2 Infection Control Nurse Orientation Objectives:Describe the role of isolation in preventing the spread of certain infectionsDescribe each type of isolation with examples of diseasesUnderstand significance of correct sequence of donning and removing PPE.ISOLATION – foundation for preventing transmission of infectious agents associated w/healthcare deliveryRole – creates a protective environment that is required to contain the transmission of infectious agents
3 Infection Control Nurse Orientation Objectives:Understand the significance of antibiotic resistant organisms seen in hospitalsUnderstand how surveillance for hospital acquired (nosocomial) infections is performed and the significance of surveillance dataAntibiotic Resistant – Global Health ProblemIncreasing morbiditycontributes to increasing mortalityincrease hc costs – nosocomial pathogens est to exceed 1.3 Billion annually
4 Chain of Infection Break The Chain PathogenSusceptible HostReservoirBreak The ChainPortal of EntryPortal of ExitBreak the chain - pathogen – appropriate antibioticsReservoir – patients – frown when we get rid of themportal of exit – Maskmode of transmission – isolationportal of entry – N-95 respsusceptible host - immunizationsModeofTransmissionWhy Isolation?.. because transmission is easier to control than the source / host!
5 What is Infection Control? Identifying and reducing the risk of infections developing or spreading
6 Nosocomial Infections Develops when a patient is staying at a healthcare facility AND was not present when the patient was admitted to the facilityAt least 5% of patients hospitalized each year in the United States develop nosocomial infections. Many are preventable
7 Standard PrecautionsGuidelines for preventing exposure to blood, body fluids, secretions, excretions (except sweat), broken skin, or mucous membranesBased on the concept that body fluids from ANY patient can be infectiousShould be used on every patientUse necessary PPE for protectionCDC guidelines requires us to use category-specific isolation (ex – TB isolation) in addtion to Standard Precautions when a patient is known or suspected to have an infectionThe front of the mask is considered contaminated and should not be touched. Remove by handling only the ties or elastic bands starting with the bottom then top tie or band. Lift the mask or respirator away from the face and discard it into the designated waste receptacle.
8 Antibiotic Resistant Microorganisms normal flora gone bad! Problem exists because of overuse and inappropriate useResistant to multiple antibioticsReduced options for treatmentRequire isolation precautionsExamples: MRSA, VRE, MDR TBSolutions: more appropriate antibiotic use, better infection control and prevention
9 CONTACT ISOLATIONused to prevent transmission of microorganisms spread by direct/indirect contact with the sourceexamples:MRSAVREC. diffcontagious skin infections… Lice & ScabiesContact infection control re: shampoo for lice/scabies – ok have found lack of contact for VRE/MRSA
10 GBMC’s Contact Isolation Precautions Sign – ORANGE Inform Families to WASH THEIR HANDS!
12 HAND WASHINGProper hand washing is the single most important ay to prevent and reduce infectionsWash and rinse hands for 15 seconds, using a dry paper towel to turn off faucetAvagard alcohol based hand wash is also available in all patient care areasHands should be washed:Before and after patient contactBefore putting on gloves and after taking them offAfter touching blood and body substances (or contaminated patient-care equipment), broken skin, or mucous membranes (even if you wear gloves)Between different procedures on the same patient
13 DROPLET ISOLATIONused to prevent transmission of microorganisms spread by large, moist droplets inhaled by or landing on the mucous membranes of the susceptible hostexamples:InfluenzaNeisseria meningitidissome pneumoniasvaccine preventable diseases:rubella, mumps, pertussisAnytime pt arrives and order to R/O MENIGITIS – PLACE IN ISOLATION IF YOU THINK YOU HAVE IT – ISOLATE!IF viral – ZERO isolation requiredIF BACTERIAL – will do gram stain/bacterial latex antigen testingGPC – CHAIN STREPGPC – Clusters/pairs STAPHONLY IF NEISSERIA MENINGITIDIS GNDC REMAIN IN ISOLATION
15 DROPLET ISOLATION BASIC COMPONENTS surgical mask within 3 foot zone HANDWASHING
