1. Nursing Orientation Infection Prevention &Control

2. Standard Precautions Environmental Cleaning- Hand Hygiene-
Must do hand hygiene even if there is no patient contact. C-Diff patients- all
staff must use gel/ soap and water before entering and wash only with soap
and water when leaving the room.
Hand washing- must wash hands with soap and water for at least 15 seconds.
Respiratory Hygiene/Cough Etiquette
Personal Protective Equipment-
Environmental Cleaning-
Use hospital approved disinfectant
Safe Injection Practices (if applicable to the nursing student and must be accompanied)

3. STANDARD PRECAUTIONS
PPE – Personal Protective Equipment
Gloves
Masks (fluid resistant)
Gowns
Protective eye wear
Use to reduce the likelihood of an occupational exposure
Use PPE according to procedure/task when anticipating
contact or splash with blood/body fluids
Isolation signs indicate the minimum PPE that must be used when entering a room. Additional PPE can be used if necessary.
Consider all patients potentially infectious, observe standard precautions at all time.
For your safety, no eating or drinking is allowed at the nursing stations.
If you encounter a patient with an illness that you are not familiar with, check with preceptor prior to entering the
patient’s room.

4. Germs (ex. MRSA) can be spread by
touching patient Or patient’s surroundings
/ environment.
Options for Evaluating Environmental Cleaning, CDC 2010
Example: Active MRSA (Methicillin Resistant
Staphylococcus aureus) requires Contact
Precautions.

5. Like Contact Precautions But….
For C Difficile
Need to wash hands with soap and water only after coming from patient’s room.
*If a patient has unexplained diarrhea, the staff should collect the 3rd loose stool within 24 hours for CDIFF testing and place patient on Contact Plus Precaution.

6. What is an Aerosol Transmissible Disease?
A disease that is transmitted by aerosols (A gaseous suspension of fine solid or liquid particles)
Cal/OSHA’s ATD Standard and Emergency Medical Services
May , Deborah Gold, MPH, CIH
Cal/OSHA – RSHU,

7. You can catch the germs when patient
coughs, sneezes or is talking.
DROPLET – BLUE sign / Private room/Surgical mask
Diphtheria
Influenza
Meningococcal disease
Mumps
Mycoplasma pneumonia
Pertussis-(whooping cough)
Plague
Rubella
SARS
Viral hemorrhagic fevers

8. Students: Note that you are not fit tested for these masks
Students: Note that you are not fit tested for these masks. You SHOULD NOT take patients that are on Airborne Precaution.
You can catch the germs when patient
coughs, sneezes or is talking.
But Germs can travel farther than 3 feet and
can stay in the air longer.
AIRBORNE – Orange sign/ N95 /Airborne Infection Isolation Room (AIIR)
Chicken pox
Anthrax
Avian influenza
Measles
Monkey pox
SARS
Small pox TB
Novel or unknown pathogens

9. Surgical Mask Does not fit tightly to the face
Is not designed to filter air inhaled by the user
Is not fit-tested
Cal/OSHA’s ATD Standard and Emergency Medical Services
May , Deborah Gold, MPH, CIH
Cal/OSHA – RSHU,

10. Documentation of Patient Education
Regulatory Basis:
The Joint Commission: National Patient Safety Goal
Senate bill 1051(MRSA)
Patient Safety Licensing
What to document education on:
MDROs, including C. diff- preventing spread of infection in the hospital
Patient with devices: central lines, foley catheters
Preventing SSI
If it was not documented, it did not happen…

11. Hospital Bundle Central Line Insertion Practices (CLIP) Central Line Associated Bloodstream Infections (CLABSI)
The basic elements of the central line bundle include the following:
hand hygiene prior to line insertion
use of full barrier precautions during insertion (including cap, sterile gown/gloves, mask, full length sterile drape)
chlorhexidine skin prep; skin dry
avoidance of the femoral site when possible
removal of unnecessary catheters (daily assessment of catheter need)

12. use of a 2-person dressing change to optimally maintain sterility
Hospital Bundle Central Line Insertion Practices (CLIP) Central Line Associated Bloodstream Infections (CLABSI)
scrubbing the hub with 70% alcohol pad or chlorhexidine pad for 15 seconds and allow to completely dry before accessing the line
use of a 2-person dressing change to optimally maintain sterility
minimize blood draws through the catheter
remove emergently placed catheters within 24 to 48 hours

13. Elevate the head of bed to 30-45 degrees unless contraindicated
Hospital Bundles Ventilator Associated Pneumonia (VAP) Prevention Bundle Central Line Associated Bloodstream Infections
Elevate the head of bed to degrees unless contraindicated
Perform oral care with chlorhexidine swabs every 12 hours, brushing and routine cleaning every 4 hours

14. Hospital Bundles Catheter Associated UTI Prevention Bundle “Holy Moly No Foley”
Patients should only have a Foley Catheter only if medically indicated
Daily review of indwelling catheter necessity with prompt removal if unnecessary
Unobstructed flow
Bag below level of bladder
Tubing secured to patient with appropriate adhesive or Velcro device
Bag off the floor
Peri-care (Keep patients clean)
Photos from-

15. Hospital Bundles Catheter Associated UTI Prevention Bundle Indications for Necessity of Foley
Daily physician order needs to be present when the patient meets the catheter appropriateness criteria and the catheter is to remain in place.
The patient must meet at least one of the following indications for catheter necessity:
Frequent urine output monitoring for critically-ill patient (e.g. shock, sepsis)
Chemically-paralyzed, sedated, or comatose patient

16. Hospital Bundles Catheter Associated UTI Prevention Bundle Indications for Necessity of Foley
Chemically-paralyzed, sedated, or comatose patient
Presence of sacral Stage III or IV pressure ulcers that are not healing because of continual contact with urine
Acute urinary retention/obstruction

17. Hospital Bundles Catheter Associated UTI Prevention Bundle Indications for Necessity of Foley
Perioperative use for selected surgical procedures (renal / urology surgery, perineal / rectal surgery, pelvic / gynecologic surgery) Catheter will be removed on POD 1 or POD2.
Trauma: spinal injury or pelvic fracture (If urethral disruption is suspected, a Urologist must see patient first)
End of life care or comfort measures per patient/family’s request
Continuous bladder irrigation
The reason for keeping the catheter, as determined by the physician, must be documented in KPHC and communicated every shift by a licensed nurse, along with the other elements of the bundle.

18. Urine collects in this loop
Hospital Bundles Catheter Associated UTI Prevention Bundle Unobstructed Urine Flow
Unobstructed Urine Flow
Obstructed Urine Flow
Photos from-
Photos from-
Dependent loop
Urine collects in this loop

19. PPE – Putting on and Safely Removing
demo

21. Clean Hands Saves Lives!
Thank you questions? Contact: Abigail evangelista, bsn Infection prevention and control manager anna Tiomico, msn academic liaison, staff educator