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119 Cards in this Set
- Front
- Back
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CDC Recommendation ranking Scheme
Category IA |
strongly supported by research, effective and applicable in most hospitals
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CDC Recommendation ranking Scheme
Category IB |
supported by some clinical research, have strong theoretical rationale. Practical to implement in most hospitals.
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CDC Recommendation ranking Scheme
Category II |
proposed by some researchers and suggested for implementation in many hospitals. Strong theoretical basis for practice
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CDC Recommendation ranking Scheme
No recommendation |
Practices that have little to no evidence or consensus regarding if efficacy exists.
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2 Tiers of Isolation Precautions
when should you utilize Standard precautions? |
Should always do!
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2 Tiers of Isolation Precautions
Transmission precautions... main idea? |
(May be additional to standard precautions)
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What are Standard Precautions?
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Standard Precautions include: handwashing, gloves, mask, eye protection, face shield, gowns, patient care equipment, environmental controls, linen handling, and OSHA standards for working in the healthcare environment.
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Standard precautions are considered which tier of precaution?
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1st Tier Precautions and 1st Tier Precautions should always be taken.
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What are Transmission-Based Precautions?
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Transmission-Based precautions are designed for patients documented or suspected to be infected with highly transmissible pathogens and require additional precautions.
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Transmission-Based precautions are considered which tier?
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a second tier precaution and may be used in addition to standard
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3 Types of Transmission-Based precautions:
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Contact
Droplet Airborne |
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Contact Precautions
main idea? |
highly transmittable, spread by close or direct contact, so masks, gowns and gloves if in close or direct contact
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Contact Precautions
associated diseases |
Acute respiratory infections or influenza, pharyngitis or pneumonia in infants or young children
Conjunctivitis in newborns Diphtheria, Staph in newborns Herpes severe or in newborns Impetigo, Multiply resistant bacteria (influenza, staph) Rabies, Rubella scabies |
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Droplet Precautions
main idea? |
prevents transmission of infectious diseases over short distances through air (droplet transmission) and occasional direct or indirect contact transmission
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Droplet Precautions
Specifications |
Private room or private cubicle if in the outpatient setting
Masks Handwashing Bagging of infectious material |
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Droplet Precautions
Diseases |
Epiglottis, Measles, Meningitis
Meningococcal pneumonia Mumps, whooping cough- pertussis Pneumonia, Haemophilis influenza |
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Airborne Precautions
main idea |
prevents infections that are transmitted by airborne droplet nuclei (small residue 5microns or smaller in size).
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Airborne Precautions
Specifications |
Airborne infection isolation room (AIIR): negative pressure room
Respirator mask: Gowns if soiling likely Gloves for contact, Handwashing Proper disposal of contaminated items, Patient transport limited. |
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Diseases commonly in airborne isolation
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TB
SARS MRSA Measles Varicella Smallpos |
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Modifications for Isolation Procedures
Unit Based, ICU |
patients have more bugs and are more susceptible, also need multiple procedures that put them at risk. private rooms, not always good because of patient accessibility, may have curtains
handwashing |
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Modifications for Isolation Procedures
Unit Based, Infants and newborns- |
plenty of staff for time for handwashing. room between cribs. good handwashing. Incubators are not a form of isolation . During outbreaks, establish groupings or cohorts
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Modifications for Isolation Procedures
Severely Compromised pts - (CA, burns, immunocompromised, transplant |
more susceptible to infections
may need protective isolation private room great pt care skills and precautions |
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Modifications for Isolation Procedures
Burn Units |
easily infected
need to prevent transfer to other patients need to prevent further colonization of own patient each center has guidelines |
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Category versus Disease Specific Isolation
Category specific groups pts by... |
the type of isolation precautions needed
Category is more general and can be implemented earlier |
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Category versus Disease Specific Isolation
Disease specific groups pts by ... |
their specific disease
Isolation needs to be more stringent for infants and children because of the increased risk of transmission. Disease specific will save money |
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CDC Recommendations and Isolation Precautions
Advantages |
designed to prevent the spread of microorganisms among pts, personnel and visitors
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CDC Recommendations and Isolation Precautions
Disadvantages |
time consuming, Costly, inconvenient for staff and visitors
difficult to give prompt care, space difficulty due to private rooms forced solitude is difficult for pts |
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It is always safer to overisolate than under isolate
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When in doubt... isolate.
