1. Nosocomial Infection ----Prevention and control
Wang kefang（王克芳）

2. Aseptic Technique Contents Concepts Principals of Aseptic Technique4
Aseptic Technique
Contents
Concepts
Principals of Aseptic Technique
Aseptic Techniques
教学目标
解释术语：无菌区、非无菌区、无菌物品
掌握无菌技术的原则
熟练掌握无菌技术的基本操作

3. Concepts Aseptic technique
the practices which prevent microorganisms invading human beings, sterile objects and areas from being contaminated during medical procedures and nursing interventions.
无菌技术(aseptic technique)
是指在医疗护理操作过程中，防止一切微生物侵入人体和防止无菌物品、无菌区域被污染的技术。
Aseptic Technique

4. Principals of Aseptic Technique
Environment requirement
Staff preparation
Distinguish different areas
Item management
Aseptic concept during procedures
Aseptic Technique

5. Environment requirement
The environment should be clean, spacious, and disinfected routinely.
The Operating table is clean, dry, and flat and the layout is rational
stop cleaning the surroundings 30 minutes before the procedures, and minimize moving to prevent dust from floating.
Aseptic Technique

6. Staff
Wear mask and cap, trim fingernails and perform hand hygiene before aseptic procedures.
Wear sterile gown and sterile gloves if necessary.
Aseptic Technique

7. Distinguish different areas
Aseptic area
refers to the sterile area which has not been contaminated.
Non-aseptic area
is a non-sterilized area or an area having been sterilized but being contaminated again.
Aseptic supply
is an aseptic item physically or chemically sterilized.
Aseptic Technique

8. Item management
Aseptic supply is an aseptic item physically or chemically sterilized.
Place aseptic supplies and non-aseptic supplies separately and have distinct label.
Keep aseptic supply in sterile package or container.
Label sterile packages with name, expiration date accurately.
Valid time :7 days/14days/1month
A set of aseptic supply is only for a client to use once.
无菌物品不可暴露在空气中，请存放于无菌包或无菌容器中
A sterile object or field becomes contaminated by prolonged exposure to the air. Microorganisms traveling through the air can fall on sterile items or fields.
Aseptic Technique

9. During Procedures
Keep the body away from the aseptic area during procedures.
Face sterile area during procedures.
Use sterile transfer forceps to fetch sterile items
Keep hands and arms above the waist level.
手部应保持在腰部或治疗台面上，不可跨越无菌区，手不可接触无菌物品。
Aseptic Technique

10. During Procedures
Keep the body away from the aseptic area during procedures.
Face sterile area during procedures.
Use sterile transfer forceps to fetch sterile items
Keep hands and arms above the waist level.
Once taken out of the container, aseptic supplies can not be put back even not be used.
Do NOT talk, laugh, cough or sneeze over a sterile field.
When in doubt about the sterility of a package, or consider it contaminated, re-sterilize the items.
手部应保持在腰部或治疗台面上，不可跨越无菌区，手不可接触无菌物品。
Aseptic Technique

11. Aseptic Techniques Apply Sterile Transfer Forceps
Apply Sterile Container
Use Sterile Package
Prepare Sterile Treatment Tray
Pour Sterile Solution
Don and Remove Sterile Gloves
Aseptic Technique

12. Do you know how to protect yourself and others from infection?
Isolation
Do you know how to protect yourself and others from infection?
Do you know what to do if you come in contact with blood?

13. Concepts
Isolation
Using a variety of methods, techniques, and measures to prevent pathogens transmission from patients and carriers.
采用各种方法、技术，防止病原体从患者及携 带者传播给他人的措施。
传染源或高度易感人群
卫生部医院隔离技术规范 2009
Isolation

14. Concepts Clean area Potentially-contaminated area Contaminated area
the area not contaminated by pathogens
such as treatment room, Nutrition pantry and pharmacy.
Potentially-contaminated area
the area that is potentially contaminated by pathogens
like office, laboratory and disinfection room.
Contaminated area
the area contaminated by pathogens which is in contact with clients directly and indirectly
such as ward, clients’ restroom and bathroom.
清洁区：隔离要求：患者及患者接触过的物品不得进入清洁区；工作人员接触患者后需脱去隔离衣及鞋后，手卫生方可进入清洁区。
潜在污染区：患者或穿隔离衣的工作人员通过走廊时，不得接触墙壁、家具等。各类检验标本应放在指定的存放盘和架上，检验后的标本及容器等应严格按要求分别处理。
污染区：污染区的物品未经消毒处理，不得带到他处，工作人员进入污染区时，必须穿隔离衣，戴口罩，帽子，必要时换隔离鞋，离开前脱隔离衣，鞋并消毒双手。
Isolation

