RET 1024L Introduction to Respiratory Therapy Lab

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RET 1024LIntroduction to Respiratory TherapyLab

• Module 3.0
• Infection Control

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Infection Control

• Specialized Equipment Handling
• Equipment Handling Procedure
• Equipment handling procedures help prevent the
  spread of pathogens

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Infection Control

• Specialized Equipment Handling
• Equipment Handling Procedure
• Nebulizers
• Large Volume Nebulizers
• Always fill with STERILE water
• Do not add fluid to partially filled reservoirs
  discard old fluid first
• Drain tubing condensate away from patient not
  back into reservoir (considered contaminated
  waste)

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Infection Control

• Specialized Equipment Handling
• Equipment Handling Procedure
• Nebulizers
• Small Volume Nebulizers
• Between treatment on the same patient, rinse with
  sterile water and air-dry
• Use only sterile fluids for nebulization and
  dispense these fluids aseptically
• When possible, use single-use medication vials

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Infection Control

• Specialized Equipment Handling
• Equipment Handling Procedure
• Humidifiers
• Whenever possible, prefilled, sterile disposable
  humidifiers should be used
• With reusable humidifiers, fluid reservoirs
  should be filled with sterile distilled water
• Do not add fluid to partially filled reservoirs
  discard old fluid first

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Infection Control

• Specialized Equipment Handling
• Equipment Handling Procedure
• Humidifiers
• Prefilled, disposable humidifiers can be used
  safely for up to 30 days
• Prefilled, sterile, disposable humidifiers do
  not need to be changed between patients in
  high-use areas such as recovery room

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Infection Control

• Specialized Equipment Handling
• Equipment Handling Procedure
• Bag-Valve-Mask Devices
• BVMs should be sterilized or high-level
  disinfected between patients
• Exterior surface should be cleaned of visible
  debris and disinfected at least once a day

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Infection Control

• Specialized Equipment Handling
• Equipment Handling Procedure
• Ventilators and Ventilator Circuits
• An inspiratory (high-efficiency particulate
  air/aerosol (HEPA) filter should be placed
  between the machinery and the external circuit
• Expiratory filters also prevent pathogens from
  being expelled into the surroundings from the
  patients expired air
• Use sterile water to fill bubble type humidifiers

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Infection Control

• Specialized Equipment Handling
• Equipment Handling Procedure
• Ventilators and Ventilator Circuits
• Contaminated condensate in the patients breathing
  circuit needs to be drained away from the patient
  not back into reservoir (considered
  contaminated waste)
• Autogenous infection may result
• Wash hands after draining tubing condensate or
  handling the fluid

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Infection Control

• Specialized Equipment Handling
• Equipment Handling Procedure

Condensation
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Infection Control

• Specialized Equipment Handling
• Equipment Handling Procedure
• Ventilators and Ventilator Circuits
• Change HMEs according the manufacturers
  recommendation and/or whenever gross contaminants
  or dysfunction are observed
• Do not routinely change HME breathing circuits
  while in use

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Infection Control
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Infection Control

• Specialized Equipment Handling
• Equipment Handling Procedure
• Pulmonary Function Equipment
• Tubing, connectors, rebreathing valve and mouth
  pieces should be subjected to high-level
  disinfection or sterilization between patients

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Infection Control

• Precautions To Prevent Transmission of Infectious
  Agents
• Because of the nature of the hospital workplace,
  occupational exposure to blood and body fluids is
  expected. This repeated exposure means
  reasonably anticipated skin, eye, mucous
  membrane, or parenteral contact with blood or
  other potentially infectious body fluids

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Infection Control

• Barrier Measures
• The major route for the spread of infections is
  by contacting infected persons. Thus measures
  that place barriers between the source and the
  host can help prevent the spread of infection.

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Infection Control

• Barrier Measures
• Handwashing
• Personal Protective Equipment (PPE)
• Gloves
• Masks
• Goggles
• Gowns
• Patient Placement
• Patient Transport

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Infection Control

• Barrier Measures
• Handwashing
• The most common route for transmission of
  nosocomial infection is hand contact
• Careful, methodical handwashing before and after
  patient contact, is the single most effective way
  to reduce exposing patients to contagious disease

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Infection Control

• Barrier Measures
• Handwashing

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Infection Control

• Barrier Measures
• Handwashing
• You may not realize you have germs on your
  hands!
• The photo shows a blood agar plate 24 hours
  after an ICU nurse placed her hand on plate

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Infection Control

• Barrier Measures
• Handwashing Indications
• Wash hands after touching blood, body fluids,
  secretions, excretions, and contaminated items,
  even if wearing gloves
• Wash hands immediately after removing gloves,
  between patient contacts, and when otherwise
  indicated to avoid cross contaminations