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Standard Precaution Guidelines
Handwashing |
The single most important means of preventing the spread of nosocomial infection
You must wash your hands before and after all Pt contact Physicians have been found to be the greatest offender You may have to wash multiple times for the same pt CDC Recommendation - IA |
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Standard Precaution Guidelines
Handwashing,- routine |
at least 15 seconds with soap
Healthcare personnel use antimicrobial soaps, foams and rinses |
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Standard Precaution Guidelines
Handwashing,- Scrubbing for a sterile field... times. |
long scrub 7 - 10 minutes
short scrub 3 - 5 minutes depends on institutional policies |
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Handwash
basic idea |
minimum 10 seconds
remove all jewelry except wedding band, turn on water, wet hands soap in palm, vigorously wash and rinse, dry with paper towel turn off water with paper towel and discard |
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Personal Protective Equipment
Apparel, Scrubs |
Are not sterile
Limit introduction of infectious agents to the sterile environment Ease movement Avoids soiling of clothes |
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Personal Protective Equipment
Apparel, masks (main idea) |
Act as a barrier to dispersal and receipt of infectious airborne material
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Personal Protective Equipment
Apparel, masks (2 kinds) |
Protect against
1. Large particle aerosols (droplets) transmitted by close contact and travel short distances (approximately 3 feet) 2. Small particle aerosol (droplet nuclei) travel larger distances and remain suspended in the air |
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Masks are recommended for persons who will...
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1. Coming in contact with patients with infections transmitted by large or small particle aerosols
2. Who have an infection that could be spread to an immunosuppressed pt |
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Personal Protective Equipment
Eye Protection, main idea |
Shields, glasses and goggles protect the eyes from contact with infected material or airborne contaminates
Shields and goggles protect in front as well as on the sides, are made of clear plastic and can be worn over glasses |
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Personal Protective Equipment
Gowns, main idea |
Prevent soiling and contamination by infectious materials
Prevent transmission of infection Create a sterile field |
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Personal Protective Equipment
Gloves, main idea |
Worn as a universal precaution to prevent transmission of infection from personnel to pt, pt to personnel
Sterile gloves are required for invasive procedures or for touching open wounds.They are all single use. You must wash your hands after removal |
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Personal Protective Equipment
Gloves, when are non sterile gloves used? |
Non-sterile gloves are worn if there is the potential to be in contact with potentially infectious materials, blood and body fluids
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Pt care equipment
categories |
Critical Items
Semicritical Items Noncritical Items |
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Pt care equipment
Critical Items |
Items that are introduced directly into the circulatory system or other areas of the body that are normally sterile. I.e. surgical instruments, implants...
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Pt care equipment
Semicritical Items |
These items have a lower degree of risk of infection However, these items are introduced into body cavities. i.e.: ETT, endoscopes...
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Pt care equipment
Noncritical Items |
Items that do not touch the pt or touch the Pt in area that are not sterile: i.e. intact skin. IE: BP cuffs, crutches.
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Rooms and Transporting of Patients
Transporting of patients, main idea? |
If isolation precautions are in effect, transportation of patients should be limited. PT care will be in the patient room.
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Rooms and Transporting of Patients
Room mates, who rooms together? |
If a Pt is not placed in a private room, they will need to be placed with appropriate room mates: infected with the same organism, or highly unlikely to transmit to each other
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Cleanliness: 3 levels (Includes Pt. equipment and Pt areas):
Cleaning |
physical removal of organic material or soil from objects.
Usually done with water, with or without detergents. Least rigorous form and only removes microorganisms, it does not kill them. It usually proceeds the next 2 levels. |
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Cleanliness: 3 levels (Includes Pt. equipment and Pt areas):
Disinfection |
intermediate level between cleaning and sterilization. 3. levels: high, intermediate and low. Performed using pasteurization or chemical germicides.
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Cleanliness: 3 levels (Includes Pt. equipment and Pt area
Sterilization |
highest level of cleanliness. Destruction of all forms of microbial life by steam under pressure, liquid or gaseous chemicals, or dry heat.
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Types of sterilization procedures
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Steam (cheap)
Ethylene oxide gas (more $) Dry heat (for oils and powders) Liquid chemicals (all other apps) |
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Types of Disinfection
Hot water |
pasteurization, used mostly for respiratory therapy equipment
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Types of Disinfection
Pool and tanks |
cleaned every 1-2 weeks, water temp, chlorine and filter Systems help decrease infection
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Types of Disinfection
Hubbard tanks and whirlpools (when disinfected?) |
must be disinfected after each Pt
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Waste Disposal
Special precautions are usually taken for the following wastes: |
Microbiological lab wastes
Pathology wastes Blood specimens Blood products |
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Disposal of articles: contaminated items are bagged in appropriate colored bags...
