STANDARD PRECAUTIONS STANDARD PRECAUTIONS

ISOLATION PRACTICESISOLATION PRACTICES

STERILE TECHNIQUESTERILE TECHNIQUE

STANDARD PRECAUTIONSSTANDARD PRECAUTIONS

1996, CDC developed a system of isolation 1996, CDC developed a system of isolation to provide guidelines on how to prevent to provide guidelines on how to prevent spread of infection (updated 2007) spread of infection (updated 2007)

………………. practices are referred to as . practices are referred to as

Standard PrecautionsStandard Precautions ( (aa 2 Tiered2 Tiered system).system).

Standard PrecautionsStandard Precautions include include

wearing protective barriers wearing protective barriers when risk of contact with when risk of contact with

any body excretions, secretions, any body excretions, secretions, and moist membranesand moist membranes and tissues.and tissues.

Acknowledges that all are potentially Acknowledges that all are potentially infectious.infectious.

FIRST TIERFIRST TIERPrecautions designed for care of Precautions designed for care of all clientsall clients

regardless of their diagnosis or regardless of their diagnosis or presumed infection status. presumed infection status.

Standard Precautions apply to:Standard Precautions apply to:

1)1) Blood Blood

2)2) All body fluids, secretions, and All body fluids, secretions, and excretions excretions

3)3) Non-intact skin Non-intact skin

4)4) Mucous MembranesMucous Membranes

SECOND TIERSECOND TIERIt alerts the nurse to take additionalIt alerts the nurse to take additional

precautions to interrupt the transmission of precautions to interrupt the transmission of a a specified specified infection or organism. infection or organism.

These These Transmission-Based PrecautionsTransmission-Based Precautions are for patients are for patients known, or suspectedknown, or suspected of of being infected by a particular pathogen being infected by a particular pathogen transmission:transmission:

(a) airborne precautions(a) airborne precautions

(b) droplet precautions(b) droplet precautions

(c) contact precautions(c) contact precautions

3 TRANSMISSION-BASED 3 TRANSMISSION-BASED PRECAUTIONSPRECAUTIONS

(must understand how the organism is (must understand how the organism is transmitted)transmitted) Airborne Precautions:Airborne Precautions: spread of microbes on spread of microbes on

small droplet nuclei through the air (< 5 microns).small droplet nuclei through the air (< 5 microns).(ie) Measles; Chicken Pox; TB(ie) Measles; Chicken Pox; TB*MASK important, door closed, negative air *MASK important, door closed, negative air

flow ventilation, private roomflow ventilation, private room

Droplet Precautions: Droplet Precautions: large particle droplets large particle droplets (> 5 microns); which transmit 3 feet in air.(> 5 microns); which transmit 3 feet in air.

(ie) Mumps; Pertussis; Influenza; SARS(ie) Mumps; Pertussis; Influenza; SARS*Private room / or cohort clients, and mask *Private room / or cohort clients, and mask

worn if within 3 feetworn if within 3 feet

Contact Precautions:Contact Precautions: for prevention of disease for prevention of disease transmitted by either direct / or indirect, contact.transmitted by either direct / or indirect, contact.

(ie)(ie) Impetigo, Scabies, Herpes Zoster, C Difficile.Impetigo, Scabies, Herpes Zoster, C Difficile. *Gloves and gown worn, private room or cohort *Gloves and gown worn, private room or cohort

clientsclients

BUGS ARE GETTING SMARTER THAN BUGS ARE GETTING SMARTER THAN THE DRUGS!!THE DRUGS!!

Some microorganisms that are Some microorganisms that are particularly difficult to destroy. particularly difficult to destroy.

Some prevalent ones are:Some prevalent ones are:

~ Methicillin-Resistant Staphylococcus ~ Methicillin-Resistant Staphylococcus Aureus Aureus (MRSA)(MRSA)

~ Vancomycin-Resistant Enterococcus ~ Vancomycin-Resistant Enterococcus (VRE)(VRE)

Skills Text p.197 Skills Text p.197 – Box 8-1 & Table 8-2Box 8-1 & Table 8-2– Guidelines for Standard Precautions Guidelines for Standard Precautions

(2 tiered system) published by the (2 tiered system) published by the CDC in 1996CDC in 1996

Standard PrecautionsStandard PrecautionsFundamentals text, p.807Fundamentals text, p.807– READREAD **********

ISOLATION IS…….ISOLATION IS……. Infection control and prevention methods Infection control and prevention methods

that are used to decrease the transfer of that are used to decrease the transfer of microorganisms.microorganisms.

