not have this "maternal immunity" against some diseases, such as whooping cough.

Prior to the diagnosis of AIDS, personal protective equipment was used only in identified infectious processes...

Once AIDS was better understood, personal protective equipment was universally applied to all patients.

When biohazard containers are full, they should be removed from the patient's room through double bagging. Two people should be doing this:

One on the inside of the room, one on the outside to receive the contaminated items and help place them in the proper protective bags. The person inside the room only touches the inside of the receiving biohazard bag; the person outside the room only touches the outside of the receiving biohazard bag.

How airborne precautions work

Patient's room must be private unless both patients have the same disease. Room may have special ventilation equipment. The door of the room must remain closed. Staff and visitors must wear masks. If staff has more direct prolonged contact with the patient, it is advisable to wear gloves, gown, hair covering, depending on the activity. Patients should leave the room as little as possible and wear a mask if they do leave.

Identifying the symptoms of MRSA

Symptoms: Drainage from a wound. Fever and chills. Elevated white blood count. -Common sites of infection: Respiratory tract. Surgical wounds. Perineum or rectum. Skin. Urinary tract.

VRE risk factors

Severe illness. Treatment with multiple antibiotics. Abdominal or cardiac surgery. Devices used in invasive procedures. Age. Intensive care unit (ICU). Prolonged or repeated hospital stays. Compromised immune system.

Exposure

Should a known exposure occur to a microorganism, i.e. HIV, the exposure must be reported to the supervisor of the unit. An incident report must be completed. Depending on the exposure, the area should be cleaned with an antiseptic solution, and if necessary, appropriate blood tests should be completed. Follow-up must be done as required by policy (either facility or CDC).

How droplet precautions work

Similar to airborne, but droplet travels no more than three feet. Therefore room should be private or people with same diseases. If patients with different diseases are placed in the same room, they should be separated by at least three feet. Staff and visitors within three feet of patient need to wear masks. If staff has more direct prolonged contact with the patient, it is advisable to wear gloves, gown, hair covering, goggles, depending on the activity. Patients should leave room as little as possible and wear masks when they leave.

Reverse Isolation

The health care provider puts on any necessary equipment to prevent exposing the compromised patient to any microorganisms. The equipment is determined by the care that is to be given.

Heterotypic vaccine

These are vaccines that are pathogens of other animals that either do not cause disease or cause mild disease in the organism being treated. An example being Vaccinia virus, which causes Cowpox, being used to treat for Smallpox.

Immunizing individual children also helps to protect the health of our community, especially those people who cannot be immunized.

These include children who are too young to be vaccinated: -Children less than a year old cannot receive the measles vaccine but can be infected by the measles virus. Those who cannot be vaccinated for medical reasons: - Children with leukemia. Those who cannot make an adequate response to vaccination: - Immunosuppressed individuals (HIV).

Keep immunizing until disease is eliminated

Unless we can eliminate the disease, it is important to keep immunizing. Even if there are only a few cases of disease today, if we take away the protection given by vaccination, more and more people will be infected and will spread disease to others. Soon we will undo the progress we have made over the years.

Vaccines help develop immunity by imitating an infection

This "imitation" infection does not cause illness but rather helps the immune system develop the same response as it does to a real infection. Then the body can recognize and fight the vaccine-preventable disease in the future. Sometimes, after getting a vaccine, the imitation infection can cause minor symptoms, such as fever. Such minor symptoms are normal and should be expected as the body builds immunity.

Reverse or Protective Isolation

This concept is the opposite of every other transmission-based precaution. It involves protecting the patient/resident from any infectious process carried by the health care providers or the public. Necessary for patients with immune deficiency/suppressed immune systems: for example AIDS patients, transplant patients, cancer chemotherapy patients.

How do vaccines prevent diseases?

Vaccines reduce the risk of infection by working with the body's natural defenses to help it safely develop immunity to disease.

We vaccinate to protect our future

We don't vaccinate just to protect our children, we also vaccinate to protect our grandchildren and their grandchildren. Our children don't have to get smallpox shots anymore because the disease no longer exists. If we keep vaccinating now, parents in the future may be able to trust that diseases like polio and meningitis won't infect, cripple, or kill children. Vaccinations are one of the best ways to put an end to the serious effects of certain diseases

infection

When germs, such as bacteria or viruses, invade the body, they attack and multiply.

Vaccine

is a biological preparation that improves immunity (resistance) to a particular disease. A ___________typically contains an agent that resembles a disease-causing microorganism and is often made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins. The agent stimulates the body's immune system to recognize the agent as foreign, destroy it, and keep a record of it, so that the immune system can more easily recognize and destroy any of these microorganisms that it later encounters.

Subunit vaccine

used for plague immunization. Instead of introducing an inactivated or attenuated microorganism to an immune system, a fragment of it can create an immune response Examples: Hepatitis B: composed of only the surface proteins of the virus. Human Papillomavirus (HPV): composed of the viral major capsid protein, and the hemagglutinin and neuraminidase subunits of the influenza virus.