LEC 8.3: Infection Prevention & Protocol

1. Standard Precautions

2. Transmission-Based Precautions

CDC’s 2-Tiered Approach to Infection Prevention and Protocol

Standard Precautions/Universal Precautions

Used in the care of all hospitalized individuals regardless of their diagnosis or possible infection status

Used in any situations involving blood all body fluids, excretion, & secretions except sweat, non intact skin & mucous membranes

Includes:

• Hand hygiene

• Use of personal protective equipment (PPE) (examples : gown, glove, mask, face shield)

• Safe injection practices

• Safe handling of potentially contaminated equipment or surfaces in the client environment

• Respiratory hygiene/cough etiquette

1. Gloves

2. Gowns

3. Masks

4. Eyewear

4 Personal Protective Equipment

1. They protect the hands when the nurse is likely to handle any body substances.

2. Reduce the likelihood of nurses transmitting their own endogenous microorganisms to individuals receiving care

3. Gloves reduce the chance that nurses' hands will transmit microorganisms from one client or object to another client.

3 Reasons Why Gloves are Worn

1. They may have imperfections or be damaged during wearing so that they could allow microorganisms entry

2. The hands may be contaminated during glove removal

2 reasons why hands are cleansed each time gloves are removed

True

True or False: Clean gloves can be unsterile unless their use is intended to prevent the entrance of the microorganism into the body.

True

True or False: Gloves must be removed before touching non-contaminated items and surfaces.

Gowns

Clean or disposable impervious __ or plastic aprons are worn during procedures when the nurse’s uniform is likely to become soiled

Sterile Gowns

PPE that may be indicated when the nurse changes the dressings of a client with extensive wounds

Single-Use Gown Technique

Usual practice in the hospital

• If paper, the gown is discarded.

• Or, placed in a laundry hamper

Face Mask

Worn to reduce the risk of transmission of organism by the droplet & airborne routes & by splatters of the body substances.

During certain techniques requiring surgical asepsis, these are worn

• To prevent droplet contact transmission of exhaled microorganisms to the sterile field or to a client’s open wound.

• To protect the nurses from splashes of body substances from the client.

(1) droplets

(2) droplet nuclei

CDC recommends that mask be worn:

1. By those close to the client if the infection is transmitted by large-particle aerosols ((1)____).

2. By all individuals entering the room if the infection is transmitted by small particle aerosols ((2)___)

1. Single-use disposable surgical masks

2. Disposable particulate respirators

2 Main Types of Face Masks

Single-Use Disposable Surgical Masks

One of the main types of face masks

Effective for use while the nurses provide care to most clients but should be changed if they become wet or soiled.

Disposable Particulate Respirators

One of the main types of face masks

Effective for droplet transmission, splatter & airborne organisms.

E.g. N95 mask

Eyewear

Indicated in situations where the body substance may splatter the face

May include goggles, glasses, or face shields.

If a nurse is wearing prescription glasses, goggles should still be worn over the glasses because the protection must extend around the sides of the glasses.

Transmission-Based Precautions

Used in addition to standard precautions for clients with known or suspected infections that spread in one of the three ways:

• Airborne

• Droplet

• Contact

Airborne Precaution (Droplet Nuclei)

Used for clients with suspected illnesses transmitted by airborne droplet nuclei (smaller than 5 microns)

Examples:

• Measles (rubeola)

• Varicella (chicken pox)

• Tuberculosis

Clients are placed in an airborne infection isolation room (AIIR) OR If unavailable, placed with another infected client with the same microorganism.

Wear N95 respirator mask when entering the room

Susceptible persons would not enter the room of the client with such infections. If unavoidable should wear respirator mask

Limit movement of clients outside the room.

Either

1. Airborne Infection Isolation Room (AIIR) OR

2. Placed with another infected client with the same microorganism

Where are clients on Airborne Precaution placed?

Cohorting

Grouping patients with the same diseases together

N95

PPE when coming into close contact with a client on Airborne Precaution?

Droplet Precaution

Used for clients known to have or suspected of having serious illnesses transmitted by particle droplets larger than 5 microns

Examples:

• Mumps

• Rubella (German measles)

• Pharyngeal Diphtheria

• Mycoplasma Pneumonia

Use standard precaution as well as the following:

• Place client in a private room

• If a client is unavailable, place the client with another client infected with the same microorganisms

• Wear mask if working within 1 meter (3 feet) of the client

• Limit the movement of client outside the room

1 meter (3 feet)

When working within ___ of a client on Droplet Precaution, mask must be worn.

Contact Precautions

Used for clients known to have or suspected of having serious illnesses easily transmitted by direct client contact or by body contact with the client’s items in the client’s environment

Examples:

• C. difficile

• E. coli

• Shigella

• Hepatitis A

• MRSA (Antibiotic resistant bacteria)

• VRE (Antibiotic resistant bacteria)

Use standard precautions as well as the following:

• Place client in a private room

• If unavailable, place client with another client infected with the same microorganism

• Wear gloves as described in standard precautions,

• Wear gown when entering a room if there is a possibility of contact with infected surfaces or items, if client is incontinent, or has diarrhea, colostomy or wound drainage not contained by a dressing.

