* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Hand Hygiene in Healthcare Settings Core
Toxoplasmosis wikipedia , lookup
Cross-species transmission wikipedia , lookup
Onchocerciasis wikipedia , lookup
Herpes simplex wikipedia , lookup
Henipavirus wikipedia , lookup
African trypanosomiasis wikipedia , lookup
Clostridium difficile infection wikipedia , lookup
Hookworm infection wikipedia , lookup
Carbapenem-resistant enterobacteriaceae wikipedia , lookup
West Nile fever wikipedia , lookup
Middle East respiratory syndrome wikipedia , lookup
Leptospirosis wikipedia , lookup
Anaerobic infection wikipedia , lookup
Marburg virus disease wikipedia , lookup
Trichinosis wikipedia , lookup
Dirofilaria immitis wikipedia , lookup
Sarcocystis wikipedia , lookup
Hepatitis C wikipedia , lookup
Sexually transmitted infection wikipedia , lookup
Schistosomiasis wikipedia , lookup
Human cytomegalovirus wikipedia , lookup
Hepatitis B wikipedia , lookup
Coccidioidomycosis wikipedia , lookup
Fasciolosis wikipedia , lookup
Oesophagostomum wikipedia , lookup
So Why All the Fuss About Hand Hygiene? Most common mode of transmission of pathogens is via hands! Infections acquired in health care settings Spread of antimicrobial resistance Evidence of Relationship Between Hand Hygiene and Health Care Associated Infections Substantial evidence that hand hygiene reduces the incidence of infections Historical study: Semmelweis More recent studies: rates lower when antiseptic handwashing was performed Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16. Indications for Hand Hygiene When hands are visibly dirty, contaminated, or soiled, wash with nonantimicrobial or antimicrobial soap and water. If hands are not visibly soiled, use an alcohol-based handrub for routinely decontaminating hands. Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16. Specific Indications for Hand Hygiene Before: – Patient contact – Donning gloves when inserting a CVC – Inserting urinary catheters, peripheral vascular catheters, or other invasive devices that don’t require surgery After: – Contact with a patient’s skin – Contact with body fluids or excretions, nonintact skin, wound dressings – Removing gloves Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16. Recommended Hand Hygiene Technique Handrubs – Apply to palm of one hand, rub hands together covering all surfaces until dry – Volume: based on manufacturer Handwashing – Wet hands with water, apply soap, rub hands together for at least 15 seconds – Rinse and dry with disposable towel – Use towel to turn off faucet Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16. Fingernails and Artificial Nails Natural nail tips should be kept short; no longer than the end of the finger tip Artificial nails should not be worn Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16. PREVENTION IS PRIMARY! Protect patients…protect health care personnel… promote quality health care! Personal Protective Equipment Definition “specialized clothing or equipment worn by an employee for protection against infectious materials” (OSHA) PPE Use in Healthcare Settings Regulations and Recommendations for PPE OSHA issues workplace health and safety regulations. Regarding PPE, employers must: – Provide appropriate PPE for employees – Ensure that PPE is disposed or reusable PPE is cleaned, laundered, repaired and stored after use OSHA also specifies circumstances for which PPE is indicated CDC recommends when, what and how to use PPE PPE Use in Healthcare Settings Types of PPE Used in Healthcare Settings • Gloves – protect hands • Gowns/aprons – protect skin and/or clothing • Masks and respirators– protect mouth/nose – Respirators – protect respiratory tract from airborne infectious agents • Goggles – protect eyes • Face shields – protect face, mouth, nose, and eyes PPE Use in Healthcare Settings Factors Influencing PPE Selection • Type of exposure anticipated – Splash/spray versus touch – Category of isolation precautions • Durability and appropriateness for the task • Fit PPE Use in Healthcare Settings Gloves • Purpose – • patient care • environmental services • Glove material – • Vinyl • Latex • Nitrile • Sterile or nonsterile PPE Use in Healthcare Settings Gloves • Purpose – patient care, environmental services, other • Glove material – vinyl, latex, nitrile, other • Sterile or non-sterile • One or two pair • Single use or reusable PPE