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GBMC Agency Nurse Orientation

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Presentation on theme: "GBMC Agency Nurse Orientation"— Presentation transcript:

1 GBMC Agency Nurse Orientation
Infection Control GBMC Agency Nurse Orientation

2 Infection Control Nurse Orientation
Objectives: Describe the role of isolation in preventing the spread of certain infections Describe each type of isolation with examples of diseases Understand significance of correct sequence of donning and removing PPE. ISOLATION – foundation for preventing transmission of infectious agents associated w/healthcare delivery Role – 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 hospitals Understand how surveillance for hospital acquired (nosocomial) infections is performed and the significance of surveillance data Antibiotic Resistant – Global Health Problem Increasing morbidity contributes to increasing mortality increase hc costs – nosocomial pathogens est to exceed 1.3 Billion annually

4 Chain of Infection Break The Chain
Pathogen Susceptible Host Reservoir Break The Chain Portal of Entry Portal of Exit Break the chain - pathogen – appropriate antibiotics Reservoir – patients – frown when we get rid of them portal of exit – Mask mode of transmission – isolation portal of entry – N-95 resp susceptible host - immunizations Mode of Transmission Why 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 facility At least 5% of patients hospitalized each year in the United States develop nosocomial infections. Many are preventable

7 Standard Precautions Guidelines for preventing exposure to blood, body fluids, secretions, excretions (except sweat), broken skin, or mucous membranes Based on the concept that body fluids from ANY patient can be infectious Should be used on every patient Use necessary PPE for protection CDC 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 infection The 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 use Resistant to multiple antibiotics Reduced options for treatment Require isolation precautions Examples: MRSA, VRE, MDR TB Solutions: more appropriate antibiotic use, better infection control and prevention

9 CONTACT ISOLATION used to prevent transmission of microorganisms spread by direct/indirect contact with the source examples: MRSA VRE C. diff contagious skin infections… Lice & Scabies Contact 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!

11 CONTACT ISOLATION BASIC COMPONENTS: gloves fluid impervious gown

12 HAND WASHING Proper hand washing is the single most important ay to prevent and reduce infections Wash and rinse hands for 15 seconds, using a dry paper towel to turn off faucet Avagard alcohol based hand wash is also available in all patient care areas Hands should be washed: Before and after patient contact Before putting on gloves and after taking them off After 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 ISOLATION used to prevent transmission of microorganisms spread by large, moist droplets inhaled by or landing on the mucous membranes of the susceptible host examples: Influenza Neisseria meningitidis some pneumonias vaccine preventable diseases: rubella, mumps, pertussis Anytime pt arrives and order to R/O MENIGITIS – PLACE IN ISOLATION IF YOU THINK YOU HAVE IT – ISOLATE! IF viral – ZERO isolation required IF BACTERIAL – will do gram stain/bacterial latex antigen testing GPC – CHAIN STREP GPC – Clusters/pairs STAPH ONLY IF NEISSERIA MENINGITIDIS GNDC REMAIN IN ISOLATION


15 DROPLET ISOLATION BASIC COMPONENTS surgical mask within 3 foot zone

16 AIRBORNE ISOLATION used to prevent transmission of microorganisms spread on very small particles that drift on air currents (droplet nuclei, dust) examples: pulmonary Tuberculosis varicella measles BLUE – IF YOU THINK YOU HAVE IT – ISOLATE TB – AFB – ACID FAST BACILLI 3 NEG’S = CLEAR A + AFB DOESN’T MEAN TB - THAT’S WHY WE DO 3 – SENT FOR CULTURE TAKES 6-8 WKS 40% OF +AFB ARE NEGATIVE STANDARD – 3 AFB SPECIMENS – 1ST THING IN THE MORNING CXR – “CAVITATIONS” +TB

17 Shingles vs. Chicken Pox
Both are caused by the varicella virus Shingles remain along nerve roots and appear on a single dermatome Shingles involving multiple dermatomes or an immunocompromised patient (WBC <4.0) consider this to be systemic and isolate just like chicken pox (airborne)

18 blue

negative air pressure isolation room door remains closed fit-tested N95 respirator Call Engineering (ext. 2060) with room # to check negative pressure. yes… HANDWASHING!

20 Surveillance Activities
Operative Procedures Critical Care Units (MICU, SICU, NICU) Targeted Surveillance Outbreak Investigation

21 Benchmarking Hospital Acquired Infections
CDC’s Hospital Infections Program Submit monthly data on ICU infections Benchmarking with similar hospitals Networking opportunities Annual reports

22 You can help by reporting suspected HAI
Surveillance Data USES Improve patient outcomes by modifying patient care practices reducing length of stay Identify education needs Evaluate new products Identify new opportunities for improvement You can help by reporting suspected HAI on the infoweb!

23 Latex Allergy Latex can cause allergies in some healthcare workers and patients All of our non-sterile gloves are latex free If you have any type of skin or other reaction to wearing latex gloves, tell the Charge Nurse

24 Key Points About PPE Don before contact with the patient, generally before entering the room Use carefully – don’t spread contamination Remove and discard carefully, either at the doorway or immediately outside patient room; remove respirator outside room Immediately perform hand hygiene There 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 first Mask or respirator Goggles or face shield Gloves The 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 PPE Remove gloves if they become torn; perform hand hygiene before donning new gloves Limit surfaces and items touched In 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 front Areas of PPE that have or are likely to have been in contact with body sites, materials, or environmental surfaces where the infectious organism may reside Clean – inside, outside back, ties on head and back Areas of PPE that are not likely to have been in contact with the infectious organism To 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
Gloves Face shield or goggles Gown Mask or respirator The 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 PPE At 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 ties Peel gown away from neck and shoulder Turn contaminated outside toward the inside Fold or roll into a bundle Discard Unfasten 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
Discard The 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 first Then lift off the top elastic Discard The 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 PPE Wash hands with soap and water or use an alcohol-based hand rub Hand 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 membranes Handle patient care equipment in a way that prevents contamination of clothing and the spread of microorganisms to other patients Appropriately 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 patients If 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 patient Place a patient on airborne, contact, or droplet precautions in a private room, if possible If 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 bleed If skin contamination should occur, wash the area immediately Splashes to the nose or mouth should be flushed with water Eye splashes require irrigation with clean water, saline, or a sterile irritant Most importantly: Complete a GBMC Employee Incident Report. Report exposure to charge nurse and Agency immediately

37 Need Infection Control?
Office - 5th floor. InfoWeb: - Contact Us - How to Enter Isolation into Meditech - Frequently Asked ??? - Policies & Procedures - much more!

38 InfoWeb…….

39 Finished! Please complete the Infection Control post-test and print out the certificate of completion for your agency

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