16 AIRBORNE ISOLATIONused to prevent transmission of microorganisms spread on very small particles that drift on air currents (droplet nuclei, dust)examples:pulmonary TuberculosisvaricellameaslesBLUE – IF YOU THINK YOU HAVE IT – ISOLATETB – AFB – ACID FAST BACILLI 3 NEG’S = CLEARA + AFB DOESN’T MEAN TB - THAT’S WHY WE DO 3 – SENT FOR CULTURE TAKES 6-8 WKS40% OF +AFB ARE NEGATIVESTANDARD – 3 AFB SPECIMENS – 1ST THING IN THE MORNINGCXR – “CAVITATIONS” +TB
17 Shingles vs. Chicken Pox Both are caused by the varicella virusShingles remain along nerve roots and appear on a single dermatomeShingles involving multiple dermatomes or an immunocompromised patient (WBC <4.0) consider this to be systemic and isolate just like chicken pox (airborne)
19 AIRBORNE ISOLATION BASIC COMPONENTS: negative air pressure isolation roomdoor remains closedfit-tested N95 respiratorCall Engineering (ext. 2060) with room # to check negative pressure.yes… HANDWASHING!
20 Surveillance Activities Operative ProceduresCritical Care Units (MICU, SICU, NICU)Targeted SurveillanceOutbreak Investigation
21 Benchmarking Hospital Acquired Infections CDC’s Hospital Infections ProgramSubmit monthly data on ICU infectionsBenchmarking with similar hospitalsNetworking opportunitiesAnnual reports
22 You can help by reporting suspected HAI Surveillance DataUSESImprove patient outcomes bymodifying patient care practicesreducing length of stayIdentify education needsEvaluate new productsIdentify new opportunities for improvementYou can help by reporting suspected HAIon the infoweb!
23 Latex AllergyLatex can cause allergies in some healthcare workers and patientsAll of our non-sterile gloves are latex freeIf you have any type of skin or other reaction to wearing latex gloves, tell the Charge Nurse
24 Key Points About PPEDon before contact with the patient, generally before entering the roomUse carefully – don’t spread contaminationRemove and discard carefully, either at the doorway or immediately outside patient room; remove respirator outside roomImmediately perform hand hygieneThere are four key points to remember about PPE use. First, don it before you have any contact with the patient, generally before entering the room. Once you have PPE on, use it carefully to prevent spreading contamination. When you have completed your tasks, remove the PPE carefully and discard it in the receptacles provided. Then immediately perform hand hygiene before going on to the next patient.
25 Sequence for Donning PPE Gown firstMask or respiratorGoggles or face shieldGlovesThe gown should be donned first. The mask or respirator should be put on next and properly adjusted to fit; remember to fit check the respirator. The goggles or face shield should be donned next and the gloves are donned last. Keep in mind, the combination of PPE used, and therefore the sequence for donning, will be determined by the precautions that need to be taken.
26 How to Safely Use PPE Keep gloved hands away from face Avoid touching or adjusting other PPERemove gloves if they become torn; perform hand hygiene before donning new glovesLimit surfaces and items touchedIn addition to wearing PPE, you should also use safe work practices. Avoid contaminating yourself by keeping your hands away from your face and not touching or adjusting PPE. Also, remove your gloves if they become torn and perform hand hygiene before putting on a new pair of gloves. You should also avoid spreading contamination by limiting surfaces and items touched with contaminated gloves.
27 “Contaminated” and “Clean” Areas of PPE Contaminated – outside frontAreas of PPE that have or are likely to have been in contact with body sites, materials, or environmental surfaces where the infectious organism may resideClean – inside, outside back, ties on head and backAreas of PPE that are not likely to have been in contact with the infectious organismTo remove PEP safely, you must first be able to identify what sites are considered “clean” and what are “contaminated.” In general, the outside front and sleeves of the isolation gown and outside front of the goggles, mask, respirator and face shield are considered “contaminated,” regardless of whether there is visible soil. Also, the outside of the gloves are contaminated.The areas that are considered “clean” are the parts that will be touched when removing PPE. These include inside the gloves; inside and back of the gown, including the ties; and the ties, elastic, or ear pieces of the mask, goggles and face shield.
