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					Infection control

Unit 13
Medical asepsis

  Asepsis- the absence of disease-
   producing microorganisms
  Medical asepsis (clean technique) – the
   medical practices that reduce the
   numbers of microorganisms or interrupt
   transmission from one person to another
  Contaminated – items have come in
   contact with known pathogens or have
   been exposed to potential pathogens.
Medical asepsis cont

  Not possible to eliminate all
   microorganisms from body or
   environment
  Ways to reduce
    Handwashing
    Use nonsterile gloves when contact with
     blood, moist body fluids (except sweat),
     mucous membranes or nonintact skin
    Cleaning or disinfecting equipment
Handwashing

  Single most important health procedure
   any individual can perform to prevent
   spread of microbes
  Warm water, fingers pointed down when
   rinsing, and friction (most important
   aspect) provides
    The most significant control measure for
     prevention of nosocomial infection
    Single most important control measure to
     break chain of infection
When to wash
   Beginning of shift
   Picking any item up from floor
   Before handling food
   After personal use of bathroom
   After using a tissue
   After coughing or sneezing
   Before handling a patient’s food or drink
   After handling a patient’s belongings
   After touching any item or environmental surface
    that is soiled
When to wash continued
 Before handling any supply considered clean
 After removing gloves
 After accidental contact with blood, body fluids
  etc
 Before or after contact with your mouth or
  mucous membranes
 Before and after caring for a patient
 Hands visibly soiled
 Anytime gloves torn
 End of shift, before going home
Waterless hand cleaners

  Alcohol based gel, lotion, or foam
   dispensed in dime to quarter-sized
   portions
  Rub product into hands until it dries, rub
   all surfaces. Takes about 15 seconds.
  Wash with soap and water whenever
   hands visibly soiled
Protect yourself

  Occupational exposure- the risk of
   coming into contact with potential
   pathogens
  Exposure incident – when your eyes,
   mouth, or nonintact skin had contact with
   blood, or other potential contagious
   material. Rinse immediately and report
   to supervisor and follow facility procedure
Standard precautions

  Used with all patients regardless of
   condition or diagnosis
  Whenever you may contact
    Blood, body fluids, secretions and excretions
    Mucous membranes
    Nonintact skin
  Work practice controls
  Personal protective equipment
Transmission-based
precautions
  Used with highly transmissible diseases
  Standard precautions used in addition to
   transmission-based precautions
  Communicable or contagious diseases
   are ones that tranfer from one person to
   another either directly or indirectly
Transfer of disease

  Through upper respiratory secretions by
   airborne and droplet transmission
  Contact transmission either direct or
   indirect with feces or other body
   secretions and excretions
  Through draining wounds or infective
   material such as blood on needles
Isolation

  Being separate or set apart a person with
   a contagious disease to prevent the
   spread of pathogens
  Cohorting – two patients with same
   disease may share the same room
  Stressful to both patient and family and
   the staff
Psychological aspects

  Fear of the disease and stress of steps
   needed
  Fear of passing disease to family and
   friends
  PPE makes person fearful
  More emotional support and care
  Plan care to spend time with the person
Transmission–based
precautions
  Used in addition to standard precautions
  Guidelines set by CDC
  types
    Airborne
    Droplet
    Contact
Airborne precautions

  Diseases transmitted by air currents, small,
   light, suspended in the air or on dust particles
  Controls
     Private room, with negative air pressure
     Door is kept closed
     All who enter room wear high-efficiency particulate
      air filter mask (HEPA), disposable or reusable. No
      facial hair. PER95 respirator or N95 respirator
      approved alternatives
Additional airborne

  If not immune to measles or chickenpox should
   not enter room if patient suspected of having
   these diseases or shingles
  If transport out of room patient wears surgical
   mask
  Addition to standard precautions
  Portable units available if no negative airflow
   room
Droplet precautions
  Disease spread by means of large droplets from
   coughing, sneezing, talking laughing
  Droplets generally do not travel move than three feet
  Influenza
  Surgical mask if working within three feet of patient
  Door can be open if more than three feet from bed
  Patient wears surgical mask during transports
  In addition to standard precautions
Contact precautions
  Direct or indirect contact responsible for spread
  Direct contact when the come in contact with
   contaminated area on patient’s skin, blood, or
   body fluids
  Indirect contact when touch items
   contaminated with infectious material
  Scabies, infected pressure ulcers,
   gastroenteritis
  Private room, door can be open
Contact continued
    Gloves before entering room. Always wash
     hands with removal of gloves. Used paper
     towel to open door when leaving
    Wear gown when entering room if uniform may
     contact the patient, blood or body fluids.
     Remove gown before leaving room and dispose
     of it to facility policy for biohazardous waste.
    Transport pt from room only when necessary.
     Continue precautions to minimize
     environmental contact
    Disposable equipment and supplies whenever
     possible
    Standard precautions still used
Isolation technique
four key points
  Name given to method of caring for patients
   with easily transmitted diseases
  Essential every person take responsibility and
   use proper isolation techniques
  All items that come into contact with person’s
   secretions, excretions, etc are considered
   contaminated. Treat in special way
  Standard precautions are always used in
   addition to special transmission based
   precautions
Isolation unit

  May be an area or private room
  Handwashing facilities and adjoining
   room with bathing and toilet facilities is
   best
  Private room for highly infectious
   infections, poor personal hygiene, require
   special air control procedures
Preparing for isolation

  Place card indication type of isolation on door
  Isolation cart outside room, next to door
  Line wastepaper basket with biohazard waste
  Laundry hamper inside room with biohazard
   laundry bag
  At sink, supply of paper towels and soap.
   Soap should be in wall dispenser or foot-
   operated dispenser
Personal protective
equipment
  Cover gown- moisture resistant material used
   when splashing is likely. Worn only once,
   discard after use
  Gloves- Three main purposes:
    Prevent NA from picking up a pathogen from a
     patient
    Avoid giving a patient a pathogen a NA has picked
     up on hands
    Avoid picking up a pathogen on a patient or
     environment and carrying it to another patient
Face mask

  Surgical mask worn with droplet
   precautions
  Use once and discard
  Change if becomes moist
  Handled only by ties
  Never left secured around neck
Protective eyewear

  Full face shield or goggles worn anytime
   splashing may occur
  Always worn with a mask
  Place mask then eyewear
  Remove eyewear then mask
equipment

  Disposable equipment used in most
   facilities
  Special precautions not needed for
   dishes unless have blood, secretions or
   drainage on them
Containment of
contaminated items
  Bagged, labeled, and disposed of according to facility
   policy
  Impenetrable bag before removed from room
  Soiled linen should be handled with care
       water-soluble bag, placed in a plastic bag
       Handle linen as little as possible
       Fold dirtiest side inward
       Do not shake
       Do not place on floor or tabletop
       Bag linen before leaving room
       Keep soiled linen separate from general linen
       Transport soiled, wet linen in a leakproof bag
Transporting patient

  Notify receiving unit of type of isolation
  If on airborne or droplet patient wears
   surgical mask
  If droplet area of skin covered while
   patient is out of room
Disinfection and
sterilization
  Disinfection- process of eliminating
   harmful pathogens from equipment and
   instruments
  Sterilization- removes all microorganisms
   from an item. Autoclave uses steam and
   pressure to kill organisms

				
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