Day 1 Standard Precautions

FAALTURA 2008

Standard PrecautionsDay 1

Basic Infection Prevention and Control Course for Nurses

FAALTURA 2008

Standard Precautions

• Applies to:– Blood– All body fluids, secretions and excretions

except sweat, regardless whether they contain visible bloof

– Non-intact skin– Mucous Membranes

FAALTURA 2008

USE STANDARD PRECAUTIONS for the care of

ALL PATIENTS

Treat all body fluids as if they were infectious

http://www.animationfactory.com/en/search/close-up.mc?&oid=4953734&s=1&sc=1&st=107&q=nurses&spage=1&hoid=58fb470305564d2e1f5a944d78c8e80c

FAALTURA 2008

Most common mode of transmission of pathogens is via

hands! Infections acquired in healthcare

Spread of antimicrobial resistance

So Why All the Fuss About Hand Hygiene?

Standard PrecautionHAND HYGIENE

FAALTURA 2008

The Inanimate Environment Can Facilitate Transmission

~ Contaminated surfaces increase cross-transmission ~Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+) Patient Environment. Hayden M, ICAAC, 2001, Chicago, IL.

X represents VRE culture positive sites

FAALTURA 2008

Principles of HandwashingHandwashing: • single most important and

effective measure to preventing transmission of infection

• removes transient microbes• prevents the transfer of

microbes to patients, staff or equipment

• wash using soap and running water

FAALTURA 2008

Specific Indications for Hand Hygiene

• Before:– Patient contact – Donning gloves – Inserting urinary catheters, peripheral

vascular catheters, or other invasive devices that don’t require surgery

• After:– Contact with a patient’s skin – Contact with body fluids or excretions,

non-intact skin, wound dressings– Removing gloves

Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.

FAALTURA 2008

Recommended Hand Hygiene Technique

• Handrubs – If hands are not visibly soiled, decontaminate them with Alcohol-based waterless handrub located in strategic locations throughout the hospital

– Apply to palm of one hand, rub hands together covering all surfaces until dry

– Volume: based on manufacturer

– If hands are not visibly soiled, use an alcohol-based handrub for routinely decontaminating hands.

• Handwashing

– 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

– When hands are visibly dirty, contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap and water.

Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.

FAALTURA 2008

Guidance for the Selection and Use of Personal Protective Equipment (PPE) in

Healthcare Settings“specialized clothing or equipment worn

by an employee for protection against infectious materials” (OSHA)

FAALTURA 2008

Types of PPE Used in Healthcare Settings

PPE Use in Healthcare Settings

FAALTURA 2008

PPE Use in Healthcare Settings:How to Safely Don, Use, and

Remove PPE

FAALTURA 2008

Key Points About PPE• Don before contact with the

patient, generally before entering the room

• Use carefully – don’t spread contamination

• Remove and discard carefully, either at the doorway or immediately outside patient room; remove respirator outside room

• Immediately perform hand hygiene


FAALTURA 2008

Sequence* for Donning PPE

• Gown first

• Mask or respirator

• Goggles or face shield

• Gloves

*Combination of PPE will affect sequence – be practical


FAALTURA 2008

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


FAALTURA 2008

How to Don a Mask• Place over nose, mouth and chin

• Fit flexible nose piece over nose bridge

• Secure on head with ties or elastic

• Adjust to fit


FAALTURA 2008

How to Don a Particulate Respirator

• Select a fit tested respirator• Place over nose, mouth and chin• Fit flexible nose piece over nose bridge• Secure on head with elastic• Adjust to fit• Perform a fit check –

– Inhale – respirator should collapse

– Exhale – check for leakage around facePPE Use in Healthcare Settings

FAALTURA 2008

How to Don Eye and Face Protection

• Position goggles over eyes and secure to the head using the ear pieces or headband

