STANDARD PRECAUTIONS

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• STANDARD PRECAUTIONS
• ISOLATION PRACTICES
• STERILE TECHNIQUE

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STANDARD PRECAUTIONS

• 1996, CDC developed a system of isolation to
  provide guidelines on how to prevent spread of
  infection (updated 2007)
• . practices are referred to as
• Standard Precautions (a 2 Tiered system).

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• Standard Precautions
  include
• wearing protective barriers
• when risk of contact with any
  body excretions, secretions,
• and moist membranes
• and tissues.
• Acknowledges that all are potentially
• infectious.

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FIRST TIER

• Precautions designed for care of all clients
  regardless of their diagnosis or presumed
  infection status.
• Standard Precautions apply to
• Blood
• All body fluids, secretions, and excretions
• Non-intact skin
• Mucous Membranes

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SECOND TIER

• It alerts the nurse to take additional
  precautions to interrupt the transmission of a
  specified infection or organism.
• These Transmission-Based Precautions are for
  patients known, or suspected of being infected
  by a particular pathogen transmission
• (a) airborne precautions
• (b) droplet precautions
• (c) contact precautions

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3 TRANSMISSION-BASED PRECAUTIONS(must understand
how the organism is transmitted)

• Airborne Precautions spread of microbes on
  small droplet nuclei through the air (lt 5
  microns).
• (ie) Measles Chicken Pox TB
• MASK important, door closed, negative air flow
  ventilation, private room
• Droplet Precautions large particle droplets
  
• (gt 5 microns) which transmit 3 feet in air.
• (ie) Mumps Pertussis Influenza SARS
• Private room / or cohort clients, and mask worn
  if within 3 feet
• Contact Precautions for prevention of disease
  transmitted by either direct / or indirect,
  contact.
• (ie) Impetigo, Scabies, Herpes Zoster, C
  Difficile.
• Gloves and gown worn, private room or cohort
  clients

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• BUGS ARE GETTING SMARTER THAN THE DRUGS!!
• Some microorganisms that are particularly
  difficult to destroy.
• Some prevalent ones are
• Methicillin-Resistant Staphylococcus Aureus
  (MRSA)
• Vancomycin-Resistant Enterococcus (VRE)

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• Skills Text p.197
• Box 8-1 Table 8-2
• Guidelines for Standard Precautions (2 tiered
  system) published by the CDC in 1996
• Standard PrecautionsFundamentals text, p.807
• READ

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ISOLATION IS.

• Infection control and prevention methods that
  are used to decrease the transfer of
  microorganisms.
• Barriers or PPE (protective personal equipment)
• may include
• gowns
• gloves
• masks
• eyewear/ goggles.

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PROTECTIVE ISOLATION akaREVERSE ISOLATION

• Protects the client with a compromised or
  suppressed immune system who is highly
  susceptible to contracting an infection.

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• Private room needed, door closed, gowns, masks,
  gloves (if direct contact), wash hands
  immediately before entering / leaving the room,
  no plants or flowers allowed.

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PROCEDURE OF ISOLATION

• Prepare room for client be organized!
• Before entering room, wash hands put on the
  necessary barrier protection.
• Place soiled linen gown into an impermeable
  laundry bag. If splatter a possibility, nurses
  gown should also be impermeable.
• Wash hands change gloves PRN during care.
• When care complete, PPE is removed inside room.

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In what order do you dress/undress PPE?

• Must think critically, esp upon leaving
  isolation..may depend upon the
• area in which you are working.
• As a general rule
• gloves are last put on 1st taken off
• if airborne precautions, mask stays on until
  out of room.
• Consider your gloves, outside of your goggles,
  front of your mask, sleeves front of your gown
  all to be
• contaminated. Remember to wash hands
• once all PPE removed.

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LEAVING ISOLATION ROOM

• Remove your protective barriers in the following
  order
• 1) Remove gloves
• 2) Remove eyewear/goggles
• 3) Remove gown (pull off inside out)
• 4) Remove mask
• 5) Wash hands immediately
• Leave mask on until after you leave room if
  airborne

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CLIENT CONCERNS RELATED TO ISOLATION

• Explain purpose of isolation the
• necessary precautions.
• Sensory deprivation may be evident
• by signs of loneliness or boredom.
• S S of depression - decreased motivation,
  anger, lack of appetite, or difficulty sleeping.
• What interventions can you plan, while working
  with a client in isolation?

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STERILE TECHNIQUE aka SURGICAL ASEPSIS
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What is the purpose of STERILE TECHNIQUE ?
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PURPOSE OF STERILE TECHNIQUE

• To ELIMINATE all microorganisms from objects that
  come into contact with the tissues of the body
  that are normally sterile.

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Where do we use Sterile Equipment and Implement
Sterile Technique?

• Operating room
• Labor and delivery
• Major diagnostic / special procedure areas
• At the bedside in 3 main situations
• 1) Procedures requiring intentional perforation
  of the skin
• ie. Inserting an IV or an injection
• 2) If the skins integrity is broken due to
  surgery or burns
• ie. Dressing changes / cleansing wounds
• 3) During procedures involving insertion of
  devices, into normally sterile body cavities
• ie. Urinary catheter

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HOW DO THINGS BECOME STERILIZED ?

• Autoclave - moist heat under pressure for
  surgical instruments
• Radiation - for drugs other heat sensitive
  items
• Chemicals - disinfect instruments (chlorine
  bleach)
• Ethylene Oxide Gas - for rubber and plastic
• What about boiling water?

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How do we know if an item is Sterilized?

• If commercially prepackaged (disposable)
• .. check the integrity of the package
• If reusable equipment (sterilized within the
  facility)
• check integrity / expiration date / also
  look for specially marked tape on the package

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AREAS WHERE STERILE EQUIPMENT IS USED AND STERILE
TECHNIQUE IS NECESSARY

• Operating room
• Labor and Delivery
• Major diagnostic areas
• At the bedside in 3 main situations
• intentional perforation of skin (IV/injection)
• when skin integrity is broken (dsg change)
• inserting device into sterile body cavity
  (catheter)

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Principles of Surgical Asepsis p 814 -
815Fundamentals text

• A sterile object remains sterile only when
  touched by another sterile object.
• Only sterile objects may be placed on a sterile
  field.
• A sterile object/ or field out of the range of
  vision, or an object held below waist level, is
  considered contaminated.
• A sterile object/or field, becomes contaminated
  by prolonged exposure to air.

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..Surgical Aseptic Principles
continued.

• If in contact with a wet contaminated surface,
  the sterile object/ or field becomes contaminated
  by capillary action.
• Microbes move in the direction of gravity.
• Edges of a sterile field are considered
  contaminated.a 2.5cm border.
• If ever in doubt - consider it unsterile!

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Preparing a a Sterile Dressing Tray
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• Prepare the sterile field..
• Sterile Pack
• Add item to the sterile field
• Add liquid to the sterile field.
• When all of the above is completeglove

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• STERILE GLOVES
• Dominant hand is gloved first. Do not touch
  outside of 1st glove, only the inside cuff (which
  is folded over)
• Then with sterile gloved dominant hand, pick up
  2nd glove by reaching under cuff.
• Keep thumb fully abducted ensure hands remain
  above the waistline.

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• Please refer to Skills testing schedule
• N125 Exam December 16, 2008 (0900h)
• _at_ Olands Center Gymnasium
• GOOD LUCK !