Chapter 15 Infection Control Copyright 2017 Cengage Learning

Chapter 15 Infection Control Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

15: 1 Principles of Infection Control • Understanding infection control is essential for all health care workers • Provide a basic knowledge of how disease is transmitted • Main emphasis on prevention of disease transmission Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

15: 1 Principles of Infection Control • Microorganism or microbe – Small living organism – Not visible to the naked eye – Microscope must be used to see them – Found everywhere in the environment – Found on and in the human body Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

15: 1 Principles of Infection Control • Microorganism or microbe – Many are part of normal flora of body – Nonpathogens are beneficial to body processes – Pathogens cause infections and disease – Most prefer warm, dark environments Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

15: 1 Principles of Infection Control • Microorganism or microbe – Need source of food and moisture – Need for oxygen varies (aerobic/anaerobic) – Human body is ideal supplier of all microorganism requirements Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Classes of Microorganisms • Bacteria – Simple, one-celled organisms – Multiply rapidly – Classified by shape and arrangement Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Classes of Microorganisms • Bacteria – Cocci are round or spherical in shape (refer to Figure 15 -1 in text) – Bacilli are rod shaped (refer to Figure 15 -3 in text) – Spirilla are spiral or corkscrew shaped (refer to Figure 15 -4 in text) Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Classes of Microorganisms • Antibiotics are used to kill bacteria • Some bacteria strains are multidrug resistant (superbugs) – MRSA – VRE – MRAB – CRE Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Classes of Microorganisms • Protozoa – One-celled, animal-like organism – Found in decayed materials and contaminated water – May have flagella for movement – Some are pathogenic Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Classes of Microorganisms • Fungi – Simple, plantlike organisms – Live on dead organic matter – Yeast and molds can be pathogenic – Antibiotics do not kill – Antifungal medications for treatment Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Classes of Microorganisms • Rickettsiae – Parasitic microorganisms that cannot live outside the cells of another living organism – Transmitted to humans by bites of fleas, lice, ticks, mites – Antibiotics are effective against many Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Classes of Microorganisms • Viruses – Smallest microorganisms – Must use electron microscope to see – Must be inside another living cell to reproduce – Spread by blood and body secretions – Very difficult to kill – Not affected by antibiotics Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Classes of Microorganisms • Viruses – Those infecting animals can mutate to infect humans • • • Severe acute respiratory syndrome (SARS) West Nile virus (WNV) Monkeypox Ebola and Marburg H 5 N 1, H 1 N 1 Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Classes of Microorganisms • Hepatitis B – Caused by HBV – Transmitted by blood serum and body secretions – Affects the liver Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Classes of Microorganisms • Hepatitis B – Expensive vaccine is available for protection – Employers must provide vaccine at no cost to employees with occupational exposure to blood or other body secretions Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Classes of Microorganisms • Hepatitis C – Caused by HVC – Transmitted by blood/blood-containing body fluids – Many infected individuals are asymptomatic – Can cause severe liver damage – No vaccine available Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Classes of Microorganisms • Acquired Immune Deficiency Syndrome (AIDS) – Caused by human immunodeficiency virus (HIV) – Suppresses the immune system – Individual becomes susceptible to cancers and infections that would not affect a healthy person – No cure and no vaccine Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Classes of Microorganisms • Helminths – Multicellular parasites also known as worms or flukes – Transmitted • By eating contaminated food • Being bitten by infected insects • When worms enter the skin Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Types of Infection • Some pathogens – Produce poisons called toxins – Cause an allergic reaction – Attach and destroy the living cells they invade Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Types of Infection • Endogenous – Disease originates within the body – Metabolic disorders, tumors, congenital abnormalities • Exogenous – Disease originates outside body – Pathogens, trauma, temperature extremes Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Types of Infection • Hospital-acquired or healthcare-associated infection (HAI) – Formerly nosocomial – Staphylococcus, pseudomonas • Opportunistic – Occur when body defenses are weak – Kaposi’s sarcoma Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Chain of Infection • Present for disease to occur and spread from one individual to another • Infectious agent • Reservoir • Portal of exit Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Chain of Infection • • Mode of transmission Portal of entry Susceptible host Refer to Figure 15 -9 in text Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Chain of Infection • Body defenses – Mucous membranes – Cilia – Coughing and sneezing – HCL in the stomach – Tears – Fever – Inflammation response – Immune response Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Chain of Infection • Eliminate any step in the chain and infection is stopped • Follow practices to interrupt or break chain • Remember, pathogens are everywhere • Transmission prevention is a continuous process Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Aseptic Techniques • Asepsis – Absence of disease-producing microorganisms • Sterile – Free of all organisms • Contaminated – Any object or area that may contain pathogens Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Aseptic Techniques • • • Handwashing Good personal hygiene Use of disposable gloves Properly cleaning instruments and equipment Thorough cleaning of environment Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Aseptic Techniques • Antisepsis – Prevent or inhibit growth of pathogens – Can usually be used on skin • Disinfection – Destroys or kills pathogens – Used mainly on objects Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Aseptic Techniques • Sterilization – Destroys all microorganisms, including spores and viruses – Use of steam under pressure, gas, radiation, and chemicals on objects Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