• Position face shield over face and secure on brow with headband

• Adjust to fit comfortably


FAALTURA 2008

How to Don Gloves

• Don gloves last

• Select correct type and size

• Insert hands into gloves

• Extend gloves over isolation gown cuffs


FAALTURA 2008

Do’s and Don’ts of Glove Use

• Work from “clean to dirty”• Limit opportunities for

“touch contamination” - protect yourself, others, and the environment– Don’t touch your face

or adjust PPE with contaminated gloves

– Don’t touch environmental surfaces except as necessary during patient care

• 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


FAALTURA 2008

Steps in Proper Sterile Gloving (Open)

FAALTURA 2008

Sequence for Removing PPE

• Gloves

• Face shield or goggles

• Gown

• Mask or respirator


FAALTURA 2008

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, e.g., sink or alcohol-based hand rub


FAALTURA 2008

How to Remove Gloves (1)

• Grasp outside edge near wrist

• Peel away from hand, turning glove inside-out

• Hold in opposite gloved hand


FAALTURA 2008

How to Remove Gloves (2)• Slide ungloved finger

under the wrist of the remaining glove

• Peel off from inside, creating a bag for both gloves

• Discard


FAALTURA 2008

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


FAALTURA 2008

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


FAALTURA 2008

Removing a Mask• Untie the bottom, then

top, tie

• Remove from face

• Discard


FAALTURA 2008

Removing a Particulate Respirator• Lift the bottom

elastic over your head first

• Then lift off the top elastic

• Discard


FAALTURA 2008

Respiratory or Cough Etiquette

FAALTURA 2008

Respiratory Protection

• Purpose – protect from inhalation of infectious aerosols (e.g., Mycobacterium tuberculosis)

• PPE types for respiratory protection– Particulate respirators– Half- or full-face elastomeric respirators– Powered air purifying respirators (PAPR)


http://www.animationfactory.com/en/search/close-up.mc?&oid=4954803&s=51&sc=51&st=107&q=nurses&spage=3&hoid=e06606ee0ce414d15e372e33036d530d

FAALTURA 2008

Elements of a Respiratory Protection Program

• Medical evaluation

• Fit testing

• Training

• Fit checking before use


FAALTURA 2008

Respiratory Hygiene/Cough Etiquette

TARGET:

Patient and family member but applies to any person with signs of colds and other

respiratory infection (ex. Cough, congestion, rhinorrhea, increased

production of respiratory secretion etc.)

FAALTURA 2008


• Absence of fever does not always exclude respiratory infection (ex. Pertussis and colds)

• Patient who has asthma, allergic rhinitis or COPD also may have cough and sneezing, although these patient are not infectious, cough etiquette measures always applies.

FAALTURA 2008


RECOMMENDATION• Instruct symptomatic person to

cover mouth/nose when sneezing/coughing.

• Use tissue and dispose not to touch receptacle.

• Observe hand hygiene after soiling of hands with respiratory secretion.

• Wear surgical mask if tolerated or maintain spatial separation > 3 feet if possible.

FAALTURA 2008


ELEMENTS:• HC personnel are advised to observe DROPLET

PRECAUTION (wear surgical mask) and hand hygiene when examining patient with S & Sx of a respiratory condition.

• HC personnel who have a respiratory infection are advised to avoid patient contact when they are actively coughing and producing respiratory secretion.

FAALTURA 2008

What Type of PPE Would You Wear?

• Giving a bed bath?

• Suctioning oral secretions?

• Transporting a patient in a wheel chair?

• Responding to an emergency where blood is spurting?

• Drawing blood from a vein?

• Cleaning an incontinent patient with diarrhea?

• Irrigating a wound?

• Taking vital signs?


FAALTURA 2008

What Type of PPE Would You Wear?

• Giving a bed bath?• Generally none

• Suctioning oral secretions?• Gloves and mask/goggles or a

face shield – sometimes gown

• Transporting a patient in a wheel chair?

• Generally none required

• Responding to an emergency where blood is spurting?

• Gloves, fluid-resistant gown, mask/goggles or a face shield

• Drawing blood from a vein?• Gloves

• Cleaning an incontinent patient with diarrhea?

• Gloves w/wo gown

• Irrigating a wound?• Gloves, gown,

mask/goggles or a face shield

• Taking vital signs?– Generally none


Documents

Day 1 Standard Precautions