L8 Protective Measures (I) Isolation Precautions - Student Version PDF

✓ f o rdifferent mode o f Transmittion Protective Measures (I): Isolation Precautions ¥ Mr Kin Wong BN, MSc, RN Senior Lecturer School of Nursing TWC College Tel: 34686875 Email: [email protected] NUR3009 Care of People...

✓ f o rdifferent mode o f Transmittion Protective Measures (I): Isolation Precautions ¥ Mr Kin Wong BN, MSc, RN Senior Lecturer School of Nursing TWC College Tel: 34686875 Email: [email protected] NUR3009 Care of People with Communicable Diseases 1 Learning Objectives After this lecture, students should be able to: Compare the isolation precautions for diseases with different modes of transmission Describe special precautions for Multidrug Resistant Organism (MDROs) Describe the criteria of clearance of MRSA carriage Devise a plan for isolation precaution of particular communicable disease appropriately NUR3009 Care of People with Communicable Diseases 2  ! " Isolation Precautions in Hong Kong A two-tier system that applies to healthcare environment in hospital and Basil f o r community. 4447k a l l patient Idient a t a l lt i m e The first tier Standard Precautions (SP) are designed for all patients/ c e l lgland residents/ clients regardless of their diagnosis, that mainly prevent specific for the transmission of microorganisms via contact of blood, body fluid, function leg.gff secretion,HEexcretion,751¥77'¥E mucous membrane and non-intact openwound skin. sliver D A. AH In conditions that Standard Precautions do not adequately confer a protection against acquisition of the infections, for example, some respiratory infections, the second tierD oTransmission-based t t precautions on top are necessary in addition to SP. ¥hE NUR3009 Care of People with Communicable Diseases 3  jhhfnftt.tt contact & a i rbone First-tier for ALL patients Second-tier for particular patients NUR3009 Care of People with Communicable Diseases 4 Alertstaff & visitor NUR3009 Care of People with Communicable Diseases 5 1. Standard Precautions Standard precautions apply to ALL patients/ residents/ clients in healthcare facilities, regardless of their diagnosis or presumed infection status. They apply to situations where they are contacts with blood, body fluids, excretions, secretions, except sweat, mucous membranes and non-intact skin. I vpathogen level Standard precautions include: Hand hygiene Personal protective equipment (PPE) Environmental control Linen management Respiratory hygiene/cough etiquette in healthcare settings NUR3009 Care of People with Communicable Diseases 6  ! # # # # HE hand hygiene 1.1 Hand Hygiene 40-60s u s Hand hygiene (hand washing/handrub) should be performed: Between direct patient/ resident/ client contacts After touching blood, body fluids, excretions, secretions, mucous membranes, non-intact skin and contaminated items ¥744 hand washing 1Physicalremoval After gloves are removed sporeform When performing the task or procedure from a contaminated site to a clean producing microorganism \ site on the same patient/ resident/ client inactivatem b., Alcoholic handrub is preferred if the hands are NOT visibly soiled Hand hygiene facilities should be available and accessible to residents and visitors Education on hand hygiene should be provided to them NUR3009 Care of People with Communicable Diseases 7 1.1 Hand Hygiene NUR3009 Care of People with Communicable Diseases 8  ! ! PPE includes bloody wound - Gloves  when contact with blood, body fluid, secretion, excretion, mucous membrane and non-intact skin (e.g. wound)  should be removed once the procedure is completed suction1 sugaryI Mask, eye protection, face shield X  when likely generate splashes of blood, body fluids, excretions or secretions  staff should wear mask if s/he has respiratory symptoms or when caring patient with respiratory symptoms Gown/apron g. e.  protect staffs’ skin and prevent soiling of the clothing of bedmaking healthcare workers/professionals when splashing procedure is anticipated ¥fI ¥ ti ¥ MRSA contactprecansion = Forsingle u s e 1 episode only. → t t singler o o m1171ft NUR3009 Care of People with Communicable Diseases 9  ¥ %① , n¥mode o ftransmitters 1.3 ② JhhT7Db¥ FE D EIH.AE#Fth If transplant h immunosuppressen t HIV i n a n edisease organ , ATERr o o m (dropletprecausion) NUR3009 Care of People with Communicable Diseases 11  ! "## 1.4 Kkx:¥¥E :#fb Yd%diIs e n d # c s s D muxH it ¥ P surgical wound n e w #excessivedischarge XIEPF¥ dressing ive bleeding → pressure A-arteryforcept KEN T ↳ change dressing ¥E¥ : ¥E¥k¥fE¥% 'I:p:#betade.eu#usendE:ffEf wet→ 4 wound infection + contamin sharp markKIf¥)3k¥§sharp environment NUR3009 Care of People with Communicable Diseases 12  # 1.5 Environmental Control t.IE#EhIE--Mhtt*tdeaniIean- ingrHItttFti'¥ IntAontbreak:daily → BD ¥44'¥HtI #EEtxdaiy.tt# ¥F¥f¥Ik¥EFN¥ hEThHIEhoII- IoEinIs b e NUR3009 Care of People with Communicable Diseases 13  Clean -> Linen Room 1.6 Linen Management Dirty -> Sluice Room Used linen should be handled and processed properly NUR3009 Care of People with Communicable Diseases 14 1.7 t.IN#Et I V Ampoule opener 'EEL × sharp needlelessport The One-hand NUR3009 Scoop Care of People with Communicable Diseases Technique: https://www.youtube.com/watch?v=AYUbpBLceTg 16  ! t¥ ¥¥k¥ glass→ dumsharpb o x  IF¥¥t 1. Respiratory hygiene/cough etiquette Alerts to clients Respiratory hygiene/cough etiquette Masking and separation of persons with respiratory symptoms Droplet precautions t t maskHE NUR3009 Care of People with Communicable Diseases 21 NUR3009 Care of People with Communicable Diseases 14  Ask n¥tEE¥F7n4response → Must t HE Intermission + ¥t rational = I 2. Transmission-based Precautions defense o n n¥communicable disease Additional precautions apply to patients/residents/clients documented or suspected to be infected with highly transmissible or epidemiology important pathogens. A combination of different additional (transmission-based) precautions should be used in addition to standard precautions. Contact precautions Droplet precautions Airborne precautions NUR3009 Care of People with Communicable Diseases 23  ! ! " 2.3 Contact Precautions In addition to Standard Precautions, Contact Precautions are used for patients/ residents/ clients known or suspected to be infected ori KA9 # I t colonized TE t h with epidemiologically important microorganisms that can KA11#AsIs} be transmitted by direct or indirect contact of patients’/ residents’/ ¥ ¥ clients’ environmental HEE surfaces or healthcare items e.g. measles, chickenpox, malaria, herpes zoster, foot and mouth disease etc. NUR3009 Care of People with Communicable Diseases 16 2.1 Contact Precautions Preventive m e a s u r e avoid c ro s sinfection Patient/resident Placement: Patient/ Resident is preferably put in a single room with toilet and handwashing facility. Alternatively, cohort patients/ residents infected or colonized with the same microorganisms. e.g. group the patients in the same cubicle. Participation of group activity in institutional patient/ resident should be avoided until symptoms are subsided. avoid cross infection e.g. stay at the ward for physiotherapy instead of going down to the physio department. ¥IF FEx¥ ht bk Cleant o dirty NUR3009 Care of People with Communicable Diseases 17 2.1 Contact Precautions Patient/Resident transport: Avoid contamin surrounding If transport is necessary, minimize the environmental contamination as far as possible, for example, cover the drainage wound with water- proof dressings NUR3009 Care of People with Communicable Diseases 18  2.1 Contact Precautions × patient contains Contact → w e a r gloves × spreadt oother Healthcare equipment : Gloves should be worn when having “dirty” patient/ resident/ client care procedure that contact with blood, body fluid, secretion, excretion, mucous membrane, non-intact skin or clinical indicated, such as infectious skin problem. Remove gloves after completing the procedures and perform hand hygiene immediately. Gloves should not be worn routinely on entry to areas such as a cubicle or a ward