Hand Hygiene Procedures PDF

Hand hygiene Definition: Hand washing means cleaning hands and wrists with rubbing together of all surfaces of hands under a stream of running water using soap or antimicrobial agent. It is one of the most important procedures for preventing the spread of hospital-acquired infect...

Hand hygiene Definition: Hand washing means cleaning hands and wrists with rubbing together of all surfaces of hands under a stream of running water using soap or antimicrobial agent. It is one of the most important procedures for preventing the spread of hospital-acquired infections. It is an essential step before surgical scrub and it is preferably done before aseptic hand wash or alcohol hand rub if hands are visibly solid or contaminated. Indications Hand washing should be performed: Before coming contact with patients &after providing care and after every patient contact. Before and after handling patients food trays. Before and after preparing and administration of medication Before and after dealing with wounds Before and after touching intimate sources that is likely to be contaminated with microorganisms such as contact with mucous membranes, blood or body fluids, secretions or execrations Before leaving the patient areas  Before wearing and after removing gloves and other protective wear When hands are visibly contaminated After using toilet Purpose: ❖ To reduce micro-organisms present in hand ❖ To prevent self-contamination ❖ To prevent cross contamination ❖ Provide safe and clean environment Types: ❖ Routine hand wash. ❖ Sanitary (healthy) hand wash. ❖ Surgical hands wash (surgical scrub). Equipment ✓ Antiseptic soap. ✓ Easy to reach sink with warm running water ✓ Individual towel or tissue paper ✓ Clean orangewood stick (optional) ✓ Emollient Preparation: Inspect the hands for breaks or cuts in skin, cover any skin lesion with a dressing before providing care. If lesions are too large to cover the nurse must be restricted from client direct care. Inspect condition of nails.  Cut nails and artificial nails and nail polish must be removed Remove jewelry watches and rings. Roll the sleeves above the elbow Procedure: No Steps Rationale 1 Stand in front of sink, keeping hands Inside sink is contaminated and uniform away from sink surface.(if which increase the risk of hands touch sink during hand washing contamination of edges ,repeat) when touched 2 Turn on water and regulate the flow and the temperature of water. 3 Avoid splashing water against Microorganisms travel and uniform grow in moisture. 4 Wet hands and wrists under running The expiry date indicates water.keep hands and forearms lower when a drug is no longer than elbows during washing appropriate to use. 5 Apply antiseptic soap and rub hands Ensure that all surface areas together of the hands and finger * Palm to palm cleansed. * Right palm over the left dorsum and left palm over the right dorsum  * palm –to- palm fingers interlocked * Back of fingers to opposing palms with fingers interlocked *Rotational rubbing of right and left thumb *Rotational rubbing of back and forwards with clasped fingers of right hand in the left palm 6 Rinse thoroughly while maintain To prevent cross infection hands point down ward 7 Dry hands and fingers from fingers to wrists 8 Turn off water using towel paper or elbow. 9 Discard towel paper To prevent cross infection 10 Apply lotions To prevent dryness of hands Steps of hand washing:  Vital signs (Body Temperature, Pulse Rate, Respiration Rate, Blood Pressure) What are vital signs? Vital signs are measurements of the body's most basic functions. The four main vital signs routinely monitored by medical professionals and health care providers include the following: Body temperature Pulse rate Respiration rate (rate of breathing) Blood pressure (Blood pressure is not considered a vital sign, but is often measured along with the vital signs.) When to take vital signs (Indications) 1- On a client's admission. 2- According to physician's order. 3- When assessing the client during home visit. 4- Before & a surgical or invasive diagnostic procedure. 5- Before& after the administration of therapy that affect cardiovascular, respiratory& temperature control functions. 