Nursing Faculty Student Orientation 51617 Infection Prevention amp Control The Chain of Infection Control and Prevention Hand Hygiene Standard Precautions amp Personal Protective Equipment PPE ID: 710929
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Infection Prevention & ControlNursing Faculty/ Student Orientation
5.16.17Slide2
Infection Prevention & ControlThe Chain of Infection – Control and PreventionHand HygieneStandard Precautions & Personal Protective Equipment (PPE)Transmission-Based PrecautionsMultidrug-Resistant Organisms (MDRO) Respiratory HygieneHealthcare Associated Infections (HAI)
National Patient Safety Goals
Sharps Safety Tips
Bloodborne Pathogens
Infectious Waste
Environmental CleanlinessSlide3
The Chain of InfectionSlide4
Hand hygiene is the single
most effective
method to prevent the spread of infection.
It is needed before and after EVERY encounter with each patient and patient environment.
All caregivers and providers are required to perform hand hygiene per Aurora Health Care Policy #183.
Hand hygiene is one of the National Patient Safety Goals.
Hand Hygiene is KeySlide5
Hand Hygiene:Soap & WaterAlcohol-based hand gelWhen to use:
Use when hands are visibly dirty, contaminated, or soiled.
Use
after caring for a patient with
C. diff
or Norovirus
Use for
routinely decontaminating hands if hands are not
visibly soiled.
Use
following soap and water after caring for a patient with
C. diff
or
Norovirus
.
How
to use:
Wet hands with water, apply soap, rub hands together for
at least 15 seconds.
Rinse and dry with disposable towel.
Use towel to turn off faucet.
Apply to palm
of one hand, rub hands together covering all surfaces until dry.Slide6
Alcohol-Based Gel Works!!! Culture of healthcare workers ungloved hand after examining the abdomen(stomach) of a patient with Methicillin Resistant Staphylococcus Aureus (MRSA). Culture of same healthcare workers hand after cleaning hands with alcohol-based foam/gel shows no MRSA growing. N Engl J Med 360;3. January 2009Slide7
Healthy Hands and Fingernails Protect our PatientsFingernail Policy for Direct Patient Care:Natural nail tips must be kept less than ¼” longArtificial nails or extenders are not allowed- germs in the adhesives have been linked to patient deaths.Nail polish must be intact and unchipped – issue with gel nails
Sores or cracks on your hands may be a source of infection for yourself and your patients.
Use only approved hand lotions.
Notify Employee Health if you have any problems with your hands including sensitivity to alcohol gel.
***Refer to the Caregiver Appearance Policy***.Slide8
Standard PrecautionsUse Standard Precautions with every patient, for their safety and yours.Standard Precautions include:Wearing Personal Protective Equipment (PPE) for any anticipated contact with any real or potentially contaminated blood, body fluids, surfaces, or areas.Safe injections practices
When Standard Precautions are not sufficient for you and your patient’s safety,
Transmission-Based Precautions
will also be implemented.Slide9
Transmission-Based PrecautionsPatients may enter our facilities with a known or suspected contagious disease or infection.A contagious disease can spread to other patients, visitors, or care givers.Safety measures called Transmission-Based Precautions are required in addition to Standard Precautions.
The three categories of Transmission-Based Precautions are:
Contact
Precautions
Droplet
Precautions
Airborne
Precautions***Remember: Standard Precautions apply to every
patient,
all
the time!***Slide10
Contact PrecautionsUse in addition to Standard Precautions.Designed to reduce the risk of transmission of microorganisms by direct or indirect contactExamples: Clostridium
difficle
, scabies, multidrug-resistant organisms (MDROs), patient with draining wounds
Wear a gown and gloves for all patient care and when entering the patient’s environment.
Dedicated use of noncritical care equipment (ex. blood pressure cuffs) to a single patient or use single-use disposable noncritical care equipment.
***Remember
SPECIAL PRECAUTIONS
must be used with
CONTACT PRECAUTIONS
for patients with infectious diarrhea.***Slide11
Contact Precautions:How to use Personal Protective Equipment (PPE) with Disposable GownBefore entering the room, put on PPE in this order:
Hand Hygiene First!
Yellow gown–tie at the waist, and use thumb holes
Gloves–should cover cuffs and thumb holes of gown
Before leaving
the room, remove PPE in this order:
(Rationale: The most contaminated item is removed first)Grab the gown on both sides of the waist and pull forward to break the back of the gown
Roll the gown down and away from the body, off of the arms (one arm at a time)
Remove gloves with gown.
Preform appropriate hand hygiene.
Exit Room.Slide12
Clostridium difficile (C. diff)/NorovirusClostridium difficile (C. diff) is a bacteria that produces spores and causes severe diarrheal illness.Norovirus is a very contagious virus that causes vomiting and diarrhea.You must both wash your hands with soap and water, and then use alcohol gel after caring for a patient with these confirmed or suspected diseases.Only bleach-containing products
will kill
C. diff
in the environment.
T
his is also recommended for Norovirus.
At Aurora Health Care, we call this “Special Precautions”Slide13
Droplet PrecautionsUse in addition to Standard Precautions.Used for illnesses that can be spread to others by speaking, sneezing, or coughing (influenza, meningitis, pneumonia)A mask is used by staff or visitors upon entering the room of a patient on droplet precautions.
Hand hygiene is essential to avoid the spreading of germs.Slide14
Droplet Precautions:How to use Personal Protective Equipment (PPE)Droplet Precautions: Prevent the spread oflarge droplet respiratory tract secretions duringclose contact with the patient. Large droplet
respiratory tract secretions can travel in the air
for about 3 feet and are spread when the patient
talks, sneezes or coughs.