Barriers or PPE (protective personal Barriers or PPE (protective personal equipment) equipment)

may include: may include: gowns gowns glovesgloves masks masks eyewear/ goggles.eyewear/ goggles.

““PROTECTIVE ISOLATION” PROTECTIVE ISOLATION” akaaka

“REVERSE ISOLATION”“REVERSE ISOLATION”

Protects the client with a Protects the client with a compromised or suppressed immune compromised or suppressed immune system; who is highly susceptible to system; who is highly susceptible to

contracting an infection.contracting an infection.

Private room needed, door closed, gowns, Private room needed, door closed, gowns, masks, gloves (if direct contact), wash masks, gloves (if direct contact), wash hands immediately before entering / hands immediately before entering / leaving the room, no plants or flowers leaving the room, no plants or flowers allowed.allowed.

PROCEDURE OF ISOLATIONPROCEDURE OF ISOLATION Prepare room for client; be organized!Prepare room for client; be organized! Before entering room, wash hands & Before entering room, wash hands &

put on the necessary barrier put on the necessary barrier protection.protection.

Place soiled linen & gown into an Place soiled linen & gown into an impermeable laundry bag. If splatter a impermeable laundry bag. If splatter a possibility, nurses gown should also be possibility, nurses gown should also be impermeable.impermeable.

Wash hands & change gloves PRN Wash hands & change gloves PRN during care.during care.

When care complete, PPE is removed When care complete, PPE is removed inside room.inside room.

In what order do you In what order do you

dress/undress PPEdress/undress PPE??Must think critically, esp upon leaving Must think critically, esp upon leaving

isolation…..may depend upon the isolation…..may depend upon the area in which you are working.area in which you are working.As a general rule:As a general rule:~~ gloves are last put on & 1 gloves are last put on & 1stst taken off taken off~ ~ if airborne precautions, mask stays on if airborne precautions, mask stays on

until out of room.until out of room.Consider your gloves, outside of your goggles, front of Consider your gloves, outside of your goggles, front of

your mask, sleeves & front of your gown all to be your mask, sleeves & front of your gown all to be contaminated. contaminated. RememberRemember to wash hands to wash hands once all PPE removed.once all PPE removed.

LEAVING ISOLATION LEAVING ISOLATION ROOMROOMRemove your protective barriers in the Remove your protective barriers in the

following order:following order:1) Remove gloves1) Remove gloves2) Remove eyewear/goggles2) Remove eyewear/goggles3) Remove gown (pull off inside out)3) Remove gown (pull off inside out)4) Remove mask4) Remove mask5) Wash hands immediately5) Wash hands immediately

Leave mask on until after you leave Leave mask on until after you leave room if airborneroom if airborne

CLIENT CONCERNS RELATED TO CLIENT CONCERNS RELATED TO ISOLATIONISOLATION

Explain purposeExplain purpose of isolation & the of isolation & the

necessary precautions.necessary precautions.

Sensory deprivation may be evidentSensory deprivation may be evident

by signs of loneliness or boredom. by signs of loneliness or boredom.

S & S of depression - decreased motivation, anger, lack S & S of depression - decreased motivation, anger, lack of appetite, or difficulty sleeping. of appetite, or difficulty sleeping.

What interventions can you plan, while working with a What interventions can you plan, while working with a client in isolation?client in isolation?

““STERILE TECHNIQUE” aka STERILE TECHNIQUE” aka “SURGICAL ASEPSIS”“SURGICAL ASEPSIS”

What is the purpose of What is the purpose of STERILE TECHNIQUE ?STERILE TECHNIQUE ?

PURPOSE OF STERILE PURPOSE OF STERILE TECHNIQUETECHNIQUE

To ELIMINATE all microorganisms To ELIMINATE all microorganisms from objects that come into from objects that come into contact with the tissues of the contact with the tissues of the body that are normally sterile.body that are normally sterile.

Where do we use Sterile Equipment Where do we use Sterile Equipment and Implement Sterile Technique?and Implement Sterile Technique?

