NCLEX Precautions review; standard, contact, airborne, droplet

Standard Precautions:

1. wash your hands (*Most important step in infection control, prevents nosocomial infections)

2. DON gloves (before coming in contact with anything wet, i.e. broken skin, mucous membranes, blood, body fluids, soiled instruments, contaminated waste materials.

3. wash hands again upon removal of gloves and between patients

Contact Precautions:

Before entering:

1.wash hands

2. DON gown then gloves

Upon entering:

1. use disposable equipment when possible

2. when not available clean and disinfect all equipment before removing from room

Before leaving the patient's room:

1. Remove gloves then gown

2. Wash hands

Contact Precautions Transporting patient:

1. PT should perform hand hygeine and wear a clean gown

2. For direct contact with pt, nurse or care provider should wear a gown and gloves.

3. Notify receiving area

Common Microorganisms which require Contact Precautions :

1. Antibiotic Resistant Organisms (Methicillin resistant Staphylococcus aureu (MRSA), Extended spectrum beta-lactamase (ESBL), Penicillin resistant Streptococcus pneumoniae (PRSP), Multi-drug resistant Pseudomonas aeruginosa (MDRP))

2. Scabies

3. Herpes Zoster (Shingles) localized

4. Diarrhea, Clostrididum difficile

Airborne Contact Precautions:

Before entering:

1.Wash hands

2. Don N95 Respirator (Mask)

3. Don gown then gloves

*Negative Pressure Isolation Room KEEP DOOR CLOSED

Before leaving pt's room:

1. Remove gloves then gown NOT N95 mask

2. Wash hands

After leaving pt's room:

1. Shut door

2. Wash hands

3. Remove N95 mask

4. Wash hands

Airborne Contact Precautions Transporting patient:

1. Patient must wear a surgical or procedure mask and a clean gown

2. Patient must wash hands

3. For direct contact with pt, nurse or care provider should wear a gown and gloves.

4. Notify receiving area

Common Microorganisms which require Airborne Contact Precautions :

1. Measles (Rubeola)

2. Tuberculosis (TB)

3. Chicken Pox (Varicella-Zoster virus)

4. Herpes Zoster (Shingles) disseminated

Droplet Contact Precautions:

Before Entering:

1. Wash Hands

2. DON Mask and Eye Protection

3. DON Gown then Gloves

Before Leaving Pt's Room:

1. Remove gloves then gown

2. Wash Hands

3. Remove eye protection and mask

4. Wash Hands

Droplet Contact Precautions Transporting patient:

1. Pt must perform hand hygeine

2. Pt must wear a surgical or procedure mask and clean gown

3. For direct contact with pt, nurse or care provider should wear a gown and gloves.

4. Notify receiving area

Common Microorganisms which require Droplet Contact Precautions :

1. Influenza (Flu)

2. Viral Respiratory tract infections (adenovirus, parainfluenza, rhinovirus, RSV)

3. Streptococcus group A pharyngitis, pneumonia, scarlet fever

4. Neisseria meningitidis invasive infections

5. H. Influenzae type b invasive infections

6. Pertussis

7. Rubella

8. Mumps

Strict isolation is:

Rules:

used to prevent the transmission of all highly communicable diseases that are spread by both, contact or airborne routes of transmission. Examples of such diseases are chickenpox and rabies

(1) Visitors must report to the nurses' station before entering the room.

(2) Door must be kept closed.

(3) Gowns must be worn by all persons entering the room.

(4) Masks must be worn by all persons entering the room.

(5) Hands must be washed on entering and leaving the room.

(6) Gloves must be worn by all persons entering the room.

(7) Articles must be discarded or wrapped before being sent to Central Supply for disinfection or sterilization.

Respiratory isolation is:

Rules

used to prevent transmission of organisms by means of droplets that are sneezed or breathed into the environment. Examples of such diseases are influenza and tuberculosis

(1) Visitors must report to the nurses' station before entering the room.

(2) Door must be kept closed.

(3) Gowns are not necessary.

(4) Masks must be worn by any person entering the room unless that person is not susceptible to the disease.

(5) Hands must be washed on entering and leaving the room.

(6) Gloves are not necessary.

(7) Articles contaminated with secretions must be disinfected.

Protective isolation is:

Rules:

used to prevent contact between potentially pathogenic microorganisms and uninfected persons who have seriously impaired resistance. Patients with certain diseases, such as leukemia, who are on certain therapeutic regimens are significantly more susceptible to infections

(1) Visitors must report to the nurses' station before entering the room.

(2) Door must be kept closed.

(3) Gowns must be worn by all persons entering the room.

(4) Masks must be worn by all persons entering the room.

(5) Hands must be washed on entering and leaving the room.

(6) Gloves must be worn by all persons having direct contact with the patient.

(7) Articles must be handled according to local SOP.

Enteric precautions are:

Rules:

used to control diseases that can be transmitted through direct or indirect oral contact with infected feces or contaminated articles. Transmission of infection depends on ingestion of the pathogen. Examples of diseases requiring enteric precautions are dysentery and hepatitis.