Use in Healthcare Settings Do’s and Don’ts of Glove Use Change gloves – During use if torn and when heavily soiled (even during use on the same patient) – After use on each patient Discard in appropriate receptacle – Never wash or reuse disposable gloves PPE Use in Healthcare Settings Gowns or Aprons • Purpose of use • Material – – Natural or man-made – Reusable or disposable – Resistance to fluid penetration • Clean or sterile PPE Use in Healthcare Settings Face Protection • 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 – Anti-fog 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 Respiratory Protection • Purpose – protect from inhalation of infectious aerosols (e.g., Mycobacterium tuberculosis) • PPE types for respiratory protection – Particulate respirators – Half- or full-face elastomeric respirators – Powered air purifying respirators (PAPR) PPE Use in Healthcare Settings Elements of a Respiratory Protection Program • Medical evaluation • Fit testing • Training • Fit checking before use PPE Use in Healthcare Settings Key Points About PPE • Don 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 Sequence* for Donning PPE • Gown first • Mask or respirator • Goggles or face shield • Gloves *Combination of PPE will affect sequence – be practical PPE Use in Healthcare Settings 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 How to Don a Mask • Place over nose, mouth and chin • Fit flexible nose piece over nose bridge • Secure on head with ties or elastic • Adjust to fit PPE Use in Healthcare Settings How to Don a Particulate Respirator • • • • • • Select a fit tested respirator Place over nose, mouth and chin Fit flexible nose piece over nose bridge Secure on head with elastic Adjust to fit Perform a fit check – – Inhale – respirator should collapse – Exhale – check for leakage around face PPE Use in Healthcare Settings How to Don Eye and Face Protection • Position goggles over eyes and secure to the head using the ear pieces or headband • Position face shield over face and secure on brow with headband • Adjust to fit comfortably PPE Use in Healthcare Settings How to Don Gloves • Don gloves last • Select correct type and size • Insert hands into gloves • Extend gloves over isolation gown cuffs PPE Use in Healthcare Settings How to Safely Use PPE • Keep gloved hands away from face • Avoid touching or adjusting other PPE • Remove gloves if they become torn; perform hand hygiene before donning new gloves • Limit surfaces and items touched PPE Use in Healthcare Settings PPE Use in Healthcare Settings: How to Safely Remove PPE “Contaminated” and “Clean” Areas of PPE • Contaminated – outside front • 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 • Clean – inside, outside back, ties on head and back • Areas of PPE that are not likely to have been in contact with the infectious organism PPE Use in Healthcare Settings Sequence for Removing PPE • Gloves • Face shield or goggles • Gown • Mask or respirator 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 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 • Fold or roll into a bundle PPE Use in Healthcare Settings • Discard Removing a Mask • Untie the bottom, then top, tie • Remove from face • Discard PPE Use in Healthcare Settings Removing a Particulate Respirator Lift the bottom elastic over your head first Then lift off the top elastic Discard PPE Use in Healthcare Settings 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 Standard Precautions • Assumes blood and body fluid of ANY patient could be infectious • Recommends PPE and other infection control practices to prevent transmission in any healthcare setting • Decisions about PPE use determined by type of clinical interaction with patient PPE Use in Healthcare Settings PPE for Standard Precautions (1) • Gloves – Use when touching blood, body fluids, secretions, excretions, contaminated items; for touching mucus membranes and nonintact skin • 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 PPE for Standard Precautions (2) • Mask and goggles or a face shield – Use during patient care activities likely to generate splashes or sprays of blood, body fluids, secretions, or excretions PPE Use in Healthcare Settings What Type of PPE Would You Wear? • Giving a bed bath? • Suctioning oral secretions? • Transporting a patient in a wheel chair? • Responding to an emergency where blood is spurting? PPE