15. Isolation Principle
在标准预防(Standard Precautions)的基础上，结合 疾病的传播途径制定相应的隔离预防措施 (Transmission-based precautions) 。
隔离病室应有隔离标志，并限制人员的出入。
Airborne Precautions
Droplet Precautions
Contact Precautions
传染病/可疑传染病患者应安置在单人隔离房间。
受条件限制的医院，同种病原体感染的患者可安置 于一室
建筑布局合理，符合有关规定。
卫生部医院隔离技术规范 2009

16. Infectious Agent
Contact
Droplet
Airborne
Direct
Indirect
Droplet Nuclei
Hands
Injection
Equipment/
Environment
Insect/
Animal

17. Isolation measures
----标准预防（Standard Precautions） ----基于传播途径的隔离 （ Transmission-based precautions）
医务人员接触病人血液、体液、分泌物、排泄物等物质时，不管是否有明显的血迹污染或是否接触非完整的皮肤和粘膜，必须采取防护措施。同时，还应根据疾病的传播途径采取空气、飞沫、接触隔离措施。

18. how isolation precautions evolved
A quick recap
how isolation precautions evolved
over time

19. HISTORY OF GUIDELINES FOR ISOLATION PRECAUTIONS IN HOSPITALS
1970
Isolation Techniques, 1st edtn.
-Introduced seven isolation precaution categories:
Strict, Respiratory, Protective, Enteric, Wound and Skin,
Discharge, and Blood
- No user decision-making required
- Simplicity a strength; over isolation prescribed for some infections
1975
Isolation Techniques, 2nd edtn.
Same conceptual framework as 1st edition
1983
CDC Guideline for Isolation Precautions
in Hospitals
-Provided two systems for isolation:
category-specific and disease specific
- Protective Isolation eliminated; Blood Precautions expanded to include Body Fluids
Categories included
Strict, Contact, Respiratory, Enteric, Drainage/Secretion,
Blood and Body Fluids
- Emphasized decision-making by users

20. HISTORY OF GUIDELINES FOR ISOLATION PRECAUTIONS IN HOSPITALS contd--
Universal precautions
Developed in response to HIV/AIDS epidemic
- Blood and Body Fluid precautions to all patients, regardless of infection status
- Did not apply to feaces, nasal secretions, sputum, sweat, tears, urine, or vomitus unless contaminated by visible blood
- Added personal protective equipment to protect HCWs from mucous membrane exposures
- Handwashing recommended immediately after glove removal
- Added specific recommendations for handling needles and other sharp devices;
1987
Body substance isolation
- Emphasized avoiding contact with all moist and potentially infectious body substances except sweat even if blood not present
- Shared some features with Universal Precautions
- Weak on infections transmitted by large droplets or by contact with dry surfaces
- Did not emphasize need for special ventilation to contain airborne infections
- Handwashing after glove removal not specified in the absence of visible soiling
1996
Guideline for Isolation Precautions in
Hospitals
- Melded major features of Universal Precautions and Body Substance Isolation into Standard Precautions to be used with all patients at all times
Included three transmission-based precaution categories:
contact, droplet & airborne
- Listed clinical syndromes that should dictate use of empiric isolation until an etiological diagnosis

21. WHAT ARE STANDARD PRECAUTIONS?
Standard Precautions include a group of infection prevention practices that apply to all patients, regardless of suspected or confirmed infection status, in any setting in which healthcare is delivered
---- America CDC in 1996 and updated in 2007
(Siegal JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee, Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, 2007)

22. All healthcare workers MUST.....
Assume that every person is potentially infected or colonized with an organism that could be transmitted in the healthcare setting.
Apply a set of work practices to
Blood
all body fluids (except sweat)
mucous membranes
non intact skin.

