Transcript Microsoft PowerPoint - infectionpreventionSH2015 [Compatibility

INFECTION PREVENTION
PART I
MARIANNE LAFF, APN
STUDENT HEALTH
Infection Prevention
Welcome to the Infection Prevention Course. This course has been
developed to help prevent the Healthcare associated spread of contact,
droplet, and airborne transmitted diseases by providing you with
information on:
Part I- included in this presentation:
•Standard Precautions
•Personal protective equipment
•Contact, droplet, and airborne precautions
•Proper procedure for Donning
•Proper procedure for Doffing
Part II Interprofessional Education- scheduled at a later time:
•View patient care video on Hand washing, Hospital acquired infection, & Donning/Doffing
•Review proper procedure for Donning and Doffing
•Return demonstration that will take place in the simulation lab. You will be scheduled at
a later time for Part II. In the simulation lab you will work with another student or “buddy”
and demonstrate correct Hand Hygiene with alcohol based gel and soap and water; and
donning and doffing of gloves, masks, and gowns.
•There are 52 slides followed by a 20 question post-test
INFECTION PREVENTION
OBJECTIVES PART I
1. Define Standard precautions and the utilization of the
appropriate Personal Protective Equipment (PPE) for
the presenting patient scenario.
2. Differentiate between Contact, Droplet, & Airborne
precautions.
3. Recall how pathogens are transmitted through contact,
droplet, & airborne infections.
4. Know the correct order to Don & Dof PPE.
INFECTION PREVENTION
OBJECTIVES PART II
Group discussion stating how the visitor, new nurse,
Nurse Dena at nurses station, Infection Prevention
Nurse, medical student, and the Director of Post-op
could have prevented the transmission of MRSA.
Return demonstrate the correct process to Don PPE
using the “buddy system” and checklist.
Return demonstrate the correct process to Dof PPE
using the “buddy system” and checklist.
Return demonstrate the correct hand washing technique.
Standard Precautions
Standard Precautions (SP) previously called Universal
Precautions are Infection Prevention practices that apply
to all patients regardless of suspected or confirmed
infectious status.
This means that all blood and body fluids are treated as if
they are infectious. This includes:
•blood, all body fluids, secretions and excretions(except sweat)
whether or not they contain visible blood.
SPs are used to prevent contact with blood & body fluids
with your non-intact skin (healthy intact skin is the best natural defense against
blood borne pathogens)
with your mucous membranes
on Equipment or surfaces that have blood, or body fluids, or
microorganisms on them that you may not see
Standard Precautions
Main foundations of Standard Precautions are:
Hand hygiene- Before and after every patient contact
Use of PPE based on risk assessment
Clean/safe environment/safe disposal or cleaning of
instruments and linen
Safe injection practices
Respiratory hygiene/cough etiquette- Patients and
visitors should cover their nose or mouth when
coughing, promptly dispose used tissues and practice
hand hygiene after contact with respiratory secretions
PPE for Standard Precautions (1)
• Gloves – Use when touching blood, body fluids, secretions,
excretions, or contaminated items and for touching mucus membranes
and nonintact skin.
•
also reduces the transmission of microorganisms on the hands of
hospital staff to patients;
•
reduces the chance of skin colonization of healthcare workers from
a patient who is infected.
• Gowns – Should be used during procedures and patient
care activities when contact of clothing &/or exposed skin with
blood, body fluids, secretions, or excretions is anticipated.
PPE Use in Healthcare Settings
PPE for Standard Precautions
(2)
• Mask and goggles or a face shield –
Protects healthcare workers from infectious material
from patients and should be used during patient care
activities likely to generate splashes or sprays of
blood, body fluids, secretions, or excretions.
•
They also protect patients undergoing sterile procedures
from respiratory aerosols from the healthcare worker.
•
They also limit spread of infectious respiratory secretions
from patients who are coughing.