Operating roomOperating room Labor and deliveryLabor and delivery Major diagnostic / special procedure areasMajor diagnostic / special procedure areas At the bedside in 3 main situations:At the bedside in 3 main situations:

1)1) Procedures requiring intentional perforation of the skin Procedures requiring intentional perforation of the skin

ie. Inserting an IV or an injectionie. Inserting an IV or an injection

2)2) If the skin’s integrity is broken due to surgery or burns If the skin’s integrity is broken due to surgery or burns

ie. Dressing changes / cleansing woundsie. Dressing changes / cleansing wounds

3)3) During procedures involving insertion of devices, into During procedures involving insertion of devices, into normally sterile body cavities normally sterile body cavities

ie. Urinary catheterie. Urinary catheter

HOW DO THINGS BECOME HOW DO THINGS BECOME STERILIZED ?STERILIZED ?

AutoclaveAutoclave - moist heat under pressure for - moist heat under pressure for surgical instrumentssurgical instruments

RadiationRadiation - for drugs & other heat sensitive items - for drugs & other heat sensitive items

ChemicalsChemicals - disinfect instruments (chlorine - disinfect instruments (chlorine bleach)bleach)

Ethylene Oxide GasEthylene Oxide Gas - for rubber and plastic - for rubber and plastic

What about boiling water?What about boiling water?

How do we know if an item is How do we know if an item is Sterilized?Sterilized?

If If commercially prepackaged commercially prepackaged (disposable): (disposable):

………….... check the integrity of the check the integrity of the package package

If If reusable equipmentreusable equipment (sterilized within (sterilized within the facility):the facility):

………… check integrity / expiration date / check integrity / expiration date / & also look for specially marked tape & also look for specially marked tape on the packageon the package

AREAS WHERE STERILE EQUIPMENT AREAS WHERE STERILE EQUIPMENT IS USED AND STERILE TECHNIQUE IS IS USED AND STERILE TECHNIQUE IS NECESSARYNECESSARY

Operating roomOperating room Labor and DeliveryLabor and Delivery Major diagnostic areasMajor diagnostic areas

At the bedside in 3 main situations—At the bedside in 3 main situations—– intentional perforation of skin (IV/injection)intentional perforation of skin (IV/injection)– when skin integrity is broken (dsg change)when skin integrity is broken (dsg change)– inserting device into sterile body cavity inserting device into sterile body cavity

(catheter)(catheter)

Principles of Surgical Principles of Surgical Asepsis Asepsis p 814 - 815Fundamentals textp 814 - 815Fundamentals text

A sterile object remains sterile only A sterile object remains sterile only when touched by another sterile object.when touched by another sterile object.

Only sterile objects may be placed on a Only sterile objects may be placed on a sterile field.sterile field.

A sterile object/ or field out of the range A sterile object/ or field out of the range of vision, or an object held below waist of vision, or an object held below waist level, is considered contaminated.level, is considered contaminated.

A sterile object/or field, becomes A sterile object/or field, becomes contaminated by prolonged exposure to contaminated by prolonged exposure to air.air.

……..Surgical Aseptic ..Surgical Aseptic Principles Principles continued…. continued…. If in contact with a wet contaminated If in contact with a wet contaminated

surface, the sterile object/ or field surface, the sterile object/ or field becomes contaminated by capillary becomes contaminated by capillary action.action.

Microbes move in the direction of Microbes move in the direction of gravity.gravity.

Edges of a sterile field are considered Edges of a sterile field are considered contaminated….a 2.5cm border.contaminated….a 2.5cm border.

If ever in doubt - consider it unsterile!If ever in doubt - consider it unsterile!

Preparing a Preparing a a Sterile a Sterile Dressing TrayDressing Tray

Prepare the sterile field…..Prepare the sterile field….. Sterile PackSterile Pack…………

Add item to the sterile field……Add item to the sterile field……Add liquid to the sterile field…….Add liquid to the sterile field…….When all of the above is complete……When all of the above is complete……

gloveglove

STERILE STERILE GLOVESGLOVES

Dominant hand is gloved first. Do not touch Dominant hand is gloved first. Do not touch outside of 1outside of 1stst glove, only the glove, only the inside inside cuff (which cuff (which is folded over)is folded over)

Then with Then with sterilesterile gloved dominant hand, pick up gloved dominant hand, pick up 22ndnd glove by reaching under cuff. glove by reaching under cuff.

Keep thumb fully abducted & ensure hands Keep thumb fully abducted & ensure hands remain above the waistline.remain above the waistline.

Please refer to Skills testing Please refer to Skills testing scheduleschedule

N125 Exam December 16, 2008 N125 Exam December 16, 2008 (0900h)(0900h)

@ Oland’s Center Gymnasium@ Oland’s Center Gymnasium

GOOD LUCK !GOOD LUCK !