6- When the client's general physical condition changes as (loss of consciousness, pain). Vital signs are useful in detecting or monitoring medical problems. Vital signs can be measured in a medical setting, at home, at the site of a medical emergency, or elsewhere. Factors affecting vital signs: Activity, Age, Anger, anxiety, drug, eating, exercise, fear, illness, noise pain, sleep, smoking, stress, weather, weight. Body Temperature What is body temperature? The normal body temperature of a person varies depending on gender, recent activity, food and fluid consumption, time of day, and, in women, the stage of the menstrual cycle. Normal body temperature can range (36.5 º C, or Celsius) to 37.5º C) for a healthy adult. A person's body temperature can be taken in any of the following ways: Orally: Temperature can be taken by mouth using either the classic glass thermometer, or the more modern digital thermometers that use an electronic probe to measure body temperature ( 36.5º C, or Celsius to 37.5º C)  Rectally: Temperature taken rectally (using a glass or digital thermometer) tend to be 0.5 higher than when taken by mouth (37º C, or Celsius) to 38.1º C). Axillary: Temperature can be taken under the arm using a glass or digital thermometer. Temperature taken by this route tend to be 0.5º C lower than those temperatures taken by mouth(35.9 º C, or Celsius) to 37º C) By ear: A special thermometer can quickly measure the temperature of the ear drum, which reflects the body's core temperature (the temperature of the internal organs) (37º C). By skin: A special thermometer can quickly measure the temperature of the skin on the forehead or temporal (37.5º C). Body temperature may be abnormal due to hyperthermia or fever (high temperature) or hypothermia (low temperature). A fever is indicated when body temperature rises about one degree or more over the normal temperature. Hypothermia is defined as a drop in body temperature below 35º C degrees Contra -Indication 1- Do not take oral temperatures on preschool children(Infant) patients receiving oxygen delirious, confused, disoriented, distress patients comatose patients  convulsive patient patients with a naso-gastric tube in place patients who have had oral surgery or mouth sore patients who are vomiting or are quite nauseated 2- Do not take rectal temperatures on ❖ infants or children unless a core temperature is needed ❖ patients who have had rectal surgery or diarrhea ❖ heart disease Duration of taking temperature 1. Tympanic – a couple of seconds – long enough to gently press a Button. 2. Oral (glass thermometer) – three minutes. 3. Axillary (glass thermometer) – five minutes 4. Electronic temperatures – when beep sounds, temperature is obtained 5. Rectal (glass thermometer) - one minute Gather Equipment/Supplies: Thermometer tray consisted of: 1- Dry cotton in alcohol container. 2-Cotton soaked with alcohol. 3- Clean thermometer. 4-Kidney basin for un clean thermometer.  5- Container with water and soap. 6- Watch with seconds. 7- Nursing record. 8- Lubricant (If assessing temperature rectally) 9- Gloves Assess temperature one of the following routes: A. Measuring a Tympanic Membrane Temperature 1. Push the “on” button and wait for the “ready” signal on the unit. 2. Slide disposable cover onto the tympanic probe. 3. Insert the probe snugly into the external ear using gentle but firm pressure, angling the thermometer toward the patient’s jaw line. Pull pinna up and back to straighten the ear canal in an adult. 4. Activate the unit by pushing the trigger button. The reading is immediate (usually within 2 seconds). Note the reading. B. Assessing Oral Temperature Steps Rationale 1-Do thorough hand washing -To reduce number of microorganisms. 2- Clean thermometer in its container with the dry cotton to the patient. 3-Hold thermometer from bottom parallel at eye level. 4-Check the thermometer mercury -Mercury level should be below level. 35ºc to have a correct reading. 5-Ask the patient to open mouth and -The space below the tongue place the bulb under the patient's contains superficial blood vessels tongue directed toward either check. that will transfer the heat. 6-Count three minutes then remove -Secretions on glass will cover the thermometer, wipe it from end to reading. bulb with dry cotton and read it. 7-Shake thermometer down. -Mercury is returned back to its chamber for reuse. 8-Wash with soap under running -Soap, running water& friction water. helps the removal of microorganisms 9-Dry with cotton sponge. -Moist environment helps in the growth of microorganisms 10-Store in its container. - Thermometer made of glass can break easily. 11-Record the temperature on the -Record provides accurate patient's chart. documentation. 