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 10-15 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 10-15 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!!