7DIDEngageFundamentalsRN2.0-Hygiene

Caring for Closed Wound Drainage Systems

Overview

• Closed wound drainage systems are utilized following surgical procedures to:
    - Remove excess fluid
    - Prevent tissue damage
    - Prevent fluid accumulation

• Key components of nursing care include:
    - Dressing changes
    - Wound assessment
    - Monitoring drainage levels
    - Reporting any complications observed

Delegation

• Registered Nurses (RNs) are permitted to delegate tasks to:
    - Competent Practical Nurses (PNs)

• RNs cannot delegate to assistive personnel, ensuring that critical care components remain under licensed supervision.

Safety Considerations

• Essential safety practices include:
    - Verification of client allergies (e.g., tape, solutions, latex)
    - Utilization of two client identifiers for safety
    - Adherence to standard safety precautions
    - Employment of sterile technique as needed

Equipment Required

• Appropriate nursing equipment includes:
    - Nonsterile gloves and Personal Protective Equipment (PPE)
    - Sterile gloves
    - Nonwoven split gauze pads
    - Absorbent pads for drainage collection
    - Sterile cotton-tipped applicators
    - Sterile cleansing solutions
    - Hypoallergenic tape for securing dressings
    - Scissors for cutting tape or gauze
    - Biohazard waste receptacle for disposal of contaminated materials

Pre-Procedure Assessment

• Comprehensive medical record review should include:
    - Location and number of drains present
    - Client allergies
    - Relevant medical history
    - Current medications
    - Client vital signs
    - Lab values, notably White Blood Cell (WBC) counts for infection indicators

• Monitor for adverse symptoms:
    - Fever
    - Tachycardia
    - Increasing pain levels
    - Changes in drainage volume
    - Changes in drainage color or consistency

Procedure Steps

1. Obtain necessary supplies for wound care.

2. Privacy: Ensure client confidentiality and comfort during the procedure.

3. Introduce yourself to the client to establish rapport.

4. Perform hand hygiene to prevent infections.

5. Apply Personal Protective Equipment as required.

6. Verify client identity using two identifiers.

7. Confirm allergies with the client prior to starting the procedure.

8. Client Education: Inform the client about the procedure conducted and its importance.

Assess Drain and Wound

• During the assessment, check for the following:
    - Increased pain levels reported by the client
    - Presence of drainage on the dressing
    - Redness around the wound site
    - Swelling in the surrounding area
    - Purulent (pus-filled) drainage indicating infection
    - Foul odor suggesting necrosis or infection

Dressing Change Process

• Initial Steps:
    - Adjust the bed to an appropriate working height.
    - Position and drape the client for comfort and privacy.
    - Remove the soiled dressing with care.
    - Inspect the drainage on the dressing for:
      - Amount present
      - Color (indicative of infection or health)
      - Odor (presence of foul odor is a sign of infection)
      - Consistency (e.g., thin or thick)
    - After removing gloves, perform hand hygiene diligently.
    - Create a sterile field for the dressing change.
    - Apply sterile gloves to prevent contamination during dressing application.

Cleaning Insertion Site

• Clean the area surrounding the drain with a sterile solution.

• Ensure the insertion site is dried thoroughly to prevent skin breakdown.

• Remove any accumulated exudate carefully.

Apply New Dressing

• Place a nonwoven split gauze pad around the drain.

• Cover with an absorbent pad to manage fluid collection.

• Secure the dressing with hypoallergenic tape to avoid skin irritation.

• Ensure tape exceeds all edges to effectively hold the dressing in place.

Securing Drain

• Loop the tubing and secure it with tape or a designated securing device.

• Always maintain the collection device below the level of the wound to facilitate proper drainage and avoid complications.

• Prevent accidental dislodgement of the drain.

After Dressing Change Procedures

• Label the dressing clearly with:
    - Initials of the nurse
    - Date of dressing change
    - Time of dressing change

• Discard used gloves and materials appropriately.

• Perform hand hygiene again to maintain cleanliness.

• Discuss findings with the client, ensuring they are informed of their current condition.

• Ensure client safety measures are in place:
    - Bed must be placed low and locked.
    - Call light should be within reach of the client.

Pediatric or Confused Clients

• Ensure that all tubing is securely fastened to avoid accidental pulling.

• Cover the drainage system if required to protect it.

• Monitor continuously to prevent complications.

Unexpected Outcomes

Sudden Cessation of Drainage

• If drainage ceases suddenly:
    1. Check the tubing for kinks or clamping that may block drainage.
    2. Gently manipulate the tubing to re-establish flow.
    3. Assess the dressing for any indication of increased drainage.
    4. Notify the healthcare provider if the issue remains unresolved.

• Possible causes for cessation of drainage include:
    - Tubing blockage
    - Serious complications, such as cardiac tamponade, depending on the type of drain used.

