Patient Care - ch. 10 Preventing Disease Transmission

1. new diseases appearing in the population

2. existing diseases that are rapidly increasing in incidence or geographic range

3. resurgent or recurrent old diseases caused by an old or mutated pathogen

emerging diseases are:

infection control department

is responsible for keeping track of these infections and developing infection control policies based on CDC recommendations

nosocomial infection

hospital acquired infection

48 hours

nosocomial infections most often occur

• contaminated hand of healthcare worker

• contaminated instruments

• urinary catheters, ventilators, central lines, and surgical sites, which can allow microbes to gain easy entrance into the body

common sources of infections

drug resistant infections

the wide and inappropriate use of broad-spectrum antibiotics has led to the development of?

• MRSA (methicillin-resistant staphylococcus aureus)

• VRE (vancomycin-resistant enterococci)

• C Diff (clostridium difficile colotitis)

multi-drug infections include:

HIV/AIDS

Hepatitis (A, E, B, C, & D)

blood-borne pathogens

hep c

which hepatitis does not have a vaccine?

needle-stick injuries

are most common cause of transmission from patients to healthcare workers

Hep E

which Hep. is uncommon in the US

rinse with cold water

what should you do immediately if your eyes or skin is contaminated with blood?

historical perspective

quarantines - current isolation techniques evolved from these practices

• develop exposure-control plan for the work site that describes employee protection measures

• includes the use of PPE clothing and equipment

• provides signs and labels to identify biohazard materials

• provide annual bloodborne pathogen training, hep B vaccinations, and medical care in the event of occupational exposure

OSHA Bloodborne pathogens standard

surgical asepsis

process of creating and maintaining an area completely free of pathogens

sterilization

treating items with heat, gas, or chemicals to make them germ-free

medical asepsis

reducing the probability of infectious organisms being transmitted to a susceptible individual

1. simple cleaning - hand hygiene, proper clean, dusting, and linen handling

2. disinfection - destruction of pathogens using chemical materials

reduces the number, growth, and spread of microorganisms

standard precautions

the minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status

• hand hygiene

• appropriate use of PPE

• cleaning & disinfecting

• handling of laundry and equipment

• safe injections practice and sharps disposal

Standard Precautions include:

hand hygiene

easiest and most effective method to control the transmission of infections

• before and after each pt encounter

• immediately after glove removal

• between patient contacts

• and as needed

when to perform hand hygiene

visibly soiled and before eating

when MUST you wash hands with soap and water

friction

most important part of hand washing

40-60 seconds

how long should washing your hands take?

20 sec

you should scrub for a min. of

lower than elbows

keep hands where when washing them?

alcohol based rubs

quicker, more effective, less irritating towards skin, cannot destroy bacterial spores such as C. Diff

• foam in - foam out

• before putting gloves on

• after removing gloves

• after contact with objects in the immediate vicinity of the patient

CDC guidelines for use of alcohol-based hand rubs:

gloves, gowns, mask, eye protection, & face shields

PPE includes

• anytime there is potential contact with blood, body fluids, secretions, excretions, mucous membranes, nonintact skin, & contaminated items

• change gloves as needed on the same patient

• remove gloves promptly after use, before touching non-contaminated items/surfaces, & perform hand hygiene

guidelines for glove use

wear a gown to protect skin and to prevent soiling of clothing when necessary

guidelines for wearing gowns

wear to protect mucous membranes of the eyes, nose, and mouth whenever splash or sprays may be likely

guidelines for wearing mask, eye protection, or face shields

cleaning

• removing visible dirt, dust, spills, et., wiping off what we can see with our eyes

• reduces the incidence of airborne infections and the transfer of pathogens by fomites

disinfecting

the actual killing of the microscopic germs that are on those same surfaces.

high-touch areas

bed rails, call lights, TV remotes, keyboards, phones, light switches, doorknobs, grab bars, toilet seats, sink faucets, etc

every patient, every time

after each use, clean all equipment that comes in contact with patients

clean, then disinfect

wipe obvious soil, then go back and disinfect with hospital-approved disinfectant wipes

dwell time

how long the disinfectant needs to stay wet on the surface to effectively kill germs

1 min

dwell time for Sani-cloth Prime wipes

4 min

dwell time for Sani-cloth bleach wipes for C. Diff

• least contaminated area → more contaminated area

• from top down

always clean in what order

• do not carry linen against your body

• wear gloves when handling soiled linen

• replace linens after each patient

• avoid contamination of clothing when handling dirty linen

• to dispose of contaminated linens:

  • fold edges to the middle without shaking or flapping

  • place loosely balled linens in designated hamper

Handling of laundry/linen

• take care to prevent injuries when using, handling, and disposing of sharps

• do not recap used needles (if must recap use one hand scoop technique)

• place used needles and syringes in puncture resistant “sharps” container

Handling of Sharps

red bag blood-soaked items and dispose of in biohazard container

handling and disposal of contaminated items and waste

• ask person to cover mouth/nose when sneezing/coughing

• wear a surgical mask

• use tissue

• perform hand hygiene

respiratory hygiene/Cough etiquette

use mouth piece, resuscitation bag or other ventilation device

Resuscitation

transmission based precautions

are the 2nd tier of basic infection control and are to be used in addition to Standard Precautions for patients who may be infected or colonized with certain infectious agents for which additional precautions are needed to precent infection transmission

• TB, measles, chickenpox

• must wear N95 respirator mask

• negative airflow room

• door must always remain closed

airborne precautions

• diptheria, pneumonia, influenza, mumps

• must wear surgical mask when coming in close contact with patients

• gowns and gloves are used if contact with secretions is likely

Droplet precautions

• MRSA, VRE

• must wear gowns and gloves for all patient contact

contact precautions

• C. Diff, norovirus, diarrheal illnesses

• must wear gowns & gloves for patient contact

• must clean equipment with bleach wipes and wash hands with soap and water

contact precautions - enteric

• must wear gowns, gloves, N-95, eye protection

• patient will be placed in a negative airflow room

• door must always remain closed

Trinity Covid 19 Precautions

• requires 2 techs

  • clean tech & dirty tech

  • clean tech handles equipment & dirty tech positions patient

  • both techs must follow all isolation precautions

• reduces contamination of equipment, which is difficult to disinfect completely

radiography of isolation patient

• cover the stretcher/wheelchair and patient with a sheet/blanket

• patients with respiratory disease must wear a mask during transport

• remove your PPE while in the hallways to prevent contamination of surface you touch during transport

• put PPE back on when you get to the x-ray room

transporting isolation patients

• prevent the spread of infections to compromised patients with limited immunity

• patients undergoing organ transplant, burn patients, neonates, chemotherapy patients

• clean equipment before entering the patient room

• good hand hygiene, gowns, gloves, masks

• clean tech - dirty tech

  • clean - touches the patient

  • dirty - us and our equipment

protective precautions