PPE Use in Healthcare Settings
Standard Precautions
Be Proactive
Handle all blood and body fluids with gloves.
Perform hand hygiene before and after contact with the patient or
their environment.
Perform hand hygiene after removing gloves (as gloves may have small
defects or tears that are not apparent, and hands routinely become contaminated
during removal of gloves).
Remove gloves and perform hand hygiene upon ending patient care
or contact with their environment and before proceeding to the next
patient care/environment.
Wear a mask and eye shield when splashes to the face may occur.
Wear a gown if soiling of clothes may occur.
No eating or drinking in patient care areas.
Misty green scrubs must be covered with a buttoned lab coat when
leaving unit where they are worn.
Perform hand hygiene:
The most effective method of preventing the spread of
infection is practicing hand hygiene.
Before donning gloves and wearing PPE on entry to the
isolation room/area.
Before any clean/aseptic procedures being performed
on a patient.
After any exposure risk or actual exposure with the
patient’s blood and body fluids.
After touching (even potentially) contaminated
surfaces/items/equipment in the patient’s surroundings.
After removal of PPE, upon leaving the patient care
area.
Hand hygiene
How to perform hand hygiene:
Clean your hands by rubbing them with an alcohol
based formulation, as the preferred means for
routine hygienic hand antisepsis if hands are not
visibly soiled (EXCEPT in the setting of Clostridium
difficile)
It is faster, more effective, and better tolerated by your hands
than washing with soap and water.
Wash your hands with soap and water when hands
are visibly dirty or visibly soiled with blood or other
body fluids including infectious diarrhea i.e. c.diff (in
order to remove the spores), norovirus
How to handrub
Handrubbing must be
performed by following
all of the illustrated
steps. Remember to
include under
fingernails and rings!
This takes only 20–30
seconds!
WHO (2014) Key Measures for Prevention
and Control of Ebola Virus Disease
How to handwash
Handwashing
must last 20 seconds
and should be performed
by following all of the
illustrated steps.
WHO (2014) Key Measures for Prevention and
Control of Ebola Virus Disease
Hand Hygiene- Most important strategy in
preventing infection in yourself & others
•
Before and after contact with
patient or environment
•
Before and after wearing gloves
•
After contact with body fluids,
mucous membranes, non-intact
skin or wound dressings
•
When moving from a
contaminated to a clean body
site
WHO (2014) Key Measures for
Prevention and Control of Ebola Virus
Disease
Personal Protective
Equipment (PPE)
The goal of PPE in the Healthcare setting is to
improve personnel safety and prevent employee
exposures to hazardous body fluids, waste,
materials and disinfectants.
PPE definition by OSHA are “specialized
equipment worn to minimize exposure to
materials”. OSHA requires employers to protect
their employees from workplace hazards.
CDC recommends when, what, and how to use
the PPE.
Personal Protective
Equipment (PPE) Key Points
Know what type of PPE is necessary for the
duties you perform and use it correctly
Factors influencing the PPE selection depends
on the:
•Type of exposure anticipated:
• Touch
• Splash/spray
•Category of isolation
• Contact
• Droplet
• Airborne
Standard Precautions:
Use of PPE based on risk assessment
17 |
Key Measures for Prevention and Control of Ebola Virus Disease
PPE for Standard Precautions
• Gloves – Use when touching blood, body
fluids, secretions, excretions, contaminated
items; for touching mucus membranes and
nonintact skin. Change gloves if they are torn
or heavily soiled and after use on each
patient.
• Gowns – Use during procedures and patient
care activities when contact of clothing/
exposed skin with blood/body fluids,
secretions, or excretions is anticipated.
PPE Use in Healthcare Settings
Face Protection
A combination or PPE types is available to protect all or parts of the
face. The selection is determined by the type of isolation
precaution for the patient and nature of the contact ie. procedure
that may cause a splash or aerosol.
