NurseReview.Org - Isolation Nursing Precautions


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  • NurseReview.Org - Isolation Nursing Precautions

    1. 1. Isolation Class 10 Last Class
    2. 2. Preventing the spread of infection <ul><li>What do we do when a client has a highly infectious disease? </li></ul>
    3. 3. Specific Infection Control Policies <ul><li>Isolation – the principle is to create a physical barrier that prevents the transfer of microorganisms. </li></ul>
    4. 4. What are appropriate barriers? Depending on - <ul><li>Organism Transmission </li></ul><ul><ul><li>Airborne </li></ul></ul><ul><ul><li>Vehicle </li></ul></ul><ul><ul><li>Contact </li></ul></ul><ul><ul><ul><li>Direct </li></ul></ul></ul><ul><ul><ul><li>Indirect </li></ul></ul></ul><ul><ul><ul><li>Droplet </li></ul></ul></ul>
    5. 5. Types of Barriers <ul><li>PPE (personal protective equipment) </li></ul><ul><ul><li>Gowns </li></ul></ul><ul><ul><li>Gloves </li></ul></ul><ul><ul><li>Masks </li></ul></ul><ul><ul><li>Eyewear </li></ul></ul>
    6. 6. <ul><li>Each institution is required to have infection control policies and guidelines. </li></ul>
    7. 7. What about when we don’t know? <ul><li>3 systems </li></ul><ul><ul><li>Universal precautions </li></ul></ul><ul><ul><li>Body substance precautions </li></ul></ul><ul><ul><li>Standard precautions </li></ul></ul>
    8. 8. Precautions to guard against the unknown <ul><li>Apply to everyone </li></ul><ul><li>General public </li></ul><ul><li>May or may not carry an infection </li></ul>
    9. 9. History Lesson <ul><li>Initially concerned with patient to patient </li></ul><ul><li>Followed by concern for health care professionals </li></ul><ul><li>1970 – Hepatitis B </li></ul><ul><li>1987 – HIV </li></ul><ul><ul><li>Universal precautions by Center for Disease Control (CDC) </li></ul></ul>
    10. 10. Universal precautions <ul><li>Stated : </li></ul><ul><li>All blood & body flds should be treated as potentially infectious. </li></ul>
    11. 11. Body Substance Isolation (BSI) <ul><li>Infection control practitioners in Seattle and SanDiego </li></ul><ul><li>Canada adopted policy but renamed it Body Substance Precautions (BSP) </li></ul>
    12. 12. Standard Precautions <ul><li>1996- newest guidelines by CDC combined the major features of universal precautions & BSP </li></ul>
    13. 13. 2 Tier System <ul><li>1996 CDC new guidelines </li></ul>
    14. 14. 1 st Tier – Standard Precautions <ul><li>Most important </li></ul><ul><li>Universal precautions + BSP </li></ul><ul><li>Applies to everyone </li></ul><ul><li>Primary strategies for prevention of infection </li></ul><ul><li>Standard precautions </li></ul><ul><ul><li>Blood, body flds., nonintact skin, mucus membranes </li></ul></ul>
    15. 15. 2 nd Tier <ul><li>Specific infections/diagnosis </li></ul><ul><li>Droplet, airborne, contact with contaminated surface </li></ul>
    16. 16. 3 Types Transmission Based Precautions <ul><li>Airborne, droplet, contact </li></ul><ul><li>Some infections combination (chicken pox) </li></ul><ul><li>These extra precautions are in addition to Standard Precautions </li></ul>
    17. 17. Airborne <ul><li>Travels on small particles </li></ul><ul><li>Air currents </li></ul><ul><li>Portal of entry – nose, mouth, mucus membranes </li></ul><ul><ul><li>Measles, chicken pox, TB </li></ul></ul>
    18. 18. Requirements for Airborne <ul><li>Negative pressure room – door closed </li></ul><ul><li>TB = HEPA filter </li></ul><ul><li>Do not enter if not immune to measles/chickenpox </li></ul><ul><li>Client wears mask when required to leave room </li></ul>
    19. 19. Droplet <ul><li>Large droplets of moisture </li></ul><ul><li>Coughing, sneezing, talking </li></ul><ul><ul><li>Travels 3 ft. or less </li></ul></ul><ul><ul><li>Enters nose / mouth </li></ul></ul><ul><ul><li>Mumps, pertusis, influenza </li></ul></ul><ul><li>Private room </li></ul><ul><li>Staff regular mask for 3 ft. </li></ul><ul><li>Client mask for transport </li></ul>
    20. 20. Contact <ul><li>Dry skin to dry skin = Direct </li></ul><ul><li>Dry skin to object = Indirect </li></ul><ul><li>Impetigo, herpes zoster, scabies </li></ul><ul><li>Gloves – for direct care or touching anything in the room </li></ul><ul><li>Private room or semi if cohort has same diagnosis </li></ul>
    21. 21. <ul><li>Remove gloves prior to exiting and wash hands </li></ul><ul><li>Gown for </li></ul><ul><ul><li>patient contact </li></ul></ul><ul><ul><li>Changing linen </li></ul></ul><ul><ul><li>Handling objects in the room </li></ul></ul>
    22. 22. <ul><li>Remove gown prior to exiting </li></ul><ul><li>Wash hands </li></ul><ul><li>Careful clothing does not touch room surfaces </li></ul>
    23. 23. Protective Isolation / Reverse isolation <ul><li>Compromised or suppressed immune system </li></ul><ul><li>Highly susceptible to infections </li></ul><ul><li>Protection from environmental pathogens </li></ul>
