VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...
4 Barrier Precautions and Isolation .ppt
1. MTI, Khyber Teaching Hospital, Peshawar
BARRIER PRECAUTIONS AND
ISOLATION
By
Rehmat Ullah
Nursing Director, MTI KTH, Peshawar
2. MTI, Khyber Teaching Hospital, Peshawar
Objectives of the Session
The participants will be able to;
Describe Standard precautions
Discuss Safe Injection Practices
Demonstrate Careful handling of sharps
Discuss Contact transmission & Isolation,
Droplet transmission & Isolation, Airborne
transmission & Isolation
Describe types of PPE & Criteria for Selection
3. MTI, Khyber Teaching Hospital, Peshawar
STANDARD PRECAUTIONS
Adaptation of uniform precautions for all patients regardless of
their diagnosis is called Standard (Universal) Precautions
Designed to reduce the risk of transmission of micro-organisms
from both recognized and unrecognized sources of infection in
the hospital.
Applies to all patients regardless of their diagnosis.
Shall be implemented when contact with any of the following are
anticipated:
Blood
All body fluids, secretions and excretions, with the exception of sweat
regardless of whether or not they contain visible blood.
Non-intact skin (this includes rashes)
Mucous membranes
4. MTI, Khyber Teaching Hospital, Peshawar
STANDARD PRECAUTIONS
1. Correct Hand hygiene practices
2. Use of personal protective equipment (e.g., gloves, gowns,
masks)
3. Safe handling of potentially contaminated equipment/surfaces/
sharp disposal in the patient environment.
4. Safe injection practices
5. Respiratory hygiene/cough etiquette
6. Reprocessing of equipment
7. Use of aseptic technique
8. Environmental cleaning
9. Safe handling and disposal of stock, linen and waste; and
10. Safe handling and transport of patient specimens.
5. MTI, Khyber Teaching Hospital, Peshawar
1. HAND HYGIENE:
Hand hygiene should be maintained before and after each physical contact as
per MTI-KTH hand hygiene guideline.
Effective hand hygiene relies on three mechanisms
of action
1. The rubbing action, or friction, that enables the
mechanical removal of microorganisms;
2. The antimicrobial properties of the hand cleansing
product (e.g. ABHR, soap) killing remaining
microorganisms; and
3. The drying of hands after hand cleaning to reduce
further spread of microorganisms.
ABHR=Alcohol-based hand rub
STANDARD PRECAUTIONS
7. MTI, Khyber Teaching Hospital, Peshawar
Hand hygiene to minimize spread of
infection
WHO 's “My 5 Moments for
Hand Hygiene”:
1. Before Touching a Patient
2. Before Clean/Aseptic
Procedure
3. After Body Fluid Exposure
Risk
4. After Touching a Patient
5. After Touching Patient
Surroundings
8. MTI, Khyber Teaching Hospital, Peshawar
STANDARD PRECAUTIONS
2. USE OF PERSONAL PROTECTIVE EQUIPMENT
(PPE)
a. GLOVES:
Gloves should be worn whenever there is a risk of exposure with the
following:
1. Blood or Blood products
2. Body fluids;
a) Urine. b) Feces. c) Saliva.
d) Mucous membranes. e) Wound drainage. f) Drainage
tubes.
g) Broken skin. h) Performing Venipuncture or other invasive procedures
i) Amniotic fluid, Cerebro – Spinal fluid, Pericardial/ Pleural fluid, Peritoneal fluid,
Synovial fluid.
9. MTI, Khyber Teaching Hospital, Peshawar
2. USE OF PERSONAL PROTECTIVE
EQUIPMENT (PPE) (Cont……)
b. MASKS:
Should be worn during procedures that are likely to generate droplets
/splashing of blood / body fluids and removed after procedure.
c. GOWN /APRON:
Should be worn when there is potential for soiling clothing with blood / body
fluids.
d. EYE SHIELD /GOGGLE:
Wear eye shield /goggle over the eyes during procedures that are likely to
generate splash of blood / body fluids.
e. SHOE COVERS:
Shoe cover should be used while cleaning spillage, entering into restricted
areas without changing personal shoes etc.
f. RESUSCITATION EQUIPMENT:
Mouth pieces or other ventilation devices should be available as alternatives for
mouth to mouth resuscitation.
