ST wk 1 Standard Precautions - Tagged.pdf

Welcome to Nursing 1090 MRS. CHERYL GOERGEN, MSN, RN  Nursing 1090 Nursing Care of Adults I: ◦ Care of adult patients: ◦ Young adult: late teens to mid/late thirties ◦ Middle adult: mid/late thirties to mid-sixties ◦ Older adult: greater than age 65 Variability occurs wit...

Welcome to Nursing 1090 MRS. CHERYL GOERGEN, MSN, RN  Nursing 1090 Nursing Care of Adults I: ◦ Care of adult patients: ◦ Young adult: late teens to mid/late thirties ◦ Middle adult: mid/late thirties to mid-sixties ◦ Older adult: greater than age 65 Variability occurs with older adults ◦ Each person is unique and ages differently ◦ Treat patients as individuals ◦ Avoid ageism, stereotypes  Standard Precaution s NURS 1090  Unit Outcomes ▪Demonstrate ability to make unoccupied and occupied beds. ▪Understand and demonstrate principles of safe patient positioning techniques including: --Therapeutic positions --Repositioning patients in bed ▪Identify principles of proper body mechanics to prevent nurse injury. ▪Provide personal hygiene to patients according to their specific needs. ▪Demonstrate range of motion exercises. ▪Define basic techniques to prevent skin breakdown ▪Assess functional status of hospitalized older adults. Verbalize the rationale for implementing standard precautions, isolation protocol and PPE  Standard Precautions Precautions used in hospitals to prevent transmission of disease that can be acquired through contact with blood, body fluids, non-intact skin and mucous membranes Protects the patient and provides protection to the health care worker. Mandated by: OSHA: Occupational Safety and Health Administration CDC: Centers for Disease Control and Prevention TJC: The Joint Commission OBN: Ohio Board of Nursing Ohio Revised Code 4273-20-01 Infection Good health depends on a safe environment-- Safe for patients and health care providers Using best practice and appropriate techniques helps decrease transmission of organisms Definition: Invasion of body tissues by microorganisms with the potential to cause disease or illness  Infection Pathogens (infectious agents) Chain of Infection Bacteria Pg. 557-558 in Pearson Staph, strep, E. Coli, TB Viruses Herpes, HIV, hepatitis Fungi Candida albicans Parasites Protozoa, worms  Infection Apply your knowledge! How does infection occur? What must happen to stop the infection? What practices can health care providers implement to interrupt the transfer of organisms?  Infection: Methods of Transmission Direct Transmission – transfer of microorganisms by direct contact or droplet spread ◦ Direct contact: touching, biting, kissing, sexual intercourse ◦ Droplet spread: particles that travel within 3 feet and come in contact with host ◦ sneezing, coughing, spitting, singing, talking  Infection: Methods of Transmission, cont. Indirect Transmission ◦ Vehicle-borne ◦ substance that transmits an infectious agent into a susceptible host. ◦ Inanimate objects: contaminated objects such as surgical instruments, dressings, patient care equipment ◦ water, food, blood, serum, and plasma ◦ Vector-borne ◦ an animal or flying/crawling insect that transports infectious agent to people ◦ flies, mosquitos, flea, tick Infection: Methods of Transmission, cont. Airborne Transmission: Very fine particles (droplets) remain suspended in air or are carried on dust particles ◦ Remain in the air for a period of time ◦ Transmitted by air currents ◦ Varicella, measles, TB, covid  Healthcare Associated Infections (Hospital Acquired Infections) Infections associated with delivery of health services in a health care facility, such as a hospital or nursing home. ◦ Endogenous: originate from patient ◦ Exogenous: originate from hospital environment and hospital personnel ◦ Iatrogenic: contaminated equipment (endoscope, foley catheter, IV) ◦ Most common sites, organisms and causes ◦ Ex: Urinary tract – E. coli – Improper urinary catheterization technique What is a nosocomial infection?  Risk Factors for Infection in Adults Chronic diseases Lifestyle – high risk behaviors Occupation Diagnostic procedures Heredity Travel History Trauma – sepsis, secondary infections Nutrition  Risk for Infection: Older Adults Older Adult – Immune system decline ◦ Causes: ◦ Cell-mediated immunity declines ◦ Alterations in structure of skin, urinary tract and lungs ◦ Skin breakdown ◦ Urinary Tract Infection ◦ Pneumonia ◦ Losses and stress suppress immune system ◦ Higher risk for air-borne infections **The very young and the very old are more susceptible to infection  Test Your Knowledge! The nurse is caring for an 80-year-old patient admitted from a long- term care facility to the medical unit for onset of new confusion and treatment of a sacral pressure injury. Due to his declining cognitive (thinking) condition, he is not able to recognize the urge to urinate and has periods of urinary incontinence. To protect the healing ulcer from his urine, the healthcare provider orders the placement of an indwelling urinary catheter (to drain his urine). From the information provided, what puts the patient at risk for infection? 