Standard Precautions

Respiratory Hygiene and Cough Etiquette- These actions include:

-Covering one's mouth and nose with a tissue when coughing or sneezing -Coughing or sneezing into one's upper sleeve or elbow (not into the hands) if a tissue is not available -Providing tissues and no-touch waste containers for tissue disposal. Using the nearest waste container to dispose of a tissue after its use -Washing the hands or using hand sanitizer after contact with respiratory secretions contaminated objects or materials -Placing a napkin over a resident's mouth if he or she cough during mealtime to prevent droplet contamination of other resident's food -Placing hand sanitizer dispensers, tissues and waste containers in convenient public areas -Providing soap dispensers and clean paper towels next to sinks -Offering masks to people who have signs or symptoms of a respiratory infection

under the needlestick safety act, employers are required to

-Identify and use effective and safer medical devices-this includes syringes with a sliding sheath/cover, needles that retract into a syringe after use, shielded or retracting catheters for IV use, and IV systems with needless access -Incorporate changes in annual updates of the exposure control plan- Must include changes that that eliminate or reduce exposure to blood-borne pathogens -Solicit input from non managerial employees who are responsible for direct patient care- must have a multidisciplinary team that identifies, evaluates, and selects safer medical devices and safer work practice controls -Maintain a sharps injury log- to help identify high-risk areas and evaluate ways to decrease injuries

respiratory hygiene and cough etiquette

-are standard precautions that protect others from spread of infection -actions related to this prevent transmission & contain respiratory secretions of residents who exhibit s&s of respiratory infection -one way to encourage it is to hang informational posters where they can be seen by visitors, family members, patients & residents

specific scenarios were handwashing should be done includes

-before & after handling any specimen -after contact with any soiled or contaminated item -after picking up any item off the floor -after personal use of the bathroom -after you cough, sneeze, or use a tissue -before & after any contact w/ mouth or mucous membranes; ex: eating, drinking, smoking, applying lip balm or inserting/ removing contact lenses -whenever hands are visibly soiled (in this case always use soap & water)

The WHO states the 5 essential times for handwashing include

-before touching a patient -before a clean or aseptic technique -after body fluid exposure or risk of exposure -after touching a patient -after touching the patient's surrounding

standard precautions must be used in any situations where hc worker may encounter:

-blood or any fluid that may contain blood -body fluids, secretions and excretions --this includes mucus, sputum, saliva, cerebrospinal fluid, urine, feces, vomit, amniotic fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, semen & vaginal secretions -mucous membranes -non-intact skin -tissue or cell specimens

potentially contaminated equipment/surfaces: cleaning, disinfection & sterilization

-cleaning is usually done with water, scrubbing & detergents -during disinfection, germicides (disinfectants) prevent microbes from spreading & destroy many microbes depending on their strength; disinfectants are available in wipes or sprays -sterilization eliminates all forms of microbes using extreme physical

handwashing background

-hand hygiene includes both hand washing w/ soap & water & use of alcohol-based hand sanitizer, which is a liquid, gel or foam preparation that kills most bacteria & fungi & stops some viruses found on skin -CDC & WHO are leaders in setting hand hygiene guidelines -unless microbes are renewed, they can survive 30-180 min on the hands -when working in hc, CNA should follow facility policy regarding how & when hand hygiene should be practiced

gloves

-hand must be washed before & after gloves are used & rings must be removed prior applying gloves -gloves must be changed after patient contact, between tasks/procedures, & on same patient if there was a chance for contamination -gloves should not be worn out of patient rooms or care areas -gloves mustn't be washed for reuse-> may cause undetected holes or deterioration of gloves -care must be taken while removing gloves to prevent contamination

