Day 1 Standard Precautions
description
Transcript of Day 1 Standard Precautions
FAALTURA 2008
Standard PrecautionsDay 1
Basic Infection Prevention and Control Course for Nurses
FAALTURA 2008
Standard Precautions
• Applies to:– Blood– All body fluids, secretions and excretions
except sweat, regardless whether they contain visible bloof
– Non-intact skin– Mucous Membranes
FAALTURA 2008
USE STANDARD PRECAUTIONS for the care of
ALL PATIENTS
Treat all body fluids as if they were infectious
FAALTURA 2008
Most common mode of transmission of pathogens is via
hands! Infections acquired in healthcare
Spread of antimicrobial resistance
So Why All the Fuss About Hand Hygiene?
Standard PrecautionHAND HYGIENE
FAALTURA 2008
The Inanimate Environment Can Facilitate Transmission
~ Contaminated surfaces increase cross-transmission ~Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+) Patient Environment. Hayden M, ICAAC, 2001, Chicago, IL.
X represents VRE culture positive sites
FAALTURA 2008
Principles of HandwashingHandwashing: • single most important and
effective measure to preventing transmission of infection
• removes transient microbes• prevents the transfer of
microbes to patients, staff or equipment
• wash using soap and running water
FAALTURA 2008
Specific Indications for Hand Hygiene
• Before:– Patient contact – Donning gloves – Inserting urinary catheters, peripheral
vascular catheters, or other invasive devices that don’t require surgery
• After:– Contact with a patient’s skin – Contact with body fluids or excretions,
non-intact skin, wound dressings– Removing gloves
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.
FAALTURA 2008
Recommended Hand Hygiene Technique
• Handrubs – If hands are not visibly soiled, decontaminate them with Alcohol-based waterless handrub located in strategic locations throughout the hospital
– Apply to palm of one hand, rub hands together covering all surfaces until dry
– Volume: based on manufacturer
– If hands are not visibly soiled, use an alcohol-based handrub for routinely decontaminating hands.
• Handwashing
– Wet hands with water, apply soap, rub hands together for at least 15 seconds
– Rinse and dry with disposable towel
– Use towel to turn off faucet
– When hands are visibly dirty, contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap and water.
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.
FAALTURA 2008
Guidance for the Selection and Use of Personal Protective Equipment (PPE) in
Healthcare Settings“specialized clothing or equipment worn
by an employee for protection against infectious materials” (OSHA)
FAALTURA 2008
Types of PPE Used in Healthcare Settings
PPE Use in Healthcare Settings
FAALTURA 2008
PPE Use in Healthcare Settings:How to Safely Don, Use, and
Remove PPE
FAALTURA 2008
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
PPE Use in Healthcare Settings
FAALTURA 2008
Sequence* for Donning PPE
• Gown first
• Mask or respirator
• Goggles or face shield
• Gloves
*Combination of PPE will affect sequence – be practical
PPE Use in Healthcare Settings
FAALTURA 2008
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
PPE Use in Healthcare Settings
FAALTURA 2008
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
PPE Use in Healthcare Settings
FAALTURA 2008
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• Perform a fit check –
– Inhale – respirator should collapse
– Exhale – check for leakage around facePPE Use in Healthcare Settings
FAALTURA 2008
How to Don Eye and Face Protection
• Position goggles over eyes and secure to the head using the ear pieces or headband
• Position face shield over face and secure on brow with headband
• Adjust to fit comfortably
PPE Use in Healthcare Settings
FAALTURA 2008
How to Don Gloves
• Don gloves last
• Select correct type and size
• Insert hands into gloves
• Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
FAALTURA 2008
Do’s and Don’ts of Glove Use
• Work from “clean to dirty”• Limit opportunities for
“touch contamination” - protect yourself, others, and the environment– Don’t touch your face
