Infection Prevention at Seton Medical Center Harker Heights

Isolation begins with clicking on the alert button. Pull down the menu and check for Alerts!

Choose the alert that best meets the need for the situation:Fall RiskC DiffElopementMDROMRSAVRECommunity Care PlanAnd many more!

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Paragon Isolation Alerts!

Did you know that Paragon can alert you to multiple alerts using one flag??Using the Alert Flag is simple and easy. Double click on the flag and a menu will pop up!

At the bottom, click on the “paper” to be able to add multiple flags: fall risk, MRSA history, hearing impaired, elopement risk, etc.

The flags will remain with the patient until they are removed. If a patient is readmitted, check the flags to see if your patient was a fall risk or was in isolation on a prior admit and if they are still appropriate, then continue those precautions. If they are not appropriate, then resolve or remove them for that admission.

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Isolation Precautions

There are 6 types of precautions:Standard – used for every patient and include gloves for contact with BSI and good hand

hygiene

Contact - used for preventing the spread of bacteria parasites and viruses from one person to another from sources including draining wounds, rashes, diarrhea, lice, urine, blood, etc.

This category includes a subset category we use here at SMCHH called Contact-C: this is for enteric isolation (diarrhea) and includes Handwashing only upon exiting the room.

Droplet – used for preventing the spread of germs caused by respiratory viruses and bacteria such as influenza, pertussis, pneumonia, meningitis, etc. Used in addition to contact

precautions, the wearing of a mask and possibly eye protection is to prevent spread of germs when an infected person talks, coughs or sneezes. Other people can become infected by breathing in the germs or getting them in their eyes.

Droplet Restricted Access – used for Ebola at SMCHH – N-95 masks required although Ebola is not airborne (it can be aerosolized)

Airborne – used to prevent the spread of germs through the air or dust. Examples include tuberculosis, measles, chickenpox, SARS, MERS-CoV, disseminated shingles (varicella/herpes zoster). Germs can remain in air or dust for a long time and spread far from you to others. Anyone who breathes in the germs can become infected. N-95 masks are used as well as contact isolation and good hand hygiene. Encourage the patient to cover the mouth and nose with a tissue when coughing or sneezing and to practice hand hygiene often.

Neutropenic – also known as Protective or Reverse isolation is used to prevent the spread of germs to the patient from outside sources when the patient’s immune system is compromised.

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Isolation Precautions

Below is a table for precautions for selected infections and conditions. It is by no means a complete list. There is an additional list at each nurses station in the infection control book. The list can also be found at: www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.htmlSimply open the link found on the page and look for appendix A. Tables 2-4 also have valuable information on TB, weaponized bacteria and viruses, and hand hygiene.

As a standard, any patient coming in with diarrheal stools should be questioned on how many per day. If there are more than 3 per day, they should be placed in enteric isolation and the physician notified.

All patients should be questioned if they have traveled out of the country in the last 30 days. This should be annotated in a group note on the admission assessment in the infection tab if they have.

The Duration of illness of any patient may be dependent upon the infection, site and severity of illness. This may be decided on a case by case basis. Please ask the Infection Prevention Nurse for guidance if you have any questions or concerns.

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Isolation Precautions

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Isolation Precautions

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MDRO: Educating the Patients

Often, patients find themselves placed on “Isolation Precautions” and yet, they fail to receive an adequate explanation of why or what that entails.

A trifold handout is available for Multi-Drug Resistant Organisms. This Handout should be given to each patient identified with an MDRO and placed on

isolation precautions and documented in Paragon. This will help meet TJC requirements for educating the patient.

Questions should be answered at the time the patient is placed on isolation: why is the patient on isolation? How long can they be expected to be on isolation? Etc.

If you are unsure of the length of duration, please consult the physician or Infection Prevention.

Questions: please email Infection Prevention @ lareine.rickmon@smchh.org or call extension 6223.

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Airborne Isolation Precautions

Airborne Precautions

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1. Needs negative pressure room. (See next slide)

2. Caregiver must wear an n-95 mask, gown and gloves.

3. Signage on door to warn others of need for PPE

4. Limit visitors [no small children]

5. Door remains closed at all times

6. Dispose of PPE in anteroom

Airborne Isolation Room (“Negative Pressure Room”)

Airborne infection isolation room (AIIR) - also known as a negative pressure room. • Used to isolate patients with a suspected or confirmed airborne infectious disease.

SMCHH has 7 negative air flow rooms available for patient use: • Emergency Department Room 10• Surgery PACU Room 1• ICU Room 1• Med/Surg rooms 207 and 245• Women’s Center Room 101• Nursery Isolette Room

A control monitor outside the room is equipped with an indicator light. When "on“, (green light is lit) active negative ventilation is occurring.