waste and linen disposal

-hc workers must wear gloves & follow agency policies when disposing of waste & soiled linen -infectious wastes such as contaminated dressings, gloves, urinary drainage bags, incontinence pads & body tissues must be placed in special infectious waste or hazardous material bags --other trash is frequently placed in plastic bags & incinerated -soiled linen should be placed in laundry bags to prevent any contamination --linen soiled w/ blood or body fluids should be placed in special bag for contaminated linen & usually soaked in disinfectant before being laundered -gloves must be worn while handling any contaminated linen & any bag containing contaminated linen must be clearly labeled & color coded (blue-linen, red-biohazard)

needlestick safety act

-in 2000, Congress passed the Needlestick Safety & Prevention act after CDC estimated that 600,000-800,000 needlestick occur each year

standard precautions

-infection prevention & control measures used to deliver safe, quality care; should be used appropriately & consistently with every patient, no exceptions --in US, measures are guided by CDC & are supported by evidence-based research -every bodily fluid must be considered a potentially infectious material & all patients must be considered potential source of infection -employers are required to make sure that every employee always uses these precautions to prevent contact with blood & other potentially infectious materials

asepsis

-its the absence of infections or infectious material -terms "clean" & "dirty" are used when discussing asepsis -when giving care, work w/ clean surfaces & the move to dirty surfaces; always touch clean body parts or surfaces before touching those that are dirty or contaminated -dont touch own face, nose or eyeglasses prior to touching a resident; will help prevent touch contamination or cross contamination

handwashing times

-many healthcare facilities require handwashing hands for 40-60 sec in totsl -CDC suggests that you scrub hands for 20 sec (7-12); equivalent to singing the "Happy Birthday" song twice

there are two different types of asepsis:

-medical asepsis- a clean technique used to reduce the number of microorganisms & prevent & control infection --medical asepsis procedures include hand hygiene, the use of PPE, and isolation -surgical asepsis- a sterile technique used to eliminate microorganisms from the surface of an object

resuscitation devices

-mouthpieces or resuscitation devices should be used to avoid mouth-to-mouth resuscitation -should be placed in a convenient location & readily accessible for use -if these devices are not disposable, must be disinfected between patient use

when to use gloves

-must be worn whenever contact w/ blood, body fluids, mucous membranes, tissue specimens, non-intact skin, secretions/excretions is possible --secretions-substances produced by cells or organs --excretions-waste produces expelled from body -must be used when: --handling or cleaning any contaminated items or surfaces --performing any invasive procedures, blood drawn or venipunctures --handling soiled linen --if you have scratches or chapped skin

soap and water: nails

-nails also harbor dirt & pathogens & must be cleaned during handwashing process --orange/cuticle stick can be used w/ care (pointed end can cause trauma) --brush can also be used to clean nails --if brush or orange stick is not available or if nails are not visibly dirty, nails can be rubbed against palm of opposite hand to get soap under nails -most hc facilities prohibit use of artificial nails or extenders & require that natural nails be kept less than 1/4 in long --these nails can harbor organisms & increase risk for infection for both patient & hc worker --long nails can puncture or tear gloves

there are 2 types of gloves used in the medical field

-nonsterile, disposable gloves- aseptic gloves that are used as PPE, not sterile. Comes in sizes S, M, & L -sterile gloves- completely free of living microorganisms & is applied & used in sterile procedures; typically comes with size options by numbers (6.5,7,7.5,8, etc.) -hypoallergenic gloves & non allergenic gloves are available if needed; most gloves are now latex-free

respirators

-protect nose & mouth & filters the air to prevent inhalation of airborne microorganisms -must fit wearer's face & provide tight seal to be effective; most agencies require an annual fit test to ensure proper size -types of respirators include disposable respirators (N95, P100), Powered Air-Purifying Respirators (PAPRs), & Self-Contained Breathing Apparatus (SCBA) Respirators

handwashing

-recommended for routine cleansing of hands when hands are visible soiled w/ blood or other body fluids, before invasive procedures & specific transmission-based precautions -antiseptic hand rubs are recommended if hands are not visibly dirty or arent soiled w/ blood or bf -friction helps remove microbes -wearing gloves is not a substitute for proper hand hygiene -knowing how to effectively perform hand hygiene procedures is essential to infections prevention & control