23. Key Components of Standard Precautions
Hand hygiene
Patient
placement
PPE
Standard
Precautions
C&D
Respiratory hygiene
Standard precautions are intended to be applied to the care of all patients in all health care settings, regardless of the suspected or confirmed presence of an infectious agent.
The main elements of standard precautions include:
Hand hygiene
Use of personal protective equipment (PPE) based on risk assessment to avoid direct contact with patient's blood, body fluids, secretions and non-intact skin
Prevention of needle sticks/sharps injuries and
Cleaning and disinfection of the environment and equipment
Respiratory hygiene and cough etiquette have been added to standard precautions to control transmission of respiratory infections.
PPE: Gloves, Gowns, Face & Eye protection
Patient placement
C&D of patient care equipment
Environmental hygiene
Textiles & laundry
Safe injection practices
Waste disposal:
Treat waste contaminated with blood, bodily fluids, secretions and excretions as clinical waste, in accordance with local regulations
Waste Management
Safe injection
Linen & laundry
Unit 6 - Infection Control Measures

24. Recommendation for all individuals with respiratory symptoms
Respiratory hygiene and cough etiquette
Perform hand hygiene if contact respiratory secretions and contaminated objects
Put on a surgical mask
Cover the nose/mouth when coughing or sneezing
Use tissue paper to contain respiratory secretions and dispose in the waste receptacle
A proper personal hygiene is important all the time and especially during Flu seasons.
All persons including healthcare workers, visitors, patients, volunteers in the hospitals with respiratory symptoms are recommended and encouraged to take respiratory hygiene and cough etiquette precaution to control transmission of respiratory infections.
Precautions of respiratory hygiene and cough etiquette include:
Cover nose and mouth when coughing or sneezing
Use tissue paper to contain respiratory secretions and dispose of them in waste basket
Perform hand hygiene after having contact with respiratory secretions and contaminated objects
Put on a surgical mask when respiratory signs and symptoms develop. Do not touch the external surface of mask.
Reference:
Centers for Disease Control and Prevention. (2004). Fact Sheet on Respiratory hygiene and cough etiquette in Healthcare Settings. Retrieved September 30, 2006, from
Unit 6 - Infection Control Measures

25. Key Components of Standard Precautions
Hand hygiene
PPE
Patient
placement
Standard
Precautions
C&D
Respiratory hygiene
Standard precautions are intended to be applied to the care of all patients in all health care settings, regardless of the suspected or confirmed presence of an infectious agent.
The main elements of standard precautions include:
Hand hygiene
Use of personal protective equipment (PPE) based on risk assessment to avoid direct contact with patient's blood, body fluids, secretions and non-intact skin
Prevention of needle sticks/sharps injuries and
Cleaning and disinfection of the environment and equipment
Respiratory hygiene and cough etiquette have been added to standard precautions to control transmission of respiratory infections.
PPE: Gloves, Gowns, Face & Eye protection
Patient placement
C&D of patient care equipment
Environmental hygiene
Textiles & laundry
Safe injection practices
Waste disposal:
Treat waste contaminated with blood, bodily fluids, secretions and excretions as clinical waste, in accordance with local regulations
Waste Management
Safe injection
Linen & laundry
Unit 6 - Infection Control Measures

26. Personal Protective Equipment(PPE)
specialized clothing or equipment worn by an employee for protection against infectious materials
Personal protective equipment, or PPE, as defined by the Occupational Safety and Health Administration, or OSHA, is “specialized clothing or equipment, worn by an employee for protection against infectious materials.”
PPE Use in Healthcare Settings

27. Types of PPE Used in Healthcare Settings
Gloves – protect hands
Gowns/aprons – protect skin and/or clothing
Masks and respirators– protect mouth/nose
Goggles – protect eyes
Face shields – protect face, mouth, nose, and eyes
All of the PPE listed here prevent contact with the infectious agent, or body fluid that may contain the infectious agent, by creating a barrier between the worker and the infectious material.
Gloves, protect the hands,
gowns or aprons protect the skin and/or clothing,
masks and respirators protect the mouth and nose, goggles protect the eyes, and face shields protect the entire face. The respirator, has been designed to also protect the respiratory tract from airborne transmission of infectious agents. We’ll discuss this in more detail later.
Goggles – protect eyes
Face shields – protect face, mouth, nose, and eyes

28. PPE for Standard Precautions: Based on Risk Assessment
IF direct contact with blood & body fluids, secretions, excretions, mucous membranes, non-intact skin
Gloves
Gown
IF there is the risk of spills onto the body and/or face
Face protection (mask plus eye protection goggle; face shield)
ASSESS THE RISK of exposure to body substances or contaminated surfaces BEFORE any health care activity.
Select PPE based on the assessment of risk:
The effectiveness of PPE is dependent on
adequate and regular supplies,
adequate staff training,
proper hand hygiene, and in particular,
appropriate human behaviour.