• Limit movement of client outside the room

• Dedicate the use of noncritical client care equipment to a single client or to clients with the same infecting microorganisms.

1. Gown

2. Gloves

PPE when coming into close contact with a client on Contact Precaution?

True

True or False: Some disease require a combination of transmission-based precautions.

COVID-19 patients placed under airborne and contact precaution

Example of a combination of transmission-based precautions

True

True or False: When a certain condition exists, transmission-based precautions are indicated until the presence or absence of the suspected agent has been confirmed.

Sterile Technique

Set of specific practices and procedures performed to make equipment and areas free from all microorganisms to maintain sterility.

1. All objects used in a sterile field must be sterile.

2. Sterile objects become unsterile when touched by unsterile objects.

3. Sterile objects that are out of sight or below the waist or table level are considered UNsterile.

4. Sterile objects can become unsterile by prolonged exposure to airborne microorganisms.

5. Fluids flow in the direction of gravity.

6. Moisture that passes through a sterile object draws microorganisms from unsterile surfaces above or below to the sterile surface by capillary action.

7. The edges of the sterile field are considered unsterile

8. The skin cannot be sterilized and is unsterile.

9. Conscientiousness, alertness, and honesty are essential qualities in maintaining surgical asepsis

9 Principles and Practices of Surgical Asepsis

sterile

One of the 9 Principles and Practices of Surgical Asepsis

1. All objects used in a sterile field must be ___

unsterile

One of the 9 Principles and Practices of Surgical Asepsis

2. Sterile objects become ___ when touched by unsterile objects.

(1) sight

(2) waist

(3) table level

One of the 9 Principles and Practices of Surgical Asepsis

3. Sterile objects that are out of (1)___ or below the (2)____ or (3)___ ___ are considered UNsterile.

airborne microorganisms

One of the 9 Principles and Practices of Surgical Asepsis

4. Sterile objects can become unsterile by prolonged exposure to ___ ___.

gravity

One of the 9 Principles and Practices of Surgical Asepsis

5. Fluids flow in the direction of ___.

(1) moisture

(2) capillary action

One of the 9 Principles and Practices of Surgical Asepsis

6. (1) ___ that passes through a sterile object draws microorganisms from unsterile surfaces above or below to the sterile surface by (2) ___ ___.

edges

One of the 9 Principles and Practices of Surgical Asepsis

7. The ___ of the sterile field are considered unsterile

skin

One of the 9 Principles and Practices of Surgical Asepsis

8. The ___ cannot be sterilized and is unsterile

(1) Conscientiousness

(2) alertness

(3) honesty

One of the 9 Principles and Practices of Surgical Asepsis

9. (1)___, (2)___, and (3)___ are essential qualities in maintaining surgical asepsis

Sterile Field

A microorganism-free area

Established by using the innermost side of the sterile wrapper or by using a sterile drape.

When established, sterile supplies & Sterile solutions can be placed on it.

Sterile forceps are used in many instances to handle & transfer sterile supplies.

Sterile Forceps

What can be used to handle and transfer sterile supplies?

Sterile Gloves

Worn during many procedures to enable the nurse to handle items freely

Prevent clients at risk from becoming infected by microorganisms on unsterile gloves or the nurses’ hands.

1. Latex

2. Nitrile

3. Vinyl

3 Types of Sterile Gloves

Latex and Nitrile

Sterile gloves that mold the wearer’s hands and allow freedom

1. Tasks that demand flexibility

2. Tasks that place stress on the material

3. Tasks that involve a high risk for exposure to pathogens

When should nitrile glove be used in performing tasks over latex?

Vinyl Gloves

Should be chosen for tasks unlikely to stress the glove material, requiring minimal precision & with minimal risk of exposure to pathogen

1. Open Method

2. Closed Method

2 Methods of Applying Sterile Gloves

Open Method

One of the methods of applying sterile gloves

Most frequently used outside the operating room

Closed Method

One of the methods of applying sterile gloves

Requires the nurse to wear a sterile gown

1. Sterile Gowning

2. Closed Gloving

What procedures are chiefly carried out in the operating or delivery rooms?

1. Apply hair cover

2. Apply mask

3. Perform surgical hand washing

Before sterile gowning and closed gloving in the operating or delivery rooms, what must be done?

Infection Prevention Nurse

A nurse specially trained to be knowledgeable about the latest research and practices in preventing, detecting, and treating infections

1. A nurse specially trained to be knowledgeable about the latest research and practices in preventing, detecting, and treating infections

2. All infections are reported to the nurse to allow recording and analyzing statistics that can assist in improving infection prevention practices.

3. May be involved in employee education.

3 Roles of the Infection Prevention Nurse

(1) research (2) practices

One of the roles of the Infection Prevention Nurse

1. A nurse specially trained to be knowledgeable about the latest (1) ___ and (2) ___ in preventing, detecting, and treating infections

(1) statistics

(2) infection prevention

One of the roles of the Infection Prevention Nurse

2. All infections are reported to the nurse to allow recording and analyzing (1)___ that can assist in improving (2) ___ ___ practices.

employee education

One of the roles of the Infection Prevention Nurse

3. May be involved in ___ ___