Standard Precautions and Isolation

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Standard Precautions and Isolation

• Chapter 20
• presented by
• Kay Privette

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Standard Precautions

• Are guidelines recommended by Centers for Disease
  Control and Prevention (CDC). Although CDC
  regulations are not subject to legal enforcement,
  facilities must follow regulations issued by OSHA
  (Occupational Safety and Health Administration)

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Standard Precautions-

• Is using preventative practices in the care of
  all clients in hospitals regardless of diagnosis
  or presumed infection status.

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• What does Standard Precautions mean to You the
  Nurse?
• How do I (the nurse) decide what protective
  equipment to wear?

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Standard PrecautionsApply to

• Blood
• All body fluids, secretions, and excretions
  except sweat, regardless of whether those fluids
  contain visible blood.
• Non-intact skin.
• Mucous membranes.

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Standard Precaution Practice

• Must be practiced with all clients.
• Represents the most effective means of decreasing
  the risk of infection among clients and
  caregivers.

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Barrier Precautions

• Used to minimize the risk of exposure to blood
  and body fluids.
• Involve use of personal protective equipment
  (masks, gowns, and gloves) to create a barrier
  between person and the microorganism and thus
  prevent transmission of the microorganism.

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Components ofStandard Precautions

• Hand hygiene
• Gloves
• Mask, eye protective, face, shield
• Gowns
• Client-care equipment
• Environmental control
• Linen
• Occupational health and blood-borne pathogens
• Client placement

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Hand Hygiene

• The most basic aspect of standard precautions.
• To prevent cross-contamination of different body
  sites on one client, hand hygiene may be
  necessary between tasks and procedures on that
  client.

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Gloves

• To be worn when touching blood, body fluids,
  secretions, excretions, and contaminated items.
• Must be changed between tasks.
• Must be removed promptly after use.
• Hands must be cleansed immediately.
• Assess client for latex allergy (Ask the pt., are
  you allergic to latex?)

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Mask, Eye Protection,Face Shield

• Should be worn to protect the mucous membranes of
  the eyes, nose, and mouth when procedures and
  client-care activities are likely to splash or
  spray blood, body fluids, secretions, or
  excretions.
• What area would you use this type of PPE?
• Surgery, patient spitting, clogged G-tube

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Gowns

• Should be worn to protect the skin and prevent
  soiling of clothing.
• Select a gown that is appropriate for the
  activity and potential amount of fluids.
• Remove soiled gowns promptly.
• Cleanse hands.

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PPE (Personal Protective Equipment)

• What type of client would you wear a gown with?
• Infectious disease or reverse isolation
• What PPE should be worn when attempting to
  control bleeding?
• Gown, mask and goggles

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Client-Care Equipment

• Reusable equipment must not be used in care of
  another client until it has been cleansed and
  sterilized appropriately.
• Single-use items must be discarded.

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Environmental Control

• Hospitals must have adequate procedures for care,
  cleansing, and disinfection of environmental
  surfaces.
• All personnel must ensure that these procedures
  are followed. Such as deep cleaning a room after
  a patient is discharged.

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• When working in the ER, blood is all over your
  equipment and the floor. What should you clean
  it with?
• Clean up with 110 Chlorine Bleach

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Linen

• Must be handled, transported, and processed in a
  manner to prevent
• Skin and mucous membrane exposure.
• Clothing contamination.
• Microorganism transfer to other clients and
  environments.

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Occupational Health andBlood-Borne Pathogens

• Take care to prevent injury when disposing of
  needles, scalpels, and other sharp instruments
  (sharps).
• Never recap used needles using both hands (can
  use one-handed scoop).
• Place sharps in designated puncture-resistant
  containers.

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Client Placement

• Clients requiring a private room include
• Those who contaminate the environment.
• Those who do not or cannot be expected to assist
  with maintaining appropriate hygiene or
  environmental control.
• If a private room is unavailable, consult
  infection-control professionals.

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Isolation

• Transmission-Based Precautions are to be used in
  addition to the Standard Precautions
• Airborne precautions
• Contact precautions
• Droplet precautions

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Airborne Precautions

• For clients known to have or suspected of having
  serious illnesses spread by airborne droplet
  nuclei.
• Diseases include measles, varicella, and
  tuberculosis

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Airborne(in addition to Standard Precautions)

• Patient placement-private room
• Private room that has negative air pressure
• Nurse must wear an N95 when entering the room
• Door must remained closed
• Pt. transport should be limited and must wear a
  surgical mask.

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Contact Precautions

• For clients with or suspected of having serious
  illnesses easily spread by direct client contact
  or contact with fomites.
• Diseases include wound, gastrointestinal, and
  respiratory infections, herpes simplex, impetigo,
  scabies, varicella (Zoster), and viral
  hemorrhagic infections.

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Contact(In addition to Standard Precautions)

• Patient placement- private room if possible but
  can cohort.
• Gloves when entering room, and change them after
  contact with infectious material such as feces,
  and wound drainage, and remove before leaving the
  room.
• Wash hands with antimicrobial agent immediately.
• Gown when entering room if anticipate clothing
  will come in contact with patient and
  environmental surfaces, or if pt. is incontinent
  (diarrhea, colostomy). Remove when leaving.
• Patient transport-limit to essential purposes
  only.
• Patient-Care Equipment-dedicate the use of
  noncritical equipment to single patient. If
  common equipment is used, clean and disinfect
  between pt.

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Droplet Precautions

• For clients known to have or suspected of having
  illnesses spread by large particle droplets.
• Diseases include meningitis, pneumonia,
  diphtheria, pertussis, scarlet fever, influenza,
  mumps, rubella, adenovirus.

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Droplets(in addition to Standard Precautions)

• Patient placement-private room if possible.
  Cohort or maintain spatial separation of 3 feet
  from other patients or visitors.
• Mask- when working within 3 feet of patient (or
  upon entering the room).
• Patient transport-limit for essential purposes
  only. Use surgical mask on patient during
  transport.

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Isolation Precautions

• Must have physician order (nurse may initiate)
• Obtain a culture
• Place signs before entering room
• Private room, adequate ventilation, use own
  supplies
• All items leaving the room should be double
  bagged.

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Reverse Isolation

• Also known as Protective Isolation.
• A barrier protection designed to prevent
  infection in clients who are severely compromised
  and highly susceptible to infection.

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Reverse IsolationIncludes Clients

• Taking immunosuppressive medications.
• Receiving chemotherapy or radiation.
• Who have diseases that depress resistance to
  infectious organisms.
• Who have extensive burns or other skin
  impairments.

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Client responsesTo Isolation

• Symptoms of anxiety, depression, rejection,
  guilt, or loneliness.
• Discuss isolation precautions and practices,
  encourage to verbalize feelings.
• Provide intellectual stimulation, diversion.
• Visitors should be encouraged in accordance with
  isolation precautions.