STANDARD PRECAUTIONS - Infection Control

Posted by Admin in Saturday, May 8, 2010

Standard precautions were developed by the Centers for Disease Control and Prevention (CDC) to provide the widest possible protection against the transmission of infection. CDC officials recommend that health care workers handle all blood, body fluids (including secretions, excretions, and drainage), tissues, and contact with mucous membranes and broken skin as if they contain infectious agents, regardless of the patient's diagnosis.
Standard precautions encompass much of the isolation precautions previously recommended by the CDC for patients with known or suspected blood-borne pathogens as well as the precautions previously known as body substance isolation. They are to be used in conjunction with other transmission-based precautions: airborne, droplet, and contact precautions.
Standard precautions recommend wearing gloves for any known or anticipated contact with blood, body fluids, tissue, mucous membrane, and nonintact skin. (See Choosing the right glove.) If the task or procedure being performed may result in splashing or splattering of blood or body fluids to the face, a mask and goggles or face shield should be worn. If the task or procedure being performed may result in splashing or splattering of blood or body fluids to the body, a fluid-resistant gown or apron should be worn. Additional protective clothing, such as shoe covers, may be appropriate to protect the caregiver's feet in situations that may expose him to large amounts of blood or body fluids (or both), such as care of a trauma patient in the operating room or emergency department.
Airborne precautions are initiated in situations of suspected or known infections spread by the airborne route. The causative organisms are coughed, talked, or sneezed into the air by the infected person in droplets of moisture. The moisture evaporates, leaving the microorganisms suspended in the air to be breathed in by susceptible persons who enter the shared air space. Airborne precautions recommend placing the infected patient in a negative-pressure isolation room and the wearing of respiratory protection by all persons entering the patient's room.
Droplet precautions are used to protect health care workers and visitors from mucous membrane contact with oral and nasal secretions of the infected individual.
Contact precautions use barrier precautions to interrupt the transmission of specific epidemiologically important organisms by direct or indirect contact. Each institution must establish an infection control policy that lists specific barrier precautions.
Equipment
Gloves • masks • goggles, glasses with side pieces, or face shields • gowns or aprons • resuscitation masks • bags for specimens • Environmental Protection Agency (EPA)–registered tuberculocidal disinfectant or diluted bleach solution (diluted between 1:10 and 1:100, mixed fresh daily), or both, or EPA-registered disinfectant labeled effective against hepatitis B virus (HBV), hepatitis C virus (HCV), mycobacteria (including tuberculosis), and human immunodeficiency virus (HIV), provided that the surface hasn't been contaminated
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with agents or volumes of or concentrations of agents for which higher level disinfection is recommended.
Implementation
  • Wash your hands immediately if they become contaminated with blood or body fluids, excretions, secretions, or drainage; also wash your hands before and after patient care and after removing gloves. Hand washing removes microorganisms from your skin. If your hands aren't visibly soiled, or it isn't possible to wash your hands, an alcohol-based hand rub can be used for routine decontamination.
  • Wear gloves if you will or could come in contact with blood, specimens, tissue, body fluids, secretions or excretions, mucous membrane, broken skin, or contaminated surfaces or objects.
  • Change your gloves and wash your hands or use a hand sanitizer between patient contacts to avoid cross-contamination.
  • Wear a fluid-resistant gown, face shield, or goggles and a mask during procedures likely to generate splashing or splattering of blood or body fluids, such as surgery, endoscopic procedures, dialysis, assisting with intubation or manipulation of arterial lines, or any other procedure with potential for splashing or splattering of body fluids.
  • Handle used needles and other sharp instruments carefully. Don't bend, break, reinsert them into their original sheaths, remove needles from syringes, or unnecessarily handle them. Discard them intact immediately after use into a puncture-resistant disposal box. Use tools to pick up broken glass or other sharp objects. Use safety devices according
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    to the instructions provided by the manufacturer. Activate all safety mechanisms on sharp devices immediately after use, even if the sharps disposal container is very close. Evaluate your work practices to make sure you're working safely, both for your own protection and for the protection of your patients and coworkers. These measures reduce the risk of accidental injury or infection. When available, use a needleless I.V. system.
  • Immediately notify your employee health provider of all needle-stick or other sharp object injuries, mucosal splashes, or contamination of open wounds or nonintact skin with blood or body fluids to allow investigation of the incident and appropriate care and documentation.
  • Properly label all specimens collected from patients, and place them in plastic bags at the collection site. Attach requisition slips to the outside of the bag.
  • Place all items that have come in direct contact with the patient's secretions, excretions, blood, drainage, or body fluids—such as nondisposable utensils or instruments—in a single impervious bag or container before removal from the room. Place linens and trash in single bags of sufficient thickness to contain the contents.
  • While wearing the appropriate personal protective equipment, promptly clean all blood and body fluid spills with detergent and water followed by an EPA-registered tuberculocidal disinfectant or diluted bleach solution (diluted between 1:10 and 1:100, mixed daily), or both, or an EPA-registered disinfectant labeled effective against HBV and HIV, provided that the surface hasn't been contaminated with agents or volumes of or concentrations of agents for which higher-level disinfection is recommended.
  • Disposable food trays and dishes aren't necessary.
  • If you have an exudative lesion, avoid all direct patient contact until the condition has resolved and you've been cleared by the employee health provider.
  • If you have dermatitis or other conditions resulting in broken skin on your hands, avoid situations where you may have contact with blood and body fluids (even though gloves could be worn) until the condition has resolved and you've been cleared by the employee health provider.
Special considerations
  • Standard precautions, such as hand hygiene and appropriate use of personal protective equipment, should be routine infection control practices.
  • Keep mouthpieces, resuscitation bags, and other ventilation devices nearby to eliminate the need for emergency mouth-to-mouth resuscitation, thus reducing the risk of exposure to body fluids.
  • NURSING ALERT Because you may not always know what organisms may be present in every clinical situation, you must use standard precautions for every contact with blood, body fluids, secretions, excretions, drainage, mucous membranes, and nonintact skin. Use your judgment in individual cases about whether to implement additional isolation precautions, such as airborne, droplet, or contact precautions or a combination of them. What's more, if your work requires you to be exposed to blood, you should receive the HBV vaccine series.
Complications
Failure to follow standard precautions may lead to exposure to blood-borne diseases or other infections and to all the complications they may cause.
Documentation
Record any special needs for isolation precautions on the nursing care plan and as otherwise indicated by your facility. Document patient and family teaching about isolation precautions.