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Red- infectious waste
Yellow- infectious linen Clear- noninfectious waste |
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Asepsis
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absence of microorganisms that produce disease
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Aseptic technique
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the methods and procedures used to create and maintain a sterile field
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Bacterial Barrier
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a barrier that keeps microorganisms from coming in contact with sterile items
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Contaminated
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An item surface or field that has come in contact with anything that is not sterile
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Nosocomial Infection:
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infection acquired while in the hospital for treatment of something else
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Shelf Life
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length of time that an item that is considered to be sterile remains sterile in its unopened package.
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Sterile:
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absence of living microorganisms
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Sterile Field
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an area in which there is no microorganisms considered to be living.
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Unsterile (nonsterile):
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anything that has not been sterilized, has come into contact with something that is not sterile, or has exceeded its shelf life.
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What is a sterile field
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A sterile field is a type of aseptic technique used to provide an area for treatment that is free of microorganisms
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There are eight requirements for creation and maintenance of a sterile
Requirement 1 |
All items within the boundaries of a sterile field must be sterile.
Proper initial packaging, Proper initial sterilization, Proper package storage, No mishandling, Used within the shelf life |
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There are eight requirements for creation and maintenance of sterile field
Requirement 2 |
Once opened, the edges of a sterile package are no longer sterile
Avoid touching the edges, or having the edges touch the package contents. Single use items are always preferred |
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There are eight requirements for creation and maintenance of a sterile field
Requirement 3 |
Once donned, gowns are sterile in the front from the shoulder to the table top including the sleeves
This is why the hands must be above the table top level at all times Unsterile personnel can only assist with tie ends using sterile forceps |
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There are eight requirements for creation and maintenance of a sterile field
Requirement 4 |
Table and patient drapes are considered sterile above the table top level and only on the top of the surface
Surfaces below the waist level are unsterile areas |
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There are eight requirements for creation and maintenance of a sterile field
Requirement 5 |
Only sterile items and personnel in sterile attire may enter a sterile area
Only sterile items and personnel in sterile attire may touch sterile items Sterile forceps are used to pass items into the sterile area (the forceps can only be used 1 time when going from unsterile to sterile |
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there are 8 req. for a sterile field
Requirement 6 |
Once you leave a sterile area , you can not re-enter until re-scrubbing, gowning and gloving. Never lean or sit on unsterile surfaces when you are in sterile attire. Be cautious when in a sterile area to not contaminate. Always be aware of your boundaries. Any infringement must be pointed out immediately to protect the pt
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there are 8 req. for a sterile field
Requirement 7 |
Penetration of a sterile covering or barrier causes contamination (usually by liquids, air or you)
Airflow is also a problem, OR's tend to be climate controlled and purified, they use air pressure gradients to cause air to flow away from the sterile site |
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there are 8 req. for a sterile field
Requirement 8 |
If in doubt, deem the area unsterile
Always protect the Pt Prepare the area immediately before use Never leave the area unattended Long delays will require new sterile fields |
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Setting Up A Sterile Field
Using a clean gown with sterile gloves |
what we will use for wound care
can push hands all the way thru the sleeves. open the gloves package drop on the sterile towel open gloves and don as above |
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Setting Up A Sterile Field
Removal of gloves |
one inside the other
hold removed dressings in one hand and deglove transfer to other hand and deglove |
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Preparation for Wound Care
Evaluation of the wound, purpose? |
determine cause
determine location, area and depth wet versus dry if infected: source, mechanism and microorganism |
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Preparation for Wound Care
Wound Measurement |
use clear rulers, q-tips and wound scales (do not touch the wound unless the device has a protective covering
may also photograph |
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Preparation for Wound Care
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get all supplies ready prior to beginning the task
use sterile technique as per protocol |
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two categories of dresing?
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Inert and Interactive
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5 types of dressings
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Dry to dry (Inert)
Wet to wet: continue wetting with saline to prevent drying or creams (chemical debriders and antibiotics) (Inert or Interactive) Wet to dry: allows for mechanical debridement when removed (Inert) Occlusive: semipermeable to air and moisture (Interactive) Rigid: full coverage barrier for physical protection (Inert) |
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6 Classifications of Dressings
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Film
Foam Hydrogels Hydrocolloids Alginates including combination Alginates Hydroactive |
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Film Dressings
Example: Suresite main idea |
Thin membranes coated with a layer of acrylic adhesive
Moisture vapor permeable and oxygen permeable which provide a moist environment, enable autolytic debridement, provide protection from chemicals, friction, shear and microbes, transmit oxygen in and CO2 and water out |
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Film Dressings
Indications: |
Management of minor burns and simple injuries like scalding, lacerations, and abrasions
Protective layer over IV’s and superficial pressure areas. |
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Film Dressings
Precautions |
Removal of the film can tear the skin
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Film Dressings
Contra-Indications |
Infection or exudation pooling
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Foam Dressings
Example: Tagaderm main idea |
One or multiple layers of soft, open cell sheets with impregnable backs.
