LABOR AND DELIVERY SKILLS
Bloodborne pathogens /StandardPrecautions
The Center for Disease Control (CDC) definesStandard Precautions as a set of precautions designed to prevent or reduce therisk of transmission of HIV, HBV, HCV and other blood-borne pathogens from both recognized and unrecognized sources of infection in health-care workers (HCWs). HCWs are defined as persons, including students and trainees, whose activitiesinvolve contact with patients or with blood or other body fluids from patients in a health-care setting.Nurses employed inlabor and delivery are exposed to blood, vaginal secretions and amniotic fluid, which are carriers of infectious diseases. Bloodis the single most important source of HIV, HBV and other bloodborne pathogens. The blood does not have to be visible to thehuman eye to be capable of transmitting disease.
Handwashing
Wash the hands thoroughly, with soap and water, after contamination with blood or other body fluids, between patients andimmediately after gloves are removed. Gloves do not replace the need to wash the hands. There may be minuscule puncturemarks on the gloves that can aid in spreading infectious diseases.
Gloves
In labor and delivery, gloves must always be worn when touching body fluids that contain blood or when handling items or surfaces with blood or body fluids what are potentially infectious. (CDC, 1999) Non sterile gloves can be used when startingthe intravenous,
phlebotomy, washing used instruments, cleaning a patient before or after a vaginal delivery, obtaining various body fluids for diagnostic purposes (peritoneal or amniotic fluids), handling the placenta and umbilical cord, and whenhandling the infant after the delivery until blood and amniotic fluid is washed off. Non-sterile gloves can also be used for procedures involving contact with mucous membranes and other non sterile examination, for example: digital examination of mucous membranes or when performing heel sticks on infants. Sterile gloves must be used for procedures that involve contactwith normally sterile areas of the body. In obstetrics this includes the use of sterile gloves during vaginal examinations to protect the transmission or introduction of infection into the vagina. Gloves should be changed between each patient contact. Never wash gloves for reuse.
Protective Barriers
The Center for Disease Control (CDC) states that all health care workers who participate in invasive procedures must useappropriate barrier precautions. (CDC, 1999).The CDC recommends that for both vaginal and cesarean deliveries gloves,gown (with protective front), plastic disposable overshoes,eyeguard and mask be worn. Both in a vaginal or cesarean section,
the floor or ground is likely to be contaminated and when the placenta is delivered, the blood may splatter.
Human Milk
Although HIV and outer surface antigens (HBsAg) have been found in the milk of mothers infected with HIV and HBV, healthcare workers do not have the same type of exposure as the infant. Therefore, universal precautions do not apply to breast milk.
Source: The Center for Disease Control (CDC)the prevention of transmission of blood-borne diseases in the health-care setting 1999.
HISTORY AND INITIAL ASSESSMENT
As with any evaluation the first and perhaps most essential component is the history. The patientshould be specifically queried about the presence or absence of leaking or ruptured membranesand the presence or absence or vaginal bleeding. A history of recent illnesses should be soughtand any prenatal complications should be reviewed. Finally, an inquiry should be made about thepatient's expectations and preparation for the labor and delivery process (childbirth classes,preferred pain management, plans for infant feeding). A careful review of the prenatal recordshould be supplemented by the patient interview with regard to recent illnesses and obstetricalcomplications.
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