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REPORTABLE DISEASES CHECKLIST

Posted by Admin in Friday, May 7, 2010

Because reporting laws vary from state to state, this list isn't conclusive and may be changed periodically. Local agencies report certain diseases to their state health departments, which in turn determine which diseases are reported to the Centers for Disease Control and Prevention (CDC).
Acquired immunodeficiency syndrome (AIDS)
Anthrax
Botulism, foodborne
Botulism, infant
Botulism, other (wound and unspecified)
Brucellosis
Chancroid
Chlamydia trachomatis, genital infections
Cholera
Coccidioidomycosis
Cryptosporidiosis
Cyclosporiasis
Diphtheria
Ehrlichiosis
Encephalitis/meningitis, arboviral
Enterohemorrhagic Escherichia coli
Giardiasis
Gonorrhea
Haemophilus influenza, invasive disease
Hansen's disease
Hantavirus pulmonary syndrome
Hemolytic uremic syndrome, postdiarrheal
Hepatitis A, acute, chronic
Hepatitis B, acute, chronic
Hepatitis B, perinatal infection
Hepatitis C, acute, chronic
Human immunodeficiency virus (HIV) infection
Legionellosis
Listeriosis
Lyme disease
Malaria
Measles
Meningococcal infections
Mumps
Pertussis
Plague
Poliomyelitis, paralytic
Psittacosis
Q fever
Rabies, animal
Rabies, human
Rheumatic fever
Rocky Mountain spotted fever
Rubella
Salmonellosis
Shigellosis
Streptococcal disease, invasive, Group A
Streptococcal toxic-shock syndrome
Streptococcus pneumonia, drug resistant, invasive disease
Streptococcus pneumonia, invasive in children over age 5
Syphilis, all stages
Syphilis, primary and secondary
Syphilis, congenital
Tetanus
Toxic shock syndrome
Trichinosis
Tuberculosis
Tularemia
Typhoid fever
Varicella
Yellow fever

