2STANDARD PRECAUTIONS1996, CDC developed a system of isolation to provide guidelines on how to prevent spread of infection (updated 2007)………. practices are referred to asStandard Precautions (a 2 Tiered system).
3Standard Precautions include wearing protective barrierswhen risk of contact with any body excretions, secretions,and moist membranesand tissues.Acknowledges that all are potentiallyinfectious.
4FIRST TIERPrecautions designed for care of all clients regardless of their diagnosis or presumed infection status.Standard Precautions apply to:BloodAll body fluids, secretions, and excretionsNon-intact skinMucous Membranes
5SECOND TIERIt alerts the nurse to take additional precautions to interrupt the transmission of a specified infection or organism.These Transmission-Based Precautions are for patients known, or suspected of being infected by a particular pathogen transmission:(a) airborne precautions(b) droplet precautions(c) contact precautions
63 TRANSMISSION-BASED PRECAUTIONS (must understand how the organism is transmitted) Airborne Precautions: spread of microbes on small droplet nuclei through the air (< 5 microns).(ie) Measles; Chicken Pox; TB*MASK important, door closed, negative air flow ventilation, private roomDroplet Precautions: large particle droplets(> 5 microns); which transmit 3 feet in air.(ie) Mumps; Pertussis; Influenza; SARS*Private room / or cohort clients, and mask worn if within 3 feetContact Precautions: for prevention of disease transmitted by either direct / or indirect, contact.(ie) Impetigo, Scabies, Herpes Zoster, C Difficile.*Gloves and gown worn, private room or cohort clients
7BUGS ARE GETTING SMARTER THAN THE DRUGS!! Some microorganisms that are particularly difficult to destroy.Some prevalent ones are:~ Methicillin-Resistant Staphylococcus Aureus (MRSA)~ Vancomycin-Resistant Enterococcus (VRE)
8Standard Precautions Fundamentals text, p.807 Skills Text p.197Box 8-1 & Table 8-2Guidelines for Standard Precautions (2 tiered system) published by the CDC in 1996Standard Precautions Fundamentals text, p.807READ *****
9ISOLATION IS…….Infection control and prevention methods that are used to decrease the transfer of microorganisms.Barriers or PPE (protective personal equipment)may include:gownsglovesmaskseyewear/ goggles.
10“PROTECTIVE ISOLATION” aka “REVERSE ISOLATION” Protects the client with a compromised or suppressed immune system; who is highly susceptible to contracting an infection.
11Private room needed, door closed, gowns, masks, gloves (if direct contact), wash hands immediately before entering / leaving the room, no plants or flowers allowed.
12PROCEDURE OF ISOLATION Prepare room for client; be organized!Before entering room, wash hands & put on the necessary barrier protection.Place soiled linen & gown into an impermeable laundry bag. If splatter a possibility, nurses gown should also be impermeable.Wash hands & change gloves PRN during care.When care complete, PPE is removed inside room.
13In what order do you dress/undress PPE? Must think critically, esp upon leaving isolation…..may depend upon thearea in which you are working.As a general rule:~ gloves are last put on & 1st taken off~ if airborne precautions, mask stays on until out of room.Consider your gloves, outside of your goggles, front of your mask, sleeves & front of your gown all to becontaminated. Remember to wash handsonce all PPE removed.
14LEAVING ISOLATION ROOM Remove your protective barriers in the following order:1) Remove gloves2) Remove eyewear/goggles3) Remove gown (pull off inside out)4) Remove mask5) Wash hands immediatelyLeave mask on until after you leave room if airborne
15CLIENT CONCERNS RELATED TO ISOLATION Explain purpose of isolation & thenecessary precautions.Sensory deprivation may be evidentby signs of loneliness or boredom.S & S of depression - decreased motivation, anger, lack of appetite, or difficulty sleeping.What interventions can you plan, while working with a client in isolation?
18PURPOSE OF STERILE TECHNIQUE To ELIMINATE all microorganisms from objects that come into contact with the tissues of the body that are normally sterile.
19Where do we use Sterile Equipment and Implement Sterile Technique? Operating roomLabor and deliveryMajor diagnostic / special procedure areasAt the bedside in 3 main situations:1) Procedures requiring intentional perforation of the skinie. Inserting an IV or an injection2) If the skin’s integrity is broken due to surgery or burnsie. Dressing changes / cleansing wounds3) During procedures involving insertion of devices, into normally sterile body cavitiesie. Urinary catheter
20HOW DO THINGS BECOME STERILIZED ? Autoclave - moist heat under pressure for surgical instrumentsRadiation - for drugs & other heat sensitive itemsChemicals - disinfect instruments (chlorine bleach)Ethylene Oxide Gas - for rubber and plasticWhat about boiling water?
21How do we know if an item is Sterilized? If commercially prepackaged (disposable):…….. check the integrity of the packageIf reusable equipment (sterilized within the facility):…… check integrity / expiration date / & also look for specially marked tape on the package
22Major diagnostic areas At the bedside in 3 main situations— AREAS WHERE STERILE EQUIPMENT IS USED AND STERILE TECHNIQUE IS NECESSARYOperating roomLabor and DeliveryMajor diagnostic areasAt the bedside in 3 main situations—intentional perforation of skin (IV/injection)when skin integrity is broken (dsg change)inserting device into sterile body cavity (catheter)
23Principles of Surgical Asepsis p 814 - 815Fundamentals text A sterile object remains sterile only when touched by another sterile object.Only sterile objects may be placed on a sterile field.A sterile object/ or field out of the range of vision, or an object held below waist level, is considered contaminated.A sterile object/or field, becomes contaminated by prolonged exposure to air.
24…..Surgical Aseptic Principles continued…. If in contact with a wet contaminated surface, the sterile object/ or field becomes contaminated by capillary action.Microbes move in the direction of gravity.Edges of a sterile field are considered contaminated….a 2.5cm border.If ever in doubt - consider it unsterile!
26Prepare the sterile field….. Sterile Pack……Add item to the sterile field……Add liquid to the sterile field…….When all of the above is complete……glove
27STERILE GLOVESDominant hand is gloved first. Do not touch outside of 1st glove, only the inside cuff (which is folded over)Then with sterile gloved dominant hand, pick up 2nd glove by reaching under cuff.Keep thumb fully abducted & ensure hands remain above the waistline.
28Please refer to Skills testing schedule @ Oland’s Center Gymnasium N125 Exam December 16, 2008 (0900h)@ Oland’s Center GymnasiumGOOD LUCK !