RNSG-1105-Module 2 Infection Prevention and control
Safety Check prior to hand washing
- assessing the fingernails are SHORT(Highest concentration of MO are under the nails) -Jewelry removed, especially rings with stones. Wedding bands may be worn sometimes -Skin free of lesions
what components are included in the Guideline for Standard Precautions (Tier1)?
-Hand hygiene. -Use of personal protective equipment (e.g., gloves, masks, eyewear). -Respiratory hygiene / cough etiquette. -Sharps safety (engineering and work practice controls). -Safe injection practices (i.e., aseptic technique for parenteral medications). -Sterile instruments and devices. -Clean and disinfected environmental surfaces.
What is the MOST effective technique in preventing transmission of infection?
-The first line defense in medical asepsis is hand-washing -Proper Hand-washing is considered the single most effective way to stop the spread of MO and PReventing infection
CDC Guidleines for infection control Tier 2 Transmission-base precautions
-Used in ADDITION to STANDARD precaution for PTs w/ suspected infections -Used for: PTs w/ suspected infection with a pathogen that can be transmitted by the following routes *AIrborne *Droplet *Contact
CDC Guideline for infection control Tier 1 Standarized Precautions
-Used in care of ALL hospitalized PTs regardless of their diagnosis or presumed infection status -Used for: *Blood *Body fluids *Secretions *Excretions *non-intact skin *Mucus membranes *regardless of whether or not they contain visible blood
Health care-associated infections (HAIs)
-an infection acquired while the client is receiving care in a health-care setting -formally called nosocomial infections -can come from exogenous source or endogenous source -most common setting for HAIs is the ICU -best way to prevent HAIs is through frequent and effective hand hygiene -most common site of HAIs is the urinary tract -most common causative agents are Escherichia coli, Staphylococcus aureus, and enterococci -an iatrogenic infection results from a diagnostic or therapeutic procedure -HAIs are not always preventable and not always iatrogenic
Gloves NOT a substitue for:
-good hygiene -worn only once per PT interventions -Discard appropriately according to facility policy -Once gloves are removed hands are thoroughly decontaminated w/ meticulous hand hygiene
What is the most effective way to CLEAN contaminated hands?
-hand-washing w/ antimicrobial soap is encouraged: *Before, after, and btwn DIRECT contact w/PT *Before putting on sterile gloves *After contact w/bodily fluids or excretions *When moving from contaminated to clean body site -After contact w/ surfaces in the PTs room -After removing gloves
hand hygiene
-reduces the number of pathogens on the hand -hands must be washed after PT contact regardless of the use of gloves. Even if you wear gloves, wash your hands -Gloved hands cannot be effectively washed
Components of transmission-based precautions-Tier 2 List the 4
1-Airborne Precautions 2-Droplet Precautions 3- Contact Precautions 4- type of isolation is protective environment or neutropenic
Tuberculosis (TB) what type of precaution?
Airborne
Types of _____________ Precautions -Used for PTs who have organisms that remain in the air and travel a longer distance -The most common of these diseases are *TB *Chicken Pox (Varicella) *MEasles (Rubeola) *Herpes Zoster -PT is in a PRIVATE NEGATIVE air pressure room where the air is brought into the room from the hallway and leaves the room via separate exhaust sys -MUST wear a particular mask (N95 mask) -KEEP PTs door CLOSED AT ALL TIMES -PTs on this precaution MUST wear mask when leaving the negative air pressure room for any reason
Airborne
What is the MOST effective way to clean uncontaminated hands?
Alcohol based hand rubs are more effective in killing bacteria than soap and water -alcohol based hand rubs are recommended by the CDC when hands are not contaminated -They protect HC workers hands, reduce the transmission of pathogens to PT, and personnel in HC settings SO REMEMBER TO FOAM In and FOAM OUT
Infection
An infection is an invasion of a susceptible host by a pathogens (bacteria, viruses, fungi, parasites) resulting in disease
PPE (personal protective equipment)
Consists of 1-gloves 2-gown 3-Respiratory protection *Airborne mask *Surgical mask 4-Eye protection *Goggles *Faceshield
Types of _____________ Precautions -Used for PT who are infected or colonized by a multi-drug resistant organism (MDRO) -The MOST common of these organisms are: *C-diff (clostridium difficle) *MRSA (MEthicillin-resistant staphylococcus aureus -This precaution include of barrier precautions such as gloves and impermeable gowns to prevent direct contact w/ infectious organism -The goal is to prevent transmission of disease by: *Direct contact where there is skin to skin btwn 2 person such as bathing and touching Indirect contact- Where there is contact with inanimate object which may serve as the vehicle for transmision of pathogens as doorknobs, table tops, and telephones
Contact
Influenza what type of precaution?