29. What Type of PPE Would You Wear?
Drawing blood from a vein?
Gloves
Responding to an emergency where blood is spurting?
Gloves, fluid-resistant gown, mask/goggles or a face shield
Cleaning an incontinent patient with diarrhea?
Gloves / gown
Irrigating a wound?
Gloves, gown, mask/goggles or a face shield
Giving a bed bath?
Generally none
Suctioning oral secretions?
Gloves and mask/goggles or a face shield – sometimes gown
Transporting a patient in a wheel chair?
Taking vital signs?
Listed here are several patient care activities that could indicate a need to wear PPE. What PPE would you wear for the following?
Giving a bed bath? (generally none)
Suctioning oral secretions? (gloves and mask/goggles or a face shield) (Respondents may correctly note that this may depend on whether open or closed suction is being used)
Transporting a patient in a wheelchair? (generally none)
Responding to an emergency where blood is spurting? (gloves, fluid-resistant gown, and mask/goggles or a face shield)
Drawing blood from a vein? (gloves)
Cleaning an incontinent patient with diarrhea? (gloves and generally a gown)
Irrigating a wound? (gloves, gown, and mask/goggles or a face shield)
Taking vital signs? (generally none)
NOTE TO TRAINER: Encourage discussion of how healthcare personnel decide for themselves which PPE will be worn. Do they over- or under-protect themselves?

30. ----Standard Precautions ----Transmission-based precautions
Isolation measures
----Standard  Precautions
Should be applied for ALL patients
----Transmission-based precautions
Contact
Droplet
Airborne
医务人员接触病人血液、体液、分泌物、排泄物等物质时，不管是否有明显的血迹污染或是否接触非完整的皮肤和粘膜，必须采取防护措施。同时，还应根据疾病的传播途径采取空气、飞沫、接触隔离措施。
These are additional precautions utilised to prevent infection when a patient is known to be or suspected of having an infectious disease.
The precautions taken are dependant on the mode of transmission of the infectious condition.
They are defined as;
Contact
Droplet
Airborne
Second core IC measure
-Standard precautions are used for all patients regardless of their diagnoses to ensure protection of the health care worker and the patient.
-For certain highly transmissible or epidemiologically important pathogens, transmission-based precautions are used in addition to standard precautions.
-Contact, droplet, and airborne precautions are meant to block the different routes of transmission that we discussed earlier.
-Since the infecting agent often is not known at the time of admission to a health care facility, transmission-based precautions are used empirically, according to the clinical syndrome and the likely etiologic agent at time, and then modified when the pathogen is identified or a transmissible infectious disease etiology is ruled out.
-These infection control principles are also used for laboratory and procedure-specific safety.
*Transmission-based precautions are often used empirically, according to the clinical syndrome and the likely etiological agent

31. All healthcare workers MUST.....
Assume that every person is potentially infected or colonized with an organism that could be transmitted in the healthcare setting.
Apply a set of work practices to
Blood
all body fluids (except sweat)
mucous membranes
non intact skin.