or adjust PPE with contaminated gloves
– Don’t touch environmental surfaces except as necessary during patient care
• 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
PPE Use in Healthcare Settings
FAALTURA 2008
Steps in Proper Sterile Gloving (Open)
FAALTURA 2008
Sequence for Removing PPE
• Gloves
• Face shield or goggles
• Gown
• Mask or respirator
PPE Use in Healthcare Settings
FAALTURA 2008
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, e.g., sink or alcohol-based hand rub
PPE Use in Healthcare Settings
FAALTURA 2008
How to Remove Gloves (1)
• Grasp outside edge near wrist
• Peel away from hand, turning glove inside-out
• Hold in opposite gloved hand
PPE Use in Healthcare Settings
FAALTURA 2008
How to Remove Gloves (2)• Slide ungloved finger
under the wrist of the remaining glove
• Peel off from inside, creating a bag for both gloves
• Discard
PPE Use in Healthcare Settings
FAALTURA 2008
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
PPE Use in Healthcare Settings
FAALTURA 2008
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
PPE Use in Healthcare Settings
FAALTURA 2008
Removing a Mask• Untie the bottom, then
top, tie
• Remove from face
• Discard
PPE Use in Healthcare Settings
FAALTURA 2008
Removing a Particulate Respirator• Lift the bottom
elastic over your head first
• Then lift off the top elastic
• Discard
PPE Use in Healthcare Settings
FAALTURA 2008
Respiratory or Cough Etiquette
FAALTURA 2008
Respiratory Protection
• Purpose – protect from inhalation of infectious aerosols (e.g., Mycobacterium tuberculosis)
• PPE types for respiratory protection– Particulate respirators– Half- or full-face elastomeric respirators– Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
FAALTURA 2008
Elements of a Respiratory Protection Program
• Medical evaluation
• Fit testing
• Training
• Fit checking before use
PPE Use in Healthcare Settings
FAALTURA 2008
Respiratory Hygiene/Cough Etiquette
TARGET:
Patient and family member but applies to any person with signs of colds and other
respiratory infection (ex. Cough, congestion, rhinorrhea, increased
production of respiratory secretion etc.)
FAALTURA 2008
Respiratory Hygiene/Cough Etiquette
• Absence of fever does not always exclude respiratory infection (ex. Pertussis and colds)
• Patient who has asthma, allergic rhinitis or COPD also may have cough and sneezing, although these patient are not infectious, cough etiquette measures always applies.
FAALTURA 2008
Respiratory Hygiene/Cough Etiquette
RECOMMENDATION• Instruct symptomatic person to
cover mouth/nose when sneezing/coughing.
• Use tissue and dispose not to touch receptacle.
• Observe hand hygiene after soiling of hands with respiratory secretion.
• Wear surgical mask if tolerated or maintain spatial separation > 3 feet if possible.
FAALTURA 2008
Respiratory Hygiene/Cough Etiquette
ELEMENTS:• HC personnel are advised to observe DROPLET
PRECAUTION (wear surgical mask) and hand hygiene when examining patient with S & Sx of a respiratory condition.
• HC personnel who have a respiratory infection are advised to avoid patient contact when they are actively coughing and producing respiratory secretion.
FAALTURA 2008
What Type of PPE Would You Wear?
• Giving a bed bath?
• Suctioning oral secretions?
• Transporting a patient in a wheel chair?
• Responding to an emergency where blood is spurting?
• Drawing blood from a vein?
• Cleaning an incontinent patient with diarrhea?
• Irrigating a wound?
• Taking vital signs?
PPE Use in Healthcare Settings
FAALTURA 2008
What Type of PPE Would You Wear?
• 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?
• Generally none required
• Responding to an emergency where blood is spurting?
• Gloves, fluid-resistant gown, mask/goggles or a face shield
• Drawing blood from a vein?• Gloves
• Cleaning an incontinent patient with diarrhea?
• Gloves w/wo gown
• Irrigating a wound?• Gloves, gown,
mask/goggles or a face shield
• Taking vital signs?– Generally none
PPE Use in Healthcare Settings