Use in Healthcare Settings • Drawing blood from a vein? • Cleaning a patient with diarrhea? • Irrigating a wound? • Taking vital signs? What Type of PPE Would You Wear? • Giving a bed bath? • Generally none • Suctioning oral secretions? • Gloves and mask/goggles or a face shield – sometimes gown • Transporting a patient in a wheel chair? • Generally none required • Responding to an emergency where blood is spurting? • Gloves, fluid-resistant gown, mask/goggles or a face shield PPE Use in Healthcare Settings • Drawing blood from a vein? • Gloves • Cleaning an incontinent patient with diarrhea? • Gloves w/wo gown • Irrigating a wound? • Gloves, gown, mask/goggles or a face shield • Taking vital signs? – Generally none PPE for Expanded Precautions • Expanded Precautions include – Contact Precautions – Droplet Precautions – Airborne Infection Isolation PPE Use in Healthcare Settings Use of PPE for Expanded Precautions • Contact Precautions – Gown and gloves for contact with patient or environment of care (e.g., medical equipment, environmental surfaces) • In some instances these are required for entering patient’s environment • Droplet Precautions – Surgical masks within 3 feet of patient • Airborne Infection Isolation – Particulate respirator* *Negative pressure isolation room also required PPE Use in Healthcare Settings Hand Hygiene • Required for Standard and Expanded Precautions • Perform… – Immediately after removing PPE – Between patient contacts • Wash hands thoroughly with soap and water or use alcohol-based hand rub PPE Use in Healthcare Settings PPE Use in Healthcare Settings: Final Thoughts PPE is available to protect you from exposure to infectious agents in the healthcare workplace Know what type of PPE is necessary for the duties you perform and use it correctly Classes of Microorganisms Non-pathogenic – normal – do not produce disease – beneficial Pathogenic – cause infection and disease May be non-pathogenic in one body system, pathogenic in another (E. coli) 48 Classes of Microorganisms Aerobic – requires oxygen to live Anaerobic – does not require oxygen to live 2.02 Understand 49 Classes of Microorganisms 6 classes of microorganisms – – – – – – Bacteria Protozoa Fungi Rickettsiae Viruses Helminths 2.02 Understand 50 Classes of Microorganisms Bacteria Often considered the causes of disease Certain bacteria – produce antibiotics – live in the body without problems – live on the roots of certain plants, converting nitrogen into a usable form – help break down dead organic matter Classified by shape and arrangement Treated with antibiotics 2.02 Understand 51 Classes of Microorganisms Bacteria – Cocci• round in shape – diplococci – streptococci – staphylococci Streptococci Staphylococcal cluste 2.02 Understand 52 Classes of Microorganisms Bacteria – Bacilli • rod shape – single – pairs – chains • may have flagella • may form spores – difficult to treat 2.02 Understand 53 Classes of Microorganisms Bacteria – Spirilla • spiral or corkscrew shape – vibrio Cholera - spirochete Treponema pallidum 2.02 Understand 54 Classes of Microorganisms Bacteria Some bacteria develop resistance to antibiotics Very difficult to cure – Methicillin-resistant Staphylococcus (MRSA) – Multidrug-resistant Staphylococcus (MDSA) 2.02 Understand 55 Classes of Microorganisms Protozoa – One celled, animal-like organism – Contain a nucleus and other defined organelles 2.02 Understand 56 Classes of Microorganisms Fungi – organisms that usually enjoy a symbiotic, but sometimes parasitic relationship with their host – provide numerous drugs and foods – provide bubbles in bread, champagne, and beer – cause a number of plant and animal diseases – fungal diseases are very difficult to treat 2.02 Understand 57 Classes of Microorganisms Fungi 2.02 Understand 58 Classes of Microorganisms Rickettsiae – rod-shaped, parasitic bacteria – live in the tissues of ticks, fleas, and lice – transmitted to humans through bites – invade the new host from within 2.02 Understand 59 Classes of Microorganisms Viruses – – – – small, infectious agent requires a host for survival over 5,000 types can combine in multiple ways to produce a wide range of diseases – produce immune response in humans – treated with antiviral drugs 2.02 Understand 60 Classes of Microorganisms Helminths – – – – – – Parasitic worm-like organisms Live inside the host Feed off their host Disrupt nutrient