gowns

-should be worn to prevent contamination of skin, clothing or uniforms -can be disposable or a kind that laundered & reused; sterile gowns also exist for procedures -should be worn for completing certain procedures that have possible exposure to bodily fluids or for isolation rooms -disposable gowns should only be worn once & then discarded -should be applied prior to entering patient's room & removed right before leaving the room --must be removed correctly to prevent contamination --contaminated gowns must be handled according to agency policy & local & state laws -wash hands immediately after removing a gown -shouldn't be worn out of patient rooms or care areas

soap and water:-recommended method for handwashing is based on following principles; they should be observed whenever hands are washed:

-soap is used as cleaning agent because it aids in removal of germs through its sudsy action & alkali content --pathogens are trapped in soapsuds & rinsed away --liquid soap from dispenser should be used whenever possible because bar soap can contain microbes -warm water should be used; less damaging to skin than hot water & creates better lather w/ soap than w/ cold water -friction must be used in addition to soap&water. helps rub off pathogens from surface of skin -all surfaces on hands must be cleaned, including palms, back/tops of hands, & between fingers -fingertips must be pointed downward; prevents water from getting on forearms & then running down to contaminate clean hands -dry paper towels must be used to turn faucet on/off, prevents contamination of hands from pathogens on faucet --dry towel must be used because pathogens can travel more readily through wet towel

PPE(personal protective equipment)

-specialized clothing & accessories that protect wearer from exposure to infectious material -PPE created barrier that prevents microorganisms from contacting wearer's skin or mucous membranes -to be effective, PPE must be put on (donned) & taken off (doffed) properly -PPE includes gloves, gowns masks respirators, goggles, face shields, & in some cases, head cover & protective gear for the feet -PPE also protects patients w/ compromised immune systems from caregivers

spills or splashes

-spills or splashes of blood, body fluids, secretions or excretions must be wiped up immediately -gloves must be worn while wiping up area w/ disposable clean cloths -area must be cleaned w/ a disinfectant solutions such as 10% bleach solution -furniture or equipment contaminated by spill/splash must be cleansed & disinfected immediately -for large spills, absorbent powder may be used to soak up fluid, after fluid is absorbed, powder is then swept up & placed in an infectious waste container

masks

-surgical masks are fluid resistant & provide werer protection against large droplets, splashes or sprays of bodily or other hazardous fluids; protects patient from wearer's respiratory emissions -masks dont fit snugly on face or provide a tight seal, so theyre not reliable protection against airborne transmission -masks may also be given to patients to reduce transmission of their infectious respiratory secretions

precautions

-to achieve medical asepsis hc staff members follow standard & transmission-based precautions --standard precautions-basic infection prevention & control practices used to prevent spread of disease for every person --transmission-based precautions-supplement standard precautions to prevent spread of disease & are used when communicable diseases are present or possible

sharps

-to avoid accidental cuts or punctures, extreme care must be taken when handling sharp objects -whenever possible, safe needles or needleless devices must be used -disposable needles must never be bent or broken after use; must be left uncapped & attached to syringe & placed in leak-proof, puncture-resistant sharps container --sharps container must be labeled with red biohazard symbol & must never be emptied or reused -surgical blades, razors, & other sharp objects must also be discarded in sharps container

face and eye protection

-used to protect eyes & face from foreign substances such as splashes of bodily fluids --necessary for certain procedures & types of care/isolation -face protection include: --face shield- protects face, mouth, nose & eyes; should cover from chin to forehead & from ear to ear --goggles- protects eyes effectively from splashes & respiratory droplets; personal or safety eyeglasses are not substitutes for goggles

masks and respirators

-used to protect nose & mouth from splashes or sprays of blood or bodily fluids, to prevent droplets from being transmitted by close contact; prevents exposure of mucous membranes to any pathogens -also used to prevent contamination of patients from caregiver's mucus & saliva -masks must fit properly & seals tightly on face; no gaps should be present around nose or chin -outside of mask is contaminated & should never be touched; only handle mask by ties or elastic bands -dont let mask or respirator hang around neck when not in use

