FUNDAMENTALS OF NURSING II

• CLEANING

• DISINFECTION

• STERILIZATION

HOW DO WE STOP THE INFECTION?

CLEANING

• visibly without dirt

• soap and water (body - skin: RN)

• environment: hospital -> utility

DISINFECTION

• kill all microbes except SPORES

• SPORES - TETANUS, FUNGAL INFECTIONS

• SKIN - ANTISEPTIC SOLUTION

• ENVIRONMENT - DISINFECTANTS

STERILIZATION

• kill all microbes

• AUTOCLAVE

• RADIATION

• GAS

• DRY HEAT

ANTISEPTIC

• USUALLY USED FOR THE SKIN

• FOR THE SKIN

• EXAMPLE:

• ALCOHOL 60% - 70%

• IODINE BASED SOLUTION

• CHLORHEXEDINE

• HYDROGEN PEROXIDE

• SILVER SULFADIAZONE

DISINFECTANTS

• USUALLY USED ON SURFACES

• FOR THE ENVIRONMENT

• EXAMPLE:

• BLEACH

• QUATERNARY AMMONIUM COMPOUNDS

• PHENOLS

• FORMALDEHYDE

Concurrent Disinfection (PATIENT)

PATIENT IS STILL A SOURCE OF INFECTION

Terminal Disinfection (ROOM)

• PATIENT IS NO LONGER THE SOURCE OF INFECTION OR HAS BEEN DISCHARGED

• TRANSFERRED OR DEATH

Prophylactic Disinfection (HOSPITAL)

• PREVENTIVE DISINFECTION OF ENVIRONMENTS TO AVOID THE SPREAD OF OCCURRING INFECTION

• “ROUTINE DISINFECTION”

• EXAMPLE: CHLORINATION OF THE HOSPITAL’S WATER SYSTEM, DISINFECTION OF SURGICAL EQUIPMENTS

AUTOCLAVE

• USE OF MOIST HEAT HIGHER THAN 121 - 134 C

• 15-30 MINUTES

 

IONIZING RADIATION (HIGH ENERGY):

• X-RAYS, GAMMA RAYS

• DEEP PENETRATION — KILLS SPORES

NON-IONIZING RADIATION (LOW ENERGY):

• UV LIGHT, INFRARED

• DOES NOT KILL SPORES

GAS

• ETHYLENE OXIDE (ETO) GAS

• EFFECTIVE AGAINST: ALL MICROORGANISMS AND SPORES

DRY HEAT

• USE OF DRY HEAT AT 150-170 C

• HOT AIR OVEN

• 1-2 HOURS

Quarantine

• separates and restricts the movement of an individual exposed to a communicable disease

• THE LONGEST INCUBATION PERIOD OF A DISEASE

COVID19

• INCUBATION PERIOD: 2-14 DAYS (10-14 DAYS)

• QUARANTINE: 14 DAYS — SCREENING AND CONFIRMATORY TEST

MPOX

• INCUBATION PERIOD: 15-21 DAYS

• QUARANTINE: 21 DAYS

ISOLATION

• separates sick people with the communicable disease

• HOW LONG? UNTIL A NEGATIVE LABORATORY TEST

COVID 19 - 1 NEGATIVE RTPCR

DIPHTHERIA - 2 NEGATIVE ELEK TEST

TUBERCULOSIS - AFTER 2 WEEKS OF TAKING ANTI-TB MEDICATION - NON-INFECTIOUS

COVID 19 -

DIPHTHERIA -

TUBERCULOSIS - — - —

Cohorting

GROUPING OF PATIENTS IN THE ISOLATION UNIT WITH THE SAME CAUSATIVE AGENT, SAME INFECTION

UNIVERSAL PRECAUTION

• NOT USED ANYMORE

• 1980s

• TWIN: HEPATITIS B AND GRID

• GRID: GAY RELATED IMMUNO DEFICIENCY - HIV FOCUS: BLOOD BORNE DISEASES ONLY

• SAME PRINCIPLE WITH STANDARD PRECAUTION SUCH AS SAFE INJECTION PRACTICES, USE PPE

STANDARD PRECAUTIONS

• 1996

• USED IN ALL LEVELS OF PREVENTION

• USED IN ALL LEVELS OF FACILITIES (CATEGORIES OF FACILITY)