•Masks – protect nose and mouth
– Should fully cover nose and mouth and prevent
fluid penetration
•Goggles – protect eyes
– Should fit snuggly over and around eyes
– Personal glasses not a substitute for goggles
– Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protection
• Face shields – protect face, nose, mouth,
and eyes
– Should cover forehead, extend below chin and
wrap around side of face
PPE Use in Healthcare Settings
Key Points About PPE
• Don (put on) 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
PPE Use in Healthcare Settings
3 Expanded (Isolation)
Precautions
In addition to consistent use of Standard Precautions, there are 3
isolation categories that reflect the major modes or microorganism
transmission in nosocomial settings. They are:
Contact Droplet &
Airborne Isolation
The rooms of these patients should be clearly marked with a sign on
the door with the type of isolation and instructions regarding the type of
precautions that must be observed. An isolation cart will be outside of
the patient room with ample supplies that are readily available.
Contact Infection Transmission
Direct CONTACT Transmission- The infected person
makes direct body surface to body surface contact with a
host.
Indirect CONTACT Transmission occurs when:
Body surface to body surface contact via an
inanimate object when:
1.The infected person contaminates an object ie. bedding, needle,
dressing, equipment then
2.The host makes contact with the contaminated object or
3.There is a physical transfer of the infections organism from the
object to the host.
Expanded (Isolation)
Precautions
Contact Isolation- prevents contact transmission.
Contact Isolation:
Applies to patient with any of the following
conditions and/or diseases:
Stool incontinence/Enteric infections (may include norovirus, rotavirus or
Clostridium difficile C.Diff, E. coli)
Viral infections (RSV, HSV, enterovirus, parainfluenza)
Draining wounds, uncontrolled secretions, pressure ulcers, ostomy tubes and/or
bags draining body fluids (Especially Staphylococcus aureus and group A
streptococcus)
Presence of generalized rash or exanthems; scabbies, impetigo
Colonization of any bodily site with multidrug-resistant bacteria (MRSA, VRE)
You must use soap and water to remove C. diff spores(alcohol based gel will
not remove the C. diff spores)
In addition to Standard Precautions:
PPE: Gloves upon entering room & gown (if clothing may come contact
with the patient or environmental surfaces, or if the patient has diarrhea)
Private room for the patient is preferred; cohorting allowed if necessary.
Contact Precautions
Wash hands with soap and water before entering and
after leaving the patient’s room
Gloves required upon entering the room.
Change
gloves after contact with contaminated secretions.
Perform hand hygiene- (Wash hands with soap and water if
patient has C. diff)
Remove gloves before leaving the room then immediately perform
hand hygiene. After hand hygiene make certain not to touch the
patients environment.
Gown required if clothing may come into contact with the patient or
environmental surfaces, or if the patient has diarrhea or
condition/disease mentioned. Remove before leaving the patient’s
room.
Place patient in a gown during transport to minimize environmental
contamination.
Droplet Infection Transmission
Droplet transmission occurs when relatively large
(larger than 5 micron) respiratory droplets containing an
infectious organism are propelled a short distance
(usually only up to 3 feet) and land on the mucous
membranes (eyes, nose, or mouth) of a host.
Respiratory droplets are generated during:
•Coughing, sneezing, talking
•During procedures ie. Suctioning & bronchoscopy
Note:
A few organisms (eg. Some respiratory viruses) can be
transmitted by droplets and via direct patient contact. In this setting, both
droplet & contact isolation is needed.
Expanded (Isolation)
Precautions
Droplet isolation- prevents droplet transmission. In
addition to Standard precautions:
PPE: Regular yellow earloop surgical mask (due to
relatively large droplet size), gloves, gown, face shield- if
anticipate spraying of respiratory secretions.
Private room for the patient
Regular mask on patient when transported Prevents
transmission via droplets of Influenza,
Meningitis, Pertussis, Resp. Syncytial Virus (RSV), group A
strep, Invasive Haemophillus influenzae type B, diphtheria,
Mycoplasma pneumoniae, pneumonic plague
Healthcare workers within 6-10 feet of patients on
droplet precautions should wear a mask.
