Handwashing and Hygiene PDF

Hygiene NSG 3100 2 Body Defenses Against Infection Specific (immune) Nonspecific defenses defenses by contrast, protect the person are directed against against all identifiable bact...

Hygiene NSG 3100 2 Body Defenses Against Infection Specific (immune) Nonspecific defenses defenses by contrast, protect the person are directed against against all identifiable bacteria, microorganisms, viruses, fungi, or other regardless of prior infectious agents. exposure. Examples Examples include include inflammation, immunizations, skin, nasal passages, immunoglobulins, T- urine flow cells 3  Breaking the Chain of Infection Etiologic Agent Correctly cleaning, disinfecting or sterilizing equipment before use Educating clients and support persons about the importance and the appropriate methods to clean, disinfect, and sterilize article 4 Breaking the Chain of Infection Portal of Exit Avoiding talking, coughing, or sneezing over open wounds or sterile fields Covering the mouth and nose when coughing or sneezing Covering wounds appropriately 5 Breaking the Chain of Infection Method of Transmission Proper hand hygiene Instructing clients and support persons to perform hand hygiene before handling food, eating, after eliminating and after touching infectious material Wearing gloves when handling secretions and excretions Wearing gowns if there is danger of soiling clothing with body substances Disposing of urine and feces in appropriate receptacles Initiating and implementing aseptic precautions for all clients Wearing masks and eye protection when in close contact with clients who have infections transmitted by droplets from the respiratory tract Wearing masks and eye protection when sprays of body fluid are possible 6 Breaking the Chain of Infection Method of Transmission Soap and water CDC recommends alcohol based antiseptic hand rubs before and after each direct client contact If visible dirt or matter or C. Diff may be present, alcohol-based rubs will not be sufficient and soap and water is a must! 7   #1 way to prevent infection  Wash hands for 20 seconds, per the CDC  Water should always run off the fingers Hand  Scrub in a circular motion  Thoroughly pat dry the hands Hygiene and arms  Keep the nails short; no artificial nails  Remove rings, watches and bracelets  Hand Hygiene  #1 way to prevent infection  Alcohol gel vs soap and water  Should wash hands for at least 15-20 sec  Water should always run off the fingers, not the elbows (hold hands lower)  Scrub in circular motions because the friction helps rid the microorganisms  Easy & Cost Effective This Photo by Unknown Author is licensed under CC BY-SA 9  Hand washing Hospital Acquired Infections (HAI’s) are most of the time due to ineffective hand hygiene (ex: MRSA). Hepatitis A transmission is usually from the fecal oral route (poor hand hygiene after using the bathroom!) 10  Hand washing When do you think we should use alcohol gel vs soap and water? Hands are visibly soiled Special considerations with C. Diff transmission There are recommendations to wash hands and then apply alcohol gel. Double protection since many people don’t always was their hands as well as they should Some facilities recommend you wash your hands after using gel 3 times You want the water to flow from least contaminated to most contaminated: Hands and fingers are considered much more contaminated then the rest of the arm and elbow (the exception to this is if you work in the OR. Their scrubs are much more detailed and have some variations from the normal hand hygiene) 11  Hand Hygiene Cont’d  Nails are one of the most commonly missed sites  Keep them short  No artificial nails!  Removal of all jewelry is recommended  Microorganisms can lodge in the settings of rings  Should check hands for any breaks or tears  Nurses with open sores may want to adjust patient assignments or keep open areas covered with bandages. 12  Hand Hygiene Cont’d  Use warm water instead of hot  Hot water removes the protective oils of the skin  Can also cause damage skin if water is too hot which will promote bacterial invasion Touch is a very therapeutic tool, don’t ever feel like you can’t touch your patient. Just be smart about the capacity in which you are doing it. o That sick child is going to want to be held, that elderly person dying is going to want to hold your hand. There is no reason you can’t use touch as a healing tool! 13 5 Moments of Hand Hygiene 14  The Science Behind Handwashing  According to WHO and the Joint Commission (2007), in the United States of America (USA):  1: 136 patients becomes severely ill as a result of acquiring an infection in hospital.  