where multiple (water yellow, THAI patients bedmakingH¥k A gown/apron should be worn if your clothing will have substantial contact with resistance) the patient/resident/client or his/her immediate environment to prevent the contamination of staff Dedicate the use of non-critical care equipment to a single patient/ resident/ client e.g. individual BP cuff, stethoscope. Otherwise, proper cleaning/ dilute E disinfection of the equipment are necessary before other patient/ resident/ client ④ use. tc + prevent c r o s s infection Alcohol NUR3009 Care of People with Communicable Diseases 19 2.1 Contact Precautions Environmental control: Should be cleaned with the same procedures used for patients on Standard Precautions, unless the infecting microorganisms and the amount of environmental contamination indicate special cleaning More frequent¥ ?environmental # cleaning/ disinfecting schedule are needed. “Active damp scrubbing” for cleaning/ disinfecting environmental surfaces should be used. avoid creation of aerosols or splashing, or dust dispersion. More frequent environmental cleaning/ disinfecting schedule are needed to eliminate the pathogenic microorganisms. NUR3009 Care of People with Communicable Diseases 20  # " 2.2 Droplet Precautions Droplet Precautions are designed for patients/ residents/ clients known or suspected to be infected with microorganisms transmitted by large-particle droplets generated by patient during coughing, 5µm > sneezing, talking, etc. m AE spreadi n 1 14 NUR3009 Care of People with Communicable Diseases 21 2.2 Droplet Precautions Patient/resident/client placement: Patient/Resident/Client should be cohorted Spatial separation of at least one metre between the infected patient/ resident/ client and other patients/ residents/ clients and visitors should be maintained. NUR3009 Care of People with Communicable Diseases 22 2.2 Droplet Precautions Patient/resident transport: Transport of institutional patient/resident from the room for essential purposes only If transport or movement is necessary, place a surgical mask on the patient/resident NUR3009 Care of People with Communicable Diseases 23 2.2 Droplet Precautions Respiratory protection: Healthcare workers should wear a surgical mask when working within one metre of the patient/ resident/ client NUR3009 Care of People with Communicable Diseases 24 2.3 Airborne Precautions Placement of patient/resident/client: e r te t r u ecte t e ecte t cr r tr tte rt c e re ue cr etre r er e t t re u e e t e r r er t e > I m. T B 1chickenpox Patient/resident/client should be put into a (airborne infection isolation room). If there is no appropriate facility to place the infectious patient/resident, s/he then should be transferred to a facility with appropriate isolation ±h¥tIhospital facilities. For ambulatory setting without room with special ventilation, the client should be put in a single room during waiting. S/he should be examined or discharged or transferred to appropriate facility as soon as possible. Video: tt ://www.youtube.com/watch?v=LcWS4k6Wg64 33 NUR3009 Care of People with Communicable Diseases  Anti-room = gown up1 down NUR3009 Care of People with Communicable Diseases 26 Source: https://www.cdc.gov/hai/pdfs/eic_in_HCF_03.pdf 2.3 Airborne Precautions Patient/resident transport: portal X-ray Transport of institutional patient/resident eg. from the room for essential purposes only If transport or movement is necessary, " " a n place a surgical mask on the patient/resident receive department If#special ¥E⇐*.# NUR3009 Care of People with Communicable Diseases 27  only resistant only 2.3 Airborne Precautions [off ,N 9 5 non-oilresistance Respiratory protection: P95 'oil prone Healthcare workers should(AGP) wear a respirator when entering the room OR performing aerosol-generating procedures 霧化), which may be ② associated with an increased risk of infection transmission ① ① ② with #4211¥ ③ cardiopulmonary resuscitation ④ Bronchoscopy ⑤ ⑤ ⑥ ⑧ nasopharyngeal aspirate high flow oxygen ④ I f conscious non-invasive healthcare worker:wearN 9 T 10-151 faceshield NUR3009 Care of People with Communicable Diseases - 38  ! ! 