Moisture vapor permeable and oxygen permeable which provide a moist environment, enable autolytic debridement, provide protection from chemicals, friction, shear and microbes, transmit oxygen in and CO2 and water out, absorb exudate, conform to the body well, increase core temp. |
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Foam Dressings
indications |
Management of burns, grafts, ulcers and simple injuries like scalding, lacerations, and abrasions and exuding wound
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foam dressings
precautions and contraindications |
Precautions: Exudate is overwhelming the foam within 24 hours, are of little value on dry wounds
Contra-Indications: None |
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why use foam rather than film?
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Primary reason to use foam over film: Foam helps absorb exudate
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foam dressings
precautions |
Exudate is overwhelming the foam within 24 hours, are of little value on dry wounds
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foam dressings
contraindications |
none
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Hydrogel Dressings
Example: DuoDERM Gel main idea |
Group of complex organic polymers with a high water content from 30-90%.
Manufactured in a thin flexible sheet or free- flowing. Gel swells increasing in size until the gel is saturated. |
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Hydrogel Dressings
indications |
Used on dry and sloughy wounds to rehydrate the eschar and enhance rapid debridement.
Used on leg ulcers, pressure wounds, necrotic wounds, simple and full thickness wounds, good with tendon injuries because they won’t dry out the surface. |
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Hydrogel Dressings
precautions |
Gel is oversaturated
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Hydrogel Dressings
contraindications |
Infection
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Hydrocolloid Dressings
Example: Nuderm main idea |
Combination of gel forming polymers with adhesives held on by a backing of foam or film.
Manufactured as a granule, powder or paste which forms a self adhesive mass in the wound |
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Hydrocolloid Dressings
indications |
Superficial leg ulcers, burns, donor sites, and pressure wounds.
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Hydrocolloid Dressings
precautions |
Fragile skin
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Hydrocolloid Dressings
contraindications |
Hyper granulation of the wound begins to occur, infection, or deep cavity wounds.
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Alginate Dressings
Example: Algicell main idea |
Manufactured from seaweed
Act as a hemostat by providing calcium ions to the wound and extracting sodium ions. |
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Alginate Dressings
indication |
Exuding, bleeding and infected wounds.
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Alginate Dressings
precaution |
Low exuding wounds
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Alginate Dressings
contraindication |
none
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Hydroactive Dressings
main idea |
Similar to Hydrocolloid, but are not gel forming.
Form foam like properties instead |
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Hydroactive Dressings
indications |
Superficial leg ulcers, burns, donor sites, and pressure wounds
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Hydroactive Dressings
precautions |
Non exuding wounds
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Hydroactive Dressings
contraindications |
none
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Topical Agents and Antiseptics
what to look out for? |
Watch for sensitization of agent to bacteria in wound
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Topical Agents and Antiseptics
should they be used for acute or chronic wounds? |
Used on both acute and chronic wounds
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why would you use compression wraps as a bandage?
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used for edema or support
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with edema, should the distal or the proximal end be tightest when bandaging with a compression wrap?
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start distal and work proximal covering the whole extremity. Pressure should be greatest distally decreasing as they go proximal
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if bandaging for support where should the tightest wraps occur when using a compression wrap?
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Not all has to be covered and the pressure should be uniform throughout.
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Spica Wrap
main idea |
Designed to separate one part and keep it abducted
Can be for wound or post surgical |
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Buddy wrap
main idea |
Binds injured to noninjured for stabilization
like bandaging a stubbed finger to a non-stubbed finger |
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Dressing removal
key things to remember |
with bandage scissors try to stay on indention lines, use gloves for removal, but not sterile gloves and dispose in proper recepticle
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Setting Up A Sterile Field
first two steps |
Pre-Wash of hands
Open all Sterile Items and locate within treatment area |
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Setting Up A Sterile Field
last 3 steps |
Sterile handwash
Gowning Gloving |
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Sterile gowning
key things to keep in mind |
the part facing you is the inside or the unsterile side; grasp gown and lift it up and away from table; keep hands above waist; shake lightly to have gown unfold; only touch the inside, locate arms and neck then put both arms in at the same time
stop when you reach the cuffs |
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Sterile Gloving
key things to keep in mind |
using the gown as mittens open the gloves; holding the cuff, put on the right glove first up to the cuff
Slide right fingers under left cuff, put on the left glove completely pull cuff up on the right; adjust fingers |