Before entering
the room:
Hand HygienePut on a mask
Before leaving
the room, remove PPE in this order:
Remove mask at the doorway &
discard
Use alcohol hand gel to clean hands or wash with soap & water
Exit RoomSlide15
Airborne PrecautionsA negative pressure room is required.Anyone entering or exiting a room with this sign must follow the posted instructions.Airborne Precautions are used with:Measles, Chicken PoxActive or Suspected TB
Disseminated Shingles
See the Infection Prevention and Control Website other diseases and infections requiring Airborne Precautions.
A N95 face mask is to be worn at all times within the room. Caregivers must be fit tested annually, or must wear a PAPR. Slide16
Airborne Precautions:How to use Personal Protective Equipment (PPE)Before entering the room:Perform Hand HygienePut on a special mask (N95) or respirator (Special masks require initial fit testing in employee health & a user seal check each time one is worn. If you are unable to obtain a good seal with the mask, or special masks are not available, a respirator must be worn.)
Before leaving
the room:
Use alcohol hand gel to clean hands or wash with soap & water
Exit Room
DO NOT Remove your mask or respirator until you have left the room!
3. Remove and discard mask after leaving the patient roomSlide17
Multidrug-Resistant Organisms (MDRO)MDRO’s are:Germs resistant to many life-saving antibiotics and require Transmission-Based Precautions in addition to Standard PrecautionsSpread from direct contact with a patient infected with a MDRO. (By touch AND by the
environment
.)
We now count some organisms that are not sensitive to ONE antibiotic as MDRO’s and put them in CONTACT isolation. (VISA/VRSA)
Useful policies found on the Infection Prevention and Control Policy and Procedure site apply to C. diff, MRSA, and MDRO’s.Slide18
MDRO’sPatients with a known or history of a MDRO will have an alert displayed in a yellow colored Infection box in the patient banner in EPIC.If you click on this yellow colored box, it will give you more information regarding the organism.Caregiver TO Dos:
Identify patients needing isolation.
Nursing may enter a “no co-sign” order for isolation
Chart “Isolation” under Daily Cares-Precautions- at least once each shift
Teach patient and family about isolation any time it is initiated and document teaching – TJC and State will look for this.
A physician’s order is needed to discontinue an isolation order.Slide19
Respiratory Hygiene:***Applies to BOTH patients AND caregivers.***Slide20
Healthcare Associated Infections (HAI)An HAI is an unexpected infection developed while staying in a healthcare setting.Each year over 2 million patients develop HAIs causing discomfort and longer stays and 99,000 patients actually die from them!Most HAI’s are passed on to the patient
from the hands of healthcare workers or from patient contact with the
environment
Patients are at risk of developing HAI’s from devices they are exposed to in the healthcare setting:
32% are urinary tract infections
22% are surgical site infections
15% are pneumonia (lung infections)
14% are bloodstream infections
In addition, hospitals will no longer be reimburses for many HAIs!Slide21
National Patient Safety Goals: (TJC, The Joint Commission)Follow best practices to prevent infections such as:Central line associated blood stream infections (CLABSI)Catheter associated urinary tract infections
(CAUTI)
Ventilator associated pneumonia
(VAP)
Surgical site infections
(SSI)
Caregivers involved in the care of patients with devices will receive education on these practices.Slide22
Stay Safe- Sharps & BloodDispose of all sharps in the designated sharps containers. Containers should be replaced when they are ¾ full.Never place hands in the sharps container and always check for exposed needles prior to using the containers.Never recap a needle unless using a safety device or the one-handed scoop method.
In case of an exposure to blood, or another body fluid,
first
wash the exposed area thoroughly
. Then clean remaining blood/fluid with an approved cleaner (
Cavi
Wipes, Dispatch, Clorox Bleach Wipes). Contact EVS if needed. Perform hand hygiene. Contact Employee Health in case of a needle stick or exposure.Wash your hands and use your PPE!Slide23
Bloodborne PathogensWhat is an exposure?A deep cut or needle stick with a sharp item contaminated with blood or body fluid.Splash to mucosal membranes (eyes, nose, mouth) with a blood or body fluidBlood contact on broken skinWhat is considered a bloodborne pathogen?
HIV
No Vaccine
Fragile if exposed to air
0.3% risk after exposure
Hepatitis B
Vaccine Series – 3 injections – offered free to all (at risk) caregivers for protection from exposure to blood or body fluids.
300 times more contagious than HIVCan be transmitted in dried bloodHepatitis CNo vaccine20-30 year incubation period
Exposures are treated as medical emergencies:
Provide first aid – wash wounds with soap/water for 5 minutes, flush eyes or mouth with large amounts of water for 5-10 minutes
Report immediately – Pose Exposure Prophylaxis recommended within 2 hours (call Employee Health)
Fill out an Employee Incident Report
Remember to keep the source patient available for assessment and testing
Follow-up testing and results will be handled through Employee Health Services.Slide24
Infectious WasteUse red bags to protect yourself and others from waste that may be infectious.Red bag all items containing blood or body fluids that are any of the following:DrippablePourableSqueezableFlakeable
Check for the availability of solidifying agents within your departments.
Improper disposal is expensive – these items do not belong in a red bag:
IV bags and lines without visible blood
Syringes without blood and needles
PPE without blood
Packaging material
Empty bedpans, emesis basins, wash pans and urinalsStool blood cardsPaper towelingDiapers and under pads with no visible bloodDressings and bandages spotted with blood.Slide25
Environmental Cleanliness RemindersIt is everyone’s responsibility to keep the environment clean***Everything patients, caregivers and visitors touch must be considered contaminated.***