Hand Washing and Isolation Precautions

Healthcare Associated Infections (HAIs) in the USA Today

• HAIs affect 5-10% of patients in US acute care hospitals.

• HAIs affect nearly 2 million patients per year.

• HAIs cost an estimated $5-10 Billion per year.

• More than 70% of bacteria that cause HAIs are resistant to at least one of the drugs most commonly used to treat the infections.

HAIs – The Human Cost

• 99,000 people will DIE this year from a HAI.

• It’s equivalent to a 747 plane crash killing all passengers and crew every other day.

• It’s one death every 6 minutes.• IT IS PREVENTABLE!

Desired Goals

• Reduce hospital acquired infections• Thereby reducing avoidable morbidity, mortality

and cost.

Key Factors:• Hand hygiene• Environmental decontamination• Identification and isolation of colonized patients• Education

Hayden M. ICAAC,2001, Chicago, IL

Contaminated Surfaces tested positive for VRE (+) in patient environment.

Hand Hygiene

• Hand hygiene is the single most important means of preventing the spread of infection.

• It is to be performed before and after every patient encounter, and after the removal of gloves.

Wash Hands

Access the CDC Hand Washing Course go to:

http://www.cdc.gov/handhygiene/training/interactiveEducation/

Personal Stethoscopes

• Personal stethoscopes should be cleaned before and after each use. An EPA registered hospital disinfectant (disinfecting surface wipes) or alcohol wipes may be used

Personal Protective Equipment

• Gowns, gloves, masks, goggles, face shields, PAPRs

• Available on the nursing units

• Gloves should be in every patient room

• Types of PPE required for each isolation category are identified on a sign posted on the door to the patient room.

Key Points About PPE

• Don before contact with the patient, generally before entering the room

• Use carefully – don’t spread contamination

• Remove and discard carefully, either at the doorway or immediately outside patient room; remove respirator outside room

• Immediately perform hand hygiene

Sequence* for Donning PPE

1. Gown first

2. Mask or respirator

3. Goggles or face shield

4. Gloves

* Combination of PPE will affect sequence – be practical

How to Don a Gown

• Select appropriate type and size

• Opening is in the back

• Secure at neck and waist

• If gown is too small, use two gowns

– Gown #1 ties in front

– Gown #2 ties in back

How to Don a Mask

• Place over nose, mouth and chin

• Fit flexible nose piece over nose bridge

• Secure on head with ties or elastic

• Adjust to fit

How to Don a Particulate Respirator

• Select a fit tested respirator• Place over nose, mouth and

chin• Fit flexible nose piece over

nose bridge• Secure on head with elastic• Adjust to fit• Perform a fit check –

– Inhale – respirator should collapse

– Exhale – check for leakage around face

How to Don Eye and Face Protection

• Position goggles over eyes and secure to the head using the ear pieces or headband

• Position face shield over face and secure on brow with headband

• Adjust to fit comfortably

How to Don Gloves

• Don gloves last

• Select correct type and size

• Insert hands into gloves

• Extend gloves over isolation gown cuffs

“Contaminated” and “Clean” Areas of PPE

• Contaminated – outside front

• Areas of PPE that have or are likely to have been in contact with body sites, materials, or environmental surfaces where the infectious organism may reside

• Clean – inside, outside back, ties on head and back

• Areas of PPE that are not likely to have been in contact with the infectious organism

Sequence for Removing PPE

1. Gloves

2. Face shield or goggles

3. Gown

4. Mask or respirator

Where to Remove PPE

• At doorway, before leaving patient room or in anteroom

• Remove respirator outside room, after door has been closed

How to Remove Gloves

• Grasp outside edge near wrist

• Peel away from hand, turning glove inside-out

• Hold in opposite gloved hand

How to Remove Gloves

• Slide ungloved finger under the wrist of the remaining glove

• Peel off from inside, creating a bag for both gloves

• Discard

Remove Goggles or Face Shield

• Grasp ear or head pieces with ungloved hands

• Lift away from face

• Place in designated receptacle for reprocessing or disposal

Removing Isolation Gown

• Unfasten ties

• Peel gown away from neck and shoulder

• Turn contaminated outside toward the inside

• Fold or roll into a bundle

• Discard

Removing a Mask

• Untie the bottom, then the top

• Remove from face

• Discard

Removing a Particulate Respirator

• Lift the bottom elastic over your head first

• Then lift off the top elastic

• Discard

Hand Hygiene

• Perform hand hygiene immediately after removing PPE.– If hands become visibly contaminated during PPE

removal, wash hands before continuing to remove PPE

• Wash hands with soap and water or use an alcohol-based hand rub

Protect Yourself and Your Patient

• PPE is available to protect you from exposure to infectious agents in the healthcare workplace

• Know what type of PPE is necessary for the duties you perform and use it correctly

Donning and Removal of PPE Video Review

http://www.siumed.edu/common/videoplayer.php?f=mp4:oec/Student/PPE.f4v

Click on the link below.

