Hand Washing, Routine Practices and Disease Specifics Practical Nursing Diploma Program Skill Labs 1

Chain of infection 1. Infectious agent – bacteria, virus, fungi 2. Reservoir – where an infection can grow: humans, animals, food, water, inanimate objects, “carriers” 3. Portal of exit – how the infectious agent is transmitted: respiratory, GI, GU, skin breaks, blood, tissue

4. Means of transmission:  Contact: direct/indirect  Vehicle: blood, food, water, inanimate objects  Vector: mosquito, lice, ticks  Airborne: droplets

5. Portal of entry – how the infectious agent gets into the host 6. Susceptible host – the young, elderly, sick

Breaking the Chain… The chain can be broken at any ring Most important thing you can do is to wash your hands!!! Make sure that you are generally healthy, take precautions for example the flu shot Assess skin; intact skin and mucous membranes will resist infection Reduce use of invasive medical devices

Noscomial infections Hospital acquired infections Significant cost to the health care system Highly preventable but can have huge costs Nurses have a significant role in preventing the development of nosocomial infections

Medical Asepsis Clean techniques Practices that reduce the number and transfer of pathogens

Principles of Medical Asepsis Wash hands Keep soiled items away from uniform Keep items off the floor – linen, drainage bags Cover mouth when coughing, sneezing etc. Then wash your hands! Clean equipment away from you Wash from clean to dirty

Dispose of soiled items promptly and following proper procedure Pour dirty liquids directly into drain to avoid splash back: WEAR GOGGLES. Sterilize items that may be contaminated –make sure that proper protocol is followed Practice good personal hygiene

The need for a dress code… To protect you and your patients Short nails harbour fewer pathogens…concerns specifically with artificial nails Jewelry is also a reservoir for pathogens It is alarmingly easy to transfer from patient to patient and from you to your family

Handwashing Perform it to remove transient and resident bacteria Soaps: make sure you are using an appropriate cleansing agent Perform a second scrub with jewelry off...unless you had it on when performing care Wash with the hands lower than the wrists, scrub 1” above the wrist

Use an orange stick to clean under the fingernails Rinse hands thoroughly Dry hands beginning with the fingers and moving up Use a clean paper towel to turn off taps Use lotion, make sure to check skin integrity

When to wash your hands Start of shift, end of shift, between patients, before and after breaks/meals, after you sneeze or use the washroom, when you remove gloves You can never do this too often Good hand washing should become a habit

How to wash your hands Wet hands and wrist area. Keep hands lower than elbows to allow water to flow toward fingertips. Cover all areas of the hands with soap. Use firm rubbing and circular motions, wash the palms and backs of the hands, each finger, area between the fingers, knuckles, wrists, & forearms.

Wash at least one inch above area of contamination. If hands are not visibly soiled, wash to one inch above the wrists. Continue this motion for seconds Dry hands beginning with fingers & moving upward toward forearms

Routine Practices May also be known as Universal Precautions Precautions taken with all patients, especially when there is potential exposure to body fluids, especially blood, excretions, non-intact skin Designed to protect all from risk of infection through transfer of infectious material from patient - patient or from patient -staff

Routine Practices include: Gloves, gowns, masks, goggles worn whenever risk of exposure to body fluids is present (emptying a urinal, suctioning a patient) Sharps disposal in puncture resistant containers Elimination of needle recapping

Immunization of personnel, e.g flu shot Garbage- use of bags as indicated by policy

Disease specific precautions Always read the sign on the door before entering the room Airborne precautions – for patients with infections that spread through the air i.e. TB, chicken pox, measles Droplet precautions – infections that spread through large particle droplets, i.e. mumps, rubella, diptheria

Contact precautions – for patients with infections that spread through contact, i.e. MRSA,VRE, C. Diff. Each type of precaution has different guidelines related to type of room, protective clothing required, patient transport, sharing of equipment etc.

Protective Clothing Gloves: use once only and then discard Not a substitute for hand washing Latex allergies are a growing problem Not needed for routine tasks that will not bring you into contact with bodily fluids

Gowns Used to prevent soiling of your clothing More common to use paper gowns Put on immediately prior to entering room and take off when leaving the room! Use once and discard

Masks Prevent from inhaling large particle aerosols and small particle droplets Also discourages you from touching your face thus limiting contact Sometimes the patient also needs to wear a mask Need to be aware of various types of masks

Debate about how long a mask is effective Special masks are available, e.g. HEPA masks, N95

Eye Wear Goggles and face shields should be worn when any risk of eye contamination is present Simply wearing eye glasses is not enough! Now seeing more face shields and other devices

Protective Clothing Putting on:, gown, glove, mask, eyewear. Taking off: remove gloves, wash hands, untie front waist string, gown (if soiled slide out), wash hands, masks & eye wear last. Wash hands!!