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Infection Control

• Barrier Measures
• Handwashing Indications
• Wash hand between tasks and procedures on the
  same patient if cross contamination of different
  body sites is possible (e.g., tracheostomy care
  following assistance with a bedpan)
• Use plain soap for routine handwashing use an
  antimicrobial soap or a waterless antiseptic if
  specified by the infection control program

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Infection Control

• Barrier Measures
• Handwashing Indications
• When hands are visibly dirty, contaminated, or
  soiled, wash with non-antimicrobial or
  antimicrobial soap and water
• If hands are not visibly soiled, use an
  alcohol-based handrub for routinely
  decontaminating hands

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Infection Control

• Barrier Measures
• Handwashing
• Remove jewelry (rings, watches, bracelets), turn
  on water (avoid hot water) and thoroughly wet
  wrists and hands

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Infection Control

• Barrier Measures
• Handwashing
• Apply 3-5 mL of soap to hands and rub together
  for at least 15 seconds cover all surfaces of
  the wrists, hands and fingers

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Infection Control

• Barrier Measures
• Handwashing
• Scrub the palm of the hand

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Infection Control

• Barrier Measures
• Handwashing
• Washing between digits and back of hand

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Infection Control

• Barrier Measures
• Handwashing
• Washing around the cuticle

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Infection Control

• Barrier Measures
• Handwashing
• Rinse wrists and hands with water and dry with a
  clean paper towel

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Infection Control

• Barrier Measures
• Handwashing
• Using paper towel, turn off faucet

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Infection Control

• Barrier Measures
• Handwashing
• When using an alcohol-based handrub, apply
  product to palm of one hand and rub hands
  together, covering all surfaces of hands and
  fingers, until hands are dry. Note that the
  volume needed to reduce the number of bacteria on
  hands varies by product.

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Infection Control

• Barrier Measures
• CDC Guideline for Fingernails
• Health care personnel should avoid wearing
  artificial nails and keep natural nails less than
  one quarter of an inch long if they care for
  patients at high risk of acquiring infections
  (e.g. Patients in intensive care units or in
  transplant units)

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Infection Control

• Barrier Measures
• Gloves
• Three major reasons for wearing gloves
• Protects caregivers from contacting a patients
  contaminated blood, body fluids, secretions,
  excretions, mucous membranes, nonintact skin, and
  other potentially infectious material
• Protection of patients from colonized healthcare
  workers during invasive procedures
• Reduce the likelihood of cross contamination
  between patients via caregivers hands

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Infection Control

• Barrier Measures
• Gloves
• Wash hands before putting on gloves
• Clean, non-sterile gloves are satisfactory for
  most purposes however, caregivers must wear
  sterile gloves during invasive procedures
• Should be changed between each patient contact

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Infection Control

• Barrier Measures
• Gloves
• Should be changed after direct contact with
  infectious material, even if in the middle of a
  procedure
• Hands must always be washed after removal of
  gloves
• Invisible defects in gloves
• Contamination occurs when removed

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Infection Control

• Barrier Measures
• Gloves
• Learn to recognize the symptoms of latex allergy
  skin rash, hives, flushing, itching, nasal, eye,
  or sinus symptoms, asthma

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Infection Control

• Barrier Measures
• Masks, Goggles, Face Shields and Respiratory
  Protection
• Provide protection of eyes, nose, and mouth
  against contact transmission of pathogens
• Should be worn during procedures that can
  generate splashing or sprays of blood, body
  fluids, secretions or excretions

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Infection Control

• Barrier Measures
• Masks, Goggles, Face Shields and Respiratory
  Protection
• Masks become ineffective when moist
• Should be discarded after each use
• N95 respirators must be worn for protective use
  with TB
• National Institute for Occupational Safety and
  Health (NIOSH)

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Infection Control

• Barrier Measures
• Gowns, Aprons, and Protective Apparel
• Prevent clothing contamination
• Protect skin from blood and body fluids

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Infection Control

• Barrier Measures
• Gowns, Aprons, and Protective Apparel
• Worn when caring for patients with contagious
  disorders
• May help reduce cross contamination
• Should be removed before leaving patients room
• Worn only once, then discarded
• Sterile gowns should be worn when caring for
  patients with burns or wounds

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Infection Control

• Barrier Measures
• PPE - Putting It All On
• Put on isolation gown opening in the back
• If needed, shoe covering would go on first
• Place mask / respirator on face
• Need to be fit-tested for N95 respirator mask
• Put on goggles or face shield
• Don correct type / size gloves

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Infection Control

• Barrier Measures
• Using PPE Effectively
• Work from clean to dirty areas
• Touch as few surfaces and items with your PPE as
  possible
• Keep gloved hands away from face