CDC Guideline for Isolation Precautions

• There are 4 isolation categories - The name of each reflects how the infectious organism/disease is transmitted.

• The next few slides will detail the requirements of each category and show examples of the signs posted on patient doors to communicate these requirements to all who enter.

4 CDC Categories

• Standard

• Contact

• Airborne

• Droplet

STANDARD PRECAUTIONS

• Assume that every person is potentially infected or colonized with an organism that could be transmitted in the healthcare setting.

• Wear PPE according to the level of anticipated contamination, when handling patient-care equipment and instruments/devices that are visibly soiled or may have been in contact with blood or body fluids.

CONTACT ISOLATION

Including:

Clostridium difficile (C-Diff)

Scabies, lice, impetigo

Patients with multiple drug resistant organisms (MDRO) like MRSA, VRE, and MDRO gram negative organisms (i.e.Pseudomonas, Acinetobacter).

•Private room required•Gown required•Gloves required

Protects from diseases spread by contact.

Contact Isolation:

Patient transport:

Patient: Patient wears clean gown.Cover any open wounds.Cover patient with clean sheet prior to transport.

HCW: Wear Personal protective equipment (PPE) when touching patient.(Healthcare Remove and dispose of PPE and perform hand hygiene prior to Worker) transporting patient.

Don clean PPE to handle patient at transport destination.

Visitors: Visitors who are not providing direct care to patients in contact precautions will not need to wear gown and gloves. This does not apply to students, residents or other healthcare providers.

Equipment: Clean glucometers, thermometers or any other equipment used for or on a patient. Dedicate stethoscope, B/P cuff to

each patient.

For patients with spore-forming organisms, such as Clostridium difficile(C. diff), you must wash hands with soap and water. Alcohol-based hand cleaners are less effective.

Memorial Medical Center ONLY

AIRBORNE PRECAUTIONS

• Primarily used for suspected or diagnosed TB.• A special ventilation room (negative airflow) is

required. Door is kept closed.• A Powered Air-purifying Respirator (PAPR) is

required to enter the room.• Some areas (surgery, MRI) wear a N-95 mask.

An annual fit-test is required for N-95 users.

Protects from disease spread by air/respiratory tract.

Airborne Isolation:

Patient transport:

Patient: Patient wears surgical mask when out of room. Follow respiratory hygiene/cough etiquette. If skin lesions are present—cover lesions with clean sheet

HCW: Wear PAPR when entering room and handling patient(Healthcare May remove PAPR once out of the room and patient is wearing worker) mask

Hand hygiene prior to transport HCW does not need to wear PAPR during transport

Equipment: Clean stretchers/wheelchairs after use Clean glucometers, thermometers, or any other equipment used for patient

AIRBORNE/CONTACT PRECAUTIONS

• Used for other occasions when a special ventilation room (negative airflow) is needed, i.e. varicella (chickenpox), measles, shingles (varicella) in an immunocompromised patient, or disseminated shingles.

• These conditions are also spread by contact so Contact precautions are required also.

• A PAPR, gown and gloves are required to enter the room.

DROPLET PRECAUTIONS

Including suspected or known:Neisseria meningitidis (meningococcemia),Meningitis of unknown origin (bacterial vs.

viral)InfluenzaPertussis (whooping cough).

A surgical type mask is required to enter the room.

Protects against diseases spread by respiratory droplets.

Droplet Isolation:

Patient Transport:

Patient: Patient wears surgical mask when out of room.Follow respiratory hygiene/cough etiquette

HCW: Wear mask when entering room(Healthcare May remove mask once patient is wearing a maskWorker) HCW does not need to wear mask during transport

Equipment: Clean stretchers/wheelchairs after useClean glucometers, thermometers or any otherequipment used for patient

SUMMARY• Standard: Wear PPE according to the level of

anticipated contamination, when handling pt-care equipment and instruments/devices that are visibly soiled or may have been in contact with blood or body fluids.

• Contact: A gown and gloves are required to enter the room.

• Airborne: A PAPR is required when entering the room.• Droplet: A surgical type mask is required to enter the

room.• Airborne/Contact: A PAPR, gown and gloves are

required to enter the room.

Equipment Decontamination

If extra equipment is taken into an isolation room and used such as a reflex hammer, tuning fork, ophthalmoscope etc., be sure to decontaminate the equipment afterward with the PDI Surface Wipes located in a canister on the infection control cart or plastic wall hanger outside the patient room. Wash your hands after decontaminating the items.

Note Taking in an Isolation Room

For droplet or airborne isolation do not take notes in the room.

For contact isolation, if you must, follow these steps.• don all appropriate PPE• take paper and a pen into the room • take and record the history information without touching any

equipment or the patient.• place the paper and pen in the anteroom or outside the door. Take

care to cover the information with a blank paper or turn the forms upside down so the information is not visible to those in the hall.

• perform the physical exam, remove the PPE, wash hands and record this information after leaving the room..