11. MTI, Khyber Teaching Hospital, Peshawar
Selection of PPE
Appropriate PPE should be selected;
To prevent contamination of skin and/or clothing
To be guided by the anticipated type and
amount of exposure to blood and body
substances
According to the likely transmission route of
microorganisms
12. MTI, Khyber Teaching Hospital, Peshawar
STANDARD PRECAUTIONS
3. SAFE HANDLING OF POTENTIALLY CONTAMINATED
EQUIPMENT/SURFACES/ SHARP DISPOSAL IN THE
PATIENT ENVIRONMENT:
Keep handling to a minimum
Do not recap, bend or break needles after use
Discard each needle into a sharps' container at the point
of use
Do not overload a bin if it is full
Do not leave a sharps' bin in the reach of children
13. MTI, Khyber Teaching Hospital, Peshawar
4. Safe injection practices
Breaches in handling practices has resulted in
transmission of HIV and viral hepatitis and in some
cases caused outbreaks of disease
Standard precautions, particularly aseptic technique,
form the basis of safe injection practices;
1. Applying aseptic technique
2. Sharp injecting devices
3. Intravenous solutions
4. Flushing
5. Medication vials and ampoules
6. Multi-dose vials
14. MTI, Khyber Teaching Hospital, Peshawar
Perform hand hygiene
Ensure that reusable equipment used for aseptic technique
procedures are cleaned and disinfected between use
Use aseptic technique in all aspects of parenteral medication
administration, medication vial use and injections.
Store and prepare medications and supplies in a clean area on
a clean surface.
Never store needles and syringes unwrapped as sterility cannot
be assured
Discard all opened vials (including multi-dose vials), IV solutions
and prepared or opened syringes that were involved in an
emergency situation
Safe injection practices
Applying aseptic technique
15. MTI, Khyber Teaching Hospital, Peshawar
Open the sterile needle, cannula, syringe or Epi-pen from
package immediately prior to use.
Needles, cannulae and syringes are sterile, single-use
items; do not reuse these for another patient or to access a
medication or solution that might be used for a subsequent
patient.
Use safety engineered sharps devices whenever possible.
Discard syringes, needles and cannulae at the point of
care in an approved sharps container.
Safe injection practices
Sharp injecting devices
16. MTI, Khyber Teaching Hospital, Peshawar
Protective packaging should not be removed until immediately
prior to use.
Never use intravenous solution containers (e.g. bags or bottles)
to obtain flush solutions for more than one patient
Additions to intravenous fluids should be made under controlled
conditions
Begin/initiate administration of spiked IV solutions (IV bag
entered by the tubing spike) within one hour of preparation
Check the expiry date on IV solution; do not use if it is expired
Disinfect IV ports using friction and 70% (v/v) alcohol, and allow
to air dry prior to accessing.
Replace the entire IV tubing if disconnected, except the transient
controlled disconnections
Safe injection practices
Intravenous solutions
17. MTI, Khyber Teaching Hospital, Peshawar
Single dose syringes should be used for flush solutions.
Disinfect IV ports using friction and 70% (v/v) alcohol, and
allow to air dry before accessing.
Safe injection practices
Flushing
18. MTI, Khyber Teaching Hospital, Peshawar
Follow the manufacturer’s instructions for storage and use.
