Infection Control

Sarah HolzhauerJoanne Burcroff

Sarah Wild

Admitting procedure of a patient

• A physician’s order is necessary for transmission-based precautions

• Patient Access and Infection Prevention Nurse should be notified of any patient being placed on Isolation Precautions. With specificity to:a) Contact b) Droplet c) Airborne

Type of isolation is to be indicated on patients Kardex, computer record, and on chart. This should include the date started and who initiated the precautions Example: Contact precautions 07/31/12 by J.Smith,

RN Requisition for other departmental services should

have an indication about isolation, Isolation stickers should be utilized where practical.

Equipment Needed for Isolation Precautions

A. A sinkB. Antimicrobial soapC. Labeled containers for infectious wastesD. Puncture-proof containers to dispose of needles and

syringesE. Isolation cart/overdoor container outside room, stocked

with:a) Disposable glovesb) Disposable masksc) Disposable Isolation gownsd) Plastic bags for waste and laundry

Types of PrecautionsStandard Precautions Standard precautions are practices that all healthcare workers must

follow in the care of ALL patients. They apply to blood, all body fluids, secretions, excretions that contain visible blood, non-intact skin and mucous membranes. They do not apply to sweat.

Contact Precautions This is the most common form of disease transmission. It can occur from

direct skin-to-skin contact, or indirect contact with a contaminated object in the patient’s environment.

Droplet Precautions Use these precautions when a patient is diagnosed or suspected of an

infection that can be spread on droplets of sputum. These germs travel a short distance (3 feet) and can cause infection when they land on your mucous membranes.

Airborne Precautions Use when a patient is suspected of an infection that can travel

throughout the patient’s room on the air currents. Examples of these diseases are TB, chickenpox, and measles.

Standard Precautions1. Gloves: Are to be worn when the staff member may have hand

contact with blood or body fluids, mucous membranes, or non-intact skin of ALL patients, and when handling contaminated items or surface

2. Mask, eye protection, face shield: Wear during patient activities that are likely to generate aerosols, splashes, sprays, etc., such as suctioning and intubation

3. Gowns: Wear a gown if contact with the patient or blood or body fluids is anticipated

4. Sharps: NEVER recap, bend, or break needles. Place used disposable needles and sharps in a puncture-resistant container at the point of use

5. Equipment: Clean equipment with the regular germicidal cleaner6. Environmental Control: Routinely clean and disinfect

environmental surfaces such as: siderails, overbed tables, bedside tables, and frequently touch surfaces.

7. Linens: All used linen is considered contaminated. Bag in the blue plastic at the site. If linen is saturated with patient secretions, double-bag, using the blue bags and place an isolation sticker on the bag.

Contact Precautions

1. Indicate the TYPE of isolation on the care plan.2. Place a GREEN isolation sticker outside the patient’s room, above

the room number.3. A gown is required when entering a contact isolation room.

Remove the gown before leaving the room.4. Gloves are to be worn and hands washed prior to leaving the

room.5. Masks are to be worn in accordance with standard precautions.6. Avoid transporting patient if possible.7. Dedicate equipment to the room, OR disinfect prior to removing

from the room.8. WASH YOUR HANDS:

Examples:MRSA, VRE, RSV, Lice, Scabies, Cellulitis with uncontrolled drainage, impetigo, E.Coli

Droplet Precautions

1. Indicate the TYPE of isolation on the care plan2. Place the ORANGE isolation sign outside the patient’s room,

above the room number.3. Wear surgical mask when working within 3 feet of the patient.4. Avoid transporting unless necessary.5. WASH YOUR HANDS!

Examples:Rubella, Mumps, Meningitis, H-flu meningitis, Pneumonia, Influenza, Parvovirus

Airborne Precautions

1. Indicate the TYPE of isolation on the care plan.2. Place the patient in a NEGATIVE PRESSURE ROOM.3. Place the pink isolation sign outside the patient’s room, above the

room number.4. Wear an N95 particulate respirator mask each time you enter the

room. 5. Visitors and family should wear a surgical mask when entering the

patient’s room.6. Transport only when necessary.7. WASH YOUR HANDS!!!8. Negative pressure rooms located in CCU and ECU.

Examples:Chicken pox, Measles, TB, pulmonary or laryngeal disease, Yersinia enterocolitis, SARS

HAND WASHING

Hand washing is the single most important step you can take to prevent the spread of any infection. Gloves do not take the place of hand washing. Hands should be washed:

1. Before eating, preparing food or taking medications2. Before and after all patient contact3. Before clean or invasive procedures4. When gloves are removed after patient contact5. After performing any personal body function

HAND WASHING PROCEDURE

Jewelry should be removed prior to washing; Watches should be moved up the arm from the wrist and the wrist should be included in the hand wash. Nails should be clean and short.

1. Turn on the faucet and adjust the water to flow and temperature.2. Apply soap and wash fingers, palms, back of hangs, and wrist for

15 seconds.3. Rinse under running water, but do not touch the inside of the sink

or faucet.4. Dry hands with paper towel.Use the paper towel to turn off the faucet.Alcohol-based hand rubs can be used to wash hands if the hands are not visibly contaminated with blood or other potentially infection materials.

Patient Placement(Contact and Droplet Precautions)

1. Private room if possible2. If private room is not available, can cohort with patients with the

same organism.3. If not able to provide 1. or 2., Staff must maintain a 3 feet space

between patients. Contact Infection Control. 1. Patient’s can not share bathrooms or sinks.

4. Airborne precautions requires patient placement in a negative pressure room

Evidenced Based Practice

• In the UK, world wide studies showed that more than 1.4 million people are affected by health-care associated infections

• Health Act 2006, In 2008 they added social care and independent health-care providers

• Since its implementation, there has been a 50% reduction in MRSA bacteremia

• Adequate Isolation precautions and hand washing were big contributors to this reduction in infection spreading

Auburn Community Hospital. (2012). Standard and transmission-based precautions. (Policy No. IC-305). Auburn, NY: Auburn Community Hospital.

 Dugdale III, D. (2012, February 26). Isolation precautions. Retrieved from

http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000446.htm 

Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., et al, L., & Camera, I. M. C. (2011). Medical-surgical nursing, assessment and management of clinical problems. (8th ed.).

 Randle, J., & Clarke, M. (2010). Infection control nurses' preceptions of the

code of hygiene. Journal of Nursing Management, 19, 218-225. doi: 10.1111/j.1365-2834.2010.01149.x