Droplet
Types of _____________ Precautions -Used for PTs who have organisms that is spread by large particles -The MOST common of these organisms are: *Rubella *Mumps *Diptheria *Influenza *Meningitis *Pertussis -MUST wear a Surgical mask -Gloves SHOULD be worn anytime handling tissues or items contaminated w/ respiratory secretions -KEEP Visitors 3ft from infected PT -PTs door closed at all times -PTs on this precaution must wear surgical masks when leaving the oom for any reason
Droplet
Types of masks
Droplet Precaution- Regular mask Airborne Precaution-N95`
Protective ___________ must be worn when: There is a RISK of spray or splash contaminating the mucus membranes of the eyes (I.e suctioning) -Plain are unacceptable because side shields are required
Faceshields goggles safety glasses
Gloves require or not required for the following: -When the activity does not have a possibility of soilage of hands w/ body fluids such as: *Changing IV bag *Feeding PT *Taking vital signs *Turning PT
Gloves NOT required
Gloves require or not required for the following: -When activity has posibility of soilage of hands w/body fluids such as: *BLOOD- collection on dressing, in stool *Contaminate items-Stethoscope thermometer *Excretion-urine NG Drainage *SEcretions-sputum
Gloves required
______________ regular soap ______________Antimicrobial soap _____________Alcholbased hand rub (foam or gel) Better, good, best
Good Better BEst
______________ are to be worn when -to prevent soiling of the HC workers clothing by the PTs blood and body fluids -provide a barrier protection because they are made of a waterproof or imprevious material -Put immediately before entering the room - Taken off immediately before exiting the room and disposed of in the PTs room
Gowns
Types of Gowns
Imprevious gown waterproof gown
Airborne precautions examples
MTV or My chicken hez tb measles, chickenpox (varicella) Herpes zoster/shingles TB
___________________- -Prevent from inhaling large particles, which travel a short distance (3ft) (DROPLET Iso-BIG DROPS) -Prevent from inhaling SMALL particles droplet which remain in the air and travel a longer distance (Airborne isolation- aerosol drops- a can of hair spray) -Can only be worn ONCE -Never Lower _____ around the neck and then bring back over the mouth and nose for use
Mask
Airborne precautions
Methods of infection control that must be used for patients known or suspected to be infected with pathogens transmitted by airborne droplet nuclei.
Droplet precautions
Must be followed for a patient known or suspected to be infected with pathogens transmitted by large-particle droplets expelled during coughing, sneezing, talking, or laughing.
Mr.B is on airborne isolation.What specific equipment is used in airborne isolation that is not used in other types of isolation?
N95 mask
What type of precaution: -Used for PTs to decrease the risk of infection in the most severe immunocompromised PTs -The most common of diseases are: 1-CANCER-Chemo 2-AIDS 3-ORgan transplants -RESTRICT visitors who have colds or contagious illnesses -Standard Precautions and ensure all caregivers are healthy -AVOID collection of standing in WTR from flowers or humidifiers to prevent bacteria found in this water
Neutropenic/Protective Environment
Patient Chemotherapy what type of precaution?
Neutropenic/Protective environment
Isolation environment
Private rooms used for isolation sometimes provide negative-pressure airflow to prevent infectious particles from flowing out of a room to other rooms and the air handling system. Special rooms with positive-pressure airflow are also used for highly susceptible immunocompromised patients such as recipients of transplanted organs. On the door or wall outside the room the nurse posts a card listing precautions for the isolation category in use according to health care facility policy. The card is a handy reference for health care personnel and visitors and alerts anyone who might enter the room accidentally that special precautions must be followed. The isolation room or an adjoining anteroom needs to contain hand hygiene and PPE supplies. Soap and antiseptic (antimicrobial) solutions need to be available. Personnel and visitors perform hand hygiene before approaching the patient's bedside and again before leaving the room. If toilet facilities are unavailable, there are special procedures for handling portable commodes, bedpans, or urinals. All patient care rooms, including those used for isolation; contain an impervious bag for soiled or contaminated linen and a trash container with plastic liners. Impervious receptacles prevent transmission of microorganisms by preventing leaking and soiling of the outside surface. A disposable rigid container needs to be available in the room to discard used sharps such as safety needles and syringes. Remain aware of infection prevention and control techniques while working with patients in protected environments. You need to feel comfortable performing all procedures and yet remain conscious of infection prevention and control principles. Depending on the microorganism and mode of transmission, evaluate which articles or equipment to take into an isolation room. For example, the CDC (2007) recommends the dedicated use of articles such as stethoscopes, sphygmomanometers, or rectal thermometers in the isolation room of a patient infected or colonized with vancomycin-resistant enterococci. Do not use these devices on other patients unless they are first adequately cleaned and disinfected. Box 28-12 describes the procedures to perform when using shared equipment.
HIV/AIDSwhat type of precaution?
Protective environment
TJC National Patient Safety Goals Goal#7
Reduce infections HAIs are a PT safety issue affecting all types of HC organizations
Draining Contaminated wound what type of precaution?
Standard
Situation: The nurse is preparing to go into Mr. As room to remove staples in his surgical site on his abdomen. He is 2 day post operative 1. What type of precautions should the nurse follow? 2. What equipment is required for the nurse to wear?
Standard Precaution gloves only
Infection control
although it is impossible to ensure that the patients environment is free of microorganisms, there are many steps that a nurse can take to reduce the spread of MO and thus promote safety for both the PT and HC personnel
C-Diff what type of precatution?
contact
MRSA what type of precaution?
contact
Break the chain of infection
hand washing
contact precautions
measures taken to prevent the spread of diseases transmitted by the physical transfer of pathogens to a susceptible host's body surface
Medical asepsis (clean technique)
practice used to remove or destroy germs and to prevent their spread from one person or place to another person or place
Droplet precautions examples
spiderman! sepsis, scarlet fever, streptococcal pharyngitis, parvovirus, pneumonia, pertussis, influenza, diptheria, epiglottitis, rubella, mumps, meningitis, mycoplasma or meningeal pneumonia, adeNovirus (Private room and mask)