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REPORTABLE DISEASES

Posted by Admin

Certain contagious diseases must be reported to local and state public health officials and, ultimately, to the Centers for Disease Control and Prevention (CDC). (See Reportable diseases checklist.) Typically, these diseases fit one of two categories:

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those reported individually based on a definitive or suspected diagnosis and those reported by the number of cases per week. The most commonly reported diseases include hepatitis, measles, salmonellosis, shigellosis, syphilis, and gonorrhea.
  • NURSING ALERT Although smallpox isn't listed on the CDC reportable diseases checklist, it's reportable. Selected microorganisms are suspected as potential agents of biological warfare and are reportable immediately to the local or state health department. These agents include anthrax, botulinum toxin, plague, smallpox, and tularemia.
In most states, the patient's physician must report communicable diseases to health officials. In hospitals, the infection control practitioner or epidemiologist reports them. The laboratory must also report organisms associated with reportable diseases. However, you should know the reporting requirements and procedures. Fast, accurate reporting helps identify and control infection sources, prevent epidemics, and guide public health planning and policy.
Equipment
Nursing procedure or infection control manual • disease-reporting form, if available.
Implementation
  • Make sure reportable diseases are listed and that the list is available to all shifts.
  • Know your facility's protocol for reporting diseases. Typically, you'll contact the infection control practitioner or epidemiologist. If this person isn't available, contact your supervisor or the infectious disease physician on call.
Documentation
Document any diseases reported to the infection control practitioner, the practitioner's name, and the date and time of the report.

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REMOVING CONTAMINATED GLOVES

Posted by Admin

Proper removal techniques are essential for preventing the spread of pathogens from gloves to your skin surface.
Follow these steps carefully.
1. Using your left hand, pinch the right glove near the top. Avoid allowing the glove's outer surface to buckle inward against your wrist.


2. Pull downward, allowing the glove to turn inside out as it comes off. Keep the right glove in your left hand after removing it.


3. Now insert the first two fingers of your ungloved right hand under the edge of the left glove. Avoid touching the glove's outer surface or folding it against your left wrist.

4. Pull downward so that the glove turns inside out as it comes off. Continue pulling until the left glove completely encloses the right one and its uncontaminated inner surface is facing out.

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Face Mask - Standard

Posted by Admin in Tuesday, May 4, 2010


  • Low breathing resistance enhances user comfort.
  • Bacterial Filtration Efficiency up to 99% meets requirements of EN14683, Type II.
  • Extra long tie bands allow secure mask positioning.
  • Strong but conformable nose clip prevents air leakage around nose.
  • Soft Ultrasonic welding provides skin comfort.
  • Carefully selected packaging material minimizes risk of odor development.
  • Natural Rubber Latex-free.