Signs of Infection

• Symptoms suggestive of infection:
    - Thick yellow, green, tan, or brown drainage
    - Foul odor associated with the drainage
    - Fever present
    - Increased WBC counts
    - Redness or swelling around the wound site

• Notify the healthcare provider immediately if these signs are noted.

Documentation

• Essential components to document:
    - Location of the wound and drain
    - Type of drain used
    - Wound and skin assessment findings
    - Characteristics of drainage observed
    - Date and time of dressing change
    - Client tolerance of the procedure
    - Provider notification if applicable

Effect of Hygiene on Health

Skin

• The skin is vital and comprises Langerhans cells that actively kill pathogens.

• The epidermis is formed of squamous epithelial cells which support structural integrity.

Definition of Hygiene

• Hygiene includes actions and health practices designed to reduce the spread of pathogens.

• Mucous membranes, such as those in the nose, contain cilia that trap particles to prevent their invasion into the body, effectively decreasing the risk of illness.

• Hygiene practices include:
    - Handwashing, noted as effective in decreasing hospital infection rates.
    - Bathing or showering.
    - Oral care routines.
    - Nail care.
    - General grooming practices.

Benefits of Hygiene

Physical Benefits

• Key physical benefits include:
    - Removal of harmful pathogens from the skin's surface.
    - Elimination of oils and dead skin cells that may lead to infection.
    - Prevention of skin breakdown due to contaminants.
    - Reduction of overall infection risk.
    - Promotion of circulation due to warm water use, leading to vasodilation.
    - Improvement in oxygen and nutrient delivery to tissues.
    - Effective removal of waste products from cellular processes.

Psychological Benefits

• The psychological advantages of routine hygiene practices are:
    - Decreased levels of stress among clients.
    - Increased levels of happiness among individuals.
    - Promotion of relaxation, beneficial to overall mental health.
    - Improvement in sleeping patterns, contributing to overall wellness.
    - Reduction in levels of pain, particularly noted in cancer patients.

Skin Integrity and Risks of Breakdown

Skin Breakdown Risks

• Risks to skin integrity include:
    - Irritation and inflammation due to factors such as moisture, friction, or allergens.
    - Cuts or tears that penetrate the skin barrier.
    - Open skin presents an entry point for bacteria, heightening infection risks.
    - Increased potential for severe outcomes like limb loss or death due to untreated skin issues.

Preventing Skin Breakdown

• Strategies for preventing skin breakdown include:
    - Regular washing with mild soap to avoid irritation.
    - Avoidance of harsh chemical products on the skin.
    - Keeping skin clean and dry to foster integrity.
    - Monitoring areas prone to breakdown for signs of redness or irritation.

Incontinence and Skin Damage

• Fecal and urinary incontinence increases skin vulnerability significantly.

• Commonly affected areas include:
    - Hips
    - Genitals
    - Buttocks
    - Perineum

• Use of a pH-balanced cleanser is recommended to:
    - Decrease irritation and skin dryness.
    - Minimize the risk of infections such as yeast infections.
    - Maintain overall skin integrity and health.

Infection Prevention

Health Care–Associated Infections (HAIs)

• HAIs are infections that are acquired in healthcare settings and are:
    - Not present at the time of patient admission.
    - Documented as the most common adverse event encountered in hospital settings.
    - Cannot be completely eradicated, necessitating preventive measures.

Hand Hygiene

• Hand hygiene is a low-cost yet effective method for preventing infection among healthcare workers and clients.

• Scenarios requiring hand hygiene include:
    - When the nurse's hands are visibly soiled.
    - After handling meals or items contaminated by infectious fluids (e.g., a client with diarrhea).

When to Use Alcohol-Based Hand Sanitizer (≥60% alcohol)

• Indicated circumstances include:
    - Before any direct contact with clients.
    - Before initiating sterile procedures.
    - Before handling invasive medical devices.
    - After contact with soiled areas before approaching any clean areas on the same client.
    - After personal interactions with clients or touching the surrounding environment.
    - After coming into contact with body fluids, including respiratory secretions.
    - After removing gloves.

When to Use Soap and Water

• Use soap and water in instances such as:
    - When hands are visibly soiled.
    - After caring for clients with infectious diarrhea.
    - After exposure to spores, particularly Clostridioides difficile.

Proper Technique for Hand Hygiene

Alcohol-Based Hand Sanitizer

• Correct use requires:
    - Application of the product to all areas of the hands.
    - Rubbing all surfaces of hands for approximately 20 seconds.
    - Ensuring the hands remain rubbed until completely dry.
    - Correct duration for sanitizing is between 15 to 20 seconds.