28 Sequence for Removing PPE GlovesFace shield or gogglesGownMask or respiratorThe sequence for removing PPE is intended to limit opportunities for self-contamination. The gloves are considered the most contaminated pieces of PPE and are therefore removed first. The face shield or goggles are next because they are more cumbersome and would interfere with removal of other PPE. The gown is third in the sequence, followed by the mask or respirator.
29 Where to Remove PPEAt doorway, before leaving patient room or in anteroom*Remove respirator outside room, after door has been closed*The location for removing PPE will depend on the amount and type of PPE worn and the category of isolation a patient is on, if applicable. If only gloves are worn as PPE, it is safe to remove and discard them in the patient room. When a gown or full PPE is worn, PPE should be removed at the doorway or in an anteroom. Respirators should always be removed outside the patient room, after the door is closed. Hand hygiene should be performed after all PPE is removed.* Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub
30 Removing Isolation Gown Unfasten tiesPeel gown away from neck and shoulderTurn contaminated outside toward the insideFold or roll into a bundleDiscardUnfasten the gown ties with the ungloved hands. Slip hands underneath the gown at the neck and shoulder, peel away from the shoulders. Slip the fingers of one hand under the cuff of the opposite arm. Pull the hand into the sleeve, grasping the gown from inside. Reach across and push the sleeve off the opposite arm. Fold the gown towards the inside and fold or roll into a bundle. (Only the “clean” part of the gown should be visible.) Discard into waste or linen container, as appropriate.
31 Removing a Mask Untie the bottom, then top, tie Remove from face DiscardThe front of the mask is considered contaminated and should not be touched. Remove by handling only the ties or elastic bands starting with the bottom then top tie or band. Lift the mask or respirator away from the face and discard it into the designated waste receptacle.
32 Removing a Particulate Respirator Lift the bottom elastic over your head firstThen lift off the top elasticDiscardThe bottom elastic should be lifted over the head first. Then remove the top elastic. This should be done slowly to prevent the respirator from “snapping” off the face.
33 Hand Hygiene Perform hand hygiene immediately after removing PPE. If hands become visibly contaminated during PPE removal, wash hands before continuing to remove PPEWash hands with soap and water or use an alcohol-based hand rubHand hygiene is the cornerstone of preventing infection transmission. You should perform hand hygiene immediately after removing PPE. If your hands become visibly contaminated during PPE removal, wash hands before continuing to remove PPE. Wash your hands thoroughly with soap and warm water or, if hands are not visibly contaminated, use an alcohol-based hand rub.* Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub
34 Handling Patient Care Equipment Handle patient care equipment soiled with blood, other body fluids, secretions, or excretions in a way that prevents contact with skin and mucous membranesHandle patient care equipment in a way that prevents contamination of clothing and the spread of microorganisms to other patientsAppropriately dispose of single use equipment (suction canisters, etc)Clean and disinfect reusable equipment. Place clean instruments in biohazard bag for transport to Central Sterile Supply and re-sterilization
35 In addition, contact precautions require that you: Don’t share non-critical equipment (such as stethoscopes and thermometers) between patientsIf a piece of equipment is used with a patient in contact isolation, then the equipment must be properly cleaned and disinfected prior to use on another patientPlace a patient on airborne, contact, or droplet precautions in a private room, if possibleIf a private room is not available, the patient may be placed with another patient who has the same (but no other) infection
36 What to do if exposed to blood / body fluids Puncture wounds should be washed immediately and the wound should be caused to bleedIf skin contamination should occur, wash the area immediatelySplashes to the nose or mouth should be flushed with waterEye splashes require irrigation with clean water, saline, or a sterile irritantMost importantly: Complete a GBMC Employee Incident Report. Report exposure to charge nurse and Agency immediately
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