15: 2 Bioterrorism • Use of microorganisms or biologic agents as weapons – Infecting humans, animals, or plants • Has been used over time by different nations not only in war but also on innocent people Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Biologic Agents • Microorganisms suitable for bioterrorism – Inexpensive, available, easily produced, spreads quickly – Maintains its survival – Brings death or disability – Transmissible from person to person – Difficult to prevent and treat Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Biologic Agents • High-priority agents – Smallpox: contagious and infectious disease, result of a variola virus – Anthrax: infectious disease caused by spores called Bacillus anthracis – Plague: infectious disease from the bacteria Yersinia pestis Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Biologic Agents • High-priority agents – Botulism: paralytic illness resulting from a nerve toxin produced by Clostridium botulinum – Tularemia: infectious disease from bacteria Fracisella tularensis – Hemorrhagic fever: infectious diseases caused by filovirus (Ebola virus and Marburg virus) Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Preparing for Bioterrorism • Bioterrorism attack could cause epidemic and public health emergency • Would have impact on health care facilities • Social disorder could ensue • Comprehensive plan is needed Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Preparing for Bioterrorism • Bioterrorism Act of 2002 involves local, regional, state, and national government – Early detection by communities – Public notification – Infection control and public education – Funding for research and study of pathogens Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Preparing for Bioterrorism • Bioterrorism Act of 2002 – Guidelines and restrictions on transport of pathogens – Mass immunization – Protection of food and water supplies – Trained personnel Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Preparing for Bioterrorism • Bioterrorism Act of 2002 – Emergency management policies – Criminal investigation of potential threats – Preparation of health care facilities – Efficiency of communication Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

15: 3 Washing Hands • • Major aspect of standard precautions Most important aseptic technique Most effective method of infection control Hands are perfect medium for spread of pathogens Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

15: 3 Washing Hands • Regular handwashing with plain soap and water • Antiseptic handwashing with antimicrobial soap and water • Antiseptic hand rub with alcohol-based cleaner (waterless) Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

15: 3 Washing Hands • World Health Organization (WHO) on when to wash hands – Before patient contact – Before clean or aseptic procedure – After contact with a patient’s skin – After touching patient surroundings Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

15: 3 Washing Hands • Also wash hands – On arrival at facility – After contact with a patient’s intact skin – Before moving from contaminated body site to clean body site during patient care – If hands become contaminated during a procedure Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

15: 3 Washing Hands • Also wash hands – Before applying and immediately after removing gloves – When gloves are torn or punctured – Before and after handling specimens – After contact with soiled or contaminated item Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

15: 3 Washing Hands • Also wash hands – After picking up any item off the floor – After personal use of the bathroom – Following a cough, sneeze, or using a tissue – Before and after contact with mouth or mucous membranes Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

15: 3 Washing Hands • • • Use soap as a cleansing agent Use warm water Use friction Clean all hand surfaces Point fingertips downward Use dry paper towels to turn faucet on and off Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

15: 3 Washing Hands • Clean nails during handwashing • Waterless hand cleaning with alcohol-based gel, lotion, or foam – Use if hands are not visibly dirty or contaminated with blood or body fluids – After 6 to 10 cleanings hands must be washed with soap and water Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

15: 4 Observing Standard Precautions • Blood and body fluids are main ways pathogens are spread • Three major pathogens: HBV, HBC, HIV • Extreme care must be taken at all times when there is an area, object, or person contaminated with blood or body fluids Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Bloodborne Pathogens Standard • Established in 1991 by OSHA • Must be followed by all health care workers • Civil penalties if not implemented by employer and followed by employees Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Bloodborne Pathogens Standard • Develop written exposure control plan • Identify all employees with occupational exposure • Provide hepatitis B vaccines free of charge • Provide personal protective equipment (PPE) Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Bloodborne Pathogens Standard • Provide adequate handwashing facilities and supplies • Ensure worksite is maintained in a clean, sanitary condition – Follow measures for immediate decontamination of surfaces when contaminated – Dispose of infectious waste correctly Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Bloodborne Pathogens Standard • Enforce rules on limited activities (eating, drinking, etc. ) in any potentially contaminated area • Provide appropriate, color-coded, and labeled containers for contaminated sharps and other infectious or biohazard wastes Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Bloodborne Pathogens Standard • Post signs at entrance to work areas with exposure to biohazardous materials – Label biohazard items with red biohazard symbol (refer to Figure 15 -16 in text) • Confidential medical evaluation and follow-up for employee after exposure incident • Provide employee training Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Needlestick Safety Act • Passed by Congress in 2000 • Centers for Disease Control and Prevention (CDC) estimated 600, 000 to 800, 000 needlesticks per year • OSHA revised Bloodborne Pathogens Standard to requirements of this act Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Needlestick Safety Act • Employer requirements – Identify and use effective and safer medical devices – Incorporate changes in annual update of exposure control plan Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Needlestick Safety Act • Employer requirements – Solicit input from nonmanagerial employees who are responsible for direct patient care – Maintain a sharps injury log Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Standard Precautions • Rules developed by the CDC to prevent spread of infection • Every body fluid considered potentially infectious • All patients considered potential sources of infection • Refer to Figure 15 -18 in text Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Standard Precautions • Use in any situation where you might contact – Blood or any fluid that contains blood – Body fluids, secretions, and excretions – Mucous membranes – Nonintact skin – Tissue or cell specimens Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Standard Precautions • Handwashing before and after patient contact • Gloves – For possible contact with blood, bodily fluids, secretions, excretions, mucous membranes, tissue specimens, or nonintact skin – Handling and cleaning contaminated items or surfaces Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Standard Precautions • Gloves – When performing invasive procedures – When performing venipuncture or blood tests – Hands must be washed immediately after removal of gloves – Gloves must not be reused Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Standard Precautions • Gowns – For procedures that cause splashing or spraying – Help prevent contamination of clothing or uniform – Contaminated gowns must be handled per policy – Hands must be washed immediately after gown removal Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Standard Precautions • Masks and eye protection – For procedures that cause splashing or spraying – Prevent exposure of mucous membranes of mouth, nose, and eyes to pathogens – Use masks once and discard; change every 30 minutes if needed Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Standard Precautions • Masks and eye protection – Protective eyewear and face shields protect front, top, bottom, and sides of eyes – If not disposable, must be cleaned and disinfected before reuse Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Standard Precautions • Sharps – Use extreme caution to avoid cuts and punctures – When possible, use safe needles or needleless devices – Use sharps containers – Follow laws regarding disposal of sharp objects Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Standard Precautions • Spills or splashes – Wipe up with disposable cleaning cloths – Wear gloves when wiping up – Use disinfectant such as 10 -percent bleach solution – Clean all contaminated surfaces – Absorbent powder can be used for large spills Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Standard Precautions • Resuscitation devices – Use to avoid need for mouth-to-mouth resuscitation – Place in convenient location, have readily accessible Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Standard Precautions • Waste and linen disposal – Wear gloves, follow agency policy – Use biohazard bags appropriately • Injuries – Immediately report cut or injury, needlestick, or splashing of blood or body fluids – Follow agency policy Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

15: 5 Sterilizing with an Autoclave • Sterilization prevents spread of infection • Autoclave uses steam under pressure or gas to sterilize • Most efficient method of sterilization • Destroys all microorganisms • Available in various sizes and types Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

15: 5 Sterilizing with an Autoclave • Preparation of items before sterilization – Wrap items that are to remain sterile • Autoclave indicators ensure sterilization • Load the autoclave correctly • Time period for sterilization varies (refer to Figure 15 -31) Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

15: 5 Sterilizing with an Autoclave • Store items properly after autoclaving – Sterilized items can remain sterile for 30 days • Dry-heat sterilization in some autoclaves • Follow directions on specific autoclave • Follow agency policy for sterilization Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

