1. Copyright © 2008 Delmar Learning. All rights reserved. Unit 13 Infection Control

2. Copyright © 2008 Delmar Learning. All rights reserved. Objectives Spell and define terms. Explain the principles of medical asepsis. Explain the components of standard precautions.

3. Copyright © 2008 Delmar Learning. All rights reserved. Objectives List the types of personal protective equipment. Describe nursing assistant actions related to standard precautions.

4. Copyright © 2008 Delmar Learning. All rights reserved. Objectives Describe airborne precautions. Describe droplet precautions. Describe contact precautions.

5. Copyright © 2008 Delmar Learning. All rights reserved. Disease Prevention In the last unit, you learned what infections are and some of their causes In this unit –You will learn actions and procedures that can help prevent the transmission of infection to protect yourself, your coworkers, and those in your care

6. Copyright © 2008 Delmar Learning. All rights reserved. Medical Asepsis Asepsis –Absence of disease-producing microorganisms

7. Copyright © 2008 Delmar Learning. All rights reserved. Medical Asepsis Medical asepsis –Reducing the numbers of disease- producing microorganisms –Or interrupting transmission from one person to another person or from a person to a place or an object

8. Copyright © 2008 Delmar Learning. All rights reserved. Handwashing Single most important health procedure any individual can perform to prevent the spread of microbes

9. Copyright © 2008 Delmar Learning. All rights reserved. Handwashing Vigorous, short rubbing together of all the surfaces of soap-lathered hands Followed by rinsing under a stream of running warm water Handwashing should take at least 15 seconds

10. Copyright © 2008 Delmar Learning. All rights reserved. Waterless Hand Cleaners Many facilities provide dispensers containing waterless hand cleaners in various locations

11. Copyright © 2008 Delmar Learning. All rights reserved. Waterless Hand Cleaners Hand cleaners –Alcohol-based gel, lotion, or foam that is dispensed in small dime- to quarter-sized portions –Alcohol products may be used to clean your hands for most routine care

12. Copyright © 2008 Delmar Learning. All rights reserved. Using Alcohol Hand Cleaner Wash at the sink if: –Hands are soiled with a protein substance –Patient is known or suspected of having a disease caused by spores

13. Copyright © 2008 Delmar Learning. All rights reserved. Hand Lotion and Cream Maintaining the integrity of the skin on your hands –Very important to prevent injury and exposure to microbes

14. Copyright © 2008 Delmar Learning. All rights reserved. Hand Lotion and Cream Hand care products –Use products from individual, personal size packages, or from a pump dispenser or squeeze bottle, but don’t touch the spout –Avoid products in a jar

15. Copyright © 2008 Delmar Learning. All rights reserved. Protecting Yourself As you perform your duties, you may contact potentially infectious material –Blood or other body fluids, that may contain pathogens

16. Copyright © 2008 Delmar Learning. All rights reserved. Standard Precautions Infection control actions used for all people receiving care –Regardless of their condition or diagnosis

17. Copyright © 2008 Delmar Learning. All rights reserved. Standard Precautions Previously called Universal Precautions Assumes blood and body fluid of any patient could be infectious

18. Copyright © 2008 Delmar Learning. All rights reserved. Standard Precautions Recommends PPE and other infection control practices to prevent transmission in any healthcare setting Decisions about PPE use determined by type of clinical interaction with patient

19. Copyright © 2008 Delmar Learning. All rights reserved. PPE for Standard Precautions (1) Gloves –Use when touching blood, body fluids, secretions, excretions, contaminated items –For touching mucus membranes and nonintact skin

20. Copyright © 2008 Delmar Learning. All rights reserved. PPE for Standard Precautions (1) Gowns –Use when in contact with clothing, exposed skin with blood/body fluids, secretions, or excretions

21. Copyright © 2008 Delmar Learning. All rights reserved. PPE for Standard Precautions (2) Mask and goggles or a face shield –Used during patient care activities likely to generate splashes or sprays of blood, body fluids, secretions, or excretions

