1. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Infection Control Unit 13

2. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Objectives Spell and define terms. Explain the principles of medical asepsis. State the purpose of standard precautions. 2

3. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Objectives List the types of personal protective equipment. Describe nursing assistant actions related to standard precautions. Describe airborne, droplet, and contact precautions. 3

4. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Disease Prevention In Unit 12, you learned what infections are and some of their causes In this unit –You will learn actions and procedures that can help prevent the transmission of infection to protect yourself, your co- workers, and those in your care 4

5. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Medical Asepsis Asepsis –Absence of disease-producing microorganisms 5

6. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Medical Asepsis Medical asepsis –Reduces the numbers of disease- producing microorganisms –Or interrupts transmission from one person to another person or from a person to a place or an object 6

7. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Handwashing Single most important health procedure any individual can perform to prevent the spread of microbes 7

8. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Handwashing Vigorous, short rubbing together of all the surfaces of soap-lathered hands Followed by rinsing under a stream of running warm water Handwashing should take at least 15 to 20 seconds; take more time if hands are visibly soiled 8

9. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Waterless Hand Cleaners Many facilities provide dispensers containing waterless hand cleaners in various locations. Alcohol-based hand cleaners are the most effective method of cleansing hands unless visible soil is present. 9

10. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Waterless Hand Cleaners Hand cleaners –Alcohol-based gel, lotion, or foam that is dispensed in small dime- to quarter-sized portions –Alcohol products may be used to clean your hands for routine care 10

11. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Using Alcohol Hand Cleaner Wash at the sink if: –Hands are soiled with a protein substance –Patient is known to have or suspected of having a disease caused by spores Clean hands for 20–30 seconds or as recommended by manufacturer Rub all surfaces well until hands are dry 11

12. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Hand Lotion and Cream Maintaining the integrity of the skin on your hands –Very important to prevent injury and exposure to microbes 12

13. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Hand Lotion and Cream Hand care products –Use products from individual, personal- size packages, or from a pump dispenser or squeeze bottle, but don’t touch the spout –Avoid products in a jar 13

14. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Protecting Yourself As you perform your duties, you may contact potentially infectious material –Blood or other body fluids that may contain pathogens 14

15. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Standard Precautions Infection control actions used for all people receiving care –Regardless of condition or diagnosis 15

16. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Standard Precautions Previously called Universal Precautions Assume that blood and body fluids of any patient could be infectious 16

17. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Standard Precautions Recommends PPE and other infection control practices to prevent transmission in any healthcare setting Decisions about PPE use determined by type of clinical interaction with patient 17

18. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. PPE for Standard Precautions 18 Gloves −Use when touching blood, body fluids, secretions, excretions, contaminated items −For touching mucous membranes and nonintact skin

19. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Gowns –Use for contact or potential contact with clothing, exposed skin with blood/body fluids, secretions, or excretions 19 PPE for Standard Precautions

20. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Mask and goggles or a face shield –Used during patient care activities likely to generate splashes or sprays of blood, body fluids, secretions, or excretions 20 PPE for Standard Precautions

21. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Transmission-Based Precautions Standard precautions do not eliminate the need for other isolation precautions A second set of precautions is used with certain highly transmissible diseases Second tier of precautions is called transmission-based precautions 21

22. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Three Isolation Techniques 1.Isolation technique is the name given to the method of caring for patients with easily transmitted diseases 2.Essential that every person take responsibility for selecting the correct PPE and using the proper isolation techniques to prevent the spread of disease to others 22

23. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Three Isolation Techniques 3.All items that come into contact with a patient’s excretions, secretions, blood, body fluids, mucous membranes, or nonintact skin are considered contaminated. Infectious material must be treated in a special way. 23

24. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Three Isolation Techniques Airborne precautions Contact precautions Droplet precautions The infection control nurse selects the type of precautions to interrupt the mode of transmission. 24

25. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Isolation Technique Standard precautions are always used in addition to transmission-based precautions. 25

26. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. New Precautions and Scre ening Standard precautions to prevent the spread of respiratory infection Begins at first contact with a potentially infected person Signs should be posted instructing those who enter on respiratory safety 26

27. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Isolation Unit May be an area or a private room Patients with the same disease may share a room A room with handwashing facilities and an adjoining room with bathing and toilet facilities is best 27

28. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. AIIR (A2R) Rooms Rooms with a special air-handling system may be called AIIR rooms Airborne infection isolation room = AIIR These rooms have negative pressure –Air flow in which air from the room is vented directly to the outside –Or air is filtered so pathogens cannot escape 28

29. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. AIIR (A2R) Rooms Special ventilation is needed for airborne precautions A HEPA respirator or NIOSH-approved mask –Must always be worn when entering an airborne precautions room 29

30. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Ultraviolet Germicidal Irradiation (UVGI) Ultraviolet germicidal irradiation (UVGI) lights –Used to eliminate pathogens in some isolation rooms 30

31. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. UVGI lights –Used intermittently as a secondary measure to kill or inactivate the pathogens in the upper portion of the room or passing through the air duct 31 Ultraviolet Germicidal Irradiation (UVGI)

32. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Lights are not on all the time Not a threat to the patient or health care workers 32 Ultraviolet Germicidal Irradiation (UVGI)

33. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Anteroom Used to enter some isolation rooms Is a small room inside the entrance to the patient room Contains a sink and containers for trash disposal 33

34. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Anteroom Reduces escape of infectious organisms when the door is opened and closed Serves as a buffer between the changes in air pressure in the patient room and the hallway Refer to Figure 13-14 34

35. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Anteroom 35

36. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Additional Respiratory Precautions CDC recommends: –Teaching new admissions and those who accompany them to use respiratory precautions –Notifying staff if symptoms of a respiratory infection are present when a person first registers for care 36

37. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Other respiratory precautions are: –Practicing respiratory hygiene/cough etiquette –Containing secretions –Covering the nose and mouth when coughing or sneezing 37 Additional Respiratory Precautions

38. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Other respiratory precautions are: –Using tissues to contain respiratory secretions –Discarding the tissues in the nearest trash can after use 38 Additional Respiratory Precautions

39. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Other respiratory precautions are: –Performing hand hygiene after contact with respiratory secretions and/or contaminated objects and/or materials –Using alcohol-based hand cleaner from dispensers mounted in public areas 39 Additional Respiratory Precautions

40. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Preparing for Isolation To prepare a patient room for isolation, do the following: –Indicate the type of isolation precautions on the door to the patient’s room –Place an isolation cart next to the door Provide PPE (personal protective equipment) as needed 40

41. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Preparing for Isolation To prepare a patient room for isolation, do the following: –Line the wastebasket inside the room with a plastic bag labeled or color-coded for infectious waste –Place a laundry hamper in the room Line it with a yellow biohazard laundry bag 41

42. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Preparing for Isolation To prepare a patient room for isolation, do the following: –At the sink, check the supply of paper towels and soap –Soap should be in a wall dispenser or foot-operated dispenser 42

43. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Personal Protective Equipment Personal protective equipment includes: –Gloves, gown, mask, and goggles or face shield Regular eyeglasses do not provide adequate protection 43

44. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Personal Protective Equipment Eye protection must also protect the sides of the eyes A mask may be worn without eye protection –But eye protection should never be worn without a mask 44

45. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Selecting PPE For maximum protection, select the appropriate PPE based on: –Type of anticipated exposure –Whether you expect only touch, or if splashes, sprays, or large volumes of blood or body fluid, secretions, or excretions may be present 45

46. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Selecting PPE For maximum protection, select the appropriate PPE based on: –Durability and appropriateness of the PPE for the task –How well the PPE fits you 46

47. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Key Points About PPE Don before contact with the patient, generally before entering the room Use carefully −Don’t spread contamination 47

48. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 48 Key Points About PPE Remove and discard carefully –Either at the doorway or immediately outside the patient room –Remove respirator outside the room Immediately perform hand hygiene

49. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Sequence for Applying Personal Protective Equipment 1)Wash hands 2)Gown 3)Mask or respirator 4)Goggles or face shield 5)Gloves 49

50. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. How to Don a Gown Select appropriate type and size Opening is in the back Secure at neck and waist If gown is too small, use two gowns Gown #1 ties in front Gown #2 ties in back 50

51. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Place over nose, mouth, and chin Fit flexible nosepiece over nose bridge Secure on head with ties or elastic Adjust to fit 51 How to Don a Mask

52. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. How to Don a Particulate Respirator Select a fit-tested respirator Place over nose, mouth, and chin Fit flexible nosepiece over nose bridge Secure on head with elastic Adjust to fit 52

53. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Perform a fit check –Inhale: respirator should collapse –Exhale: check for leakage around face 53 How to Don a Particulate Respirator

54. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. How to Don Eye and Face Protection Position goggles over eyes Secure to the head using the ear pieces or headband Position face shield over face Secure on brow with headband Adjust to fit comfortably 54

55. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. How to Don Gloves Don gloves last Select correct type and size Insert hands into gloves Extend gloves over isolation gown cuffs 55

56. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Do’s and Don’ts of Glove Use Work from “clean to dirty” Limit opportunities for “touch contamination” Protect yourself, others, and environment Don’t touch your face or adjust PPE with contaminated gloves Don’t touch environmental surfaces except as necessary during patient care 56

57. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Change gloves –During use if torn and when heavily soiled (even during use on the same patient) –After use on each patient Discard in appropriate receptacle –Never wash or reuse disposable gloves 57 Do’s and Don’ts of Glove Use

58. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. How to Safely Use PPE Keep gloved hands away from face Avoid touching or adjusting other PPE Remove gloves if they become torn –Wash hands before donning new gloves Limit surfaces and items touched 58

59. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. “Contaminated” and “Clean” Areas of PPE Contaminated – outside front –Areas of PPE that have or are likely to have been in contact with body sites, materials, or environmental surfaces where the infectious organism may reside 59

60. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Clean – inside, outside back, ties on head and back –Areas of PPE that are not likely to have been in contact with infectious organisms 60 “Contaminated” and “Clean” Areas of PPE

61. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Sequence for Removing Personal Protective Equipment 1)Gloves 2)Wash hands 3)Goggles or face shield 4)Gown 5)Mask 6)Wash hands 61

62. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Where to Remove PPE At doorway, before leaving patient room or in anteroom Remove respirator outside room –After door has been closed Ensure that hand hygiene facilities are available at the point needed –Sink or alcohol-based hand cleaner 62

63. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. How to Remove Gloves (1) Grasp outside edge near wrist Peel away from hand Turn glove inside-out Hold in opposite gloved hand 63

64. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Slide ungloved finger under the wrist of the remaining glove Peel off from inside Create bag for both gloves Discard 64 How to Remove Gloves (2)

65. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Remove Goggles or Face Shield Grasp ear or head pieces with ungloved hands Lift away from face Place in designated receptacle for reprocessing or disposal 65

66. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Removing Isolation Gown Unfasten ties Peel gown away from neck and shoulder Turn contaminated outside toward the inside Fold or roll into a bundle Discard 66

67. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Removing a Mask Untie the bottom & top tie Remove from face Discard 67

68. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Removing a Particulate Respirator Lift the bottom elastic over your head first Then lift off the top elastic Discard

69. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Hand Hygiene Perform hand hygiene immediately after removing PPE If hands become visibly contaminated during PPE removal –Wash hands before continuing to remove PPE 69

70. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Hand Hygiene Wash hands with soap and water or use an alcohol-based hand cleaner (rub) Ensure that hand hygiene facilities are available at the point needed –Sink or alcohol-based hand rub 70

71. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Equipment Disposable patient care equipment is used by many facilities It is ideal for patients on isolation precautions Frequently used equipment remains in the patient’s unit 71

72. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Containment of Contaminated Articles It is important that contaminated equipment be bagged, labeled, and disposed of –According to the health care facility’s policy for the disposal of infectious waste 72

73. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Contaminated articles leaving the patient’s room –Must be handled so that pathogens will not be spread 73 Containment of Contaminated Articles

74. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Transporting the Patient in Isolation Sometimes a patient in isolation has to be transported to another area of the health care facility for treatment or testing 74

75. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Notify the receiving unit of your intention to transport the patient –Describe the type of transmission-based precautions being used 75 Transporting the Patient in Isolation

76. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Disinfection and Sterilization Disinfection –Process of eliminating harmful pathogens from equipment and instruments Sterilization removes all microorganisms from an item 76

77. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Sterile Procedures Surgical asepsis –Environment kept free of microorganisms –Pathogens and nonpathogens –In procedures in which surgical asepsis is used Equipment and supplies must be sterile 77

78. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Sterile Field An area of sterile equipment and materials 78