Use single-use ampoules or single-dose vials
Never enter a vial with a syringe or needle/cannula that has
been used on a patient
Cleanse the rubber stopper/bung of the vial
Discard single dose vials after use
Unwanted portions of ampoules must be discarded at the time
the dose is prepared
Never store medication vials in clothing or pockets
Inspect vials and discard if sterility has been compromised
Examine the vial for any particulate matter, discoloration or
turbidity. If present, do not use and discard immediately
Safe injection practices
Medication vials and ampoules
19. MTI, Khyber Teaching Hospital, Peshawar
Should be used for a single patient whenever possible and
discarded immediately after use
Must only be used between multiple patients where there is
no other alternative product available
Keep multi-dose vials away from the immediate patient
environment
Dispose of opened multi-dose medication vials 28 days
after opening, or unless specified otherwise by the
manufacturer
Reflect date opened and/or date of expiration
Safe injection practices
Multi-Dose Vial
20. MTI, Khyber Teaching Hospital, Peshawar
Safe injection practices
5. USE OF ASEPTIC TECHNIQUE
set of practices aimed at minimising contamination
and is particularly used to protect the patient from
infection during procedures
1. Sequencing
2. Environmental control
3. Hand hygiene
4. Maintenance of aseptic fields
5. PPE
21. MTI, Khyber Teaching Hospital, Peshawar
The five essential principles of aseptic technique are:
1. Sequencing:
Performing a risk assessment
Pre-procedure preparation
Performing the procedure
Post procedure practices, handover and documentation
2. Environmental control:
Ensure there are no avoidable nearby environmental risk factors, such
as bed making or patients using commodes
3. Hand hygiene:
Perform hand hygiene before a procedure and after a procedure or
body fluid exposure
Safe injection practices
USE OF ASEPTIC TECHNIQUE
22. MTI, Khyber Teaching Hospital, Peshawar
The five essential principles of aseptic technique are:
4. Maintenance of aseptic fields:
Cleaning and/or disinfection of key site(s) and key part(s) prior to
procedure(s)
Establishing an aseptic field
Use of sterile equipment
Maintenance of the aseptic field, including protecting the key sites
and key parts
Use of a non-touch technique
5. PPE:
Correct selection and use of sterile and non-sterile PPE
Safe injection practices
USE OF ASEPTIC TECHNIQUE
23. MTI, Khyber Teaching Hospital, Peshawar
STANDARD PRECAUTIONS
6. Safe handling and disposal of stock, linen and
waste; and Safe handling and transport of
patient specimens
B .LAB SPECIMENS:
Use leakproof container
should be labeled with biohazard symbol for shipping
If outside contamination of the primary container occurs,
it should be placed within a second container
24. MTI, Khyber Teaching Hospital, Peshawar
STANDARD PRECAUTIONS
C. BLOOD SPILLS
Shall be cleansed by following Spillage Guideline
Decontaminate the area using the approved solution
Gloves should be worn during cleaning and decontamination
D. LINEN
Gloves should be worn while handling solid/dirty linen
The soiled/wet linen should not be shaken and should be rolled
outward to inward and place in an alginate bag then in white bag label
it and finally disposed in The Linen Hamper & sent to the laundry.
Linen contaminated with cytotoxic material, or if indicated by infection
control should be double bagged in red bags, labeled and sent for
incineration
E. CLINICAL/INFECTIOUS WASTE:
Clinical waste should be disposed in designated container by the user.
25. MTI, Khyber Teaching Hospital, Peshawar
DEALING WITH SPILLAGE
What is Major Spill
Quantity
More than 30 ml of liquids
More than 30 grams of solid
Concentration
High concentrated Acid or Alkali
Characteristics of Spill
Flammable / Ignitable – can lead to fire
Toxicity- can lead to inhalational or skin injury
Corrosive – damage to skin and eyes
Substances like mercury spill
26. MTI, Khyber Teaching Hospital, Peshawar
a. LIQUID SPILL MANAGEMENT
Protocols for cleaning Spillage of Blood
Wear Gloves
Pour, without splashing, a disinfectant appropriate for the
size and surface contaminated, e.g. Isopropyl alcohol,
Dakin’s or house hold bleach 1: 100 dil or 1: 10 dilution.
Place absorbent paper (e.g. news / tissue paper over the
spill. Allow a contact time of 20 minutes.
Wipe up the spill. Put absorbent paper in the yellow bag.
Wash hands (with gloves on).
Remove gloves.
Wash hands.
27. MTI, Khyber Teaching Hospital, Peshawar
b. MERCURY SPILL MANAGEMENT
Protocols for Mercury Spillage
1. Remove everyone from the area that has been contaminated with
mercury.
2. Keep the heat below 200 C and ventilate the area.
3. Put on face mask in order to prevent breathing of mercury vapor.
4. Remove all jewelry from hands and wrists.
5. Use Personal Protective Equipment while handling mercury.
6. Cardboard sheets should be used to locate and push the spilled
beads of mercury together.
7. Mercury should be placed carefully in a container with some water.
8. Never us a broom or vacuum cleaner.
9. It should be disposed off at hazardous waste facility or given to a
mercury-based equipment manufacture.
28. MTI, Khyber Teaching Hospital, Peshawar
STANDARD PRECAUTIONS
7. RESPIRATORY HYGIENE/COUGH ETIQUETTE:
Alerts to clients
Cover the mouth and nose when coughing and sneezing
Perform hand hygiene after contact with respiratory
secretions & contaminated objects.
Maintain an appropriate distance from & between
symptomatic patients, at least 1 meter (3 feet).