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Infection Control

• Barrier Measures
• Using PPE Effectively
• If gloves become torn or heavily soiled, remove
  them, wash hands, and replace them even if you
  are working with only one patient
• Avoid touching or adjusting other PPE

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Infection Control

• Barrier Measures
• PPE - Taking It All Off
• Remove all PPE, except respirators, at the
  doorway, before leaving the patients room.
  Respirators are to be removed outside of the
  patients room and discarded in the designated
  waste receptacle

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Infection Control

• Barrier Measures
• PPE - Taking It All Off
• Gloves
• Outside of gloves are contaminated!
• Grasp the outside edge of one glove near the
  wrist and peel the glove away from hand
• While holding the removed glove in your gloved
  hand, slide the ungloved finger under the wrist
  of the remaining glove and peel it off. Dispose
  of your gloves in the appropriate biohazard
  container (red bag)

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Infection Control

• Barrier Measures
• Taking It All Off PPE
• Goggles/Face Shield
• Outside of goggles or face shield are
  contaminated!
• To remove, handle by clean head band or ear
  pieces
• Place in designated receptacle for reprocessing
  or in waste container

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Infection Control

• Barrier Measures
• PPE - Taking It All Off
• Gowns
• Gown front and sleeves are contaminated!
• Unfasten neck, then waist ties
• Remove gown by peeling it away from your neck and
  shoulders
• Turn the contaminated outside of the gown toward
  the inside
• Hold the gown away from your body and fold it
  into a bundle
• Discard it in the appropriate biohazard container
  (red bag).

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Infection Control

• Barrier Measures
• Taking It All Off PPE
• Mask or Respirator
• Front of mask/respirator is contaminated!
• Untie the bottom and then the top ties of mask,
  remove it from your face and discard it in the
  appropriate biohazard container (red bag)

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Infection Control

• Barrier Measures
• Taking It All Off PPE
• Perform hand hygiene immediately after removing
  PPE

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Infection Control

• Barrier Measures
• Patient Placement
• Private rooms help prevent
• Contact transmission
• Droplet transmission
• Airborne transmission (negative pressure room)

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Infection Control

• Barrier Measures
• Transport of Infected Patients
• Transporting infected patients should be limited
• The patient being transported needs to wear
  appropriate PPE
• Masks, gowns, impervious dressings

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Infection Control

• Barrier Measures
• Handling of Contaminated Articles and Equipment
• Contaminated items, whether reusable or
  disposable, should be enclosed in an impervious
  bag before removal from a patients room
• Prevents accidental exposure of personnel and
  environment
• Must be bagged without contaminating the bags
  outer surface, otherwise double bag
• Reusable patient-care equipment must be delivered
  to the applicable processing area

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Infection Control

• Barrier Measures
• Handling of Contaminated Articles and Equipment
• All disposable articles contaminated with blood
  or body fluids must be disposed of in the proper
  biohazard container

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Infection Control

• Barrier Measures
• Used Needles and Syringes
• Contaminated sharps can transmit hepatitis and
  HIV
• Never recap used needles use one-handed scoop
  method or mechanical device

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Infection Control

• One-handed Scoop Method

To safely recap needles, use the "one-hand"
technique Step 1Place the cap on a flat
surface, then remove your hand from the
cap. Step 2 With one hand, hold the syringe
and use the needle to "scoop up" the cap. Step
3When the cap covers the needle completely,
secure the cap onto the needle hub by pressing
the cap against a hard surface, e.g., table
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Infection Control

• Mechanical Needle Recapping Devices

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Infection Control

• Be careful !!!
• Be careful !!!
• Be careful !!!
• Be careful !!!
• Be careful !!!
• Be careful !!!
• Be careful !!!
• Be careful !!!

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Infection Control

• Used Needles and Syringes
• Always dispose of sharps in an appropriate
  puncture-resistant container

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Infection Control

• Handling Laboratory Specimens
• Gathering Specimens
• Do not contaminate exterior of the container
• Place in a impervious bag appropriately labeled
• Transport in a sturdy container with a secure lid

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Infection Control

• Isolation Precautions
• Specific combinations of barrier methods
• Two levels of Isolation precaution
• Standard precautions
• Used in caring for ALL patients
• Transmission-based precautions
• Added to standard precautions when dealing with
  patients with known or suspected pathogens
  contact, droplet, airborne

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Infection Control

• Isolation Precautions
• Standard Precautions
• Used when caring for ALL patients, regardless of
  suspected or confirmed infection status, in any
  setting in which healthcare is given
• These include
• Hand hygiene
• Gloves
• Gowns
• Mask
• Eye protection or face shield
• Handling of contaminated equipment