1. 2. 3. 4.  Asepsis Definition: The absence of disease-causing microorganisms ◦ Aseptic technique – practices/procedures to reduce the risk of transmission of organisms from one person to another ◦ Two types of aseptic technique ◦ Medical - we will discuss NOW ◦ Practices that control spread of organisms ◦ Surgical – (we will discuss weeks 9&10) ◦ Practices that keep an area or object free of all microorganisms  Medical Asepsis Clean technique Intended to reduce the number and control transmission of microorganisms Used with ALL patients Achieved by implementation of Standard Precautions  Medical Asepsis Achieved by following Standard Precautions Precautions used by all care providers to all hospitalized patients ◦ Regardless of diagnosis or infection status Designed to: ◦ Decrease risk of transmission ◦ Protect persons from exposures ◦ Both patient and healthcare providers ◦ Prevent or control infection and its spread Apply to: ◦ All patients and healthcare personnel  Standard Precautions For use with all patients Hand hygiene Gloves PPE (personal protective equipment) as needed Clean or dispose of used equipment properly Private room as needed “Cough Etiquette” Avoid touching facial mucous membranes  Standard Precautions Tier 1 Applies to the care of all patients, regardless of suspected or confirmed presence of an infectious agent. Blood All body fluids (except sweat) Mucous membranes Broken (nonintact) skin  Transmission Based Precautions Tier 2 Control measures used in addition to standard precautions designed to interrupt transmission of known infectious agents ◦ For patient with known or suspected infection (active or colonized) ◦ Categories ◦ Contact: private room; gloves, gown ◦ Droplet: private room or cohort; mask ◦ Airborne: private room, negative-pressure airflow; mask  Infection Control Measures How do we prevent the spread of infection? Hand Hygiene: single most important act of medical asepsis ◦ Used with all forms of precautions ◦ Standard Precautions (Tier 1) ◦ Transmission-Based Precautions (Tier 2) ◦ National Patient Safety Goal ◦ Antiseptic Agents: Instant alcohol hand rubs, foams or gel/hand sanitizer ◦ Handwashing: Soap/water ◦ Must wash hands when visibly soiled ◦ Avoid artificial nails, gel or acrylic nail products ◦ Use only soap and water for patients with C. Difficle---WHY?  Hand Hygiene: Recommended Technique Waterless Antiseptic Agent – instant alcohol-based antiseptic product (rub, foam, or gel) ◦ Apply to palm of one hand, rub hands together covering all surfaces until dry ◦ Volume: apply 1 palmful/1 pump (3-5 mL) Hand Washing ◦ Wet hands with water, apply 5-10 mL liquid soap, rub hands together for at least 20 seconds, use plenty of lather and friction ◦ Rinse (keep hands down, elbows up)and dry with disposable towel ◦ Use clean, dry paper towel to turn off faucet www.cdc.gov: Guidelines for Handwashing  Hand Hygiene: Recommendations (from CDC) Recommendations (from CDC): Before patient contact Before clean/aseptic procedures After contact with patient, blood, body fluids, or contaminated surfaces (even if gloves are worn) After removing gloves Before and after eating, using bathroom, blowing nose, etc. Demonstration of Handwashing Procedure View the Handwashing video found in the Standard Precautions Video file on Black board (in the week one content) Isolation Practices Practices to prevent the transmission of microorganisms The appropriate use of Personal Protective Equipment (PPE) – includes gowns, gloves, masks, eyewear Critical thinking….what PPE should be used? Based on nursing assessment With all patient interactions: HAND HYGIENE before and after care  Personal Protective Equipment 1. Gloves a) Protective barrier--against touching contaminated items and known sources of infection such as secretions, blood b) Reduce risk of transmission to self c) Reduce risk of transmission to others d) Must perform hand hygiene after removal e) Exam gloves vs. sterile gloves Personal Protective Equipment-- Gloves EXAM STERILE GLOVES GLOVES  Personal Protective Equipment Masks, Eye Protection, and Face Shields a. Protect against splashes/sprays b. Protect