22. Copyright © 2008 Delmar Learning. All rights reserved. Transmission-Based Precautions Standard precautions do not eliminate the need for other isolation precautions A second set of precautions is used with certain highly transmissible diseases Second tier of precautions is called transmission-based precautions

23. Copyright © 2008 Delmar Learning. All rights reserved. Four Isolation Techniques 1.Isolation technique is the name given to the method of caring for patients with easily transmitted diseases 2.Essential that every person take responsibility and use the proper isolation techniques to prevent the spread of disease to others

24. Copyright © 2008 Delmar Learning. All rights reserved. Four Isolation Techniques 3. All items that come into contact with a patient’s excretions, secretions, blood, body fluids, mucous membranes, or nonintact skin are considered contaminated. Infectious material must be treated in a special way.

25. Copyright © 2008 Delmar Learning. All rights reserved. Isolation Technique 4. Standard precautions are always used in addition to transmission-based precautions

26. Copyright © 2008 Delmar Learning. All rights reserved. Isolation Unit May be an area or a private room Patients with the same disease may share a room A room with handwashing facilities and an adjoining room with bathing and toilet facilities is best

27. Copyright © 2008 Delmar Learning. All rights reserved. AII (A2) Rooms Rooms with a special air handling system may be called A2 rooms These rooms have negative pressure –Air flow in which air from the room is vented directly to the outside –Or filtered so pathogens cannot escape

28. Copyright © 2008 Delmar Learning. All rights reserved. AII (A2) Rooms Ventilation is needed for airborne precautions A HEPA respirator or NIOSH-approved mask –Must always be worn when entering an airborne precautions room

29. Copyright © 2008 Delmar Learning. All rights reserved. Ultraviolet Germicidal Irradiation (UVGI) Ultraviolet Germicidal Irradiation (UVGI) lights –Used to eliminate pathogens in some isolation rooms

30. Copyright © 2008 Delmar Learning. All rights reserved. Ultraviolet Germicidal Irradiation (UVGI) UVGI lights –Used intermittently as a secondary measure to kill or inactivate the pathogens in the upper portion of the room or passing through the air duct

31. Copyright © 2008 Delmar Learning. All rights reserved. Ultraviolet Germicidal Irradiation (UVGI) Lights are not on all the time Not a threat to the patient or health care workers

32. Copyright © 2008 Delmar Learning. All rights reserved. The Anteroom Used to enter some isolation rooms Is a small room inside the entrance to the patient room It contains a sink and containers for trash disposal

33. Copyright © 2008 Delmar Learning. All rights reserved. The Anteroom Reduces escape of infectious organisms when the door is opened and closed It serves as a buffer between the changes in air pressure in the patient room and the hallway Refer to Figure 13-11

34. Copyright © 2008 Delmar Learning. All rights reserved. The Anteroom

35. Copyright © 2008 Delmar Learning. All rights reserved. Additional Respiratory Precautions CDC recommends: –Teaching new admissions and those who accompany them to use respiratory precautions –Notifying staff if symptoms of a respiratory infection are present when they first register for care

36. Copyright © 2008 Delmar Learning. All rights reserved. Additional Respiratory Precautions Other respiratory precautions are: –Practicing respiratory hygiene/cough etiquette –Containing secretions –Covering the nose and mouth when coughing or sneezing

37. Copyright © 2008 Delmar Learning. All rights reserved. Additional Respiratory Precautions Other respiratory precautions are: –Using tissues to contain respiratory secretions –Discarding the tissues in the nearest trash can after use

38. Copyright © 2008 Delmar Learning. All rights reserved. Additional Respiratory Precautions Other respiratory precautions are: –Performing hand hygiene after contact with respiratory secretions and/or contaminated objects and/or materials –Using alcohol hand cleaner from dispensers mounted in public areas

39. Copyright © 2008 Delmar Learning. All rights reserved. Preparing for Isolation To prepare a patient room for isolation, do the following: –Indicate type of isolation precautions on the door to the patient’s room –Place an isolation cart next to the door Provide PPE (personal protective equipment) as needed