• USED IN BOTH COMMUNICABLE AND NON-COMMUNICABLE PATIENTS

• SUPPORTS TRANSMISSION BASED PRECAUTIONS

• Hand hygiene

• Wearing personal protective equipment

• Safe injection practices

• Safe handling of contaminated materials

• Respiratory hygiene/cough etiquette

ELEMENTS OF STANDARD PRECAUTIONS

HAND HYGIENE

• MOST PRACTICAL AND MOST EFFECTIVE METHOD OF PREVENTING THE SPREAD OF MICROORGANISM

• ELEMENT: FRICTION

• HANDWASHING: (WHO): 20 SECONDS - VISIBLY CLEAN - SOAP AND WATER

• HAND RUBBING: (JCI): 30 SECONDS - USING ALCOHOL (60%-70%)

PERSONAL PROTECTIVE EQUIPMENT

PREVENTS CONTAMINATION

Gloves

• PREVENTS CONTACT WITH BLOOD AND BODY FLUIDS

• BEST: LATEX BASED - CHEMICAL AND CUT RESISTANT

• IF WITH ALLERGY: NITRILE AND VINLYL

Gowns

• PREVENTS CONTACT WITH BLOOD AND BODY FLUIDS

• PROTECTS OUR UNIFORM

• FLUID RESISTANT: APRON

• CONTACT

• ENTERIC

• COMPLETE ISOLATION

Mask

• PREVENTS THE SPREAD OF AIRBORNE AND DROPLET DISEASES

• DROPLET: (3 FEET, 1 METER, MORE THAN 5 MICRONS) — SURGICAL MASK

• AIRBORNE: (DROPLET NUCLEI, FLOATERS, LESS THAN 5 MICRONS) — N95 MASK

N95 MASK:

• 0.3 MICRONS

• N - NON RESISTANT TO OIL

• 95 - 95% OF ALL AEROSOLIZED MICROORGANISM CAN BE FILTERED BY THIS MASK UP TO —

Goggles, face shields

PROTECTS FROM SPLASHES AND SQUIRTS

• HANDWASHING

• GOWN

• MASK

• GOGGLES/FACE SHIELD

• GLOVES

DONNING PPE

• GLOVES

• GOGGLES/FACE SHIELD

• GOWN

• MASK

• HANDWASHING

DOFFING PPE

• NEVER recap needle

• NEVER bend/break needle

• NEVER reuse/share contaminated needle

• Throw used needles in a puncture resistant container

• NEVER SOAK IN THE DISINFECTANT

SAFE INJECTION PRACTICES

• BLACK

• GREEN

• YELLOW

• YELLOW WITH BLACK BAND

• ORANGE

• RED

COLOR OF CONTAINER AS PER DOH

Black

• NON-INFECTIOUS DRY WASTE (RUBBISH)

• OFFICE REFUSE: PAPER, FOLDER

Green

• NON-INFECTIOUS WET WASTE (GARBAGE)

• KITCHEN, CANTEEN, PANTRY

Yellow

INFECTIOUS AND PATHOLOGICAL (BLOOD AND BODY FLUIDS)

Yellow with Black Band

• BLACK BAND: BIOHAZARD LOGO

• HAZARDOUS WASTE + HEAVY METALS FROM LABS

Orange

• RADIOACTIVE

• LABORATORY OR CANCER UNIT

Red

• PRESSURIZED CONTAINER

• PUNCTURE RESISTANT CONTAINER

• RED

• YELLOW

IF PATIENT IS COMMUNICABLE:

• CONTACT PRECAUTION

• AIRBORNE PRECAUTION

• DROPLET PRECAUTION

• PROTECTIVE ENVIRONMENT

TRANSMISSION - BASED PRECAUTIONS:

CONTACT PRECAUTIONS

• INFECTIOUS BODY FLUID

• INFECTIOUS WOUND

• EXAMPLE: SCABIES, CUTANEOUS DIPHTHERIA, HERPES SIMPLEX 1&2

• PPE: GLOVES AND GOWN

• COHORT? YES! (SAME CAUSATIVE AGENT, SAME INFECTION)

• DEDICATED VITAL SIGNS EQUIPMENT

ENTERIC PRECAUTION

• INFECTIOUS DIARRHEA

• INFECTIOUS FECAL-ORAL DISCHARGES

• EXAMPLE: AMOEBIASIS, TYPHOID FEVER, BACILLARY DYSENTERY

• PPE: GLOVES AND GOWN

• COHORT? YES! (SAME CAUSATIVE AGENT, SAME INFECTION)

• ADDITIONAL: ANTE ROOM (DONNING, DOFFING, HANDWASHING AREA)

• EXCLUSIVE USE OF TOILET

ENTERIC PRECAUTION SPECIAL HANDLING:

• INFECTIOUS DIARRHEA

• INFECTIOUS FECAL-ORAL DISCHARGES

• CASES THAT CAN CAUSE OUTBREAK

• EPIDEMIC

• EXAMPLE: CHOLERA, ROTA VIRUS, HEPATITIS A AND E

• PPE: GLOVES AND GOWN

• COHORT? NO!