mucous membranes of eyes, nose and mouth  Personal Protective Equipment Gowns a. Protect clothing & skin from splashes/sprays b. Shoe covers, hair covers  Isolation Practices Patient care equipment a. Avoid contamination from dirty equipment b. Guard against injury from sharp instruments Linen and Laundry a. Minimal handling b. Hold away from uniform c. Color coded linen bags (used in some agencies)  Isolation Practices Patient Placement a. Private rooms for patients who are: - contaminated and likely to spread infection - compromised and at risk for infections Patient Transport a. Limit transport when patient is contaminated b. Use barriers as necessary c. Notify destinations prior to transport  Personal Protective Equipment: Use in the Health Care Setting: How to Apply, Use and Remove PPE  Key Points About PPE Type of PPE depends on level of precautions required Apply before contact with patient, preferable prior to entering patient room Keep hands away from face Limit surfaces touched Remove and discard carefully Immediately perform hand hygiene Work from clean to dirty Never walk into hallways, nursing stations, supply rooms with ANY PPE ◦ EVEN IF YOU JUST PUT IT ON AND DID NOT COME IN CONTACT WITH THE PATIENT  Sequence for Applying (Donning)PPE Hand Hygiene Apply gown Mask or respirator Goggles or face shield Gloves Combination of PPE used will affect sequence of application and removal.  How to Apply a Gown 1. Select appropriate type and size 2. Opening is in the back 3. Fasten at neck and waist 4. If gown too small, use 2 gowns 1. Gown #1 ties in front 2. Gown #2 ties in back  How to Apply a Mask 1. Place over nose, mouth and chin 2. Fit flexible nose piece over nose bridge 3. Secure on head with ties (or elastic over ears) 4. Adjust to fit  How to Apply a Particulate Respirator Mask 1. Masks are fitted to worker 2. Place over nose, mouth and chin 3. Fit flexible nose piece over nose bridge 4. Secure on head with elastic 5. Adjust to fit 6. Perform a fit check - Inhale: Respirator should collapse - Exhale: Check for leakage around face  How to Apply Eye and Face Protection 1. Position goggles over eyes and secure to the head using the ear pieces or headband 2. Position face shield over face and secure on brow with headband 3. Adjust to fit accordingly  How to Apply Gloves 1. Gloves are applied last in the sequence of PPE 2. Select correct type and size 3. Insert hands into gloves 4. Extend gloves to cover wrist of isolation gown 5. Keep gloved hands away from face 6. Remove gloves if torn; perform hand hygiene before donning new gloves  Safe Removal of PPE Contaminated’ and ‘Clean’ Areas of PPE Contaminated areas: outside front, gloves ◦ Areas of PPE that have or are likely to have been in contact with body sites, materials, or environmental surfaces where the infectious organism may reside Clean areas: inside, outside back, ties on head and neck -- Areas of PPE that are not likely to have been in contact with the infectious organism Sequence for Removal (Doffing) of PPE Gloves Gown Protective eyewear: Goggles/face shield Mask Hand Hygiene  Sequence for Glove Removal Remove one glove by grasping upper outside cuff near wrist with opposite gloved hand Pull glove inside out over hand Discard glove (or hold in opposite gloved hand) With ungloved hand slide finger under inside cuff of remaining glove and pull off, inside out Dispose of gloves properly by touching only the insides Hand hygiene (if no other PPE worn)  Sequence for Gown Removal Unfasten ties at waist and neck Peel away from neck and shoulders, touching inside of gown only Turn contaminated surface outside toward the inside Fold or roll into a bundle Discard Sequence for Protective Eyewear Removal Grasp ear or head pieces with ungloved hands Lift away from face Place in designated receptacle for reprocessing or disposal  Sequence for Mask Removal **Remember: Front of mask or respirator is contaminated – DO NOT TOUCH Grasp bottom, then top ties or elastics and remove Discard Hand hygiene  Hand Hygiene After PPE Removal Perform hand hygiene immediately after removing PPE. *If hands become visibly contaminated during PPE removal, wash hand before continuing to remove PPE Wash hands with soap and water or use an alcohol-based hand rub *Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub  Practice, Practice, Practice College Lab first week of class in H-257/H-258 in the H-Building—second floor. Arrive between 7:45-7:55. Practice/Demonstrate Hand Hygiene Practice/Demonstrate application and removal of PPE Supplies will be provided in the Lab **Remember to do the assigned readings!!