32. Contact Precautions 经接触传播疾病如肠道感染、多重耐药菌感 染、皮肤感染等的患者
耐甲氧西林金黄色葡萄球菌-MRSA
耐万古霉素肠球菌-VRE
产超广谱β-内酰胺酶-ESBLs细菌
多重耐药铜绿假单胞菌-MDR-PA
经接触传播疾病如肠道感染、多重耐药菌感 染、皮肤感染等的患者
在标准预防的基础上，还应采用接触隔离措 施
多重耐药菌（Multidrug-Resistant Organism，MDRO），主要是指对临床使用的三类或三类以上抗菌药物同时呈现耐药的细菌。常见多重耐药菌包括耐甲氧西林金黄色葡萄球菌（MRSA）、耐万古霉素肠球菌（VRE）、产超广谱β-内酰胺酶（ESBLs）细菌、耐碳青霉烯类抗菌药物肠杆菌科细菌（CRE）（如产Ⅰ型新德里金属β-内酰胺酶[NDM-1]或产碳青霉烯酶[KPC]的肠杆菌科细菌）、耐碳青霉烯类抗菌药物鲍曼不动杆菌（CR-AB）、多重耐药/泛耐药铜绿假单胞菌（MDR/PDR-PA)和多重耐药结核分枝杆菌等。
contact precautions,
guidelines recommended by the Centers for Disease Control and Prevention for reducing the risk of transmission of epidemiologically important microorganisms by direct or indirect contact. Direct-contact transmission involves skin-to-skin contact and physical transfer of microorganisms to a susceptible host from an infected or colonized person. This can occur when health care personnel perform patient-care activities that require physical contact, such as turning or bathing the patient. Direct-contact transmission can also occur between two patients, such as by hand contact, with one patient serving as the source of infectious microorganisms and the other as a susceptible host. Indirect-contact transmission involves contact of a susceptible host with a contaminated intermediate object, usually inanimate, in the patient's environment. Contact Precautions apply to specified patients known or suspected to be infected or colonized with epidemiologically important microorganisms that can be transmitted by direct or indirect contact.

33. Contact Precautions ----患者的隔离 患者接触过的物品
Limit patient contact with non-infected persons
Place patient in a single room or cohort with similar patients
Limit transportation
患者接触过的物品
可重复使用的（被单、衣物） 灭菌-清洁-消毒-灭菌
无保留价值的：焚烧处理
Contact Precautions are used for protection against contact (i.e., hand contamination or self-contact) with large droplets
The key elements of Contact Precautions for patients suspected or confirmed of having a disease spread by droplets or some common respiratory pathogens are:
Using clean, non sterile gloves for all episodes of direct patient contact
Changing the gloves after each patient contact
Use a gown (disposable or re-washable) for each patient contact and disposing of it as either waste or laundry depending on its type, after each episode
Use dedicated specific equipment (preferable single-use) for a single patient and clean and disinfect shared equipment between patient uses.
HCWs should avoid contact with their face, eyes or mouth when their ungloved or gloved hands may be contaminated
Limit patient movement outside of their designated room
Limiting patient contact with other well patients
Putting the patient in a single room or in a room only with other patients with the same diagnosis or with similar risk factors
Contact Transmission
Persons infected with some common respiratory pathogens can spread their disease by either contaminating their own hands, the hands of a healthcare worker or an environmental surface.
Hands can transmit these diseases when they have contact with contaminated surfaces followed by contact with either another body surface such as the conjunctival or nasal mucosa or an intermediate object.

34. Contact Precautions ----医务人员的防护(2-1) Use disposable, gown or apron
进入隔离病室，戴口罩、帽子，从事可能污染工作服的操作时，应穿隔离衣；离开病室前，脱下隔离衣，按要求悬挂，每天更换清洗与消毒;或使用一次性隔离衣。
接触甲类传染病穿脱防护服。
鼠疫 霍乱 H1NI SARS

35. Contact Precautions ----医务人员的防护(2-2) Use disposable gloves
接触隔离患者的血液、体液、分泌物、排泄物等物质时，应戴手套；离开隔离病室前，接触污染物品后应摘除手套，洗手/手消毒。手上有伤口时应戴双层手套。

36. Airborne Precautions
病原微生物经悬浮在空气中的微粒-气溶胶 来传播的疾病如肺结核、水痘等
在标准预防的基础上，还应采用空气隔离 措施。
病原微生物经由悬浮在空气中的微 粒—气溶胶来传播的方式。这种微粒能在空气中悬浮较长时间，并可随气流漂浮到较远处，所以可造成多人感染，甚至导致医院感染暴发流行。
Airborne Transmission
Airborne precautions are used for protection against inhalation of tiny infectious droplet nuclei,
In addition to standard precautions
Use a particulate respirator when entering the patient isolation room. PERFORM SEAL CHECK BEFORE EACH USE!
Place the patient in adequately ventilated room (≥ 12 air changes per hour)
Limit patient movement and ensure that the patient wears a medical mask if outside their room.
Airborne precautions should also be performed during the performance of any aerosol-generating procedures associated with pathogen transmission (e.g., endotracheal intubation, bronchoscopy)
Examples of infections where Airborne Precautions should be used are: Infectious pulmonary and laryngeal tuberculosis, Varicella zoster virus (chickenpox), Rubeola virus (Measles), Viral hemorrhagic fevers (Lassa, Ebola, Marburg and Crimean-Congo viruses).

