Infection Control and Isolation Procedures

Infection Control and Isolation

• Room Assignments: Clients with infections require specific rooms, based on the type of infection.

• Isolation Precautions (Types): Different types of isolation are used to prevent the transmission of infections.

  • Contact Precautions: Used for infections spread by direct contact (e.g., wound infections, RSV, scabies). Caregivers and visitors wear gowns and gloves. Patients are placed in private rooms or cohorted with others with the same infection, maintaining 3 feet between clients. PPE must be removed before leaving the room.

  • Droplet Precautions: Used for infections spread through large droplets produced by coughing or sneezing (e.g., rubella, pertussis, mumps). Providers and visitors wear surgical masks. Private rooms or cohorting are used, with at least 3 feet between clients. Clients wear masks when moving outside their rooms. Cough etiquette and hand hygiene are crucial. Use individual equipment whenever possible.

  • Airborne Precautions: Used for infections spread by small airborne particles (e.g., measles, varicella, tuberculosis, COVID-19). Patients need private rooms with negative pressure and closed doors. Providers and visitors wear N95 or higher masks (fit testing is required). Wear full PPE if splashing is expected.

  • Protective Isolation: Used for immunocompromised clients, especially during the first 100 days after hematopoietic stem cell transplant or as needed. No plants; this is maintained using positive airflow, and masks should be worn if they move outside the room.

Personal Protective Equipment (PPE)

• Gloves: Worn when contact with blood, bodily fluids, secretions, excretions, non-intact skin, mucous membranes, or contaminated items is anticipated.

• Eye Protection: Protective eyewear should be worn if there's a risk of splash contamination when dealing with body fluids or during wound irrigation.

Hand Hygiene

• Frequency: Hand hygiene is performed before and after client interaction.

• Importance: Essential to prevent the spread of germs.

• Specific Situations: Different techniques may be necessary for different pathogens. For Clostridium difficile, soap and water are essential to eliminate spores.

Healthcare-Associated Infections (HAIs)

• Types: Include catheter-associated urinary tract infections (CAUTIs), surgical site infections (SSIs), ventilator-associated pneumonia (VAPs), and central line-associated bloodstream infections (CLABSIs).

• Concerns: HAIs are costly. They pose serious risk of morbidity and mortality, and generate a negative perception of the healthcare system.

Signs of Infection and Inflammation

• Generalized Infection Signs: Fever, chills, increased pulse and respiratory rate, malaise, fatigue, anorexia, nausea/vomiting, abdominal cramping/diarrhea, and enlarged lymph nodes.

• Inflammation Signs (Local): Redness, warmth, edema, pain/tenderness, and loss of function in the affected area.

• Inflammation Signs (Exudate): Clear (serous), bloody (sanguineous), or pus-filled (purulent) discharge.

• Inflammation Signs (Late Stages): Tissue repair with formation of scar tissue.

Breaking the Chain of Infection

• Methods: Proper handwashing, disinfection/sterilization, and isolation of infected patients are vital.

Safety

Fall Risk Assessment and Interventions

• Assessment: Multidisciplinary approach with strong administrative support to review past falls, investigate causes, and develop policies.

• Interventions: Non-skid footwear, low bed positions, locked bed wheels/wheelchair brakes, adequate lighting, call lights within reach, client education, signage.

Restraints

• Rationale: Restraints are used with extreme caution and when necessary to minimize risk of injury.

• Application: Applied correctly, with minimal tightness to prevent circulation problems.

• Nursing Care: Regular assessment, repositioning, care to prevent skin breakdown, frequent monitoring of vital signs.

• Complications: Potential for complications including pressure injuries, circulation impairments and emotional distress.

Fire Safety

• Actions: Remove persons from danger, activate alarm, close doors/windows, address small fires.

Client Safety Goals

• Identification: Use of two client identifiers.

• Communication: Clear communication; use ISBARR method and communicate critical results.

• Medication Safety: Label medications correctly; be aware of high-alert medications like anticoagulants; perform medication reconciliation.

