Standard Precautions Fundamentals PDF

Standard Precautions Fundamentals 1 © 2017 Assessment Technologies Institute®, LLC | Privacy Policy | Terms of Use Pathogens Viruses. Bacteria. Fungi. Prions. Parasites. Privacy P...

Standard Precautions Fundamentals 1 © 2017 Assessment Technologies Institute®, LLC | Privacy Policy | Terms of Use Pathogens Viruses. Bacteria. Fungi. Prions. Parasites. Privacy Policy | Terms of Use 2 Chain of Infection Causative agent – Bacteria, virus. – Fungus, prion, parasite. Reservoir – Human, animal. – Water, soil, insects. Portal of exit – Respiratory tract, Gastrointestinal, Genitourinary. – Skin, mucous, blood, body fluids. Mode of transmission – Contact, droplet, airborne, vector-borne. Portal of entry – Same as portal of exit. Susceptible host – Compromised defense mechanisms. View Image: Chain of Infection Privacy Policy | Terms of Use 3 Hand Hygiene Hand hygiene is the No. 1 way to prevent the spread of infection. Alcohol-based waterless products are best used unless hands are visibly soiled. Privacy Policy | Terms of Use 4 Definitions Isolation and barrier protection – Includes appropriate use of personal protection equipment (PPE) Gloves, masks, respirators, gowns, and eyewear. – The need for and type of barrier equipment depends on the infection and transmission route. The Center for Disease Control (CDC) describes two tiers of precautions. – Tier One, also known as standard precautions, is the most important and should be used with all clients Gloves. Handwashing. Privacy Policy | Terms of Use 5 CDC Tiers Tier Two precautions are specific, based on medical diagnosis – For example, different precautions will be used for different diseases, depending on how each disease is transmitted Contact. Droplet. Airborne. New recommendations will be forthcoming and ever changing as we see more drug resistance – e.g., Methicillin resistant staph aureus (MRSA), Vancomycin resistant enterococci (VRE), Ebola. – Nurses can decrease costs for their institution by being aware of what barrier devices are needed for each of their clients and using protective equipment accordingly. Privacy Policy | Terms of Use 6 Barrier Equipment Gloves – Prevents contamination by direct/indirect contact. Single use only. – Gloves go on after gowns and must be pulled over gown sleeves. Gowns – Barrier protection against contact with infectious body/blood fluids or waste. Fluid resistant. Ripped gowns should be changed. Masks – Prevents inhalation of droplet nuclei larger than 5 microns. – Become ineffective if moist or wet. Never reuse. Particulate respirator – Prevents inhalation of droplet nuclei smaller than 5 microns. – Most commonly used for clients who have tuberculosis (TB). Eyewear/face shields – Glasses or goggles with side shields to prevent contamination of the eyes from splashing/splattering of secretions. Privacy Policy | Terms of Use 7 Standard Precautions Tier One Description Barrier Equipment Diseases Used Used for the care of Gloves All client care in which all clients. Gowns you could come in Apply anytime you Masks contact with bodily could come in contact Eyewear depending fluids. with bodily fluids. on the care of patient If it’s wet, sticky, and Wash hands for 15 to doesn’t belong to you, 30 seconds with protect yourself. soap. Use friction. Privacy Policy | Terms of Use 8  Standard Precautions Tier Two Tier Two Description Barrier Equipment Used Diseases Use Contact thewhen Apply closedyoubullet style, Privatedarker room orgray cohort(R 71 G clients 69 B 68) 18pt Shigella have direct or Gloves Enteric infections (C. diff) indirect contact Gowns Herpes simplex with a client with a + standard precautions Scabies colonized Varicella zoster infection. Multi-drug resistant organisms Droplet Apply when Private room or cohort clients Rubella infections Mask Mumps organism’s droplet + standard precautions Pertussis nuclei are larger Pneumonia than 5 microns. ‒ Streptococcal ‒ Mycoplasma ‒ Meningococcal Airborne Apply when Private room with negative Measles infections airflow (at least 6 exchanges Varicella organism’s droplet per hour) Tuberculosis nuclei are smaller Particulate respirator mask than 5 microns. + standard precautions Privacy Policy | Terms of Use 9 Reverse Isolation/Protective Precautions Used to protect the client from health care workers and others. Most commonly seen in clients who have: – Cancer. – Immunosuppression from autoimmune disorders Human immunodeficiency virus (HIV). Acquired immune deficiency syndrome (AIDS). Strict hand washing for all persons in contact with client. Avoid fresh fruits and vegetables. No fresh flowers, plants, or standing water in room. Restrict visitors who may be ill. Privacy Policy | Terms of