40. Copyright © 2008 Delmar Learning. All rights reserved. Preparing for Isolation To prepare a patient room for isolation, do the following: –Line wastepaper basket inside the room with a plastic bag labeled or color-coded for infectious waste –Place a laundry hamper in the room Line it with a yellow biohazard laundry bag

41. Copyright © 2008 Delmar Learning. All rights reserved. Preparing for Isolation To prepare a patient room for isolation, do the following: –At the sink, check the supply of paper towels and soap –Soap should be in a wall dispenser or foot- operated dispenser

42. Copyright © 2008 Delmar Learning. All rights reserved. Personal Protective Equipment Personal protective equipment includes: –Gloves, gown, mask, and goggles or face shield Regular eyeglasses do not provide adequate protection

43. Copyright © 2008 Delmar Learning. All rights reserved. Personal Protective Equipment Eye protection must also protect the sides of the eyes A mask may be worn without eye protection –But eye protection should never be worn without a mask

44. Copyright © 2008 Delmar Learning. All rights reserved. Selecting PPE For maximum protection, select the appropriate PPE based upon: –Type of anticipated exposure –Whether you expect only touch, or if splashes, sprays, or large volumes of blood or body fluid, secretions, or excretions may be present

45. Copyright © 2008 Delmar Learning. All rights reserved. Selecting PPE For maximum protection, select the appropriate PPE based upon: –Durability and appropriateness of the PPE for the task –How well the PPE fits you

46. Copyright © 2008 Delmar Learning. All rights reserved. Key Points About PPE Don before contact with the patient, generally before entering the room Use carefully – Don’t spread contamination

47. Copyright © 2008 Delmar Learning. All rights reserved. Key Points About PPE Remove and discard carefully – Either at the doorway or immediately outside patient room – Remove respirator outside room Immediately perform hand hygiene

48. Copyright © 2008 Delmar Learning. All rights reserved. Sequence for Applying Personal Protective Equipment 1)Wash hands 2)Gown 3)Mask or respirator 4)Goggles or face shield 5)Gloves

49. Copyright © 2008 Delmar Learning. All rights reserved. How to Don a Gown Select appropriate type and size Opening is in the back Secure at neck and waist If gown is too small, use two gowns Gown #1 ties in front Gown #2 ties in back

50. Copyright © 2008 Delmar Learning. All rights reserved. How to Don a Mask Place over nose, mouth, and chin Fit flexible nose piece over nose bridge Secure on head with ties or elastic Adjust to fit

51. Copyright © 2008 Delmar Learning. All rights reserved. How to Don a Particulate Respirator Select a fit tested respirator Place over nose, mouth and chin Fit flexible nose piece over nose bridge Secure on head with elastic Adjust to fit

52. Copyright © 2008 Delmar Learning. All rights reserved. How to Don a Particulate Respirator Perform a fit check –Inhale – respirator should collapse –Exhale – check for leakage around face

53. Copyright © 2008 Delmar Learning. All rights reserved. How to Don Eye and Face Protection Position goggles over eyes Secure to the head using the ear pieces or headband Position face shield over face Secure on brow with headband Adjust to fit comfortably

54. Copyright © 2008 Delmar Learning. All rights reserved. How to Don Gloves Don gloves last Select correct type and size Insert hands into gloves Extend gloves over isolation gown cuffs

55. Copyright © 2008 Delmar Learning. All rights reserved. Do’s and Don’ts of Glove Use Work from “clean to dirty” Limit opportunities for “touch contamination” Protect yourself, others, and environment Don’t touch your face or adjust PPE with contaminated gloves Don’t touch environmental surfaces except as necessary during patient care

56. Copyright © 2008 Delmar Learning. All rights reserved. Do’s and Don’ts of Glove Use Change gloves –During use if torn and when heavily soiled (even during use on the same patient) –After use on each patient Discard in appropriate receptacle –Never wash or reuse disposable gloves