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USE OF ISOLATION EQUIPMENT

Posted by Admin

Isolation procedures may be implemented to prevent the spread of infection from patient to patient, from the patient to health care workers, or from health care workers to the patient. They may also be used to reduce the risk of infection in immunocompromised patients. Central to the success of these procedures is the selection of the proper equipment and the adequate training of those who use it.
Equipment
Materials required for isolation typically include barrier clothing, an isolation cart or anteroom for storing equipment, and a door card announcing that isolation precautions are in effect.
Barrier clothing:
Gowns • gloves • goggles • masks. Each staff member must be trained in their proper use.
Isolation supplies:
Labels • tape • laundry bags (and water-soluble laundry bags, if used) • plastic trash bags.
An isolation cart may be used when the patient's room has no anteroom. It should include a work area (such as a pull-out shelf), drawers or a cabinet area for holding isolation supplies and, possibly, a pole on which to hang coats or jackets.
Preparation of equipment
Remove the cover from the isolation cart if necessary, and set up the work area. Check the cart or anteroom to ensure that correct and sufficient supplies are in place for the designated isolation category.
Implementation
  • Remove your watch (or push it well up your arm) and your rings according to facility policy. These actions help to prevent the spread of microorganisms hidden under your watch or rings.
  • Wash your hands before putting on gloves to prevent the growth of microorganisms under gloves.
Putting on isolation garb
  • Put the gown on and wrap it around the back of your uniform. Tie the strings or fasten the snaps or pressure-sensitive tabs at the neck. Make sure your uniform is completely covered to prevent contact with the patient or his environment.
  • Place the mask snugly over your nose and mouth. Secure ear loops around your ears or tie the strings behind your head high enough so the mask won't slip off. If the mask has a metal strip, squeeze it to fit your nose firmly but comfortably. (See Putting on a face mask.) If you wear eyeglasses, tuck the mask under their lower edge. If goggles are worn, put them on at this time.
  • Put on the gloves. Pull the gloves over the cuffs to cover the edges of the gown's sleeves.

Removing isolation garb
  • Remember that the outside surfaces of your barrier clothes are contaminated.
  • While wearing gloves, untie the gown's waist strings.
  • With your gloved left hand, remove the right glove by pulling on the cuff, turning the glove inside out as you pull.
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    Don't touch any skin with the outside of either glove. (See Removing contaminated gloves.) Then remove the left glove by wedging one or two fingers of your right hand inside the glove and pulling it off, turning it inside out as you remove it. Discard the gloves in the trash container.
  • Untie the neck straps of your gown. Grasp the outside of the gown at the back of the shoulders and pull the gown down over your arms, turning it inside out as you remove it to ensure containment of the pathogens.
  • Holding the gown well away from your uniform, fold it inside out. Discard it in the laundry or trash container as necessary.
  • If the sink is inside the patient's room, wash your hands and forearms with soap or antiseptic before leaving the room. Turn off the faucet using a paper towel and discard the towel in the room. Grasp the door handle with a clean paper towel to open it, and discard the towel in a trash container inside the room. Close the door from the outside with your bare hand.
  • Remove the mask last to prevent contaminating your face or hair in the process. Untie your mask, holding it only by the strings. Discard the mask in the trash container. Remove goggles.
  • If the sink is in an anteroom, wash your hands and forearms with soap or antiseptic after leaving the room.

Special considerations
  • If airborne precautions are required, a particulate respirator should be worn rather than a surgical mask.
  • Use gowns, gloves, goggles, and masks only once, and discard them in the appropriate container before leaving a contaminated area. If your mask is reusable, retain it for further use unless it's damaged or damp. Be aware that isolation garb loses its effectiveness when wet because moisture permits organisms to seep through the material. Change masks and gowns as soon as moisture is noticeable or according to the manufacturer's recommendations or your facility's policy.
  • At the end of your shift, restock used items for the next person. After patient transfer or discharge, return the isolation cart to the appropriate area for cleaning and restocking of supplies. An isolation room or other room prepared for isolation purposes must be thoroughly cleaned and disinfected before use by another patient.

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PROPER HANDWASHING TECHNIQUE

Posted by Admin

To minimize the spread of infection, follow these basic handwashing instructions. With your hands angled downward under the faucet, adjust the water temperature until it's comfortably warm.
Add soap and work up a generous lather by scrubbing vigorously for 10 seconds. Be sure to clean beneath fingernails, around knuckles, and along the sides of fingers and hands.
Rinse your hands completely to wash away suds and microorganisms. Pat dry with a paper towel. To prevent recontaminating your hands on the faucet handles, cover each one with a dry paper towel when turning off the water.


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