Identify persons with symptoms suggestive of acute
respiratory illness & teach them to use a surgical mask &
practice cough etiquette.
screen patients for symptoms of respiratory infections &
provide a separate space in the waiting area distant from
other patients (at least 1 meter/3 feet).
29. MTI, Khyber Teaching Hospital, Peshawar
STANDARD PRECAUTIONS
8. Reprocessing of equipment
Single patient use - for use only on the same patient.
Reusable invasive equipment - used once then decontaminated e.g. surgical
equipment.
Reusable non-invasive equipment - reused on more than one patient
following decontamination between each use e.g. commode, patient trolley.
All sterilized packaged items must be checked for visible contamination, expiry
dates and that the package is intact.
Decontamination of reusable non-invasive care equipment must be
undertaken:
between each use;
after blood or body fluid contamination;
at regular predefined intervals as part of an equipment cleaning protocol;
before disinfection; and
before inspection, servicing or repair.
All reusable non-invasive equipment must be rinsed and dried following
decontamination then stored clean and dry.
30. MTI, Khyber Teaching Hospital, Peshawar
STANDARD PRECAUTIONS
9. Environmental cleaning
Prompt disposal of single use items, such as adhesive tapes
and gloves, after use
Large surfaces and surfaces frequently touched by patients,
such as bed rails, chair rails, tables and door handles, are
routinely cleaned
Devices frequently touched by patients and HCWs, including
sphygmomanometer, Glucometer, IV pumps and monitors are
routinely cleaned
All blood and body substance spills are cleaned and disinfected
Minimize clutter in shared administrative areas, such as clinical
nurses workstations, and
Ensure that keyboards, computers, tablets, telephones
(including personal mobiles) and other frequently touched
surfaces are routinely cleaned
33. MTI, Khyber Teaching Hospital, Peshawar
MODES AND ROUTES OF
TRANSMISSION
A mode of transmission describes how a
microorganism moves between individuals.
Transmission can either occur;
Vertically, from mother to child, or
Horizontally, between individuals who are not necessarily
related.
horizontal transmission will use either a direct or indirect
mode of transmission to leave the current host and
colonise the next host
Routes of transmission may involve;
Direct contact & indirect contact
Droplet, Airborne and/or vector-borne
34. MTI, Khyber Teaching Hospital, Peshawar
CONTACT TRANSMISSION ROUTES
Refer to the movement of microorganisms from a
colonised or contaminated source to a susceptible
host, via either direct or indirect physical contact
Direct contact transmission involves skin-to-skin contact
and the physical transfer of microorganisms directly from one
person to another person
From colonized HCW & Patient to Other
Indirect contact transmission involves the initial transfer of
microorganisms from a host individual to an intermediary
object and then subsequent transfer to another individual.
Contact with fomites and the environment.
35. MTI, Khyber Teaching Hospital, Peshawar
DROPLET TRANSMISSION ROUTE
Involves large droplets carrying microorganisms
from a colonised or infected individual, often
produced by coughing, talking and breathing
Due to their size, large droplets can only travel
very short distances (≤ 1 metre) before either
settling and contaminating surfaces, mucosa,
Therefore, requires close contact between the
colonised or infected host and other susceptible
individuals
36. MTI, Khyber Teaching Hospital, Peshawar
AIRBORNE TRANSMISSION ROUTE
A form of indirect transmission that occurs by the
dissemination of small expelled aerosols that can
carry microorganisms.
Aerosols are much smaller than droplets and are
often produced by coughing, talking and breathing
as well as during clinical aerosol generating
procedures (AGP) such as suctioning, intubation
and chest physiotherapy.
Such aerosols can travel long distances and can
remain suspended in the air for prolonged periods
of time
37. MTI, Khyber Teaching Hospital, Peshawar
COMMON SOURCE ROUTE
The spread of microorganisms from a single
source.
Often facilitated by the contamination of food or
water and is best illustrated by institutional
foodborne outbreaks.
38. MTI, Khyber Teaching Hospital, Peshawar
Simultaneous transmission routes
Simultaneously employ multiple transmission
routes.
For example,
NOROVIRUS can be spread by direct contact, indirect
contact, droplet transmission and common-source
transmission through contaminated food.
39. MTI, Khyber Teaching Hospital, Peshawar
TRANSMISSION-BASED PRECAUTIONS
Transmission-based precautions are to be
applied in addition to standard precautions.
There are three types of transmission-based
precautions, tailored to the different forms of
transmission:
Contact precautions
Droplet precautions; and
Airborne precautions.