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Infection Control

• Isolation Precautions
• Standard Precautions
• Application of standard precautions is
  determined by the extent of anticipated blood,
  body, fluid, or pathogen exposure
• Gloves
• Worn when touching blood, body fluids,
  secretions, excretions, mucous membranes,
  nonintact skin and contaminated items is
  anticipated

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Infection Control

• Isolation Precautions
• Standard Precautions
• Gowns
• Worn during procedures and patient-care
  activities when contact of clothing/exposed skin
  with blood/body fluids, secretions, and
  excretions is anticipated
• Mask, eye protection (goggles), face shield
• Worn during procedures and patient-care
  activities likely to generate splashes or sprays
  of blood, body fluids, secretions, especially
  suctioning, endotracheal intubation

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Infection Control

• Isolation Precautions
• Standard Precautions
• Respiratory Hygiene/Cough Etiquette NEW!
• Instruct symptomatic persons to cover mouth/nose
  when sneezing/coughing use tissues and dispose
  in no-touch receptacle observe hand hygiene
  after soiling of hands with respiratory
  secretions wear surgical mask if tolerated or
  maintain spatial separation, gt3 feet if possible

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Infection Control
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Infection Control

• Isolation Precautions
• Contact Precautions
• Intended to prevent transmission of infectious
  agents which are spread by direct or indirect
  contact with the patient or the patients
  environment
• Single patient room is preferred (cohorting may
  be required with spatial separation of 3 feet)
• Gowns and gloves are worn for all interactions
  that involve contact with the patient or
  contaminated areas in the patients environment

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Infection Control

• Isolation Precautions
• Contact Precautions
• Donning PPE upon room entry and discarding before
  exiting the patient room is done to contain
  pathogens
• Common examples of diseases
• C. difficile
• VRE
• Staphylococcal and enteric bacterial infection

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Infection Control
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Infection Control

• Isolation Precautions
• Droplet Precautions
• Intended to prevent the transmission of pathogen
  spread through close respiratory or mucous
  membrane contact with respiratory secretions
• Special air handling and ventilation are not
  required to prevent transmission the door of
  the room may remain open
• Single patient room is preferred (cohorting may
  be required with spatial separation of 3 feet
  with curtains drawn)

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Infection Control

• Isolation Precautions
• Droplet Precautions
• Healthcare personnel wear a mask (a respirator is
  not necessary) for close contact generally
  donned upon entering the room
• Transport patient with a surgical mask if
  tolerated and follow Respiratory Hygiene/Cough
  Etiquette
• Some respiratory diseases transmitted via
  droplets
• H. Influenza (Epiglotitus)
• Meningitis
• Streptococcal pneumonia
• Influenza
• Rubella (German measles)

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Infection Control
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Infection Control

• Isolation Precautions
• Airborne Precautions
• Prevent the transmission of infectious agents
  that remain infectious over long distances when
  suspended in the air
• Common examples of airborne transmitted diseases
• Legionellosis
• M. tuberculosis (TB)
• Varicella (Chicken pox)
• Rubeola virus (Measles)

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Infection Control

• Isolation Precautions
• Airborne Precautions
• Special air handling and ventilation are required
  in patient rooms and in certain special procedure
  rooms (bronchoscopy suite)
• 12 air exchanges/hr new construction and
  renovation
• 6 air exchanges/her existing facilities
• Air is exhausted directly outside or recirculated
  through a HEPA filtration before return

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Infection Control

• Isolation Precautions
• Airborne Precautions
• Special air handling and ventilation

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Infection Control

• Isolation Precautions
• Airborne Precautions
• Place patient in a private room if not possible,
  place patient in a room with a patient who has
  active infection with the same microorganism
  (cohorting)
• The door to the patients room must remain closed
  and the patient in the room
• Healthcare personnel caring for the patient must
  wear a mask or respirator (N95), depending on the
  disease-specific recommendations donned prior
  to entering the room, removed outside the room
• If patient transport is essential, place a
  surgical mask on the patient

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Infection Control
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Infection Control

• Isolation Precautions
• Neutropenic Precautions
• AKA Reverse Isolation or Protective Precautions
• Primarily used for the following types of
  patients with
• Extensive burns
• Neutropenia abnormally low number of neutrophils
  caused by immunosuppressive therapies, e.g.,
  chemotherapy, radiation, or disease

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Infection Control

• Isolation Precautions
• Neutropenic Precautions
• Private room with positive pressure - door
  closed
• Strict hand-hygiene
• PPE (gloves, gowns, masks) kept outside of the
  room
• PPE removed outside of the room
• Transport only if necessary
• Patient to wear mask and gown