hand sanitizers

-waterless hand cleaning with an alcohol-based gel, lotion or foam has been proved safe for use during routine patient care --most contain alcohol to provide antisepsis & a moisturizer to prevent drying of the skin -it is recommended to use when the hands are not visibly dirty & are not contaminated with blood or body fluids -it is recommended that hands be washed w/ soap and water after 6-10 cleansings w/ alcohol-based products

steps to handwashing (1-5)

1- locate sink where there is sufficient supply of antimicrobial soap; warm, running water; clean paper towels in dispenser; appropriate waste container nearby 2- if sleeves are long, push them up arms until theyre close to elbows 3-remove any watches or rings; if cant remove watch push it up arm away from hand & wrist 4-using clean dry paper towel turn on faucet, dont touch faucet w/ bare hands; adjust water temp until water is warm; be sure water doesnt splash on scrubs --always consider sink to be contaminated, stand far enough away from sink that clothing doesnt touch it; dont touch inside of sink at any time 5- thoroughly wet hands, wrists & skin 1-2 in above wrist --washing in downward direction prevents after from getting on forearms & then running back down to contaminated hands

the basic rules of standard precautions include

-PPE -handwashing -respiratory hygiene -preventing contamination -sharps safety -spills or splashes -resuscitation devices -waste and linen disposal -injuries

how to properly use alcohol-based cleansers

-a small amount is applied to the palm of the hands -the hands are rubbed vigorously so the solution is applied to all surfaces of the hands, fingers, nails & wrists -the hands should be rubbed until they are dry, usually at least 20 sec

potentially contaminated equipment/surfaces

-all equipment & working surfaces must be cleaned & decontaminated after contact w/ blood or other potentially infectious materials -1st step in eliminating microbes from contaminated surfaces & equip is cleaning -cleaning must always precede disinfection & sterilization procedures -gloves must always be worn during CD&S procedure -all disposable equipment can be used only once & then must be thrown away -contaminated equipment, clothing & supplies are double-bagged in biohazard waste bags for proper handling & disposal -CNA also ensure that rooms are cleaned after discharge (sometimes called terminal cleaning or "stripping" a room) -depending on facility policy, procedure may be carried out by CNA, shared w/ housekeeping department or completed only by housekeeping staff

injuries

-any cut, injury, needle stick, or splashing of blood or body fluids must be reported immediately -agency policy must be followed to deal w/ injury or contamination -every hc facility must have policy stating actions that must be taken immediately when exposure or injury occurs, including reporting any injury, documenting any exposure incident, recording care given, nothing follow-up to exposure incident & identifying ways to prevent similar exposure

steps to handwashing (12-17)

12-clean nails with orange stick or brush if visbly dirty, or for 1st handwashing of the day; if nails not visibly dirty, can be cleaned by rubbing against palm of opposite hand 13-rinse hands from forearms down to fingertips, keeping fingertips pointed downward 14-use clean paper towel to dry hands thoroughly, from tips of fingers to wrist; discard towel in waste container 15-use another dry paper towel to turn off faucet 16-discard all used towels in waste container; leave area neat & clean 17-apply water-based hand lotion if desired

steps to handwashing (6-11)

6- remove hands from water stream; apply enough soap & work it into thick lather over hands, wrists, & skin at least 1-2 in above wrist 7-rub palms together in circular motion for at least 15 sec 8-put palm of one hand on back of the hand; rub together several times; repeat after reversing position of hands 9-interlace fingers on both hands & rub them back & forth 10-hold left thumb in palm of right hand; rub in circular motion; repeat for opposite thumb 11-encircle wrist w/ palm & fingers of opposite hand; use circular motion to clean front, back & sides of wrist; repeat for opposite wrist