IMS CH 66

Hand Hygiene

• Cornerstone of infection prevention.
  • Always perform hand hygiene at point of care.
  • Acceptable methods:
  • Hand-washing with soap & water (minimum 20 s scrub).
  • Alcohol-based hand rub (ABHR)—except when contraindicated.
  • Absolute indications for soap-and-water (no ABHR):
  • Visible soil/blood on hands.
  • C. difficile or other spore-forming organisms.
• Remember: "On infection the answer is hand-washing."

Transmission-Based Precautions – Overview

• Built on top of Standard Precautions (gloves when touching body fluids, respiratory etiquette, safe injection, etc.).
• Three main categories:
  1. Contact
  2. Droplet
  3. Airborne
• COVID-19 requires all three simultaneously.

Contact Precautions

• PPE:
  • Gown + gloves before room entry.
  • Mask not required unless combined with droplet/airborne component or the patient is coughing in close proximity.
• Room: single-patient preferred; cohort if same pathogen.
• Dedicated or disposable equipment (BP cuff, stethoscope).
• Hand hygiene: soap/ABHR except where noted.
• Examples/organisms:
  • Standard contact: MRSA, VRE, ESBL, Acinetobacter.
  • Enhanced contact (spore-forming → bleach wipe-down): C. difficile.
  • Surfaces wiped with bleach-based disinfectant.
  • NO alcohol sanitizer; must wash with soap & water.
• MDRO list from lecture:
  • CRE – Carbapenem-Resistant Enterobacteriaceae.
  • CRAF – Carbapenem-Resistant Acinetobacter complex (newer term mentioned).
  • Routine screening swabs: perineum + axilla.

Droplet Precautions

• Pathogen size > $5\,\mu m$; travel ≈ $3\,\text{ft}$.
• PPE on entry:
  • Surgical / procedure mask covering nose & mouth.
  • Eye protection if splash risk.
  • Gown & gloves only if contact with secretions or risk of soiling (e.g., ADLs).
• Quick in-room tasks (e.g., move bedside table) may not need gown.
• Examples/organisms:
  • Influenza A & B — contagious $5\,\text{days}$ while on oseltamivir.
  • Bacterial meningitis (incl. “rule-out” cases).
  • Streptococcal pharyngitis (strep throat) — droplet isolation $24\,\text{h}$ after start of antibiotics.

Airborne Precautions

• Pathogen size < $5\,\mu m$; stays suspended.
• Room:
  • Negative pressure with ≥ $12$ air exchanges/hr.
  • Door closed.
• PPE:
  • Fit-tested N95 (or higher) respirator.
  • Fit test required annually and PRN (weight-change, facial surgery, etc.).
  • Example: lost weight → may need small size; gained weight → possibly large.
• Examples/organisms:
  • Mycobacterium tuberculosis (pulmonary / laryngeal TB).
  • Varicella-zoster virus (chickenpox; also contact).
  • Rubeola (measles) – not in audio but classic.

Combination / High-Risk Pathogens

• COVID-19 (SARS-CoV-2)
  • Treat as contact + droplet + airborne simultaneously.
  • Eye protection, gown, gloves, N95, negative-pressure room if AGPs performed.

Device-Associated Infections

• CLABSI – Central-Line–Associated Blood Stream Infection.
  • Daily line-necessity review; remove if not essential.
• CAUTI (instructor said “your Foley”): same concept for urinary catheters.

Additional Vector-Borne & Emerging Pathogens

• Zika virus — mosquito-borne; causes congenital anomalies.
• “Vector” mention: insect bites as disease carriers.

Pain Assessment & Opioid Safety

• Mnemonic OPQRST for pain evaluation:
  • Onset
  • Provocation/Palliation
  • Quality
  • Region/Radiation
  • Severity (0-10)
  • Timing
• Prior to administering opioid / PCA:
  • Assess & document:
  • Respiratory rate
  • Oxygen saturation
  • Level of consciousness
  • Blood pressure
  • Current pain level
  • Monitor for constipation (opioid side effect)
• Post-administration: reassess pain & vitals per policy.

Miscellaneous Study Reminders

• Review endocrine content for Kaplan exam.
• No sexually transmitted disease (STD) content this semester; will appear in OB block.
• Always revert to hand hygiene as foundational answer for infection-control questions.