Outline for Team Leading

7/30/2019 Outline for Team Leading

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Running head: TRANSMISSION-BASED PRECAUTIONS

The Guidelines and Protocols of Isolation Precautions in Hospitals

Jeffrey B. Viernes

NURS 360 Health and Illness III

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Outline of Content

I. What is Hospital Acquired infection? (CDC, 2012)

A. It is an infection acquired from other patients, hospital staffs, contaminated

objects or solutions during hospitalization.

II. What is the statistics of hospital acquired infection? (Paddock, 2010)

A. In 2009, nearly 1.8 million people were believed to have acquired healthcare-

associated infections, resulting nearly 100,000 related deaths.

B. More recently, it was estimated that approximately one out of 20 hospitalized

patients would become infected with HAI.

C. From 2009-2010, there is a great reduction (32%) of HAI among reporting

hospitals (CDC, 2012).

III. Types of Hospital Acquired Infections (CDC, 2012)

A. Central line associated bloodstream infections.

B. Surgical site infection.

C. Catheter associated urinary tract infection.

D. Ventilator assisted pneumonia.

IV. Why are hospital infections increasing? (CDC, 2012)

A. Antimicrobial resistance.

B. Poor infection prevention and control practices.

C. Lack of coordinated surveillance systems and reporting.

D. Few efforts to research and develop new drugs.

V. What are the components of the chain of infection? (Berman, Kozier, & Erb, 2008)

A. Microorganism

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1. Bacteria

2. Fungi

3. Protozoa

4. Viruses

5. Prions

B. Reservoirs

1. People

2. Food

3. Equipment

4. Water

C. Susceptible host

1. Immunosuppression

2. Diabetes patient

3. Immobility

4. Age

5. Surgery

6. Cancer

7. Normal flora suppression

D. Transmission Route

1. Direct

2. Contact

3. Ingestion

4. Airborne

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5. Fomites

E. Place of Entry

1. Mucous membrane

2. GI tract

3. Respiratory tract

4. Broken Skin

F. Exit Point

1. Body fluids

2. Skin

3. Droplets

VI. How do we break the chain of infection? (Berman, et. al., 2008)

A. Clean Hands

1. Hand washing and alcohol based solution.

B. Safe practices

1. Waste disposal

2. PPE

3. Adhering to transmission based precaution per hospital protocol.

4. Aseptic procedure

C. Risk Management (CDC, 2012)

1. Risk management is the systematic application of management

policies, procedures, and practices to the task of identifying, analyzing,

assessing, treating, and monitoring risk.

2. Risk management is the responsibility of all staffs.

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VII. What consist of Personal Protective Equipment? (Berman, et. al., 2008)

A. Gloves

1. Protect the hands when the nurse is likely to handle any body

substances.

2. Reduce the likelihood of nurses transmitting their own microorganisms

to the individual receiving the care.

3. Reduce the chance that the nurses hands will transmit microorganism

from one client to another.

B. Gowns

1. Worn during procedures when the nurses uniform is likely to become

soiled.

a. Sterile gown

b. Single use gown

C. Face Masks

1. Reduce the risk for transmission of organisms by the droplet contact

and airborne routes, and by splatters of body substances.

a. Mask should be worn by those close to the client if the

infection is transmitted by large particle aerosols.

i. Measles, mumps, acute respiratory disease in children

b. Mask should be worn by all person entering the room if the

infection is transmitted by small particle aerosols.

i. Pulmonary tuberculosis and SARS

ii. N95 mask

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D. Eyewear

1. Indicated in situations where body substances may splatter the face.

VIII. Three types of isolation rooms (RICPRAC, 2008)

A. Class S- Standard Air Pressure Isolation Room

1. The isolation room requirements for persons known or suspected to

have infections requiring contact or droplet precautions.

a. Hand washing facility in the room

b. Door on room remain closed

c. Sign on door denoting the type of isolation

d. Standard air conditioning

e. Gloves, Gowns, and Goggles

B. Class N- Negative Pressure Isolation Room

1. The isolation room requirements for persons known or suspected to

have infections requiring airborne precautions.

a. Hand washing facilities in the room

b. Door on room must remain closed

c. Sign on door denoting type of isolation

d. Negative pressure air conditioning

e. Gloves, gowns, goggles, and masks (N95)

C. Class P- Positive Pressure Isolation Room

1. The isolation room requirements for persons who are profoundly

Immunocompromised.

a. Hand washing facilities in the room

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b. Door on room must remain closed

c. Sign on door denoting type of isolation

d. Positive pressure air conditioning

e. Gloves, gowns, goggles

IX. Standard Precaution (Wilcox Memorial Hospital, 2012)

A. Designed for all client in hospital

B. These precaution apply to:

1. Blood

2. All body fluids

3. Excretion and secretion except sweat

4. Broken skin

5. Mucous membrane

C. Designed to reduce risk of transmission of microorganism and to minimize the

risk of nosocomial transmission of infectious agents:

1. From patient to patient

2. From patient to health care worker

3. From health care worker to patient

D. What do we need to do to prevent the transmission of microorganism from

one patient to another?