37. Airborne Precautions ----患者的隔离 Use surgical mask
Place patient in a single room or cohort with similar patients
Limit patient movement
Room ventilation or disinfect
An isolation room with a mechanical ventilation system is recommended for Airborne Precautions.

38. Airborne Precautions ----医务人员的防护
Use a particulate respirator(医用防护口罩)when entering the patient isolation room；
进行可能产生喷溅的诊疗操作时，应戴防护目镜或防护面罩，穿防护服
当接触患者及其血液、体液、分泌物、排泄物等物质时应戴手套。

39. Droplet Precautions 接触经飞沫传播的疾病，如百日咳、白喉 、流行性感冒、病毒性腮腺炎、流行性脑 脊髓膜炎等
在标准预防的基础上，还应采用飞沫隔离 措施。
飞沫传播又称微粒传播，是指经较大的飞沫气溶胶微粒(粒径大于5um)而传播的疾病。在空气中悬浮的时间不长，喷射的距离不过1m左右。
Examples of diseases transmitted by droplets are: Mumps, Influenza virus, Group A streptococcus (prior to commencing and for the first 24 hours on antimicrobial treatment), Neisseria meningitides, Bordetella pertussis (whooping cough) and Severe Acute Respiratory Syndrome (SARS).

40. Droplet Precautions ----患者的隔离 Use surgical mask；
Limit patient movement。
Maintain a distance ≥ 1 meter between infectious patient and others
Place patient in a single room or cohort with similar patients
Room ventilation or disinfect
Droplet Precautions are used in addition to Standard Precautions to provide protection to clinicians and others protection from infections spread by large droplets generated by coughs and sneezes, such as Neisseria meningitidis, and pertussis
Critical additional protection measures under Droplet Precautions are:
the use of a medical/ procedural mask (by HCWs) when within a meter of a patient
Physically maintaining distance between the infected patient and other persons by a distance of at least one meter from all other persons,
Limit patient movement. If a patient has to leave the area, the patient should wear a medical mask, if tolerated, for the duration of their time away.

41. Droplet Precautions ----医务人员的防护 进行可能产生喷溅的诊疗操作时，应戴护目镜或防护面罩，穿防护服；
Use a mask when < 1 m of patient
进行可能产生喷溅的诊疗操作时，应戴护目镜或防护面罩，穿防护服；
当接触患者及其血液、体液、分泌物、排泄物等物质时应戴手套。

42. 保护性隔离----反向隔离 （protective isolation）
适用范围
抵抗力低下或极易感染的患者，如严重烧伤、早产儿、白血病、脏器移植及免疫缺陷患者等。

43. 保护性隔离措施 单间隔离，有条件可放在正压病房 注意口腔卫生，采用洗必泰漱口，每天至少4次 患者 尽量不与其他无关人员接触
严格执行手卫生规范
正确穿戴口罩、帽子、隔离衣（接触患者面为清洁面）
患感染性疾病期间，不得进入隔离室
无关人员不得进入隔离室
治疗、护理应有计划的集中进行，减少出入室的次数
不进入隔离室内探视。必要时应做好手卫生并戴口罩
疑患感染时，不得探视
不得携带鲜花、宠物入室
保证隔离室内压力高于走廊
定期对室内环境进行消毒。 患者
工作人员
家属 访客
环境 管理

44. Terminal Disinfection
Terminal disinfection of the client
Terminal disinfection of the ward
终末消毒处理是指对出院、转科或死亡患者及其所住病室、所用物品及医疗器械等进行的消毒处理。
Isolation

45. Terminal disinfection of the client
Transferred to other wards or discharged
bathe the clients and wear clean clothes
take their personal items with them after disinfection.
For the dead client
clean the body with disinfectant and plug the mouth, nose, ears, anus with sterile cotton, change wound dressing, envelop the body with disposable linen.
Isolation