(1) Visitors must report to the nurses' station before entering the room.

(2) Gowns must be worn by all persons having direct contact with the patient.

(3) Masks are not necessary.

(4) Gloves must be worn by all persons having direct contact with the patient or with articles contaminated with fecal material.

(5) Special precautions are necessary for articles contaminated with urine and feces. Articles must be disinfected or discarded

Wound and skin precautions are:

Rules:

used to prevent the spread of microorganisms found in infected wounds (including burns and open sores) and contact with wounds and heavily contaminated articles. Conditions requiring these precautions include infected burns, infected wounds, and infections with large amounts of purulent discharge. Diseases that may require wound and skin precautions include herpes, impetigo, and ringworm.

(1) Visitors must report to the nurses' station before entering the room.

(2) Gowns must be worn by all persons having direct contact with the infected wound.

(3) Masks are not necessary except during dressing changes.

(4) Gloves must be worn by all persons having direct contact with the infected area.

(5) Special precautions are necessary for instruments, dressings, and linens.

CAUTION: Only hospital personnel who have been vaccinated with poliomyelitis vaccine should have direct contact with patients who have active poliomyelitis.

Blood precautions are:

Rules:

used to prevent acquisition of infection by patients and personnel from contact with blood or items contaminated with blood. Examples of diseases that require blood precautions (refer to Lesson 1) are HBV and HIV/AIDS

Secretion precautions-lesions are:

used to prevent acquisition of infection by personnel and patients from direct contact with wounds and secretion-contaminated articles. Some examples of diseases requiring these precautions are conjunctivitis, gonorrhea, and syphilis

Secretion precautions-oral are:

used to prevent acquisition of infection by personnel from direct contact with oral secretions. Some examples of diseases requiring these precautions are herpes areolas and scarlet fever.

Excretion precautions are:

used to prevent acquisition of infection by personnel and patients from direct contact with fecal excretions. Some examples of diseases requiring these precautions are poliomyelitis and staphylococcal food poisoning.

If it's not one of these 4 diseases and you know it's HIGHLY contagious, it's probably droplet, so know the 4 airborne are!

(think: My Chicken Has TB)

measles

chicken pox

Herpes zoster aka shingles

TB

airborne precautions, room considerations

Remember: Private room or cohort w/ negative pressure w/ 6 - 12 air exchange/hr AND MASK. N95 mask for TB.

Droplet precautions

SSS PPP IDER MMM AN

S = Sepsis

S = Scarlet Fever

S = Streptococcal Pharyngitis

P = Paravirus B19

P = Pneumonia

P = Pertussis

I = Influenza

D = Diptheria (Pharyngeal)

E = Epiglottitis

R = Rubella

M = Mumps

M = Meningitis

M = Mycoplasma or Meningeal Pneumonia

AN = Adenovirus

CONTACT precautions

MRS WEE

M = Multidrug Resistant Organism

R = Respiratory Infection

S = Skin Infections

W = Wound Infections

E = Enteric Infection (Clostridium Difficile)

E = Eye Infections (Conjunctivitis)

SKIN Infections:

V CHIPS

V-CHIPS

V = Varicella

C = Cutaneous Diptheria

H = Herepes Zoster

I = Impetigo

P = Pediculosis

S = Scabies

AIRBORNE PRECAUTION:

<5 microns

Private room with closed door

negative pressure room/ 6-12 exchange/hr

PPE: N95, Hepa Filter

DSE: (Remember MTV Hz)

Measle

TB/ TB suspect

Varicella

Herpes Zoster

SARS

DROPLET PRECAUTION:

>5 microns

Private room

YES to cohort, 3ft separation

PPE: Surgical Mask

DSE: (Remember "Dropletism")

Diptheria

Rubella

Oral Pharyngitis

Pertussis/ Pneumonia

Legionnaire's Disease

Erythema infectiosum (5th disease) -contagious when no rash

Tonsilitis

Influenza

Scarlet Fever

Mumps/ Meningitis

CONTACT PRECAUTION:

Private room

YES to cohort, 3ft separation

Secretions: skin wounds, eyes, nose, ears

Patient has own BP/Stet equipment

PPE: Gloves and Gown

DSE: RSV, MRSA, VRSA, VRE, CDAD, STD, Conjunctivitis, Impetigo

ENTERIC PRECAUTION:

Private room with bathroom facility

YES to cohort

PPE: Gloves and Gown

DSE: Hep A, Shigella, Salmonella, Norwalk virus (improper/ contaminated food)

Crytosporidiosis, Gardiasis (common in day care/ children)

NEUTROPENIC PRECAUTION:

Private room

PPE: Mask

DSE: Chemo/ Cancer patients, AIDS/HIV, Major burns/ surgery,

SLE, Transplant patient taking 4C's (Cellcept, Corticoidsteroids, Cytoxan, Cyclosporin)

order in which the nurse should remove personal protective equipment(ppe)

gloves,

goggles

gown

mask

note it's in alpha order

Diseases requiring enteric precautions

C-diff

Dysentery from infectious cause

Hepatitis A