12- Collect equipment. C. Assessing Axillary Temperature Steps Rationale 1-Do thorough hand washing -To reduce number of microorganisms 2- Bring clean thermometer in its container with the dry cotton to the patient. 3-Hold thermometer from bottom parallel at eye level. 4-Check the thermometer -mercury level should be mercury level. below 35ºc to have a correct reading. 5- Make sure the axilla is dry and -close contact of the clean, place thermometer bulb in thermometer with the the notch. superficial blood vessels in axilla ensures a more accurate registration of temperature. 6-The forearm is crossing chest and hand resting on opposite shoulder. 7- Hold end of thermometer in place. 8. Count five minutes then -It takes longer to get an remove thermometer. accurate temperature reading. 9- Wipe it from end to bulb with -perspiration on glass will dry cotton and read it. cover on reading. 10- Shake thermometer down. -mercury is returned back to its chamber for reuse. 11 -Wash with soap under -Soap, running water& running water. friction helps the removal of microorganisms. 12- -Dry with cotton sponge. -Moist environment helps in the growth of microorganisms. 13-Store in its container. -Thermometer made of glass can break easily. 14- Record the temperature on - Record provides accurate the patient's chart. documentation. 15-Collect equipments. D. Assessing Rectal Temperature Steps Rationale 1-Do thorough hand -To reduce number of washing microorganisms. 2- Bring clean thermometer in its container with the dry cotton to the patient. 3-Hold thermometer from bottom parallel at eye level. 4-Check the thermometer -mercury level should be below mercury level. 35°c to have a correct reading. 5-Lubricate the bulb and the -lubrication reduced friction area above bulb to (1.5-2.5 and makes it is easier without inches) with lubricant. injuring tissues. 6-Insert the thermometer about 0.5 -1.5 inches ,and hold end of thermometer in place 7- Count one minute then -It take little to get an accurate remove thermometer. temperature reading 8-Wipe it from end to bulb -Fecal matter on glass will with dry cotton and read it. distort reading 9- Shake thermometer - Mercury is returned back to down. its chamber for reuse. 10 -Wash with soap under -Soap, running water& friction running water. helps the removal of microorganisms.  11- Dry with cotton sponge. -Moist environment helps in the growth of microorganisms. 12-Store in its container. -Thermometer made of glass can break easily. 13- Record the thermometer - Record provides accurate on the patient's chart. documentation. 14-Collect equipment. Pulse rate Definition of pulse The pulse is the palpable bounding of the blood flow in the peripheral artery The pulse rate It’s the number of pulsing sensation occurring in one minute. Also it is defined as the measurement of the heart rate, or the number of times the heart beats per minute. As the heart pushes blood through the arteries, the arteries expand and contract with the flow of the blood. Taking a pulse not only measures the heart rate, but also can indicate the following (Heart rhythm &Strength of the pulse) The normal pulse for healthy adults ranges from 60 to 100 beats per minute (b/m). The pulse rate may fluctuate and increase with exercise, illness, injury, and emotions. Females ages 12 and older, in general, tend to have faster heart rates than do males. Athletes, such as runners, who do a lot of cardiovascular conditioning, may have heart rates near 40 beats per minute and experience no problems. Characteristics of pulse ❖ Rate: Normal range is 60 – 100 beats per minute. - Tachycardia (> than 100 b/m) - Bradycardia. (< than 60 b/m) ❖ Quality of pulse is determined as well as rate -Rhythm – regular or irregular -Strength – Bounding or thread (weak) ❖ Circumstances affecting pulse rate. Body temperature Emotions Sites for taking the pulse: 1. Radial artery Felt in wrist at the base of thumb. 2.Brachial Felt in cubital fossa at the median line of artery the arm 3. Apical pulse Heard in left center of chest just below the level of nipple. 4.Temporal Felt in front of ear. artery  5. Dorsal pedis Felt on the back of foot. artery(pedal pulse) 6. Femoral Felt on the groin. artery 7. Carotid On each side at front of neck. artery 8. Popliteal Felt on the back on the knee. artery Posterior tibial Felt behind and below the medial pulse malleolus Equipments: (Watch& nursing record) Procedure for peripheral pulse Steps Rationale 1-Do thorough hand washing. -To reduce number of microorganisms. 