Airborne Infection Transmission
Airborne transmission occurs when tiny respiratory
droplet nuclei (smaller than 5 micron) containing an
infectious organism are propelled in the air. These
droplet nuclei can travel for long periods of time,
traveling long distances on air currents.
Transmission occurs when droplet nuclei are inhaled. The
nuclei droplets are generated during:
talking, laughing, coughing, or sneezing
procedures involving the respiratory tract such as suctioning,
intubation, or bronchoscopy.
Expanded (Isolation)
Precautions
Airborne isolations- prevents airborne
transmission.In addition to Standard Precautions:
PPE: N-95 respirators (due to small nuclei size) for staff;
gloves, gown, goggles or face shield if anticipate
spraying of respiratory fluids
Private room with negative pressure AIIR(airborne infection isolation room)
Regular mask on patient being transported (exception Ebola)
Prevents transmission of:
TB, Chickenpox (until lesions are crusted over), Severe Acute Resp.
Syndrome (SARS), and Varicella Zoster(localized in
immunocompromised patient) or disseminated (until lesions are crusted
over), Measles, and Aspergillus.
Because of Ebola’s high mortality rate, high viral load to low infectious
dose, airborne isolation is used (PAPR full body suit; no exposed skin)
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When using PPE
Don PPE before contact with the patient & before entering
the room
Avoid touching or adjusting PPE
Remove gloves if they become torn or damaged
Change gloves between patients
Perform hand hygiene before donning new gloves and
after doffing PPE
Avoid touching your eyes, mouth, or face with gloved or
ungloved hands
Remove & discard PPE carefully then immediately perform
hand hygiene
PPE soiled with blood or body fluids must be removed before leaving
the work area. Discard bloody scrubs into the soiled linen container.
Donning PPE
The next 8 slides will review the sequence and
correct technique to Don (Put on) PPE
Sequence for putting on (DONNING)
Personal Protective Equipment (PPE)
Hand Hygiene
Gown- fully cover torso from neck to knees, arms to end of wrists,
wrap around the back, fasten in back of neck and waist
Mask or Respirator
Goggles or Face Shield (if indicated) - place over face and
eyes and adjust to fit
Gloves- to cover wrist of isolation gown Keep hands away from
face
Limit surfaces touched
Change gloves when torn or heavily contaminated then perform
hand hygiene
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
PPE Use in Healthcare Settings
Correct Mask technique
For the Yellow surgical mask: Take out a face mask from the box and inspect it for
rips or holes. If you notice the mask is ripped or torn, throw it out and select another
one.
Hold the mask by the ear loops and place the loops over your ears.
Verify which sides are the top and front of the mask.
The part of the mask with a stiff bendable edge or metal strip is the top. The brighter
yellow side of the mask faces outward, while the lighter yellow side is against your
face. Pinch the metal strip, or stiff edge, of the mask so it molds to the shape
of your nose. Pull down the mask's bottom so it covers your mouth and chin.
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N 95 Respirator Mask
For the N95 mask (filtering capacity of 95% of airborne particles): Select the size
that you were fitted for. Take out the mask and inspect it for rips or holes.
Separate the edges to fully open it.
Slightly bend the nose wire to form a gentle curve.
Hold the mask upside down to expose the 2 headbands.
Separate and pull the headbands up over your head. Release the lower headband and position it
at the base of our neck. Position the remaining headband on the crown of your head (See photo
next slide).
Conform the nosepiece across the bridge of your nose by firmly pressing down with your fingers.
Continue to adjust the respirator and secure the edges until you feel you have achieved a good
facial fit. Take a few deeps breaths in and out to check for a leak, adjust if necessary.
If a mirror is not available, ask another healthcare professional to confirm correct mask placement.