absorption Lead to weakness Excrete toxins making host susceptible to other diseases – Approximately 30 billion people globally are infected 2.02 Understand 61 Classes of Microorganisms Bacteria Protozoa Fungi Rickettsiae Viruses Helminths 2.02 Understand 62 Methods used to control the spread of infection Vaccinations Administration of a foreign antigen to produce immunity to a disease. Most effective and least expensive method to prevent disease 2.02 Understand 63 Methods used to control the spread of infection Vaccinations Injected pathogen may be live, weakened, killed or inactivated Administered to stimulate the immune response 2.02 Understand 64 Methods used to control the spread of infection Vaccinations May be given after disease exposure or after the disease was contracted Given by injection or orally 2.02 Understand 65 Methods used to control the spread of infection Aseptic Control Antisepsis Disinfection Sterilization 2.02 Understand 66 Methods used to control the spread of infection Aseptic Control Antisepsis – effective in preventing or inhibiting the growth of pathogenic organisms, but not spores or viruses – safe to be used on skin 2.02 Understand 67 Methods used to control the spread of infection Aseptic Control Disinfection – destroys pathogenic organisms that are already present – not effective against spores or viruses – chemicals are used – not used on skin 2.02 Understand 68 Methods used to control the spread of infection Aseptic Control Sterilization – kills all microorganisms, including spores and viruses – methods • • • • steam under pressure gas radiation chemicals – not used on skin 2.02 Understand 69 Methods used to control the spread of infection Aseptic Control Antisepsis Disinfection Sterilization 2.02 Understand 70 Methods used to control the spread of infection Precautions 2.02 Understand 71 Methods used to control the spread of infection Standard Precautions Used on ALL patients Includes: – Hand washing – Personal Protective Equipment (PPE) • Gloves • Gowns • Masks and eye protection – – – – – Needle stick safety Sharps Spills and splashes Resuscitation devices Waste and linen disposal – Injuries 2.02 Understand 72 Methods used to control the spread of infection Standard Precautions Hand washing 2.02 Understand 73 Methods used to control the spread of infection Standard Precautions Personal protection equipment (PPE) 2.02 Understand 74 Methods used to control the spread of infection Standard Precautions Gloves 2.02 Understand 75 Methods used to control the spread of infection Standard Precautions Gowns 2.02 Understand 76 Methods used to control the spread of infection Standard Precautions Masks and eye protection 2.02 Understand 77 Methods used to control the spread of infection Standard Precautions Needlestick safety 2.02 Understand 78 Methods used to control the spread of infection Standard Precautions Sharps 2.02 Understand 79 Methods used to control the spread of infection Standard Precautions Spills and splashes 2.02 Understand 80 Methods used to control the spread of infection Standard Precautions Resuscitation devices 2.02 Understand 81 Methods used to control the spread of infection Standard Precautions Waste and linen disposal 2.02 Understand 82 Methods used to control the spread of infection Standard Precautions Injuries 2.02 Understand 83 Methods used to control the spread of infection Standard Precautions Used on ALL patients Includes: – Hand washing – Personal Protective Equipment (PPE) • Gloves • Gowns • Masks and eye protection – – – – – Needle stick safety Sharps Spills and splashes Resuscitation devices Waste and linen disposal – Injuries 2.02 Understand 84 Methods used to control the spread of infection Bloodborne Pathogen Standard Applies to all occupational exposure of blood or other potentially infectious material. Blood = human blood, blood components, blood products Bloodborne pathogens = disease causing organisms in blood (Hep. B, Hep. C, HIV) 2.02 Understand 85 Methods used to control the spread of infection Bloodborne Pathogen Standard In an emergency when you cannot identify body fluids or tell whether they contain blood, treat all body fluids as potentially infectious. 