This is equivalent to 2 million cases per year,  Incurring additional costs of US$ 4.5–5.7 billion  About 90, 000 deaths  According to CDC (2018), teaching people about handwashing helps them and their communities stay healthy. Handwashing education in the community:  Reduces the number of people who get sick with diarrhea by 23-40%  Reduces diarrheal illness in people with weakened immune systems by 58%  Reduces respiratory illnesses, like colds, in the general population by 16-21%  Reduces absenteeism due to gastrointestinal illness in schoolchildren by 29-57%  Father of Hand Hygiene: Ignaz Semmelweis 15   Skin  Feet  Nails  Oral and nasal cavities  Ears Hygiene   Perineal-genital area Teeth  Hair  Eyes   Culture  Religion Factors  Environment Influencing  Developmental level Personal  Health and energy Hygiene  Personal preferences   Decreased or lack of motivation  Weakness or tiredness  Pain or discomfort  Perceptual or cognitive impairment  Inability to perceive body part or spatial relationship Etiologies of  Neuromuscular or musculoskeletal impairment Self-Care   Medically imposed restriction Therapeutic procedure restraining mobility (IV Deficits infusion or cast)  include:  Severe anxiety Environmental barriers This Photo by Unknown Author is licensed under CC BY-NC   Removes accumulated oil, perspiration, dead skin cells, and some bacteria Purpose of  Stimulates circulation Bathing  Produce a sense of well-being  Personal Hygiene  Assess functional level and allow for as much independence as possible  Completely Independent: no help whatsoever needed  Semi-Dependent: Requires help from another person  Moderately Dependent: Requires help from another person + equipment or device  Totally Dependent: Does not participate at all in the activity, needs complete assistance Independence is a major theme in nursing! You don’t want to do EVERYTHING for your patient. Instead make them an active participant in their care by allowing them to do as much as possible. This gives them a feeling of being in control.  Other factors to consider  Balance  Ability to sit unsupported  Activity tolerance  Coordination  Adequate muscle strength  Joint range of motion (ROM)  Vision  Client preferences 20  Personal Hygiene Assisting with personal hygiene is the perfect time to do a thorough skin examination on your patient. Be sure you accurately and precisely document any abnormalities noted 21 Stop – Think-Pair-Share In groups What are some common skin problems that may be noted during the bath? What are some common foot problems that may be noted during the bath? What are some common nail problems that may be noted during the bath? What are some common problems with the hair/scalp that may be noted during the bath? 22  Types of hygienic care Early morning Morning Hour of sleep  Urinal or  Usually after  Elimination bedpan breakfast  Washing face  Washing face  Elimination and hands and hands  Bath or shower  Oral care  Oral care  Perineal care  Back massage  Oral, nail, and hair care  Complete bed bath Self-help bed bath Categories Partial bath of Cleansing Baths Bag bath Towel bath Tub bath  Be sure you document type of bath, assistance, and any other skin protective measures you took. (Example: partial versus complete baths) Be flexible. Let your patients bathe at the time of day that works best for them If your patient has dementia, bathing can be extra challenging Bathing o Be patient o Come prepared your client o Offer distraction such as music or television o Warn them ahead of time what you are doing and where you will be touching o If they get irritable or distressed, stop and return at a later time to only wash the important areas Bathing  General Guidelines of Skin Care 1. Intact healthy skin is the body’s first line of defense. Bacteria thrive in warm, moist environments. 2. The degree to which the skin protects the underlying tissues from injury depends on the general health of the cells, the amount of subcutaneous tissue, and the dryness of skin 3. Moisture in contact with the skin for more than a short time can result in increase bacterial growth and irritation. Make sure skin is dry after the bath. 4. Body odors are caused by resident skin bacteria acting on body secretions. 5. Skin sensitivity to irritation and injury varies among individuals and in accordance with their health. Skin sensitivity is greater in infants, very young children, and older adults. Nutritional status can affect skin sensitivity (obese and emaciated) and intactness of the skin. Check the need for hypoallergenic products.. 6. Agents used for skin care have selective actions and purposes 1. Soap, CHG (Chlorhexidine), oil, cream/lotion, powder, deodorant, antiperspirant 27  Providing Perineal Care  Female: Be sure you spread the labia and get between all of the folds Use different sections of the washcloth and take one stroke with each Always wipe front to back  Male Be sure you get the scrotum If the client is uncircumcised, you will need to retract the foreskin 28  Lifespan Considerations in Bathing  Infants: Sponge baths are suggested for the newborn because daily tub baths are not considered necessary. After the bath, the infant should be immediately dried and wrapped (to get warm). Parents need to be advised that the infant’s ability to regulate body temperature has not fully developed and newborns’ bodies lose heat readily.  Children: Encourage a child’s participation as appropriate for developmental level. Closely supervise children in the bathtub. Do not leave them unattended. 29  Lifespan Considerations in Bathing  Adolescents: Assist adolescents are needed to chose deodorants and antiperspirants. Secretions from newly active sweat glands react with bacteria on the skin, causing a pungent odor.  