If you do not put your N95 on correctly, it won’t be as protective for you as it should be.
If you have a large mustache, goatee, or beard, you cannot use the N95 mask for airborne
exposure protection. You will need to use a PAPR (powered air purifying respirator) hood to
protect you.
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How to Don Eye and Face
Protection
• Position goggles over eyes
and secure to the head using
the ear pieces or headband.
Googles should feel snug but
not tight.
• Position face shield over face
and secure on brow with
headband
• Adjust to fit comfortably
PPE Use in Healthcare Settings
How to Don Gloves
The last of PPE to be donned is a pair of
gloves.
•Don gloves last
•Select correct type and size that best fits
you.
•Insert hands into gloves.Adjust as needed
•Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
Doffing PPE
The next 6 slides will review the sequence and
correct technique to Dof (remove) PPE
Sequence for Removing (Doffing) PPE
Gloves- hand hygiene between steps if hands become
contaminated
Goggles or face shield (if used) - outside of goggles or
face shield is contaminated!
Gown- front of gown and sleeves are contaminated!
Mask or respirator- front is contaminated!
Hand hygiene- immediately after removing all PPE and
between steps if hands become contaminated.
“Contaminated” and “Clean” Areas of PPE
To remove PPE Safely, you must first be able to identify
what sites are “contaminated” or “clean”
•Contaminated –Areas of PPE that have or are likely to
have been in contact with body sites, materials, or
environmental surfaces where the infectious organism may
reside.
•In general, the outside front and sleeves of the isolation gown and outside
front of the goggles, mask respirator, face shields & gloves are considered
contaminated.
•Clean – Areas of PPE that are not likely to have been in
contact with the infectious organism.
•
Inside of gloves; inside and back of the gown including ties; ties,
elastic or ear pieces of the mask, goggles and face shield.
PPE Use in Healthcare Settings
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
PPE Use in Healthcare Settings
Sequence for Removing (Doffing) PPE
Gloves- hand hygiene between steps if hands become
contaminated
Goggles or face shield (if used) - outside of goggles or
face shield is contaminated!
Gown- front of gown and sleeves are contaminated!
Mask or respirator- front is contaminated
Hand hygiene- immediately after removing all PPE
How to Remove Gloves (1)
• Grasp outside edge near
wrist
• Peel away from hand,
turning glove inside-out
• Hold in opposite gloved
hand
PPE Use in Healthcare Settings
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
PPE Use in Healthcare Settings
Remove Goggles or Face
Shield
• Grasp ear or head
pieces with ungloved
hands
• Lift away from face
PPE Use in Healthcare Settings
• Place in designated
receptacle for
reprocessing or
disposal
Removing Isolation Gown
• Unfasten ties
• Peel gown away from
neck and shoulder
• Turn
contaminated
outside toward the
inside
PPE Use in Healthcare Settings
• Fold or roll into a
bundle
Hand Hygiene
• Perform hand hygiene immediately after
removing PPE.
– If hands become visibly contaminated during PPE
removal, wash hands before continuing to remove
PPE
• Wash hands with soap and water or use an
alcohol-based hand rub
* Ensure that hand hygiene facilities are available at the
point needed, e.g., sink or alcohol-based hand rub
PPE Use in Healthcare Settings
Conclusion
I hope this course has been both informative and helpful.
Please exit the course and take the mandatory postassessment test in myLUMEN > myExams/Quizzes,
InfectionPrevention_InterPro_PCM1_2017.
You will be notified when you will be required to participate
in Part II- Interprofessional Education.
References
•
•
•
CDC.gov
CDC.gov. PPE use in Health Care settings
CDC.gov > Ebola update > For Healthcare Workers >
Medscape: PPE Donning & Doffing
Demonstration N95/Gown
• OSHA.gov/publications/OHSA3151.html
• WHO (2014) Key Measures for Prevention and
Control of Ebola Virus Disease
• 2014 Up to date:General principles of infection control