2.02 Understand 86 Methods used to control the spread of infection Tuberculosis Standard OSHA Standard to reduce occupationally transmitted/acquired TB Requires FIT tested and training in the use of specific respiratory PPE PPD skin test annually 2.02 Understand 87 Methods used to control the spread of infection Extended Infection Control Precautions Standard Precautions PLUS Airborne Precautions Contact Precautions Droplet Precautions 2.02 Understand 88 Methods used to control the spread of infection Extended Infection Control Precautions Transmission based precautions – Additional precautions used with patients infected with pathogens that are spread via: • airborne transmission • droplet transmission • direct contact – Requires isolation 2.02 Understand 89 Methods used to control the spread of infection Extended Infection Control Precautions Airborne precautions – Patient pathogens are transmitted by airborne droplets – Specific PPEs• fitted mask 2.02 Understand 90 Methods used to control the spread of infection Extended Infection Control Precautions Contact precautions – Patient pathogens are able to be spread by direct or indirect contact – Specific PPEs • gloves • gowns 2.02 Understand 91 Methods used to control the spread of infection Extended Infection Control Precautions Droplet precautions – Used when large-particle droplets are expelled during coughing, sneezing, talking or laughing – Specific PPEs• mask if working within 3 feet of patient 2.02 Understand 92 Methods used to control the spread of infection Extended Infection Control Precautions Protective or reverse precautions 2.02 Understand 93 Methods used to control the spread of infection Extended Infection Control Precautions Standard Precautions PLUS Airborne Precautions Contact Precautions Droplet Precautions 2.02 Understand 94 Transmitting Infection Direct contact Indirect contact Airborne Vector-borne 2.02 Understand 95 Transmitting Infection Direct contact Person to person Animal to person Mother to unborn child 2.02 Understand 96 Transmitting Infection Indirect contact Pathogens are passed along on inanimate objects 2.02 Understand 97 Transmitting Infection Airborne Pathogens are carried through the air Cling to surroundings and are spread 2.02 Understand 98 Transmitting Infection Vector-borne Insects carry pathogen from host to host Flea Mosquito Tick 2.02 Understand 99 Transmitting Infection How you get an infection… – Causative agent – Reservoir – Portal of exit – Mode of transmission – Portal of entry – Susceptible host…breaking the chain! 2.02 Understand 100 Chain of Infection Causative agent Source or reservoir Susceptible host Portal of entry Portal of exit Mode of transmission 2.02 Understand 101 Chain of Infection Causative agent – pathogen 2.02 Understand 102 Chain of Infection Reservoir – area where the pathogen can live 2.02 Understand 103 Chain of Infection Portal of exit – way for the pathogen to escape from the reservoir 2.02 Understand 104 Chain of Infection Mode of transmission – way for pathogen to be transmitted 2.02 Understand 105 Chain of Infection Portal of entry – way to enter new reservoir 2.02 Understand 106 Chain of Infection Susceptible host – able to be affected – person likely to get sick 2.02 Understand 107 Chain of Infection Causative agent Source or reservoir Susceptible host Portal of entry Portal of exit Mode of transmission 2.02 Understand 108 Types of Infections 2.02 Understand infection control procedures Types of Infections Infection invasion of the body by microorganisms invading microorganisms: – use the host’s resources to multiply – interfere with normal function – 3rd leading cause of death in the U. S. 2.02 Understand 110 Types of Infections Local infection only a specific portion of the body is infected – – – – – – pain redness heat at the site swelling pus foul smelling drainage 2.02 Understand 111 Types of Infections Systemic infection affects the entire body – – – – – – fever aches chills nausea vomiting weakness 2.02 Understand 112 Types of Infections Endogenous (endo- inside; genous- type or kind) – type or kind of infection or disease that originates from within the body Exogenous (exo- outside; genoustype or kind) – type or kind of infection or disease that originates outside the body 113 Types of Infections Nosocomial infections – Hospital acquired infection – Transmitted by the health care worker Opportunistic infections – Infections that occur when the body’s defenses are weakened 2.02 Understand 114 Types of Infections VERY IMPORTANT Any sign of infection must be reported to the nurse or doctor!