2-Explain procedure to patient 3-Place patient in comfortable position either -Uncomfortable position can sitting or lying increase pulse rate. 4-Let patient's hand and arm rest on the bed table or patient's chest 5-Put two or three fingers on the wrist at the base of patient's thumb 6- Do not use thumb to palpate -the thumb has its own pulse because of a main artery present 7-Count pulse for a full minute -Irregularities can be detected more accurately in full minute. 8- Record characteristics of pulse on the - Record provides accurate patient's chart documentation. 9- Report any abnormalities of rate, rhythm and volume Respiration Rate What is the respiration rate? The respiration rate is the number of breaths a person takes per minute. Respiration is normally quiet, effortless, and regular.The rate is usually measured when a person is at rest and simply involves counting the number of breaths for one minute by counting how many times the chest rises. Respiration rates may increase with fever, illness, and with other medical conditions such as (respiratory and heart disease). When checking respiration, it is important to also note whether a person has any difficulty breathing. Assessing Respiration A. Each breath includes inspiration and expiration. B. Measure by observing chest rise and fall. C. Measured in breaths per minute. D. Normal range = 12-20 cycle per minute. E. abnormal increase> than 20 = Tachypnea – if breathing in great depth then called hyperpnoea F. abnormal decrease< than 12 = Bradypnea G. Difficulty in breathing is called dyspnea H.A absence of breathing is called apnea J. Quality of breathing is determined as well as the rate of breathing Depth (deep or shallow) Clarity of breath sounds Pain with breathing Procedure for measuring respiration rate Steps Rationale 1-Do thorough hand washing. 2-Hold patient's hand as if counting the pulse. Don’t tell the person you are counting respiration.  3-Place arm of patient with your hand holding wrist a cross patient's chest. 5-Observe as well abdominal wall. 6-Count inspirations for a full minute 7- Record characteristics of respiration on the patient's chart 8- Report any abnormalities of rate, rhythm and depth. Blood Pressure Definition: The amount of force exerted against the wall of an artery by the blood.you measure systolic and diastolic pressure.The systolic pressure (when the heart contracts) is the pressure in the arteries when the heart contracts.it is the higher pressure. The diastolic pressure (when the heart is at rest) is the pressure in the arteries when the heart is at rest. It is the lower pressure. Purpose: To assess the force of blood ejected against the walls of the vessels i.e. Systolic and diastolic blood pressure. Normal and abnormal blood pressure Systolic pressure: 90mmhg or higher but lower than 120mmhg. Diastolic pressure: 60mmHg or higher but lower than 80 Treatment is indicated for: Hypertension: the systolic pressure is 130mmhg or higher or the diastolic pressure is 80mmhg or higher Hypotension: the systolic pressure is below 90mmhg or the diastolic pressure is below 60mmhg. Principles: 1-Choose a cuff of appropriate size for the patient. A cut which is too large or too small will give false reading. 2- Using the left arm. 3-Cuff should be applied over bare arm; don't place the cuff over clothing..a mercury column should be read at eye level to obtain accurate reading. 4-Brachial pulse is located on the medial aspect of the antecubital apace. 5-Avoid taking blood pressure in case of radical mastectomy and in arm with cast. Equipments: 1- Sphygmomanometers either mercury, aneroid and digital. 2- A stethoscope 3- Alcohol swab 4- Nursing record Procedure: 1-Wash your hands, explain the procedures and assemble equipment. 2-Place the patient in comfortable lying or sitting position.expose left arm.keep it at the level of the heart and the palm is up. 3- Roll the cuff around the upper arm with the cuff's lower edge one inch above the antecubital fossa. 5- Clean ear tips and stethoscope with alcohol swab, place ear tips of stethoscope in your ears pointing forward. Feel the brachial pulse with your fingertips. Place the stethoscope over the artery where you felt the beat.  6- Close the valve of the Sphygmomanometer bulb, and palpate radial pulse ,then pump the bulb 6- Rapidly inflate the cuff to 30mmHg above level previously determined by palpation. 7-Releases pressure to let air come out gradually. 8-Listen with the stethoscope and simultaneously observe the sphygmomanometer. The first knocking sound is the subject's systolic pressure. When the knocking sound disappears, that is the diastolic pressure (such as 120/80mmhg). 