Nursing Orientation Infection Prevention &Control

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 patient’s room.

4. Germs (ex. MRSA) can be spread by touching patient Or patient’s 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 patient’s 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/OSHA’s ATD Standardand Emergency Medical Services • May 20 2010, Deborah Gold, MPH, CIH • Cal/OSHA – RSHU, dgold@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/OSHA’s ATD Standardand Emergency Medical Services • May 20 2010, Deborah Gold, MPH, CIH • Cal/OSHA – RSHU, dgold@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 Bundle“Holy 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/upload/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/family’s 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/upload/CAUTI_Prevention_Netlearning_11_22_2011_FINAL.pdf Photos from- http://www.sharp.com/b2b/students/upload/CAUTI_Prevention_Netlearning_11_22_2011_FINAL.pdf Dependent loop Urine collects in this loop

19. PPE – Putting on and Safely Removing • demo

21. Clean Hands Saves Lives! Thank youquestions? Contact:Abigail evangelista, bsnInfection prevention and control managerAbigail.d.evangelista@kp.org323-648-1301annaTiomico, msnacademic liaison, staff educatoranna.l.faraon-tiomico@kp.org323-857-2845