• ADDITIONAL: ANTE ROOM (DONNING, DOFFING, HANDWASHING AREA)

• EXCLUSIVE USE OF TOILET

• SEPARATED LAUNDRY

• SEPARATED VS EQUIPMENTS

• SEPARATED KITCHEN MATERIALS AND UTENSILS

• FOOD PREPARED BY THE CLIENT SHALL BE CONSUMED ONLY BY THE CLIENT

DROPLET PRECAUTIONS

• 3 FEET, 1 METER, GREATER THAN 5 MICRONS

• SURGICAL MASK

• SINGLE ROOM OCCUPANCY (PREFERENCE)

• COHORT? YES! (SAME CAUSATIVE AGENT, SAME INFECTION)

• SPATIAL SEPARATION - DIVIDER OR CURTAIN

AIRBORNE PRECAUTIONS

• DROPLET NUCLEI, FLOATERS, LESS THAN 5 MICRONS

• N95 MASK - 0.3 MICRONS

• COHORT? NO!

• PRIVATE ROOM WITH HEPA FILTER

• HEPA FILTER: PRESSURIZED ROOM

• HEPA: HIGH EFFICIENCY PARTICULATE AIR FILTER

• NEGATIVE PRESSURE

6-12 AIR CHANGES PER HOUR

AIRBORNE PRECAUTIONS

NUMBER OF AIR CHANGES:

PROTECTIVE ENVIRONMENT

• REVERSE ISOLATION

• NEUTROPENIC ISOLATION

• PATIENT: IMMUNOCOMPROMISED, CANCER - CHEMOTHERAPY OR RADIATION THERAPY, TRANSPLANT - ORGAN AND STEM CELL

• PRIVATE ROOM WITH HEPA FILTER (NO COHORT)

• POSITIVE PRESSURE WITH MORE THAN 12 AIR CHANGES PER HOUR

• IPOD GADGET = NO PARTICLES

• POTTERY PLANTS = SOIL = FUNGAL SPORE = THAT CAN CAUSE COMPLICATION

• POLLENS = FRESH FLOWERS = SEVERE ALLERGY

AVOID: (PROTECTIVE ENVIRONMENT)

Peripheral IV Lines (PIVs) Midline Catheter

• PERIPHERAL

• INSERTED INTO: SMALL PERIPHERAL VEINS (USUALLY IN THE HAND OR ARM)

• USE: SHORT TERM (72-90 HOURS TO 3-4 DAYS)

• COMMON FOR: IV FLUIDS ANTIBIOTICS, PAIN MEDS

• EXAMPLE: A STANDARD IV LINE IN THE ER OR HOSPITAL ROOM

• “— = PRIMARY, PLAIN, AND SHORT-TERM”

MIDLINE CATHETER

• MIDLINE

• LONGER CATHETER PLACED INTO A PERIPHERAL VEIN

• INSERTED INT: PERIPHERAL VEIN (E.G., BASILIC, CEPHALIC), BUT DIES NOT REACH CENTRAL VEINS

• USE: INTERMEDIATE-TERM (1-4 WEEKS)

• LONGER THAN A REGULAR PIC BUT NOT A CENTRAL LINE

• “— IS IN THE MIDDLE NOT PIV, NOT PICC”

Central Venous Catheter

INSERTED DIRECTLY INTO A LARGE CENTRAL VEIN

NON TUNNELED CVC

• SHORT TERM USE (ICU/EMERGENCY)

• PLACED DIRECTLY INTO CENTRAL VEINS

• HIGHER INFECTION RISK

TUNNELED CVC

• FOR LONG-TERM USE (WEEKS-MONTHS)

• SURGICALLY TUNNELED UNDER THE SKIN BEFORE ENTERING A VEIN

• LOWER INFECTION RISK THAN NON-TUNNELED

Peripherally Inserted Central Catheter

• PICC

• LINE LONG CATHETER INSERTED INTO A PERIPHERAL VEIN AND ADVANCE INTO A CENTRAL VEIN NEAR THE HEART

• INSERTED IN ARM, ADVANCED TO CENTRAL VEIN (SVC)

