1. Isolation Class 10 Last Class

2. Preventing the spread of infection What do we do when a client has a highly infectious disease?

3. Specific Infection Control Policies Isolation – the principle is to create a physical barrier that prevents the transfer of microorganisms.

4. What are appropriate barriers? Depending on - Organism Transmission Airborne Vehicle Contact Direct Indirect Droplet

5. Types of Barriers PPE (personal protective equipment) Gowns Gloves Masks Eyewear

6. Each institution is required to have infection control policies and guidelines.

7. What about when we don’t know? 3 systems Universal precautions Body substance precautions Standard precautions

8. Precautions to guard against the unknown Apply to everyone General public May or may not carry an infection

9. History Lesson Initially concerned with patient to patient Followed by concern for health care professionals 1970 – Hepatitis B 1987 – HIV Universal precautions by Center for Disease Control (CDC)

10. Universal precautions Stated : All blood & body flds should be treated as potentially infectious.

11. Body Substance Isolation (BSI) Infection control practitioners in Seattle and SanDiego Canada adopted policy but renamed it Body Substance Precautions (BSP)

12. Standard Precautions 1996- newest guidelines by CDC combined the major features of universal precautions & BSP

13. 2 Tier System 1996 CDC new guidelines

14. 1 st Tier – Standard Precautions Most important Universal precautions + BSP Applies to everyone Primary strategies for prevention of infection Standard precautions Blood, body flds., nonintact skin, mucus membranes

15. 2 nd Tier Specific infections/diagnosis Droplet, airborne, contact with contaminated surface

16. 3 Types Transmission Based Precautions Airborne, droplet, contact Some infections combination (chicken pox) These extra precautions are in addition to Standard Precautions

17. Airborne Travels on small particles Air currents Portal of entry – nose, mouth, mucus membranes Measles, chicken pox, TB

18. Requirements for Airborne Negative pressure room – door closed TB = HEPA filter Do not enter if not immune to measles/chickenpox Client wears mask when required to leave room

19. Droplet Large droplets of moisture Coughing, sneezing, talking Travels 3 ft. or less Enters nose / mouth Mumps, pertusis, influenza Private room Staff regular mask for 3 ft. Client mask for transport

20. Contact Dry skin to dry skin = Direct Dry skin to object = Indirect Impetigo, herpes zoster, scabies Gloves – for direct care or touching anything in the room Private room or semi if cohort has same diagnosis

21. Remove gloves prior to exiting and wash hands Gown for patient contact Changing linen Handling objects in the room

22. Remove gown prior to exiting Wash hands Careful clothing does not touch room surfaces

23. Protective Isolation / Reverse isolation Compromised or suppressed immune system Highly susceptible to infections Protection from environmental pathogens

24. Protective Isolation / Reverse isolation What do you need ? Private room – door closed Gown, mask, gloves if direct contact Wash hands No plants / flowers

25. Procedure Before instituting EXPLAIN to client & family Disease Purpose of isolation Steps to follow Time frame

26. Room Preparation Private with BR facilities Sign on door Isolation cart outside door Laundry hamper in room Waste basket with plastic bag Thermometer, B/P cuff, stethoscope in room Sharps receptacle

27. Be organized Gather equipment prior to entering room Remove rings and wash hands Don PPE Gown usually disposable Gloves up over cuff of gown

28. Put your watch in a plastic bag if no clock in room Linen is placed in a water soluble bag & then cream/yellow bag No special treatment for dishes / trays

29. Exiting Room Untie gown at waist Remove gloves properly Remove mask Untie gown at neck, drop over shoulders, don’t touch outside, fold inwards, and discard

30. Exiting Room Wash hands Use paper towel on door handle Wash hands again outside room Important to do as much client care as you can while you are in the room….CLUSTER ACTIVITY.

31. Basic Principles Wash hands prior to entering & exiting room Careful disposal of contaminated materials Knowledge of disease and mode of transmission Protection of client and public during transport

32. Client Consideration Isolation Loneliness Self – esteem, body image Boredom

33. Sterile Technique / Surgical Asepsis Purpose – to eliminate all microorganisms from objects that come into contact with the tissues of the body that are normally sterile.

34. Practice Areas Operating room Labor and delivery Major diagnostic area At the bedside in 3 main situations 1.Procedures requiring intentional perforation of the skin

35. 2.When the skin’s integrity is broken due to surgery or burns 3.During procedures involving insertion of devices into normally sterile body cavities

36. Any break in technique could result in contamination increasing clients risk for infection.

37. Methods of Sterilization Steam – most common Dry heat Ethylene oxide gas Chemicals Indicator of sterility – tape on pkg. turns color or forms lines Expiration Date

38. Examples of sterilization processes Moist heat /steam Radiation Autoclave- instruments, parental solutions, dressings Drugs, foods, heat sensitive items

39. Examples of sterilization processes Chemicals All types microorganisms Rapid action Work with water Stable in heat & light Inexpensive Not harmful to body tissue Instruments Glass thermometers Ex. Chlorine – used to disinfect water & for housekeeping purposes

40. Examples of sterilization processes Ethylene oxide gas Destroys microorganisms by altering cells’ metabolic processes. Rubber Plastic

41. Examples of sterilization processes Boiling water Cheap Imp. – bacterial spores andsome viruses resist boiling. Not used in hospitals! Items should be boiled for at least 15 min.

42. Practical Exam Prepare a sterile field Add an item Add a liquid Don sterile gloves