41. MTI, Khyber Teaching Hospital, Peshawar
INTRODUCTION
Isolation precautions are needed to prevent the
transmission of pathogenic microorganisms within
the healthcare setting.
The patients of following disease categories
should be treated under isolation.
Severe influenza cases, Sub-acute respiratory
Syndrome (SARS), Open case of tuberculosis,
Anthrax, diphtheria, Pertussis, Pneumonic plague,
Chicken pox, and patients infected with multidrug
resistant bacterial pathogens
42. MTI, Khyber Teaching Hospital, Peshawar
ISOLATION POLICIES
Patient placement - Appropriate patient placement is
a significant component of isolation precautions.
Determine patient placement based on the following
principles:
Route(s) of transmission of the infectious agent
Risk factors for transmission in the infected patient
Risk factors for adverse outcomes resulting from health
care associated infection in other patients in the area.
Availability of single-patient rooms
Patient options for room-sharing
43. MTI, Khyber Teaching Hospital, Peshawar
CONTACT PRECAUTIONS
PURPOSE
It is the intent of this facility to use contact precautions for patients
known or suspected to have serious illness easily transmitted by
direct patient contact or by contact with items in the patient’s
environment. Examples include;
1. Multiresistant organisms e.g.,
a. Methicillin resistant staphylococcus aureus (MRSA)
b. Pan resistant Acinetobacter
c. Vancomycin resistant enterococci (VRE)
d. Carbapenemase-producing Enterobacteriaceae (CRE)
e. Any other resistant organisms
2. Scabies
3. Clostridium difficile diarrhoea
4. Open draining wounds
45. MTI, Khyber Teaching Hospital, Peshawar
DROPLET PRECAUTIONS
PURPOSE:
It is intent of this facility to use droplet precautions to decrease the risk of droplet transmission
of infectious agents.
Droplets may be generated by patient’s coughing, sneezing, talking, or during the performance
of procedure, e.g., suctioning. Droplet precautions may be considered for:
Disease Duration
Pertussis 9 days after start of treatment
Rubella 7 days after onset or rash
Mumps 9 days after onset of swelling
Meningococcal infections 1 day after start of treatment
Meningitis (Haemophilus influenza, type b) 1 day after start of treatment
Influenza 5 days after onset of illness
Mycoplasma pneumonia Until resolution of symptoms
Plague (pneumonic) 2 days after treatment
Diphtheria (pharyngeal) Until two cultures negative
47. MTI, Khyber Teaching Hospital, Peshawar
AIRBORNE PRECAUTIONS
PURPOSE: It is intent of this facility to use precautions to decrease risk of air borne
transmission of infectious diseases. These precautions will be used for patients known or
suspected to be infected with a disease spread by small droplet nuclei (5mm or small).
These include:
Disease Duration
Pulmonary tuberculosis 14 days after start of effective therapy
Chickenpox or Herpes Zoster until crusting of lesions
Measles 4 days after onset of rash
SARS 10 days after resolution of symptoms
Small pox until all scabs have crusted
Viral Hemorrhagic fever Duration of Illness plus contact measures
(Due to Lassa, Marburg, Crimean-Congo fever viruses)
Develop systems (e.g., triage, signage) to identify patients with known or suspected
infections that requires Airborne Precautions upon entry into the health facility.
49. MTI, Khyber Teaching Hospital, Peshawar
ISOLATION PROCEDURE
DROPLET PRECAUTIONS:
1. All steps as in STANDARD PRECAUTIONS PLUS
2. MASK - a mask should be worn within 3 feet of the patient.
CONTACT PRECAUTIONS
1. All steps as in STANDARD PRECAUTIONS PLUS
2. GLOVES - Gloves should be worn when entering the
room.
3. GOWNS - A gown should be worn for contact with the
patient and with patient items.
AIRBORNE PRECAUTIONS
1. All steps as in STANDARD PRECAUTIONS PLUS
2. MASK - An N-95 respirator (mask)
50. MTI, Khyber Teaching Hospital, Peshawar
ISOLATION PROCEDURE
Place patient in a single-patient room
Use of personal protective equipment
Patient transport
Limit transportation,
If needed, infected or colonized areas of the patient’s body are contained and
covered
Don clean PPE
Handle patient-care equipment and instruments/devices according to
Standard Precautions
Ensure room environment is clean before and after visit/transportation