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Isolation Class 10 . Last Class. Preventing the spread of infection. What do we do when a client has a highly infectious disease?. Specific Infection Control Policies. Isolation – the principle is to create a physical barrier that prevents the transfer of microorganisms.

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Isolation Class 10

Last Class


Preventing the spread of infection

  • What do we do when a client has a highly infectious disease?


Specific Infection Control Policies

  • Isolation – the principle is to create a physical barrier that prevents the transfer of microorganisms.


What are appropriate barriers? Depending on -

  • Organism Transmission

    • Airborne

    • Vehicle

    • Contact

      • Direct

      • Indirect

      • Droplet


Types of Barriers

  • PPE (personal protective equipment)

    • Gowns

    • Gloves

    • Masks

    • Eyewear


  • Each institution is required to have infection control policies and guidelines.


What about when we don’t know?

  • 3 systems

    • Universal precautions

    • Body substance precautions

    • Standard precautions


Precautions to guard against the unknown

  • Apply to everyone

  • General public

  • May or may not carry an infection


History Lesson

  • Initially concerned with patient to patient

  • Followed by concern for health care professionals

  • 1970 – Hepatitis B

  • 1987 – HIV

    • Universal precautions by Center for Disease Control (CDC)


Universal precautions

Stated :

All blood & body flds should be treated as potentially infectious.


Body Substance Isolation (BSI)

  • Infection control practitioners in Seattle and SanDiego

  • Canada adopted policy but renamed it Body Substance Precautions (BSP)


Standard Precautions

  • 1996- newest guidelines by CDC combined the major features of universal precautions & BSP


2 Tier System

  • 1996 CDC new guidelines


1st Tier – Standard Precautions

  • Most important

  • Universal precautions + BSP

  • Applies to everyone

  • Primary strategies for prevention of infection

  • Standard precautions

    • Blood, body flds., nonintact skin, mucus membranes


2nd Tier

  • Specific infections/diagnosis

  • Droplet, airborne, contact with contaminated surface


3 Types Transmission Based Precautions

  • Airborne, droplet, contact

  • Some infections combination (chicken pox)

  • These extra precautions are in addition to Standard Precautions


Airborne

  • Travels on small particles

  • Air currents

  • Portal of entry – nose, mouth, mucus membranes

    • Measles, chicken pox, TB


Requirements for Airborne

  • Negative pressure room – door closed

  • TB = HEPA filter

  • Do not enter if not immune to measles/chickenpox

  • Client wears mask when required to leave room


Droplet

  • Large droplets of moisture

  • Coughing, sneezing, talking

    • Travels 3 ft. or less

    • Enters nose / mouth

    • Mumps, pertusis, influenza

  • Private room

  • Staff regular mask for 3 ft.

  • Client mask for transport


Contact

  • Dry skin to dry skin = Direct

  • Dry skin to object = Indirect

  • Impetigo, herpes zoster, scabies

  • Gloves – for direct care or touching anything in the room

  • Private room or semi if cohort has same diagnosis


  • Remove gloves prior to exiting and wash hands

  • Gown for

    • patient contact

    • Changing linen

    • Handling objects in the room


  • Remove gown prior to exiting

  • Wash hands

  • Careful clothing does not touch room surfaces


Protective Isolation / Reverse isolation

  • Compromised or suppressed immune system

  • Highly susceptible to infections

  • Protection from environmental pathogens


Protective Isolation / Reverse isolation

What do you need ?

  • Private room – door closed

  • Gown, mask, gloves if direct contact

  • Wash hands

  • No plants / flowers


Procedure

  • Before instituting

    • EXPLAIN to client & family

      • Disease

      • Purpose of isolation

      • Steps to follow

      • Time frame


Room Preparation

  • Private with BR facilities

  • Sign on door

  • Isolation cart outside door

  • Laundry hamper in room

  • Waste basket with plastic bag

  • Thermometer, B/P cuff, stethoscope in room

  • Sharps receptacle


  • Be organized

  • Gather equipment prior to entering room

  • Remove rings and wash hands

  • Don PPE

  • Gown usually disposable

  • Gloves up over cuff of gown


  • Put your watch in a plastic bag if no clock in room

  • Linen is placed in a water soluble bag & then cream/yellow bag

  • No special treatment for dishes / trays


Exiting Room

  • Untie gown at waist

  • Remove gloves properly

  • Remove mask

  • Untie gown at neck, drop over shoulders, don’t touch outside, fold inwards, and discard


Exiting Room

  • Wash hands

  • Use paper towel on door handle

  • Wash hands again outside room

    Important to do as much client care as you can while you are in the room….CLUSTER ACTIVITY.


Basic Principles

  • Wash hands prior to entering & exiting room

  • Careful disposal of contaminated materials

  • Knowledge of disease and mode of transmission

  • Protection of client and public during transport


Client Consideration

  • Isolation

  • Loneliness

  • Self – esteem, body image

  • Boredom


Sterile Technique / Surgical Asepsis

Purpose – to eliminate all microorganisms from objects that come into contact with the tissues of the body that are normally sterile.


Practice Areas

  • Operating room

  • Labor and delivery

  • Major diagnostic area

  • At the bedside in 3 main situations

    • Procedures requiring intentional perforation of the skin


  • When the skin’s integrity is broken due to surgery or burns

  • During procedures involving insertion of devices into normally sterile body cavities


  • Any break in technique could result in contamination increasing clients risk for infection.


Methods of Sterilization

  • Steam – most common

  • Dry heat

  • Ethylene oxide gas

  • Chemicals

  • Indicator of sterility –

    • tape on pkg. turns color or forms lines

    • Expiration Date


Moist heat /steam

Radiation

Autoclave- instruments, parental solutions, dressings

Drugs, foods, heat sensitive items

Examples of sterilization processes


Chemicals

All types microorganisms

Rapid action

Work with water

Stable in heat & light

Inexpensive

Not harmful to body tissue

Instruments

Glass thermometers

Ex. Chlorine – used to disinfect water & for housekeeping purposes

Examples of sterilization processes


Ethylene oxide gas

Destroys microorganisms by altering cells’ metabolic processes.

Rubber

Plastic

Examples of sterilization processes


Boiling water

Cheap

Imp. – bacterial spores andsome viruses resist boiling. Not used in hospitals!

Items should be boiled for at least 15 min.

Examples of sterilization processes


Practical Exam

  • Prepare a sterile field

  • Add an item

  • Add a liquid

  • Don sterile gloves


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