9- Records at least systolic and diastolic first and second sounds heard 10- Record reading in patients note. 11-Return equipment to proper place.wash your hands. Medication administration Goals: To improve student the knowledge, skills and positive attitude toward medication administration. Definition: Medication administration is defined as preparing, giving and evaluating the effectiveness of prescription drug. The ten “rights” of drug administration: 1. The right medication  2. The right dose. 3. The right patient. 4. The right route. 5. The right time. 6. The right documentation. 7. The right of the patient to refuse the medication. 8. The right education. 9. The right evaluation. 10. The right assessment. Routes of drug administration: Enteral: drug placed directly in the GIT tract. Oral: swallowing per mouth (p.o). Sublingual: placed under the tongue. Tubal: gastric tube administration Rectum: absorption through the rectum. 1. Parentral : I.M: Intramuscular (vastus laterals, deltoid and dorsogluteal). S.C: subcutaneous (outer surface of upper arm, around umbilicus& thighs)  I.D: intradermal (internal forearm). I.V: intravenous (within the vein) 2. Others: topical &drops& inhalation Medication orders:  Once daily: (OD, Q24 hrs.).  Twice daily: (BID,Q12hrs)  Three times: (TID,Q8hrs)  Four times daily: (Q6hrs)  Give now only: (STATE)  As needed: (PRN)  Continuous during 24 hrs (INFUSION rate …..) (1) Oral Route: -In this route the drug is placed in the mouth and Swallowed. It is also called per oral (p.o) Advantages of Oral Route Convenient - Can be self-administered, pain free, easy to take Absorption - Takes place along the whole length of the gastro intestinal tract. Cheap - Compared to most other parenteral routes. Disadvantages of oral route:  Irritation to gastric mucosa – nausea and vomiting Destruction of drugs by gastric acid and digestive juices (e.g. insulin). Effect too slow for emergencies Unpleasant taste of some drugs Unable to use in unconscious patient. Unable to use patient with nausea and vomiting. Examples:- The example of dosage forms which are used by oral route include 1. Tablet 2. Capsules 3. Syrups etc 2) Parenteral Routes:- In this route of administration the drug does not pass through the gastrointestinal tract. It directly reaches to the blood. Forms of drugs taken in parenteral rout: 1. Vial: closed glass or plastic container with a stopper on the top. 2. Ampoule: glass container that must be broken off to allow withdrawal of drug. Ampoule vial Parts of syringe: The nurse chooses the needle length according to the patient size and weight and tissue into which medication use. The nurse use longer needle for I.M injection and shorter needle for S.C Intramuscular injection: An intramuscular injection is a technique used to deliver a medication deep into the muscles. This allows the medication to be absorbed into the bloodstream quickly. Administration of injection (medication) with an angle 90 º into the muscle Intramuscular injection sites Intramuscular injections are often given in the following areas: 1. Deltoid muscle of the arm: The deltoid muscle is the site most typically used for vaccines. However this site is not used often for I.M injection because it's small muscle and very close to radial nerve and radial artery. To locate this site, feel for the bone (acromion process) that is located at the top of the upper arm. The correct area to give the injection is two finger widths below the acromion process. At the bottom of the two fingers, will be an upside down triangle. Give the injection in the center of the triangle. 2. Vastus laterals muscle of the thigh: a) Recommended site of injection for infant b) Located at the middle third of the anterior lateral aspect of the thigh. c) Assume back-lying or sitting position. 3. Dorsogluteal muscles of the buttocks: a) The site shouldn’t be used in infant under three years because the gluteal muscle are b) To locate the site, the nurse draw an imaginary line divides the buttock into four quadrants. the upper outer quadrant is the site of injection  c) Avoid hitting sciatic nerve, major blood vessels or bone. 4.Ventrogluteal: a) The area contains no large nerves or blood vessels and less fat. 5. Rectusfemoris site: a) Located at the middle third, anterior aspect of thigh Muscular injection procedure Equipments: Patient medication chart. Ampoule or vial - Alcohol swab. -Dry cotton Gloves -Sharp’s container,  Injection tray -two needles ( one to draw up the drug injection & one to administer) of appropriate size Procedure: No Steps Rational 1 ;Check the patient's prescription sheet To ensure that pt. is Is written and signed by the given the correct drug in.prescribing doctor a prescribed dose, with Drug Dose appropriate diluents and Date and Time of administration by correct rout. Route Dilute as appropriate 2 Prepare equipment. 