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)