1. Personal Protective Equipment and Infection Control

2. Objectives
At the completion of this module you will be able to:

3. Asepsis
Steps taken to minimize the onset and spread of infection are based on asepsis.
Two types of aseptic technique:
Medical asepsis
Surgical asepsis

4. Medical Asepsis Use of clean technique. Examples: Hand hygiene
Barrier techniques
Routine environmental cleaning

5. Surgical Asepsis Use of sterile technique. Examples:
Procedures in the operating room
Invasive procedures like inserting a urinary catheter

6. Personal Protective Equipment (PPE)
Used to protect the patient and nurse from the spread of infection.
Includes:
Hand washing
Mask
Face shield
Cap – use in the operating room
Eyewear
Gown
Gloves

7. Important Point
Assess the need for PPE for each task you plan and for all patients regardless of their diagnosis.

8. Hand Hygiene
Most basic and important step of to prevent spread of infection.
Choices include alcohol-based hand rub or soap and water.

9. Important Point
Alcohol- based hand rubs are preferred unless the hands are visibly dirty or exposed to some organisms because:
Alcohol-based hand rubs are more effective in removing microorganisms.
Some alcohol-based hand rubs contain emollients, which cause less skin irritation and dryness than soap.

10. Hand Hygiene
Use alcohol-based hand rub for the following if the hands aren’t visibly soiled:
Before and after direct contact with patients.
Before applying sterile gloves and inserting an invasive device, for example a urinary catheter.
After contact with wound dressing.
When moving from a contaminated area to a clean body site during patient care.
After contact with inanimate objects.
After removing gloves.

11. Hand Hygiene
Wash with plain or antibacterial soap and water for at least 15 seconds if:
Hands visibly dirty.
Hands soiled with blood or body fluid.
After removing PPE.
Before eating, and after using the toilet.
Wash with nonantimicrobial soap and water for at least 15 seconds if:
Exposed to spore-forming organisms like Clostridium difficile or Bacillus anthracis.
Exposed to MRSA or VRE

12. Clean Gloves
Use when touching blood, body fluids, secretions, excretions, nonintact skin, mucous membranes or contaminated items.

13. Remember!
Hand hygiene is performed before applying gloves and after removing gloves.
Hand hygiene is performed between each patient contact.

14. Masks, Eyewear, Face shield
Use if patient care activities generate splashes or sprays of blood or body fluid.

15. Gowns Use if soiling of clothing is likely from blood or body fluid.
Dispose of paper gown after each use. Cloth gown needs to be laundered and need to be placed in the linen hamper after each use.
Hand hygiene is required after removal of the gown.

16. Types of Precautions
Standard – use of PPE when appropriate for patient contact
Transmission-Based- use of PPE for a specific type of patient

17. When to use Standard Precautions?
Apply to contact with blood, blood products, all body fluids, secretions, excretions (except sweat), nonintact skin, and mucous membranes.
Apply to equipment and surfaces contaminated with these potentially infectious materials.

18. Standard Precautions
In order to prevent the spread of infections, respiratory hygiene/cough etiquette should be emphasized and includes:
Cover the nose/mouth when coughing or sneezing or cough or sneeze into your upper sleeve, not your hands.
Use tissues to contain respiratory secretions and dispose in the nearest waste container.
Perform hand washing after contacting respiratory secretions and contaminated objects/materials.
Patients with a fever or cough should wear a mask until placed in a patient care room.
After room placement, staff wear a mask.
Sit at least 3 feet away from others if coughing.

19. Important Point
Handle all body fluids from all patients as if they were contaminated.
Equipment that is used for more than one patient, such as an IV pump, needs to be cleaned in between patients.
Some equipment is disposable and should be thrown away after patient use.
Use plastic bags for moist, soiled items.

20. When to use Transmission-Based Precautions?
Use with patients who are:
Known or suspected to be infected.
Colonized with microorganisms transmitted by contact, droplet or airborne route or by contact with contaminated surfaces.

21. Transmission-Based Precautions
Three types include:
Airborne
Droplet
Contact
May be combined for diseases that have multiple routes of transmission.
Used in addition to Standard Precautions.

22. Transmission-Based Precautions
Place appropriate sign on patient’s door.
Follow directions on sign for use of PPE based on type of isolation precaution.
Educate family and visitors about appropriate use of PPE before they enter the patient room.
Follow directions if the patient is transported from the room to another area in the facility.

23. Airborne Precautions Droplet nuclei smaller than 5 microns
Examples: Measles, chickenpox (varicella), disseminated varicella zoster, pulmonary or laryngeal tuberculosis

24. Barrier Protection for Airborne Precautions
Private room
Negative-pressure airflow of at least 6-12 exchanges per hour via HEPA filtration
Mask or respiratory protection device worn by caregiver and visitors
N 95 respirator required for patient with known or suspected tuberculosis
Mask placed on patient when they leave the room; patient leaves the room only if necessary.

25. Droplet Precautions
Droplets larger than 5 microns, being within 3 feet of patient
Examples: Influenza, meningitis, diptheria (pharyngeal), pneumonia or scarlet fever in infants and young children, pertussis, mumps, mycoplasma pneumonia, meningococcal pneumonia or sepsis , streptococcal pharyngitis, pneumonic plague

26. Barrier Protection for Droplet Precautions
Private room or cohort patients.
Wash hands before entering and leaving room.
Wear a surgical mask when within 3 feet of a patient. Mask worn by caregiver and visitors.
Place a mask on the patient when they need to leave the room.

27. Contact Precautions Direct or environmental contact
Colonization or infection with multidrug-resistent organisms such as VRE and MRSA, Clostridium difficile, Shigella and other enteric pathogens, major wound infections, herpes simplex, scabies, varicella zoster, conjunctivitis, respiratory syncytial virus in infants, young children or immunocompromised adults

28. Barrier Protection for Contact Precautions
Private room or cohort patients per policy
Wash hand before entering and leaving room.
Put on glove and gown at the door.
Use patient dedicated disposable equipment if possible.
If shared equipment, clean and disinfect.
PPE worn by caregivers and visitors.

29. Applying PPE 1. Gown 2. Mask or fitted respirator
Make sure it covers all outer garments, tie at neck and waist
2. Mask or fitted respirator
Around mouth and nose
3. Eyewear or googles if needed
Snuggly around face
Side shields if the person wears glasses
4. Clean gloves
Cuffs over edge of gown

30. Correct Order for Putting On PPE
Visualize a person standing with their hands above their head.
PPE goes on from bottom to top of person.
1. Gown
2. Mask
3. Goggles
4. Gloves
Remember “G to G” or gown to gloves

31. Removing PPE 1. Gloves 2. Goggles 3. Gown 4. Mask
Grasp cuff, pull inside out over hand hold in hand and peel glove off over first glove
2. Goggles
Handle by headband or earpiece
3. Gown
Untie neck, then back strings, allow to fall from shoulders, touch inside only
4. Mask
If secures over ears, pull away from face
If tie-on, untie bottom then top string, pull away from face
Always perform hand hygiene after removing PPE

32. Correct Order for Removing PPE
Remember “alphabetical order”
Gloves
Goggles
Gown
Mask