(It is not necessary to have an anteroom for airborne isolation, however a separate anteroom is available in rooms 207 and ICU Bed 1 and should be used as the only access into these rooms for isolation care.)

Only staff that have been fit tested by SMCHH are permitted in Airborne Isolation rooms.

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Airborne Isolation Rooms (“Negative Pressure Rooms”)

The Airborne Isolation rooms are always on, however with the doors open, they will not be at the proper pressure. To return the room the correct negative pressure, pull the door shut.

By pulling the door shut, the higher differential in the room will cause the air to flow correctly in a negative pressure manner and thereby keep any possible germs out of the hallway.

A smoke test or paper test is done regularly to test theNegative pressure rooms.

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Wound Care Consults

Wound Care Consults print when ordered in CPOE!Simply click the “Refer to Wound Care RN” box on the skin tab, during the Admission or Daily Assessment, to order a wound care consult for any patient with a Braden <18 and at risk for breakdown. Or for any patient being admitted with pressure ulcers or open wounds, or for worsening wounds.

Wound Care RN consults ordered in CPOE will print as well. Simply look up consult and look for Wound Care Nurse.Order in Paragon Order in CPOE

Consults print on a designated Wound Care printer. If a consult has been ordered and patient has not been seen within 24 hours, please call ext. 6223 and email Paige and Silvia. (Wound care Physicians are available if a consult is needed on the weekend – Call the operator for the on call list.)

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Wound Care Reminders

During an admission screen, if a patient has a Braden less than 18 and/or skin breakdown, initiate a Wound Care Nurse consult.Email the Wound Care Nurses in addition to clicking the button and ordering Paragon.Chart the wound(s) in Paragon on admission to include measurements. Describe the wound and put the measurements in the comments section in the top box. If charted in the bottom box, they will only be seen If you search the chart.

Chart the dressing and drainage and changes to the wound in the bottom box under site assessment (this box is fresh every time you open to chart on it, the top box is a one time only chartable box

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Wound Care Reminders

Measure the wound Length X Width X Depth with the head being your landmark for 12 o’clock. Using the “clock” system, measure the longest and widest areas. If there is dead tissue in the bottom of the wound, you cannot measure depth.

If there is undermining, chart how deep the undermining is using the clock system.Undermining is the separation of tissue from the surface under the edge of the wound.

And make sure the patient’s name, date and a measuringTool are in the picture.

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Taking a Picture

There are two cameras available to take pictures:One is located in ICU in the telemetry room and is mainly used in ICU. (If a floor other than ICU borrows this camera, it must be checked out with the telemetry tech and returned as soon as possible!)

A second camera is located on the second floor in either med-station, in addition to the cord.

***Cameras must be disinfected with a Super SaniWipe prior to being returned to their designated location. ***

There are two printers available: one on 2West and one in ICU Tele Monitor RoomPictures are to be printed and placed under the Nursing tab in the patient’s chart within 24 hours of admission. Pictures must be dated, timed and labeled with the site of the wound and a patient label must be placed on the sheet.

After printing pictures, delete them from the memory. This keeps the space open and provides for quick turnaround time for the next user.

The use of personal cameras or cell phones for taking pictures is prohibited by SMCHH.

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Taking a Picture

To take a good picture, sometimes it may take two or three attempts.

Turn up the lights! Turn on the overhead lights; make sure the wound is visible.Place a measuring device by the wound with the patient’s name written on it (or a label)When pressing down the button on the camera, give it a second or two to focus while you are holding it down. Then it will take the picture. Simply pressing the button and letting go may result in an unfocused picture.

Look at the pictures to see if there is one that is printable. If one is acceptable, continue on with the assessment. Assessment and measurements are to be done within 24 hours of admission.If a NEW wound is found (pressure ulcer) post admission, it must be documented upon discovery and Wound Care notified.

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Wound Care Reminders

Do not put a dry dressing on a wound. It will stick and dry to the wound and may damage when trying to take it off. Alginate or hydrofiber dressings can be put on wounds. They can be moistened if the wound is dry and left dry to absorb if the wound is wet. They can be covered with foam dressings or gauze. We have Melgisorb here. A foam dressing can be considered as well, it will pad and absorb and also protect.

Ask the attending physician for an order if Wound Care is not immediately available. CPOE has wound care order sets for easy wound order entry. If you know the wound type (moist with necrotic tissue), look it up and it will give you the appropriate orders. These are approved order sets based on wound type.

Wound care does not need to see intact surgical wounds, unless they are red and irritated, then please notify Paige so she can follow it for Infection Prevention.

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Wound Care Reminders

• You can locate a copy of the current wound care policy on the intranet. • Your responsibilities on the unit are: Measure and picture the wound, document

the wound in the wound care assessment in Paragon, open the care plan, submit wound care and dietician consults.

• The Wound Care Team is appreciative of your help! Without your help, we could not accomplish all that we do!