• CAN BE LEFT IN FOR WEEKS TO MONTHS

• USED FOR LONG-TERM ANTIBIOTICS, CHEMO, TPN

• “— = PERIPHERALLY INSERTED CENTRAL CATHETER”

Implanted Port (Port-a-Cath)

• PORT

• SMALL DEVICE SURGICALLY IMPLANTED UNDER THE SKIN TAHT LEADS INTO A CENTRAL VEIN

• SURGICALLY PLACED UNDER THE SKIN

• ACCESSED WITH A SPECIAL NEEDLE

• USED FOR LONG-TERM CHEMO OR FREQUENT INFUSIONS

• “— = PERMANENT AND PROTECTED UNDER SKIN”

• PATIENT IS NOT ADMITTED

IT’S AN EMERGENCY! (IMCI/RHU)

Intravenous Therapy Procedure

1. Verify Doctors Order

• NO DOCTOR’S ORDER NEEDED ONLY IF —

• Mastectomy

• Arteriovenous Fistula or Shunt

• MPOX

• CENTRAL LINE

Intravenous Therapy Procedure

1. Assess for Contraindications:

• Same side as a —

• — or — for Dialysis

• Skin Area that is Infected (EXCEPT —)

• Arm Weak, Traumatize or Paralyzed = —

• Edematous Extremity = —

• Hand, Forearm, Antecubital Fosa

• Legs and Feet

• Thrombus Formation

• Distal

• Scalp and Feet

• Umbillicus

Intravenous Therapy Procedure

6. Select IV Site and Tie Tourniquet

• —, — and — are Suitable Sites

• — and — NOT suitable sites = Risk for —

• Start at — area to provide options

• Avoid Dominant Hand

• Avoid areas of Flexion

• — and — are suitable for Infants

• Newborn = suitable —

15 – 30

Intravenous Therapy Procedure

Perform venipuncture by Anchoring vein below site and gently stretching the skin. Insert the IV cannula at — degree angle

MACRO DRIP (10-20 gtt/ml)

DROP FACTOR: 10, 15, OR 20 DROPS/ML

USE:

• WHEN LARGE VOLUMES NEED TO BE INFUSED QUICKLY

• FOR ADULTS

• IN EMERGENCY OR TRAUMA SITUATIONS

• EXAMPLE: IF USING A 10 GTT/ML SET, YOU NEED ONLY 10 DROPS TO DELIVER 1 ML OF FLUID

MICRODRIP (10-20 gtt/ml)

DROP FACTOR: 60 DROPS/ML

USE:

• FOR PRECISE, SLOW INFUSIONS

• PEDIATRICS OR NEONATAL CARE

• MEDICATIONS REQUIRING EXACT DOSING

• EXAMPLE: IT TAKES 60 TINY DROPS TO DELIVER 1 ML OF FLUID

• 72 HOURS TO 96 HOURS

SET DUE FOR IV THERAPY

CHANGE VENIPUNCTURE SITE

• EVERY — HOURS TO — HOURS

• 48-72

• 7

CHANGE IV DRESSING

• WHEN WET: AS NEEDED OR A SPECIFIED BY THE AGENCY POLICY

• GAUZE: — HOURS OR AS SPECIFIED BY THE AGENCY POLICY

• TRANSPARENT GAUZE: — DAYS OR AS SPECIFIED BY THE AGENCY POLICY

• 96

CHANGE IV TUBINGS

• EVERY — HOURS

• 24

CHANGE IV BAG/BOTTLE

• EVERY — HOURS

VOLUMETRIC PUMP

• Use a volume-based mechanism (peristaltic or piston).

• Deliver precise amounts of fluid.

• Common in hospitals for continuous infusion (e.g., antibiotics, saline).

PATIENT – CONTROLLED ANALGESIA PUMPS

• Allow patients to self-administer a preset dose of pain medication.

• Used postoperatively or for chronic pain control.

SYRINGE PUMP

Example: Agilia

• Use a motor to push the plunger of a syringe.

• Ideal for small volume and slow, precise infusions (e.g., in NICU or anesthesia).

Gravity Infusion Devices

• Ex: Infusoma

• are one of the most common types of IV systems used. This system uses gravity to deliver medication, making it simple and low-cost.