46. Terminal disinfection of the ward
Close the doors and windows, open bedside table, spread the quilt and place the mattress vertically on the bed, fumigate them with disinfectant or disinfect by ultraviolet light.
Then open the door and windows
furniture and floor: rubbing
Thermometer: immersion
Blood-pressure meter and stethoscope: fumigation
Mattress, quilt and pillows: ultraviolet light.
Isolation

47. Isolation techniques
Hand hygiene
Cap and mask
Goggles/Face shields
Gloves
Gowns/aprons

48. Cap

49. masks 口罩种类 效果 棉布口罩 机械过滤 pm10<30% 医用外科口罩（一次性） 仅对飞沫等大颗粒有一定的滤过作用
口罩种类  
效果  
棉布口罩 
机械过滤 pm10<30%
医用外科口罩（一次性）
仅对飞沫等大颗粒有一定的滤过作用
防尘口罩（N95） 
对病毒、细茵以及PM2．5大小的空气污染物颗粒都具有滤过作用   
滤过率取决于纱布厚度
滤过率90%
滤过率95%---99%
Pm： Particulate matter

50. wash hands:
Before Wear a mask after taking off the mask

51. 如何佩戴N95口罩 １拉松头带。金属 软条向上，将手 穿过头带 ２戴上口罩，头带分 别置於头顶後及 颈後
一手托住防护口罩，有鼻夹的一面背向外， 如图A. 2 。
A.2.2 将防护口罩罩住鼻、口及下巴，鼻夹部位向上紧贴面部，如图A. 3 。
A.2.3 用另一只手将下方系带拉过头顶，放在颈后双耳下，如图A.4 。
A.2.4 再将上方系带拉至头顶中部， 如图A. 5。
A.2.5 将双手指尖放在金属鼻夹上，从中间位置开始，用手指向内按鼻夹，并分别向两侧移动和按压，根据鼻梁的形状塑造鼻夹，
每次佩戴医用防护口罩进入工作区域之前， 应进行密合性检查。检查方法将双手完全盖住防护口罩， 快速的呼气，若鼻夹附近有漏气应按A 调整鼻夹，若漏气位于四周，应调整到不漏气为止。
正确检查：以双手轻按口罩，然後刻意呼吸，空气应该不会从口罩边缘泄漏。 负压检查：以双手轻按口罩，然後刻意呼吸，口罩中央会稍凹陷。
３将双手的食指及中 指由中央顶部向两 旁同时按压金属软 条。
４检查妥当（密合 性检查）

52. DON’T × × × × ×

53. ——Face shields

54. Goggles: 安全的玻璃来防护眼睛
Goggle-----Avoid splashes or sprays to the eyes

55. Gowns
– Use during procedures and patient care activities when contact of clothing/ exposed skin with blood/body fluids, secretions, or excretions is anticipated
A gown should be used during procedures and patient care activities when contact of clothing and/or exposed skin with blood, body fluids, secretions, or excretions is anticipated. Aprons are sometimes used as PPE over scrubs, such as in hemodialysis centers when inserting a needle into a fistula.
PPE Use in Healthcare Settings

56. Gloves Indications for gloving and for glove removal
Under Standard Precautions, gloves should be used when touching blood, body fluids, secretions, excretions, or contaminated items and for touching mucous membranes and nonintact skin.

57. 手套的种类
●　 无菌乳胶手套
● 　清洁一次性使用乳胶手套
● 　双层手套
● 　一次性使用薄膜手套
● 　卫生胶手套

58. 手套的使用
Glove use does not replace any hand hygiene action ≠

59. Prevention Is Primary! Protect patients…protect healthcare personnel…
promote quality healthcare!

60. 医院隔离预防 教学内容 教学目标 5 概述 隔离原则 隔离预防措施 常用隔离技术 解释术语：隔离、清洁区、潜在污染区、污染区、标准预防
掌握隔离的原则与措施
掌握隔离技术的基本操作方法

61. Words: Hand Hygiene Handwashing Isolation Alcohol-based handrub
Aseptic Technique
Aseptic area
Aseptic supply
Isolation
Clean area
Contaminated area