3 Check for any known drug allergies. To prevent administration of inappropriate drug. 4 Select the correct medication and check it The expiry date indicates hasn’t expired when a drug is no longer appropriate to use. 5 Check the drug hasn’t already been To protect patient from administer receiving an additional dose 6 Hand wash and dry thoroughly To prevent cross infection 7 Wear gloves. 8 Use non touch technique attach one To prevent cross needle to the syringe and prepare the infection injection insure no air remains in the syringe. 9 Remove needle and replace with sterile To reduce pain and needle. Dispose used sharp in sharps subcutaneous tissue container injury. 10 Take drug chart and injection tray to To gain patient consent patient and explain procedure and reassure patient. 11 Check the patient's identity by To ensure correct patient ensuring their identity band receive the drug 12 Choose the injection site and ensure privacy. 13 Assist the patient into required To ensure patient position comfort. 14 Remove the appropriate clothes to expose To gain access for the site of injection injection site 15 Clean injection site with alcohol To reduce the number of swab pathogens 16 Stretch the skin around the injection To facilitate insertion of site. the needle and to reduce the sensitivity of nerve ending 17 Hold the needle at an angle 90º quickly To prevent hematoma plunge into skin 18 Pull back the plunger ; if blood appear indicate needle is not in a withdraw the needle and replace it and blood vessels begin again, if no blood is aspirated depress the plunger and inject drug slowly 10sec /ml 19 When the injection is complete wait To allow absorption of for 10 sec before withdrawing the drug and prevent leakage needle smoothly and rapidly at the site 20 withdraw the needle rapidly.Apply Massage may cause pressure with cotton to the injection tissue irritation site Don’t massage. 21 Observe for any adverse reaction, Record the administration on appropriate chart. 22. Ensure all sharps and non -sharp waste are To ensure safe disposal disposed safely. and avoid laceration or injury to staff. Administration of subcutaneous injections A subcutaneous (S.C) injecting is a method of drug administration into the subcutaneous tissue up to 2ml of drug solution can be injected directly beneath the skin. The drug becomes effective within 20 minutes. Purpose: 1. Administer drugs when a small amount of fluid is to be injected, when the patient is unable to take the drug, or the drug is destroyed by intestinal secretion. 2. Administer vaccines, heparin and insulin. 3. Self- administration is possible. Equipments: Patient medication chart. -Injection tray. Syringe of small size. Two needles ( one to draw up the drug injection & one to administer) of appropriate size Ampoule or vial -Alcohol swab -Dry cotton. Gloves -Sharp’s container Sites: 1. Outer aspect of upper arm. 2. Posterior chest wall below the scapula.  3. Anterior abdominal wall from bellow the breast to the iliac crest. 4. The anterior and lateral aspect of the thigh. Sites of subcutaneous administration of drug Procedure: No Steps Rational 1 Check the patient's prescription sheet To ensure that pt. is given Is written and signed by the prescribing the correct drug in a.doctor prescribed dose, with Drug appropriate diluents and Dose by correct rout. Date and Time of administration Route Dilute as appropriate 2 Prepare equipment. 3 Check for any known drug allergies. To prevent administration of inappropriate drug.  4 Select the correct medication and check it The expiry date indicates hasn’t expired when a drug is no longer appropriate to use. 5 Check the drug hasn’t already been To protect patient from administer receiving an additional dose 6 Hand wash and dry thoroughly To prevent cross infection 7 Use non touch technique attach one To prevent cross infection needle to the syringe and prepare the injection insure no air remains in the syringe. 