Seizure Precautions

• Interventions: Call rapid response team (RRT), place in side-lying position (avoid aspiration), protect head, remove harmful objects, loosen tight clothing around the neck, continuous monitoring, document seizure characteristics, and monitor ABCs (airway, breathing, circulation).

Home Oxygen Use Education

• Precautions: No smoking around oxygen; keep open flames and electrical appliances away; never use while cooking; turn off if a fire; install/test smoke detectors.

Body Mechanics

• Positioning: Stay close to the object; contract abdominal/back muscles, keep head/shoulders aligned, slightly bend your knees, and pivot/step instead of twisting.

Vital Signs

Blood Pressure

• Technique: Use a cuff appropriate size to client arm; place cuff 1 inch above elbow crease, with arrow aligned with brachial artery; client can be seated or lying, arm supported at heart level, palm up, or thigh if needed; inflate 30 mmHg above expected systolic, release slowly 2 mmHg /sec; record first and fifth Korotkoff sounds. Use a two-step process when possible.

• Normal Range: 120/80 mmHg

• Hypertension Stages: Stage 1 (130-139/80-89), Stage 2 (>140/>90), Crisis (>180/>120).

• Risk Factors: Excessive sodium, obesity, alcohol consumption, stress, family history.

• Interventions: Exercise, stress reduction, low-sodium diet, and weight loss (if needed).

• Hypotension Intervention: Change positions slowly, increase fluids, avoid temperature extremes, elevation (unless contraindicated).

• Orthostatic Hypotension: Measure blood pressure changing position (lying to sitting, sitting to standing). Diagnosed by drop of at least 20 mmHg systolic, or 10 mmHg diastolic.

Apical Pulse

• When Taken: When illness, weakness or rapid radial pulse are suspected.

• Duration: 1 minute

• Where: At apex of the heart (5th intercostal space, left mid-clavicular line).

Respirations

• Counting: One breath in and one breath out equals one respiration count.

• Patterns: Eupnea (normal), apnea (cessation), Cheyne-Stokes (cyclical shallow/deep with apnea), Kussmaul (deep, rapid, regular).

• Causes of Patterns: Eupnea occurs when relaxed; Apnea in opioid overdose & heart failure; Cheyne-Stokes in stroke, brain tumor, and heart failure; Kussmaul in DKA and renal disease.

Peripheral Pulses

• Locations: Temporal, carotid, brachial, femoral, popliteal, dorsalis pedis, posterior tibial.

• Documentation: 0 absent, +1 weak, +2 normal, +3 strong, +4 bounding.

Oxygen Saturation

• Obtaining: Place sensor on intact digit, earlobe, or bridge of nose; document stable readings.

• Normal: 95-100%.

• Low Interventions: Auscultate lungs, increase oxygen flow, monitor for respiratory arrest, possible intubation.

Temperature

• Sites: Oral, temporal, rectal, axillary, tympanic.

• Benefits/Limitations: Assess benefits and drawbacks of temperature from chosen sites.

Mobility

Range of Motion (ROM)

• Active vs. Passive: Active ROM performed by the client; Passive ROM supported by staff

Bed Positions

• Positions Used For: Supine, prone, semi-Fowler's, Fowler's, Trendelenburg, semi-prone positions with their intended use.

Mobility Aids

• Crutches Fit: Crutches should be placed 1-2 inches below the axilla, at a 15-30 degree angle, with body weight supported by hands, not axilla.

• Stockings (Anti-embolism): Applied in the morning before leg distention, or 15-30 minutes after elevation.

• Ambulation Assistance: Support the back and hold the gait belt.

• Moving Clients in Bed: Place sling from shoulders to mid-thigh, raise the side rail, move to the other side of the bed, then lower the side rail and roll the client.

• Transferring: Methods based on patient's weight bearing: lift, sit-to-stand, gait belt/ambulation, or no assistance.

• Immobility Complications: A summary of complications by system, categorized by complication with interventions.

Movement Pairs

• Types: Flexion/extension, abduction/adduction, pronation/supination, circumduction, rotation, inversion/eversion, dorsiflexion/plantar flexion.