Older Adults: Changes of aging can decrease the protective function of the skin. These changes include fragile skin, less oil and moisture, and a decrease in elasticity. To minimize skin dryness in older adults, avoid excessive uses of soap. The ideal time to moisturize the skin is immediately after bathing. Avoid excessive powder because it causes moisture loss and is a hazardous inhalant. Cornstarch should also be avoided because in the process of moisture it breaks down into glucose and can facilitate the growth of organisms. Protect older adults and children from injury related to hot water burns. 30  Skin Problems & Care  Dry Skin  Bathe less frequently/mild or no soap/rinse well  Increase fluid intake  Humidify air  Use moisturizing creams and lotions. Best time to moisturize is after a bath/shower.  Cool or cold causes vasoconstriction which can inhibit blood flow to the skin.  Rashes  Tepid bath to relieve itching (pruritis). Hot causes vasodilation which can make itching worse!  Avoid scratching  Avoid clothing that is irritating or causes excessive perspiration, such as polyester/wool  Keep area clean with mild soap  Acne  Wash face using hot water  Avoid oily creams or cosmetics that block ducts  Never squeeze or pick at the lesions b/c this can increase the potential for infection and scarring 31  Foot Care  Keep feet from getting dry (dry = risk for breakdown) but avoid putting lotion between the toes (breeding ground for bacteria)  Inspect feet carefully, use a mirror if necessary (look for redness, swelling, or areas of breakdown)  Change socks daily  Wear comfortably, well-fitting shoes that do not rub.  Do not walk barefoot at all!  Exercise feet daily to improve circulation  Avoid constriction (tight pants, crossing the legs, etc.)  Don’t let feet get too cold (causes vasoconstriction and poor perfusion)  Have family cut or file nails straight across-may need a referral to podiatrist 32  Diabetic Foot Care Diabetics are at an increased risk for infection because of the high sugar content in their blood (bacteria thrive in that environment). In addition, many diabetics experience neuropathy, meaning they have poor sensation in their lower extremities (many times they have poor feeling in their feet). As a result, they need to have routine inspection and foot care. If they get minor scrapes or cuts, they may not notice them, which predisposes them to infection. Diabetics are at high risk for lower extremity amputations Try to file diabetic’s nails instead of cut. Think about consulting a podiatrist to cut their nails 33  Oral Care  Brush teeth thoroughly after meals and at bedtime  Floss daily  Ensure adequate intake of nutrients, particularly calcium, phosphorus, vitamins, A, C, and D, and fluoride  Avoid sweet foods and drinks between meals  Eat coarse, fibrous foods such as raw veggies  Dental checkup every 6mo w/fluoride This Photo by Unknown Author is licensed under CC BY-SA  If providing oral care to unconscious client, lay them on their side and have suction available.  Should begin brushing teeth around 18mo  Foam swabs are used often in the hospital settings to clean the mouths of dependent clients  The use of lemon glycerin swabs in not recommended because they irritate and dry out the oral mucosa and can decalcify teeth. 34  Hair Care  Assess for hair related conditions:  Lanugo, alopecia, dandruff, hair loss, ticks, pediculosis (lice), scabies, & hirsutism  Be gentle and use oil if the hair is tangled  Older adults are more susceptible to temperature drops so it’s important to use warm water when shampooing their hair and dry hair promptly  Be cautious about shaving patients, and if it’s necessary, use a safety or electric razor.  Be sure you shave in the direction of the hair growth  Always wear gloves b/c tiny nicks and cuts can cause exposure to blood borne pathogens  Excessively matted or tangled hair could indicate lice. Look for nits at the base of the scalp 35  Eye & Ear Care Eye Care Ear Care  Always wipe/wash from inner canthus of  For adults, examination of ear eye to outer to prevent particles and requires you to pull the pinna up fluid from draining into the lacrimal sac and back to visualize the structures. and nasolacrimal duct.  If dirt or dust get into eyes, rinse with  Avoid cotton tipped swabs b/c they clean, tepid water push cerumen back further into the canal  Guard against eyestrain and protect vision by having adequate lighting for  If you remove a hearing aid turn it reading and obtaining shatterproof off or batteries will continue to run lenses for glasses  Regular eye examinations, especially after 40, to detect problems such as cataracts and glaucoma. 36  Bed-Making  Wear gloves, and possibly a gown if the situation warrants it  Hold soiled linens away from your body and place them directly in a bin  Draw sheet for patient transfers  Call light within reach  Side rails up  Side-rails are a good safety mechanism, but you must be careful about the mental/cognitive status of your patient.  Sometimes putting side rails up can contribute to falls if the patient is confused and tries to climb over them.  Never put more than 3 rails up. (4=restraint) 37