8 Remove needle and replace with sterile To reduce pain and needle. dispose used sharp in sharps subcutaneous tissue injury. container 9 Take drug chart and injection tray to To gain patient consent patient and explain procedure and reassure patient. 10 Check the patient's identity by ensuring To ensure correct patient their identity band receive the drug 11 Choose the injection site and ensure privacy. 12 assist the patient into required position To ensure patient comfort. 13 remove the appropriate clothes to expose the To gain access for site of injection injection site 14 Clean injection site with alcohol swab To reduce the number of pathogens introduced into the skin by the needle at time of insertion 15 Gently pinch the skin up into a fold To elevate the subcutaneous tissue and left the adipose tissue away from the underlying muscle. 16 Insert the needle into the skin at an angle Injection medication into of 45º and release the grasped skin ,inject compressed tissue irritated the drug slowly nerve fibers and causes the patient discomfort. 17 Withdraw the needle rapidly; apply To prevent hematoma pressure to any bleeding point. Don’t rub formation interferes with or massage absorption 18 When the injection is complete wait for To allow absorption of 10 sec before withdrawing the needle drug and prevent leakage smoothly and rapidly at the site 19 Ensure that all sharps and non-sharps to ensure safe disposal and waste are disposed safely to avoid laceration or other injury to staff 20 Observe any adverse reaction and record administration in appropriate sheets.  Administration of intra-dermal injections Definition: Administration of an injection (medication) with an angle (5º: 15º) into the dermal layer of the skin Purpose: The drug is injected into the layers of the skin, e.g. Bacillus Chalmette–Guerin (BCG) vaccination and drug sensitivity tests. It is painful and only a small amount of the drug can be administered. Equipments: Patient medication chart. –Gloves Injection tray. - Sharp's container Syringe of small size. two needles ( one to draw up the drug injection & one to administer) of appropriate size Ampoule or vial -Alcohol swab. - Dry cotton. Site: Forearm Procedure: No Steps Rationale 1 ;Check the patient's prescription sheet To ensure that pt. is.Is written and signed by the prescribing doctor given the correct drug Drug in a prescribed dose, Dose Date and Time of administration with appropriate Route diluents and by correct Dilute as appropriate rout. 2 Prepare equipment. 3 Check for any known drug allergies. To prevent administration of inappropriate drug. 4 Select the correct medication and check it hasn’t The expiry date expired indicates when a drug is no longer appropriate to use. 5 Check the drug hasn’t already been administer To protect patient from receiving an additional dose 6 Hand wash and dry thoroughly To prevent cross infection 7 Use non touch technique attach one needle to the To prevent cross syringe and prepare the injection insure no air infection remains in the syringe. 8 Remove needle and replace with sterile needle. To reduce pain injury. dispose used sharp in sharps container 9 Take drug chart and injection tray to patient and To gain patient consent explain procedure and reassure patient. 10 Check the patient's identity by ensuring their To ensure correct identity band patient receive the drug 11 Choose the injection site and ensure privacy. 12 Assist the patient into required position 13 Clean injection site with alcohol swab for 30 To reduce the number seconds and allow it to dry. of pathogens introduced into the skin by the needle at time of insertion 14 Stretch the skin around the injection site. To facilitate insertion of the needle and to reduce the sensitivity of nerve ending 15 Holding the needle with the angle 5:15 slowly plunge into the skin and administer the drug. 16 Notice that while injecting the medication, small Bleb indicate bleb approximately 6 mm in diameter appears on medication is deposited skin surface in derms 17 Withdraw the needle while applying gentle Massaging damage pressure ,do not massage injection site underlying tissue it may disperse medication into underlying tissue layer and alter test result 18 Make circle around injection site, stay with Severe anaphylactic patient 3:5 minutes and observe for any allergic reaction is characterized reaction. by: dyspnea, wheezing 19 Record the administration in appropriate chart. To maintain accurate records, provide point of reference in the event of any queries and prevent any duplication of medication 20.Ensure all sharps and non- sharp waste are disposed safely.