57. Copyright © 2008 Delmar Learning. All rights reserved. How to Safely Use PPE Keep gloved hands away from face Avoid touching or adjusting other PPE Remove gloves if they become torn – Wash hands before donning new gloves Limit surfaces and items touched

58. Copyright © 2008 Delmar Learning. All rights reserved. “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

59. Copyright © 2008 Delmar Learning. All rights reserved. “Contaminated” and “Clean” Areas of PPE 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

60. Copyright © 2008 Delmar Learning. All rights reserved. Sequence for Removing Personal Protective Equipment 1)Gloves 2)Wash hands 3)Goggles or face shield 4)Gown 5)Mask 6)Wash hands

61. Copyright © 2008 Delmar Learning. All rights reserved. Where to Remove PPE At doorway, before leaving patient room or in anteroom Remove respirator outside room –After door has been closed Ensure that hand hygiene facilities are available at the point needed –Sink or alcohol-based hand rub

62. Copyright © 2008 Delmar Learning. All rights reserved. How to Remove Gloves (1) Grasp outside edge near wrist Peel away from hand Turn glove inside-out Hold in opposite gloved hand

63. Copyright © 2008 Delmar Learning. All rights reserved. How to Remove Gloves (2) Slide ungloved finger under the wrist of the remaining glove Peel off from inside Create bag for both gloves Discard

64. Copyright © 2008 Delmar Learning. All rights reserved. Remove Goggles or Face Shield Grasp ear or head pieces with ungloved hands Lift away from face Place in designated receptacle for reprocessing or disposal

65. Copyright © 2008 Delmar Learning. All rights reserved. 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

66. Copyright © 2008 Delmar Learning. All rights reserved. Removing a Mask Untie the bottom & top tie Remove from face Discard

67. Copyright © 2008 Delmar Learning. All rights reserved. Removing a Particulate Respirator Lift the bottom elastic over your head first Then lift off the top elastic Discard

68. Copyright © 2008 Delmar Learning. All rights reserved. Hand Hygiene Perform hand hygiene immediately after removing PPE If hands become visibly contaminated during PPE removal –Wash hands before continuing to remove PPE

69. Copyright © 2008 Delmar Learning. All rights reserved. Hand Hygiene Wash hands with soap and water or use an alcohol-based hand rub Ensure that hand hygiene facilities are available at the point needed –Sink or alcohol-based hand rub

70. Copyright © 2008 Delmar Learning. All rights reserved. Equipment Disposable patient care equipment is used by many facilities It is ideal for patients on isolation precautions Frequently used equipment remains in the patient’s unit

71. Copyright © 2008 Delmar Learning. All rights reserved. Containment of Contaminated Articles It is important that contaminated equipment be bagged, labeled, and disposed of –According to the health care facility’s policy for the disposal of infectious waste

72. Copyright © 2008 Delmar Learning. All rights reserved. Containment of Contaminated Articles Contaminated articles leaving the patient’s room –Must be handled so that pathogens will not be spread

73. Copyright © 2008 Delmar Learning. All rights reserved. Transporting the Patient in Isolation Sometimes a patient in isolation has to be transported to another area of the health care facility for treatment or testing

74. Copyright © 2008 Delmar Learning. All rights reserved. Transporting the Patient in Isolation Notify the receiving unit of your intention to transport the patient –Describe the type of transmission-based precautions being used

75. Copyright © 2008 Delmar Learning. All rights reserved. Disinfection and Sterilization Disinfection –Process of eliminating harmful pathogens from equipment and instruments Sterilization removes all microorganisms from an item

76. Copyright © 2008 Delmar Learning. All rights reserved. Sterile Procedures Surgical asepsis –Environment kept free of microorganisms –Pathogens and nonpathogens –In procedures in which surgical asepsis is used Equipment and supplies must be sterile

77. Copyright © 2008 Delmar Learning. All rights reserved. Sterile Field An area of sterile equipment and materials