1. Perform proper hand hygiene after contact with blood, body fluids,

secretions, excretions, and contaminated objects whether or not gloves

are worn.

a. Perform proper hand hygiene immediately after removing

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gloves.

b. Use a nonmicrobial product for routine hand cleansing.

c. Use an antimicrobial agent or an antiseptic agent for the control

of specific outbreaks of infection.

2. Wear clean gloves when touching blood, body fluids, secretions,

excretions, and contaminated items.

3. Wear a mask, eye protection, or a face shield if splashes or sprays of

body fluids, secretions, and excretions can be expected.

4. Wear a clean non-sterile gown if client care is likely to result in

splashes or sprays of bodily fluids.

5. Handle client care equipment that is soiled with blood and body

secretions carefully to prevent the transfer of microorganism to others

and the environment.

6. Handle, transport, and process linens that are soiled with blood and

bodily fluids in a manner to prevent contamination of clothing and the

transfer of microorganisms to others and to the environment.

7. Prevent injuries from used scalpels, needles, or other equipment, and

place in puncture resistant containers.

X. Transmission-Based Precautions (Wilcox Memorial Hospital, 2012)

A. Airborne Precaution

1. Place client in a private room that has a negative air pressure, 6-12 air

changes per hour, and either discharge of air to the outside or a

filtration system for the room.

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2. If private room is not available, place client with another client who is

infected with the same microorganism.

3. Wear a respiratory device (N95) when entering the room of a client

who is known or suspected of having pulmonary tuberculosis.

4. Susceptible people should not enter the room of a client who has

rubeola or varicella. If they must enter, they should wear a respirator.

5. Limit movement of client outside the room to essential purposes. Place

surgical mask on the client during transport.

B. Droplet Precaution

1. Place client in private room.

2. If a private room is not available, place client with another client who

is infected with the same microorganism.

3. Wear a mask if working within 3 feet of the client.

4. Limit movement of client outside the room to essential purposes. Place

surgical mask on the client during transport.

C. Contact Precaution


2. If a private room is not available, place client who is infected with the

same microorganism.

3. Wear gloves as described in standard precaution.

a. Change gloves after contact with infectious material.

b. Remove gloves before leaving clients room.

c. Cleanse hands immediately after removing gloves.

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d. If the client is infected with C.diff, do not use an alcohol-based

hand rub, as it may not be effective on the spores. Use soap and

water.

4. Wear a gown when entering the room if there is possibility of contact

with infected surfaces or items, or if the client is incontinent, or has

diarrhea, a colostomy, or wound drainage not contained by a dressing.

a. Remove gown in the client room.

b. Make sure uniforms does not contact possible contaminated

surfaces.

5. Limit movement of client outside the room.

6. Dedicate the use of non-critical client care equipment to a single client

or to clients with the same infecting microorganism.

D. Enhanced Precaution


2. When entering room/cubicle to hang a medication, answer a call light,

or provide patient education, PPEs are not necessary required unless

contact with the patient, bed, bedside table/chair, or patient care items

that may have been in contact with the patient is anticipated.

3. Hand hygiene is required.

4. Wear gloves for all direct patient care activities.

5. Wear gowns for all direct patient care activities, especially when in

contact with blood and body fluids.

6. Wear a surgical mask when entering patients room until culture

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results are known.

7. Use dedicated equipment whenever possible for routine care

8. Have patient change into a clean gown and disposable foot covers

prior to leaving the room. Cover all wounds. Patient should wear mask

until cultures are negative.

9. Ask visitors to wash their hands upon entering and leaving the room.

References

Berman, A., Syndre, S., Kozier, B., & Erb, G. L. (2008).Kozier and Erb's Fundamentals of

Nursing, Concepts, Process, and Pratice. (8th ed., pp. 669-705). Upper Saddle River,

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New Jersey: Pearson Education Incorporated.

Center for Disease Control and Prevention. Center for Disease Control and Prevention, (2011).

Hand Hygiene in Healthcare Setting. Retrieved from National center for Emerging and

Zoonotic Infectious Diseases website: http://www.cdc.gov/handhygiene/Basics.html.

Center for Disease Control and Prevention. Center fo Disease Control and Prevention, (2012).

Simplified Tracking: Streamlining HAI Data Collection in NHSN. Retrieved from

National Healthcare Safety Network website: http://www.cdc.gov/hai/eip/pdf/NHSN-

factsheet_Tracking.pdf.

Paddock, C. (2010). Hospital-Acquired Infections, MRSA, Killed 48,000 Americans in One

Year.Medical News Today, 170(4), 347-353. Retrieved from http://www.medicalnews

today.com/articles/180065.php.

Rural Infection Control Practice Group (2008). Concepts Principles and Processes of Infection

Control. In A. Gray, M. Stevenson, B. Fowkes, J. Grinter & J. Hellsten (Eds.),Infection

Prevention and Control Manual(3rd ed.). Retrieved from http://docs.health.vic.gov.au

/docs/5B41C6DFA9DECA257A600005F10F/$FILE/RICPRAC InfectionPreventionAnd

ControlManual ThirdEdition.pdf .

Wilcox Memorial Hospital. Infection Control Policy and Procedures, (2012). Standard

Precaution and Transmission-Based Precautions. Lihue, Kauai.

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Outline for Team Leading