Nursing Orientation Infection Prevention

1
Nursing OrientationInfection Prevention Control
2
Standard Precautions

• Hand Hygiene-
• Must do hand hygiene even if there
  is no patient contact. C-Diff patients- all
• staff must use gel/ soap and water
  before entering and wash only with soap
• and water when leaving the room.
• Hand washing- must wash hands with
  soap and water for at least 15 seconds.
• Respiratory Hygiene/Cough Etiquette
• Personal Protective Equipment-
• Environmental Cleaning-
• Use hospital approved disinfectant
• Safe Injection Practices (if applicable to the
  nursing student and must be accompanied)

3
STANDARD PRECAUTIONS

• PPE Personal Protective Equipment
• Gloves
• Masks (fluid resistant)
• Gowns
• Protective eye wear
• Use to reduce the likelihood of an occupational
  exposure
• Use PPE according to procedure/task when
  anticipating
• contact or splash with blood/body fluids
• Isolation signs indicate the minimum PPE that
  must be used when entering a room. Additional PPE
  can be used if necessary.
• Consider all patients potentially infectious,
  observe standard precautions at all time.
• For your safety, no eating or drinking is allowed
  at the nursing stations.
• If you encounter a patient with an illness that
  you are not familiar with, check with preceptor
  prior to entering the
• patients room.

4
Germs (ex. MRSA) can be spread by touching
patient Or patients surroundings / environment.

Options for Evaluating Environmental Cleaning,
CDC 2010
Example Active MRSA (Methicillin Resistant
Staphylococcus aureus) requires Contact
Precautions.
5

• Like Contact Precautions But.
• For C Difficile
• Need to wash hands with soap and water only after
  coming from patients room.
• If a patient has unexplained diarrhea, the staff
  should collect the 3rd loose stool within 24
  hours for CDIFF testing and place patient on
  Contact Plus Precaution.

6
What is an Aerosol Transmissible Disease?

• A disease that is transmitted by aerosols (A
  gaseous suspension of fine solid or liquid
  particles)

Cal/OSHAs ATD Standardand Emergency Medical
Services May 20 2010, Deborah Gold, MPH,
CIH Cal/OSHA RSHU, dgold_at_dir.ca.gov
7
You can catch the germs when patient coughs,
sneezes or is talking.

• DROPLET BLUE sign / Private room/Surgical mask
• Diphtheria
• Influenza
• Meningococcal disease
• Mumps
• Mycoplasma pneumonia
• Pertussis-(whooping cough)
• Plague
• Rubella
• SARS
• Viral hemorrhagic fevers

8
Students Note that you are not fit tested for
these masks. You SHOULD NOT take patients that
are on Airborne Precaution.
You can catch the germs when patient coughs,
sneezes or is talking. But Germs can travel
farther than 3 feet and can stay in the air
longer.

• AIRBORNE Orange sign/ N95 /Airborne Infection
  Isolation Room (AIIR)
• Chicken pox
• Anthrax
• Avian influenza
• Measles
• Monkey pox
• SARS
• Small pox
• TB
• Novel or unknown pathogens

9
Surgical Mask

• Does not fit tightly to the face
• Is not designed to filter air inhaled by the user
• Is not fit-tested

Cal/OSHAs ATD Standardand Emergency Medical
Services May 20 2010, Deborah Gold, MPH,
CIH Cal/OSHA RSHU, dgold_at_dir.ca.gov
10
Documentation of Patient Education

• Regulatory Basis
• The Joint Commission National Patient Safety
  Goal
• Senate bill 1051(MRSA)
• Patient Safety Licensing
• What to document education on
• MDROs, including C. diff- preventing spread of
  infection in the hospital
• Patient with devices central lines, foley
  catheters
• Preventing SSI
• If it was not documented, it did not happen