BLOOD TRANSFUSION THERAPY OR BLOOD REPLACEMENT

IS THE IV ADMINISTRATION OF WHOLE BLOOD, ITS COMPONENT OR A PLASMA DERIVED PRODUCTS FOR THERAPEUTIC PURPOSES

BLOOD TRANSFUSION PURPOSE:

• Restore intravascular volume

• Restore the oxygen-carrying capacity of blood (Hgb)

• Provide clotting factors

• For patients with hypovolemic shock (loss of blood volume)

Autologous

• PATIENT’S OWN BLOOD IS COLLECTED AND REINFUSED TO SAME PATIENT AT A LATER TIME

• REDUCES RISK OF DISEASES TRANSMISSION AND TRANSFUSION COMPLICATIONS

• ELECTIVE SURGERY

• NOT AN OPTION FOR PATIENT WITH LEUKEMIA AND BACTEREMIA

Homologous / Allogeneic

• BLOOD IS DONATED BY ANOTHER PERSON

• DESIGNATED DONOR - PATIENT SELECTS THEIR OWN COMPATIBLE DONORS

TYPE A

RECEIVE FROM: A O

DONATE TO: A, AB

TYPE B

RECEIVE FROM: B O

DONATE TO: B, AB

TYPE AB

RECEIVE FROM: ALL

DONATE TO: AB

TYPE O

RECEIVE FROM: O

DONATE TO: ALL

• BLOOD

• PLASMA

• OXYGEN

• TO FIGHT INFECTION

• CLOTTING FACTORS

— red fluid that flows in our veins, component —

RBC - —

WBC - —

PLATELET - —

ANTIGEN

— protein, surface of the RBC

• Type A

• Type B

• Type AB

Merong Antigen:

Type O "Universal Donor"

Walang Antigen:

ANTIBODY

— outside of the RBC

• Type A

• B

• O

Meron Antibodies —

Type AB

Walang Antibodies:

Type AB

"Universal Recipient"

Rh factor (or Rhesus factor)

is a type of protein on the outside of your red blood cells (RBCs)

RH SYSTEMS = Rhesus Factor

"D Antigen", also an ANTIGEN found on the surfaced of RBCs

Rh Positive

• Has D antigen on RBC surface;

• Can Receive both (+) (-)

Rh Negative

• No D antigen on RBC surface;

• can only receive from (-)

• WHOLE BLOOD

• PACKED RBC

INFUSED WITHIN 4 HOURS:

WHOLE BLOOD

• Volume: 300 – 550ml;

• Infusion Time: within 4 hours

• Storage – 35 days; 1 -6C

• Indications:

• Massive Hemorrhage

• Trauma

• CS Delivery

PACKED RBC

• Volume: supplied in 250 – 350 ml;

• Storage: 42 days , 1 - 6C;

• Infusion Time: Within 4 hours

• Indications:

• Severe Hemorrhage

• Shock

• Severe Anemia

• Hypoxemia

• Replaces RBC Mass

• Emergencies

FRESH FROZEN PLASMA

• Volume: 200 – 250ml;

• Infusion Time: Thawed first prior to Infusion within 2 hours;

• 15 – 30 minutes infusion time (depends on DO)

• Storage: Up to 1year; -18C

• Disseminated Intravascular Coagulation

• Thrombotic Thrombocytopenic Purpura (TTP)

• Replaces Plasma

• Contains most coagulation factors and complement

FRESH FROZEN PLASMA

Indications:

CRYOPRECIPITATE

• Volume: 5 – 20ml/unit; 1 unit/10kg body weight;

• Infusion Time: Infuse Immediately for 15 – 30mins

• Highly Concentrated form of Fibrinogen;

• Prepared from Fresh Frozen Plasma

• Storage: up to 1 year; -18C or colder

• Hemophilia Repleces Fibrinogen

• Von Willebrand’s Diseases Disseminated Intravascular Coagulation

• Thrombotic Thrombocytopenic Purpura (TTP)

CRYOPRECIPITATE

Indications:

PLATELETS

• Volume: 40 – 70ml/unit; 1unit/ 10kg body weight

• Infusion Time: 15 to 30 minutes; given rapidly upon receipt from the blood bank

• Storage: 5 – 7 days, Room Temp

• Whole blood is centrifuged and the platelet-rich plasma is separated

• Evaluated 1 hour and 18 to 24 hours after, an increase of 5000 to 10,000mm3 is expected.

• Thrombocytopenia

• Platelets Dysfunctions

PLATELETS

Indications: