2/20/14

Guide lines for Disposing of Contaminated Equipment

• Disposable gloves: place in isolation bag separate from burnable trash and direct to appropriate hospital area for disposal

• Glass equipment: Bag separately from metal equipment and return to CSR (Central Sterilization Room).

• Metal equipment: Bag all equipment together, label and return to CSR

• Rubber and plastic items: Bag items separately and return to CSR for gas sterilization.

• Dishes: Requires no special precautions unless contaminated with infected material; then bag, label and return to Kitchen.

• Plastic or paper dishes: Dispose of these items in burnable trash.

• Soiled linens: place in laundry bag, and send to separate area of laundry room from special care. If possible place linens hot-water-soluble bag. This method is safes for handling as bag may be placed directly into washing machine. (Double-bagging is usually required because these bags are easily punctured or torn. They also dissolve when wet.)

• Food and liquids: Dispose of these items by putting them in toilet – flush thoroughly.

• Needles and syringes: Do not recap needles; place inpuncture proof (resistant) container.

• Sphygmomanometer and stethoscope: Require no special precaution unless they are contaminated. If contaminated, disinfect using the appropriate cleaning protocol based on the infective agent.

Thermometers:
Dispose of electronic probes cover with burnable trash. If probe or machine is contaminated, clean with appropriate disinfectant or infective agent. If reasonable thermometers are used, disinfect with appropriate solution.

Study questions
• Describe infection prevention in health care setups
• List chain of infection
• Identify between medical asepsis and surgical asepsis
• Discuss the purpose, use and components of standard precautions.
• Maintain both medical and surgical asepsis
• Describe how to setup a client’s room for isolation, including appropriate barrier techniques.
• Identify hoe to follow specific airborne, droplet and contact precautions.
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Protocol for Leaving Isolation Room

Untie gown at wrist
- Take off gloves
- Untie gown at neck
- Pull gown off and place in laundry hamper
- Take off goggles or face shield
- Take off mask
- Wash hands

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Transporting Isolated Client outside the Room

Equipment
- Transport Vehicle
- Bath blanket
- Mask for client if needed

Procedure
1. Explain procedure to patient

2. If client is being transported from a respiratory isolation room, instruct him or her to wear a mask for the entire time out of isolation. This prevents the spread of airborne microbes.

3. Cover the transport vehicle with a bath blanket if there is a chance of soiling when transporting a client who has a draining wound or diarrhea.

4. Help client to transport vehicle. Cover client with a bath blanket.

5. Tell receiving department what type of isolation client needs and what type of precaution hospital personnel should follow.

6. Remove bath blanket, and handle as contaminated linen when client returns to room.

7. Instruct all hospital personnel to wash their hands before they leave the area.

8. Wipe down transportation vehicle with antimicrobial solution if soiled.
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Using Double Bagging for Isolation

Equipment
2 isolation bags
Items to be removed from room
Gloves

Procedure
1. Follow dress protocol for entering isolation room, or, if you are already in the isolation room, continue with step 2.

2. Close isolation bag when it is one-half to three-fourths full. Close bag inside the isolation room.

3. Double-bag for safety if outside of bag is contaminated, if the bag could be easily penetrated, or if contaminated material in the bag is heavy and could break bag.

4. Set-up a new bag for continued use inside room. Bag is usually red with the word “Biohazard” written on outside of bag.

5. Place bag from inside room in to a bag held open by a second health care worker outside room if double bagging is required. Second health care worker makes a cuff with the top of the bag and places hands under cuff. This prevents hands from becoming contaminated.

6. Place bag in to second bag with out contaminating outside of bag. Secure top of bag by typing a knot in top of bag.

7. Take bag to designated area where biohazard material is collected; usually “dirty” utility room.

8. Remove gloves and wash hands

N.B. Out side of base is contaminated
Base could easily be penetrated
Contaminated material is heavy and could break bas.
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Removing Items from Isolation Room

Equipment
- Large red isolation bags
- Specimen container
- Plastic bag with biohazard level
- Laundry bag
- Red plastic container in room
- Cleaning articles

Procedure
1. Place laboratory specimen in plastic bag. Afix biohazard label to plastic bag.

2. Dispose of all sharps in appropriate red plastic container in room.

3. Place all linen in linen bag

4. Place reusable equipment such as procedure trays in plastic bags.

5. Dispose of all garbage in plastic bags

6. Double bag all material from isolation room. Follow procedure for utilizing double-bagging for isolation. All materials removed from an isolation room is potentially contaminate. This will prevent spread of micro organisms.

7. Replace all bags, such as linen bag and garbage, in appropriate container in room.

8. Make client’s room clean as necessary, using germicidal solution.

9. Leave the client’s room today
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Using a Mask

Equipment
Clean mask

Procedure
1. Obtain mask from box

2. Position mask to cover your nose and mouth

3. Bend nose bar so that it conforms over bridges of your nose

4. If you are using a mask with string ties, tie top strings on top of your head to prevent slipping. If you are using a con-shaped mask, tie top strings over your ears.

5. Tie bottom strings around your neck to secure mask over your mouth. There should be no gaps between the mask and your face.

6. Important; change mask every 30 minutes or sooner if it becomes damp as effectiveness is greatly reduced after 30 minutes or if mask is moist.

7. Wash your hands before removing mask.

8. To remove mask, untie lower strings first, or slip elastic band off without touching mask.

9. Discard mask in a trash container

10. Wash your hands
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Donning and Removing Isolation Attire

Equipment
- Gown
- Clean gloves

Procedure
For donning attire
1. Wash and dry hands

2. Take gown from isolation cart or cupboard. Put on a new gown each time you enter an isolation room.

3. Hold gown so that opening is in back when you are wearing the gown.

4. Put gown on by placing one arm at a time through sleeves, put gown-up and over your shoulder

5. Wrap gown around your back, tying strings at your neck.

6. Wrap gown around your waist, making sure your back is completely covered. Tie string around your waist.

7. Done eye shield and/or mask, if indicated. Mask is required if there is a risk of splashing fluids.

8. Don clean gloves and pull gloves over gown wristlets.

For Removing Attire
1. Unite gown waist strings

2. Remove gloves and dispose of then in garbage bag.

3. Next, untie neck strings, bringing them around your shoulders, so that gown is partially off your shoulders.

4. Using your dominant hand and grasping clean part of wristlet, put sleeve wristlet over your non-dominant hand. Use your non-dominant hand to up pull sleeve wristlet over your dominant hand.

5. Grasp outside of gown through sleeves at shoulders. Pull gown down over your arms.

6. Hold both gown shoulders in one hand, carefully draw your other hand out of gown, turning arm of gown inside out. Repeat this procedure with your other arm.

7. Hold gown away from your body. Fold gown up inside out.

8. Discard gown in appropriate place

9. Remove eye shield and/or mask and place in receptacle.

10. Wash your hands.

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Preparing for Isolation

Purpose
To prevent spread of microorganisms
To control infectious diseases

Equipment
Specific equipment depends on isolation precaution system used.
- Soap and running water.
- Isolation cart containing masks, gowns, gloves, plastic bags isolation tape.
- Linen hamper and trash can, when needed.
- Paper towel
- Door card indicating precautions

Procedure
1. Check orders for isolation

2. Obtain isolation cart from central supply, if needed.

3. Check that all necessary equipment to carry out the isolation order is available.

4. Place isolation card on the client’s door.

5. Ensure that linen hamper and trash cans are available, if needed.

6. Explain purpose of isolation to client and family.

7. Instruct family in procedures required.

8. Wash hands with antimicrobial soap* before and after entering isolation room.

* Types of antimicrobial soap or agent depend on infectious agent and client condition.
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Types of isolation

Historically, two primary types of isolation systems were used in health care:
1. Category -specific isolation
2. Disease- specific isolation

Currently these isolation classifications are mostly replaced by standard precaution and transmission based precaution. How ever, still some facilities follow such system.

Category specific isolation, specific categories of isolation (eg. Respiratory, contact, enteric, strict or wound) are identified, using color-coded cards. This form of isolation is based on the client’s diagnosis. The cards are posted outside the client’s room and state that visitors must check with nurses before entering.

Disease:
specific isolation, uses a single all-purpose sign. Nurse selects the items on the card that are appropriate for the specific disease that is causing isolation.
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Isolation

Is defined as separation from others, separation of people with infectious disease or susceptible to acquire disease from others. Isolation technique is a practice that designed to prevent the transmission of communicable diseases.

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Procedures for putting on sterile gloves

Steps:
1. Wash the hands to limit the spread of microorganisms

2. Open the outer glove package, on a clean, dry, flat surface at waist level or higher

3. If there is an inner package, open it in the same way, keeping the sterile gloves on the inside surface with cuffs towards you.

4. Use one hand to grasp the inside upper surface of the glove’s cuff for the opposite hand. Lift the glove up and clear it of the wrapper.

5. Insert the opposite hand in to the glove, placing the thumb and finger in to the proper openings. Pull the gloves in to place, touching only the inside of the glove at cuff. Leave the cuff in place.

6. Slip the fingers of the sterile gloved hand under (inside) the cuff of the remaining glove while keeping the thumb pointed outward.

7. a. Insert the ungloved hand in to the glove
   b. Pull the second glove on; touching only then outside of the sterile glove with the other sterile gloved hand        and keeping the fingers inside the cuff.
   c. Adjust gloves and snap cuffs in to place. Avoid touching the inside glove and wrist area

8. Keep the sterile gloved hands above waist level. Make sure not to touch the cloths. Keep hands folded when not performing a procedure. Both actions help to prevent accidental contamination.
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Items to be use to maintain sterility technique

Hair covering:
In sterile environments a cap or hood is worn to cover the hair. Remember that no hair can show. If the hair is long, a special type of hood will be worn.

 Surgical Mask
In strict sterile situations such as in operation room (OR) or with protective isolation, the mask covers the mouth and nose. The purpose of mask is to form a barrier to stop the transmission of pathogens. In the OR or during other sterile procedure, the mask prevents harmful microorganisms in your respiratory tract from
spreading to the client. When the client has an infection, the mask protects you from his/ her pathogens.

 Sterile gown
Sterile gown is commonly worn in the OR, with protective isolation and some times in the delivery room. The hands touch only the part of sterile gown that will touch the body after the gown is in place. Thus, touch only the inside of the gown. Some one else ties the strings. The back of the gown is considered contaminated, even though it was sterile when put on. Any part of the gown below waist level and above nipple level is also considered contaminated. Be careful when wearing a sterile gown not to touch any thing that is unsterile.

Sterile Gloves
For some procedures sterile gloves are worn. Remember that once gloves are put on, touching any thing unsterile contaminates them. Therefore, make all preparations before putting on gloves.


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2/19/14

Sterilization:

It is the process of exposing articles to steam heat under pressure or the chemical disinfectants long enough to kill all microorganisms and spores.

Exposure to steam at 18 pounds of pressure at a temperature of 125oc for 15 minutes will kill even the toughest organisms. A pressure steam sterilizer is called an autoclave.

Some chemicals also can be used to sterilize an object. However, chemical disinfectants powerful enough to destroy germs or extreme temperature cannot be used on certain articles, such as plastic.

Sharp cutting instruments usually sterilized by dry heat, or chemicals. To day, however, most sharps such as scalpels, and suture removal scissors- are disposable. Needles used for injections are always discarded. Other methods of sterilization include radiation and gas sterilization with ethylene oxide.
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Disinfection and sterilization

Disinfection: is a process that results in the destruction of most pathogens, but not necessarily their spots. Common methods of disinfection include the use of alcohol wipes, a hexachlorophene or chlorohexidine gluconate soap scrub, or povidone-iodine scrub to kill microorganisms on the skin.

Stronger disinfectants include phenol and mercury bichoride, which are too strong to be used on living tissue. Boiling can be used to disinfect in animate objects. However, it does not destroy all microorganisms or spores.
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Surgical Asepsis (sterile technique)

Definition: 
Practices, which will maintain area free from microorganisms, as by surgical scrub, or sterile technique. Surgical asepsis is used to maintain sterilize. Use of effective sterile technique means that no organisms are carried to the client. Microorganisms are destroyed before they can enter the body.

Sterile technique is used when changing dressings, administering parentral (other than the digestive tract) medications, and performing surgical and other procedures such as urinary catheterization. With surgical asepsis, first articles are sterilized, and then their contact with any unsterile articles is prevented. When a sterile article touches an unsterile article, it becomes contaminated. It is no longer sterile.

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Standard Precaution Guidelines

- Wash hands thoroughly after removing gloves and before and after all client contact

- Wear gloves when there is direct contact with blood, body fluids, secretions, excretions, and contaminated items. This include neonate before first bath, wash as soon as possible if an anticipated contact with this body substances occurs.

- Protect clothing with gowns or plastic aprons if there is a possibility of being splashed or direct contact with contaminated material.

- Wear masks, goggles, or face shield to avoid being splashed including during suctioning, irrigations, and deliveries.

- Do not break or recap needles, discard them intact in to puncture resistant containers except for ABG ( arterial blood gas).

- Place all contaminated articles and trash in leak proof bags. Check hospital policy regarding double bagging.

- Clean spills quickly with a 1:10 solution of bleach or according to facility policy.

- Place clients at risk of contaminating the environment in a private room with separate bathroom facilities.

- Transport infected clients using appropriate barriers,

- Dispose waste using three baskets system
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Donning Protective Gear Utilizing Standard Precautions

Equipment
- Disposable gloves
- Gown
- Mask
- Apron
- Cap
- Protective eye wear (gogle)

Procedure
1. Wash hands using soap and dry.

2. Put on gown by placing one arm at a time though sleeves wrap gown around body so it cover clothing completely.

3. Bring waist ties from back to front of gown or turn back according to hospital policy. This ensures that entire clothing is covered by the gown, preventing accidental contamination.

4. Tie gown at neck or adher velcro strap to gown

5. Don mask. Rationale: Masks are worn when there is an anticipated contact with respiratory droplet secretiveness.

6. Don protective eye wear such as face shield. Face shields will protect the nurse from splashing of blood or body fluids while caring for clients.
7. Done disposable gloves.
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Standard Precaution

Nursing Process

Assessment
• Assess for skin integrity
• Assess for presence of drainage from lesions or body cavity.
• Assess for ability to deal with oral secretions.
• Assess for compliance to hygiene measure (i.e., covering mouth when coughing, ability to control body fluid).
• Assess ability to carry out activities of daily living (ADL).
• Assess extent of barrier techniques needed (i.e., gloves, gown, mask, protective eye wear).
• Assess need for special equipment (i.e., hazardous west bags, plastic bags for specimens).

Planning
• To prevent clients (especially compromised clients) from acquiring nosolomial infections.
• To prevent the spread of micro organism to health professionals.
• To reduce potential for transmission of micro organisms.
• To protect hospital personnel and others from contamination.
• To provide appropriate equipment and techniques for preventives measures.

Implementation/Procedures
Donning protective gear utilizing standard precautions.
Exiting a client’s room utilizing standard precautions.

Evaluation/Expected outcomes
- Clients remain infection free.
- Transmission of micro organism is controlled.
- Health care workers protected from micro organism.
- Appropriate nursing interventions are carried out for the client.

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Donning and Removing Gloves

Equipment
- Gloves (both clean and sterile)
- Trash receptacle

Procedure
1. Wash your hands to remove microorganism and avoid contamination.

2. Remove glove from glove receptacles

3. Hold glove at wrist edge and slip finger into opening. Pull glove up to wrist.

4. Place gloved hand under wrist edge of second glove and slip fingers in to opening.

5. Remove glove by pulling off, touching only out side of glove at cuff, so that glove turns inside out.

6. Place rolled-up glove in palm of second hand.

7. Remove second glove by slipping one finger under glove edge and pulling down and off so that glove turns inside out. Both gloves are removed as a unit.

8. Dispose of gloves in proper container, not at bedside.

9. Wash your hands.
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Basic Medical Asepsis

Hand washing (Medical Asepsis)

 Purpose
• To prevent the spread of infection
• To increase psychological comfort

Equipment
• Soap for routine hand washing
• Orange wood stick for cleaning nails, if available
• Running warm water, paper towel, trash basket

Procedure
1. Stand in front of but away from sink to avoid touching of uniform to a sink.

2. Ensure that paper towel is hanging down from dispenser.

3. Turn on water using foot pedal or faucet (using elbow of hand) so that flow is adequate, but not splashing.

4. Adjust temperature to warm. Rationale: cold does not facilitate sudsing and cleaning; hot is damaging to skin.

5. Wet hands under running water, wet hands facilitate distribution of soap over entire skin surface.

6. Place a small amount, one to two teaspoons (5-10mL) of liquid soap on hands. Thoroughly distribute overhands. Soap should come from a dispenser, possible; this prevents spread of microorganism.

7. Rub vigorously, using a firm, circular motion, while keeping your fingers pointed down, lower than wrists. Star with each finger, then between fingers, then palm and back of hand to create friction on all surfaces.

8. Wash your hands for at least 10-15 seconds. Duration of washing is important to produce mechanical action and allow antimicrobial products time to achieve desired effect.

9. Clean under your fingernails with an orangewood stick. (This should be done at least at start of day and if hands are heavily contaminated).

10. Rinse your hands under running water, keeping fingers pointed down ward in order to prevent contamination of arms.

11. Resoap your hands, rewash, and rerinse if heavily contaminated.

12. Dry hands thoroughly with a paper towel, while keeping hands positioned with fingers pointing up. Moist hands tend to gather more microorganisms from the environment.

13. Turn off water faucet with dry paper towel, if not using foot pedal to avoid contaminating the hands.

14. Restart procedure at step 5 if your hands touch the sink any time between steps 5 and 13.
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