Soap and Water

• Proper handwashing procedures involve:
    - Wetting hands thoroughly.
    - Applying the recommended amount of soap to all hand surfaces.
    - Rubbing vigorously for 15 to 20 seconds.
    - Covering all surfaces of the hands when washing.
    - Avoiding hot water, as it can lead to skin dryness.
    - Rinsing under running water effectively.
    - Drying hands with a disposable towel to avoid cross-contamination.
    - Using the towel to turn off the faucet without direct hand contact to minimize germ transfer.

Client Education

• Educate clients about proper hand hygiene techniques and when to wash hands:
    - After using the restroom.
    - Before and after eating meals.
    - After coughing or sneezing.
    - Following blowing the nose.

Health Promotion

Definition

• Health promotion is defined as strategies aimed at helping clients take control of their health, encourage disease prevention, facilitate behavioral change, and improve overall well-being.

Focus Areas

• Key domains of health promotion target:
    - Mental health
    - Physical health
    - Spiritual health
    - Social well-being

Social Determinants of Health

• Social determinants refer to the conditions in which individuals are born, live, work, and age. Important factors include:
    - Housing quality
    - Access to nutritious foods
    - Public safety in neighborhoods
    - Quality of education available to individuals
    - Employment opportunities

Health Inequities

• Definition and impacts of health inequities:
    - Differences in health outcomes across groups.
    - Observable both nationally and globally.
    - Influenced heavily by the aforementioned social determinants.

Client-Specific Factors Affecting Hygiene Practices

Factors Influencing Hygiene

• Variants such as culture, personal religion, and developmental stages can profoundly influence individual hygiene practices. Specific factors include:
    - Cognitive function also plays a role in ability to perform personal hygiene tasks.
    - Physical ability can limit or facilitate individual practices.
    - Personal preferences are pivotal to individual choices regarding hygiene.
    - Emotional state can impact motivation and willingness to engage in hygiene activities.

Privacy and Dignity

• While providing care, ensure the client’s dignity and privacy by:
    - Exposing only the necessary body parts during procedures.
    - Utilizing a bath blanket for covering exposed areas.
    - Asking the client before exposing their body during care.
    - Allowing the client to hold a towel for modesty during bathing.
    - Maintaining respect for modesty at all times during care dealings.
    - Delegation to Unlicensed Assistive Personnel (UAP) or Certified Nursing Assistants (CNA) is permitted for tasks such as bathing or dressing clients.
    - RNs should evaluate holistically during hygiene protocols.

Cultural and Religious Considerations

• Understanding cultural sensitivities is key in providing care. Aspects to consider include:
    - Respecting modesty preferences of clients from diverse backgrounds.
    - Considering the sexual identity and gender preference of caregivers assigned to clients.
    - Some cultural groups have structured hygiene rituals, such as:
      - Brushing teeth and bathing upon waking.
      - Engaging in prayer or meditation.
      - Eating specific meals post-morning routines.
    - Certain communities advocate hand washing before meals, and some prefer eating with their hands, emphasizing the importance of hand hygiene.

Developmental Considerations

Newborns and Infants

• Recommended bathing frequency is three times a week to avoid skin dryness due to frequent bathing.

• Sponge baths are advised until the umbilical cord falls off (within the first 1-2 weeks).

Umbilical Cord Care

• Care routines should include:
    - Keeping the area clean and dry
    - Small drops of blood from the cord should not be alarming; however, caregivers must report:
      - Active bleeding
      - Foul-smelling discharge
      - Redness around the area
      - Crying when the cord is touched

Diaper Dermatitis

• Causes of diaper dermatitis include:
    - Moisture exposure
    - Contact with urine or feces
    - Infection or allergic reactions

• Generally most prevalent in infants aged 9-12 months.

• Treatment strategies involve:
    - Frequent diaper changes to maintain a clean environment.
    - Cleansing the area with soap-free cleansers.
    - Application of topical emollIENTs to soothe irritated skin.

• Cleaning the skin with a soap-free cleanser is the preferred approach to maintain skin integrity.

School-Aged Children and Teenagers

• Notable changes during this stage include:
    - Hormonal changes leading to oily skin and increased sweating.
    - Daily bathing is recommended.
    - Hair washing is suggested every other day to maintain cleanliness.
    - Use of deodorants and antiperspirants becomes essential.
    - Mild, noncomedogenic cleansers are encouraged to avoid skin breakouts.

Older Adults

• Factors leading to resistance towards bathing may be:
    - Pain experienced during bathing procedures.
    - Fear of falling and fear of water temperature could inhibit the bathing process.
    - Fatigue and limited mobility also play a part in the decision to refrain from bathing.

• Best practices include:
    - Providing clients choices regarding their bathing methods and preferences may encourage them to engage in personal hygiene practices.
    - Inquire about their reasons for refusing care, to address any concerns or comfort levels regarding bathing.
    - Offer options to modify their bathing routine to accommodate individual capabilities.
    - Never ignore a refusal to bathe; this could lead to neglect and abuse.