Use 10 Tier Two Precautions Contact precautions – Use when within 3 feet of client Impetigo. Shigella. Herpes simplex. Multidrug-resistant organisms like MRSA or VRE. – Use gown, gloves and if any potential for spraying, face gear. – Private room or with clients with same illness. Privacy Policy | Terms of Use 11 Tier Two Precautions Airborne – Use when particles are less than 5 mcg Measles. Varicella. TB. – Private room, N95 or higher HEPA respirator, and negative-pressure airflow exchange. – If splashing or spraying, use additional face gear. 12 Droplet Precautions Protection against droplets 5 mcg or larger that can travel 3 to 6 feet – Haemophilus influenzae type B. – Streptococcal pharyngitis. – Scarlet fever. – Rubella. – Pertussis (whooping cough). – Mumps. – Pneumonic plague. Private room unless someone shares same disease. Masks for everyone. Privacy Policy | Terms of Use 13 Removal of Protective Equipment Remove gloves – Grasp glove and pull inside out. – Tuck finger of ungloved hand inside cuff of gloved hand, and remove inside out. Remove eyewear – Remove per agency policy. Remove gown – Untie waist and neck strings of gown. – Remove hands from sleeves without touching outside of gown and fold inside out. Remove mask – Untie top string and then bottom strings. – Do not touch outside of mask and dispose immediately in garbage. Privacy Policy | Terms of Use 14 Care of the Client in Isolation: Nursing Measures Be mindful of equipment brought into the room and bag and contaminated articles before removing them from the room. Most facilities now use disposable thermometers and BP cuffs, and have a wall clock for use. – If not, put watch in a plastic Ziploc bag before entering the room. A pen should be left in the room and clipboards should be kept outside of the room. Inside the room are two hampers – One for garbage and one for linens. – These bags are emptied at the end of the shift and as needed. – Some facilities use dissolvable bags. Privacy Policy | Terms of Use 15 Care of the Client in Isolation: Bagging Follow facility policy. Generally, it is the same for all clients’ rooms. It prevents accidental exposure of personnel to contaminated articles. All reusable equipment should be bagged in a waterproof impervious bag. The bag should not be overfilled and should be tied tightly. Biohazardous waste should be disposed of in red bags – Cultures. – Discarded human tissue or body parts. – Blood and blood products. – Sharps materials Needles. Glass. – Select isolation material. Privacy Policy | Terms of Use 16 Care of the Client in Isolation Transporting clients – Clients should leave their room only for essential diagnostic or surgical procedures. – Place appropriate barrier equipment on client. – Notify department of client’s need for isolation. Education – Instruct assistive personnel, clients, and families proper isolation measures and the reasons for them. – Compliance increases with knowledge (instructing client and family about why isolation is necessary) and decreases infection rates. – A card should always be placed on the client’s door explaining type of isolation and protective equipment needed. – Hampers, soap, and disposable equipment should all be maintained in the room. – Encourage proper hand hygiene and the use of hand sanitizers. Privacy Policy | Terms of Use 17 Care of the Client in Isolation: Psychosocial Implications Provide the client with sensory stimulation – Reading materials. – TV. – Clock. – Calendar. – Crossword puzzles. Care should be taken not to rush when providing care – Rushing may result in the client feeling even more isolated. Explain to families that clients in isolation are at an increased risk for depression, social isolation, and altered body image – Time with visitors may help in decreasing these risks. Privacy Policy | Terms of Use 18 CDC Precautions Tiers View Video: Precautions Privacy Policy | Terms of Use 19 Learning Activity Review Questions 1. A nurse is admitting a client who has suspected bacterial meningitis. Which of the following should the nurse use when entering the room? (select all that apply) A. Negative air pressure room. B. Wear mask when within 3 feet of client. C. Place a surgical mask on the client if transporting to another department. D. Use sterile gloves when handling dirty linen. E. Wear a gown when performing care that may result in splashing. Privacy Policy | Terms of Use 20 Learning Activity Review Questions 2. A client who has HIV has been admitted to a unit. What data indicates the client should be placed in protective isolation? A. Diagnosis of HIV. B. Mouth sores. C. WBC count 2,100. D. A break in the client’s skin. Privacy Policy | Terms of Use 21 Privacy Policy | Terms of Use 22