11
Hospital Bundle Central Line Insertion Practices
(CLIP)Central Line Associated Bloodstream
Infections (CLABSI)

• The basic elements of the central line bundle
  include the following
• hand hygiene prior to line insertion
• use of full barrier precautions during insertion
  (including cap, sterile gown/gloves, mask, full
  length sterile drape)
• chlorhexidine skin prep skin dry
• avoidance of the femoral site when possible
• removal of unnecessary catheters (daily
  assessment of catheter need)

12
Hospital Bundle Central Line Insertion Practices
(CLIP)Central Line Associated Bloodstream
Infections (CLABSI)

• scrubbing the hub with 70 alcohol pad or
  chlorhexidine pad for 15 seconds and allow to
  completely dry before accessing the line
• use of a 2-person dressing change to optimally
  maintain sterility
• minimize blood draws through the catheter
• remove emergently placed catheters within 24 to
  48 hours

13
Hospital BundlesVentilator Associated Pneumonia
(VAP) Prevention BundleCentral Line Associated
Bloodstream Infections

• Elevate the head of bed to 30-45 degrees unless
  contraindicated
• Perform oral care with chlorhexidine swabs every
  12 hours, brushing and routine cleaning every 4
  hours

14
Hospital Bundles Catheter Associated UTI
Prevention BundleHoly Moly No Foley

• Patients should only have a Foley Catheter only
  if medically indicated
• Daily review of indwelling catheter necessity
  with prompt removal if unnecessary
• Unobstructed flow
• Bag below level of bladder
• Tubing secured to patient with appropriate
  adhesive or Velcro device
• Bag off the floor
• Peri-care (Keep patients clean)

Photos from- http//www.sharp.com/b2b/students/up
load/CAUTI_Prevention_Netlearning_11_22_2011_FINAL
.pdf
15
Hospital Bundles Catheter Associated UTI
Prevention BundleIndications for Necessity of
Foley

• Daily physician order needs to be present when
  the patient meets the catheter appropriateness
  criteria and the catheter is to remain in place.
  
• The patient must meet at least one of the
  following indications for catheter necessity
• Frequent urine output monitoring for
  critically-ill patient (e.g. shock, sepsis)
• Chemically-paralyzed, sedated, or comatose
  patient

16
Hospital Bundles Catheter Associated UTI
Prevention BundleIndications for Necessity of
Foley

• Chemically-paralyzed, sedated, or comatose
  patient
• Presence of sacral Stage III or IV pressure
  ulcers that are not healing because of continual
  contact with urine
• Acute urinary retention/obstruction

17
Hospital Bundles Catheter Associated UTI
Prevention BundleIndications for Necessity of
Foley

• Perioperative use for selected surgical
  procedures (renal / urology surgery, perineal /
  rectal surgery, pelvic / gynecologic surgery)
  Catheter will be removed on POD 1 or POD2.
• Trauma spinal injury or pelvic fracture (If
  urethral disruption is suspected, a Urologist
  must see patient first)
• End of life care or comfort measures per
  patient/familys request
• Continuous bladder irrigation
• The reason for keeping the catheter, as
  determined by the physician, must be documented
  in KPHC and communicated every shift by a
  licensed nurse, along with the other elements of
  the bundle.

18
Hospital Bundles Catheter Associated UTI
Prevention BundleUnobstructed Urine Flow
Unobstructed Urine Flow
Obstructed Urine Flow
Photos from- http//www.sharp.com/b2b/students/up
load/CAUTI_Prevention_Netlearning_11_22_2011_FINAL
.pdf
Photos from- http//www.sharp.com/b2b/students/up
load/CAUTI_Prevention_Netlearning_11_22_2011_FINAL
.pdf
Dependent loop Urine collects in this loop
19
PPE Putting on and Safely Removing

• demo

20
(No Transcript)
21
Thank youquestions? ContactAbigail
evangelista, bsnInfection prevention and control
managerAbigail.d.evangelista_at_kp.org323-648-1301
anna Tiomico, msnacademic liaison, staff
educatoranna.l.faraon-tiomico_at_kp.org323-857-2845

• Clean Hands Saves Lives!