    24. 24. Protective Isolation / Reverse isolation <ul><li>What do you need ? </li></ul><ul><li>Private room – door closed </li></ul><ul><li>Gown, mask, gloves if direct contact </li></ul><ul><li>Wash hands </li></ul><ul><li>No plants / flowers </li></ul>
    25. 25. Procedure <ul><li>Before instituting </li></ul><ul><ul><li>EXPLAIN to client & family </li></ul></ul><ul><ul><ul><li>Disease </li></ul></ul></ul><ul><ul><ul><li>Purpose of isolation </li></ul></ul></ul><ul><ul><ul><li>Steps to follow </li></ul></ul></ul><ul><ul><ul><li>Time frame </li></ul></ul></ul>
    26. 26. Room Preparation <ul><li>Private with BR facilities </li></ul><ul><li>Sign on door </li></ul><ul><li>Isolation cart outside door </li></ul><ul><li>Laundry hamper in room </li></ul><ul><li>Waste basket with plastic bag </li></ul><ul><li>Thermometer, B/P cuff, stethoscope in room </li></ul><ul><li>Sharps receptacle </li></ul>
    27. 27. <ul><li>Be organized </li></ul><ul><li>Gather equipment prior to entering room </li></ul><ul><li>Remove rings and wash hands </li></ul><ul><li>Don PPE </li></ul><ul><li>Gown usually disposable </li></ul><ul><li>Gloves up over cuff of gown </li></ul>
    28. 28. <ul><li>Put your watch in a plastic bag if no clock in room </li></ul><ul><li>Linen is placed in a water soluble bag & then cream/yellow bag </li></ul><ul><li>No special treatment for dishes / trays </li></ul>
    29. 29. Exiting Room <ul><li>Untie gown at waist </li></ul><ul><li>Remove gloves properly </li></ul><ul><li>Remove mask </li></ul><ul><li>Untie gown at neck, drop over shoulders, don’t touch outside, fold inwards, and discard </li></ul>
    30. 30. Exiting Room <ul><li>Wash hands </li></ul><ul><li>Use paper towel on door handle </li></ul><ul><li>Wash hands again outside room </li></ul><ul><li>Important to do as much client care as you can while you are in the room….CLUSTER ACTIVITY. </li></ul>
    31. 31. Basic Principles <ul><li>Wash hands prior to entering & exiting room </li></ul><ul><li>Careful disposal of contaminated materials </li></ul><ul><li>Knowledge of disease and mode of transmission </li></ul><ul><li>Protection of client and public during transport </li></ul>
    32. 32. Client Consideration <ul><li>Isolation </li></ul><ul><li>Loneliness </li></ul><ul><li>Self – esteem, body image </li></ul><ul><li>Boredom </li></ul>
    33. 33. Sterile Technique / Surgical Asepsis <ul><li>Purpose – to eliminate all microorganisms from objects that come into contact with the tissues of the body that are normally sterile. </li></ul>
    34. 34. Practice Areas <ul><li>Operating room </li></ul><ul><li>Labor and delivery </li></ul><ul><li>Major diagnostic area </li></ul><ul><li>At the bedside in 3 main situations </li></ul><ul><ul><li>Procedures requiring intentional perforation of the skin </li></ul></ul>
    35. 35. <ul><ul><li>When the skin’s integrity is broken due to surgery or burns </li></ul></ul><ul><ul><li>During procedures involving insertion of devices into normally sterile body cavities </li></ul></ul>
    36. 36. <ul><li>Any break in technique could result in contamination increasing clients risk for infection. </li></ul>
    37. 37. Methods of Sterilization <ul><li>Steam – most common </li></ul><ul><li>Dry heat </li></ul><ul><li>Ethylene oxide gas </li></ul><ul><li>Chemicals </li></ul><ul><li>Indicator of sterility – </li></ul><ul><ul><li>tape on pkg. turns color or forms lines </li></ul></ul><ul><ul><li>Expiration Date </li></ul></ul>
    38. 38. Examples of sterilization processes <ul><li>Moist heat /steam </li></ul><ul><li>Radiation </li></ul><ul><li>Autoclave- instruments, parental solutions, dressings </li></ul><ul><li>Drugs, foods, heat sensitive items </li></ul>
    39. 39. Examples of sterilization processes <ul><li>Chemicals </li></ul><ul><ul><li>All types microorganisms </li></ul></ul><ul><ul><li>Rapid action </li></ul></ul><ul><ul><li>Work with water </li></ul></ul><ul><ul><li>Stable in heat & light </li></ul></ul><ul><ul><li>Inexpensive </li></ul></ul><ul><ul><li>Not harmful to body tissue </li></ul></ul><ul><li>Instruments </li></ul><ul><li>Glass thermometers </li></ul><ul><li>Ex. Chlorine – used to disinfect water & for housekeeping purposes </li></ul>
    40. 40. Examples of sterilization processes <ul><li>Ethylene oxide gas </li></ul><ul><ul><li>Destroys microorganisms by altering cells’ metabolic processes. </li></ul></ul><ul><li>Rubber </li></ul><ul><li>Plastic </li></ul>
    41. 41. Examples of sterilization processes <ul><li>Boiling water </li></ul><ul><ul><li>Cheap </li></ul></ul><ul><ul><li>Imp. – bacterial spores andsome viruses resist boiling. Not used in hospitals! </li></ul></ul><ul><li>Items should be boiled for at least 15 min. </li></ul>
    42. 42. Practical Exam <ul><li>Prepare a sterile field </li></ul><ul><li>Add an item </li></ul><ul><li>Add a liquid </li></ul><ul><li>Don sterile gloves </li></ul>