2.3 Airborne Precautions Respiratory protection (cont’d): For caring patients/residents/clients with known or suspected measles or chickenpox, susceptible persons should not enter the room if other immune caregivers are available. ¥patient'¥dialysis #Thea i r bone The:¥tIH¥#isolation Eh → onlycall renaln u r s e NUR3009 Care of People with Communicable Diseases 29 3. Precautions for Multidrug Resistant Organism (MDROs) Definition of MDRO: Superbacteria They are germs, mostly bacteria, which over time have adapted to antibiotics, making antibiotics less effective or not effective at all e.g. Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin- Resistant Enterococci (VRE) etc. × I s ✓ c a r r i e r eg.stick skino n Colonization- When a person is colonized with a multi-drug resistant organism the germs are present in or on the body but the person is not ill. He is a carrier of the organism and can spread it to other people even though he has no symptoms of illness. Infection- An illness that results from the presence and invasion of the germs. The person with an infection can spread it to others. NUR3009 Care of People with Communicable Diseases 30 3. Precautions for Multidrug Resistant Organism (MDROs) ~ Contact pretension Measures: Single room for patient placement with handwashing and toilet facilities is preferred. Number of persons entering the room should be minimized. A frequent cleaning/ disinfecting schedule for the environment and patient care equipment. Dedicated non-critical items are preferred. Otherwise, decontamination should be done before sharing the equipment with other patients. Patient transfer should be avoided. If transfer is inevitable, the receiving department/ institute should be notified. Patient’s risk on spreading of MDRO’s should be evaluated from time to time in order to implement the relevant precautionary measures. NUR3009 Care of People with Communicable Diseases 31 3. Precautions for Multidrug Resistant Organism (MDROs) decolonization localtreatment → Criteria of Clearance E¥E¥z-ve of MRSA Carriage: 2 swap At least two consecutive screening cultures results are negative Swabs should be taken from groins, axillae, nasopharynx and +/- wound f TENA swapping 1¥17 48 hours interval between swabs t e t re u re t t e t r r t r e e ut (Leave for 1 mins before rinising) ctr L r e e t e t L t tr ec t r e rt cu r rt e u er ur er (taking steroids If antimicrobials are given for treatment of MRSA infection, the screening should be taken 48 hours after completion of targeted antimicrobial treatment and NOT having steroid because they will cause false negative result AoktHhhI¥I FF74th#swap NUR3009 Care of People with Communicable Diseases 33 NUR3009 Care of People with Communicable Diseases 48 × pregnant NUR3009 Care of People with Communicable Diseases 49 4. Handling of dead body When handling of dead bodies: Avoid direct contact with blood or body fluids from the dead body Put on appropriate personal protective equipment (PPE) Make sure any wounds are covered with waterproof bandages or dressings Do NOT smoke, drink or eat. Do NOT touch your eyes, mouth or nose Place the dead body in a robust and leak-proof opaque plastic bag of not less than 150 μm thick, which should be zippered closed. Pins are NOT to be used. (The bagged body should be placed in another opaque body bag if the deceased was suspected to be suffering from highly infectious diseases). Attach an appropriate identity label to the body bag Remove personal protective equipment after handling of the dead body Then, wash hands with liquid soap and water immediately NUR3009 Care of People with Communicable Diseases 34  1 bag Grid-19 HepatitisB ✓vaccine double bagging + vaccine ↳¥ NUR3009 Care of People with Communicable Diseases 35 Key Elements on Prevention and Control of Coronavirus disease (COVID-19) in Healthcare Settings  Suggested Website NUR3009 Care of People with Communicable Diseases 52 CIAO!