15: 6 Using Chemicals for Disinfection • Chemicals disinfect, but do not sterilize – Most do not kill spores and viruses • Used to disinfect instruments that do not penetrate body tissue • Proper cleaning of items is essential • Chemical solutions used Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

15: 6 Using Chemicals for Disinfection • • • Antirust tablets or solutions may be added Requirements for disinfection Chemical must completely cover items Care of chemical solutions Proper handling of disinfected items Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

15: 7 Cleaning with an Ultrasonic Unit • Used to remove dirt, debris, blood, saliva, tissue from instruments prior to sterilization • Uses sound waves for cleaning • Method of aseptic control, not sterilization • Use only ultrasonic solutions in unit Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

15: 7 Cleaning with an Ultrasonic Unit • Care of glass beakers • Care of the permanent tank • Read manufacturer’s instructions before using ultrasonic unit • Refer to Figure 15 -37 in text Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

15: 8 Using Sterile Techniques • Many procedures require use of sterile techniques to protect patients from infection • Surgical asepsis keeps an object or area free from living organisms Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

15: 8 Using Sterile Techniques • Sterile – Free from all organisms • Contaminated – Organisms and pathogens are present Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

15: 8 Using Sterile Techniques • Important to differentiate between sterile and contaminated areas or items while using sterile technique • Correct techniques must be strictly followed to maintain sterility and prevent contamination Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

15: 8 Using Sterile Techniques • Sterile field – Area used for placement of sterile supplies • All sterile items need to be checked before use • Observe agency guidelines for date • Necessary to keep sterile field dry Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

15: 8 Using Sterile Techniques • Drop technique – For gauze, pads, dressings, small items • Mitten technique – For bowls, drapes, linens • Transfer forceps – For cotton balls, small items Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

15: 9 Maintaining Transmission-Based Isolation Precautions • Some diseases are communicable – Caused by easily transmitted organisms • Epidemic – Spreads rapidly person to person, affects large numbers • Pandemic – Wide geographic area, high proportion of populace Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

15: 9 Maintaining Transmission-Based Isolation Precautions • Use in addition to Standard Precautions • Provides extra protection against specific diseases or pathogens • Protects patient, family, health care workers • Type used depends on the causative organism of disease Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

15: 9 Maintaining Transmission-Based Isolation Precautions • Communicable diseases spread in many ways – Direct contact with a patient – Contact with dirty linen, equipment, supplies – Contact with blood, body fluids, secretions, excretions Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

15: 9 Maintaining Transmission-Based Isolation Precautions • Contaminated (dirty) – Items that contain disease-producing organisms; must not be touched unless protected • Clean – Items that do not contain disease-producing organisms; prevent contamination of these areas Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Standard Precautions • Use on all patients • Patient must be in private room if he or she contaminates environment or cannot maintain appropriate hygiene • Follow recommendations for use of PPE Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Airborne Precautions • Use for patients known or suspected to be infected with pathogens transmitted by airborne droplet nuclei – Rubella, varicella, tuberculosis, shingles • Refer to Figure 15 -45 in text Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Droplet Precautions • Use if patient is known or suspected to be infected with pathogens transmitted by largeparticle droplets – Neisseria meningitis, multidrug-resistant Streptococcus meningitis, severe viral influenza • Refer to Figure 15 -47 in text Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Contact Precautions • Use if patient is known or suspected to be infected with epidemiological microorganisms transmitted by direct or indirect contact – Viral or hemorrhagic conjunctivitis or fevers, diphtheria, scabies • Refer to Figure 15 -48 in text Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Ebola Virus Precautions • Strict enforcement of standard, contact, and droplet precautions • Patient is to be placed in an airborne infection isolation room (AIIR) with restricted visitation • Medical equipment is dedicated to the patient • Needles and blood draws are limited to necessity only Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Ebola Virus Precautions • Personal protective equipment (PPE) is a high priority • PPE must cover all of the skin, head, neck, body, and feet • Powered air-purifying respirator (PAPR) or a N 95 respirator (at minimum) must be worn at all times Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Ebola Virus Precautions • Double gloves should be worn when in direct contact with the patient • Diligent hand hygiene is essential • A separate room or area should be designated for the donning and doffing of the PPE Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.

Protective or Reverse Isolation • Methods used to protect certain patients from organisms present in the environment • Used mainly for immunocompromised patients, whose body defenses cannot protect them from infection and disease • Precautions vary based on patient’s condition Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.