PREVENTION IS BETTER THAN CURE
Isabelita T. Arao RN, PhD October 13, 2011
Review of the common hazards in healthcare setting How to prevent from acquiring such infections How to prevent Healthcare Associated Infections (HAI)
PREVENTION - actions we take to prevent us for illness and promote better health
CURE – to make healthy again through treatment
Common Hazards in Healthcare Setting
1. Blood-borne and biological hazards 2. Waste anesthetic gas exposure 4. Ergonomic hazards from lifting and repetitive tasks
. Respiratory hazards 5. Potential chemical and drug exposure 3.
Percutaneous Injury as a means of Transmission of Bloodborne Pathogen
Needle stick injury Cut with a sharp object Contact with mucous or non intact skin or body fluids
000 sharps injuries annually (CDC) Nurses have the highest rate
.000-1 Million HCW annually (US) >100.Needle stick injury (NSI)
1 in 8 HCW receives a NSI 800.00 United Kingdom Hospitals/year 86% of all occupationally related infections 385.
Single NSI Probability of Infection
HIV ----------3-5 chances in 1000
Hepatitis B --------300 chances in 1000 Hepatitis C --------.20-50 chances in 1000
Risk of Infection Depends on:
Immune status of the HCW The severity of the NSI
injuries which occur after Clinical procedure but before disposal (collision with HCW.Main Causes of NSI
24%--Injuries which occur during a clinical exposure (IV insertions. disposal. restless patient) 48% -. clean up.injuries which occur after disposal (concelled sharps)
. recapping) 28% .
Risk of HIV Transmission in Hospital Setting
1 in 1000 mucous membrane exposure 3-5 chances in 1000 NSI Syringes containing HIV infected blood can still transmit even after being rinsed for up to 4 weeks HIV can survive up to 2 hours outside the body
Risk of Hepatitis B Transmission
Over 300 million carriers globally 100-200 HCW died annually in the US Highly infectious if transmitted by blood or via contact with other body fluids 10 % leads to chronic infection 30% risk from NSI or mucosal exposure
Wearing heavy duty gloves when disposing sharps 4. single-handed method)
. Adapting safe technique and procedures (no recapping. Using Standard Precautions (Universal Precaution) 2.Prevention of Occupational Exposure to HIV/HBV
Prevention of Occupational Exposure to HIV/HBV
5. covering breaks in skin especially the hands
. Making appropriate disinfectants and cleaning materials available 6. lab tests. Sterilizing equipment properly 7. Eliminating unnecessary injections.
2. before donning & after removing gloves.General Measures to reduce the Risk of Occupational Exposure to BBV in Healthcare Setting
1. Wash hands before and after contact with each patient. Change gloves between patients 3. Cover existing wounds. skin lesions and all breaks in exposed skin with waterproof dressing
Wear gloves when contact with blood can be anticipated 5. Avoid wearing open footwear in situations where blood maybe spilt. Clean up spillage promptly and disinfect surfaces
. or where instruments or needles are handled 7. Avoid sharp usage where possible 6.General Measures to reduce the Risk of Occupational Exposure to BBV in Healthcare Setting
when handling chemical disinfectant and when cleaning up spillage. 9.General Measures to reduce the Risk of Occupational Exposure to BBV in Healthcare Setting
8. Follow safe procedures for disposal of contaminated waste
. Wear gloves when cleaning equipment prior to sterilization or disinfection.
Avoid recapping Discard disposable syringes and needles into sharp container. Provide sharp containers in adequate numbers and never overfill.Safe Handling and Disposal of Sharps
Place disposable sharps in sharp container immediately after use. never re-use
Safe Handling and Disposal of Sharps
Remove needles from syringe when essential (transferring blood to a container. aspirating anesthesia)
Reducing Risk of Blood-Skin Contact
Change glove if puncture is suspected. eyes and face Waterproof gown or wear a surgical gown with waterproof cuff and sleeves
. Change glove regularly if performing prolonged surgical procedures Protect body.
Other Measures to Prevent BBV Transmission
Hepatitis B immunization Decontamination and waste disposal Decontamination of equipment Disposal of clinical waste (sharps) Double bag contaminated linen (for safe transportation and laundry) Label specimen (“danger of infection” or color coding))
CARCINOGENIC – any substance or agent capable of promoting or causing the development of cancer.
CHEMOTHERAPEUTIC AGENTS –
> 42% of nurses who worked for long periods of time developed cancer > 16% incidence of cancer of those who worked frequently to radiation
genitourinary and musculoskeletal disorders)
. cardiovascular. ANESTHETIC AGENT > 36% of nurses who worked with anesthetic agents during pregnancy have birth defects (CNS.TERATOGENIC – substances capable of causing congenital malformation de to action on the embryo.
USE OF LATEX GLOVES. DISINFECTANTS AND OTHER CHEMICALS may actually be accountable for the higher asthma rate among nurses and HCW
REPRODUCTIVE TOXICITY – substance affecting fertility (miscarriage. infertility and fetal death) ANTIRETROVIRAL MEDICINES > 19% higher rate in difficulty conceiving was reported among nurses with frequent and long term exposure to these drugs
LONG TERM EXPOSURE TO MERCURY > neurotoxin
Inhalation Skin contact Skin absorption Ingestion injection
Activities which may Lead to Exposure
Reconstituting powdered drug (Fransman et al. 2004) Expelling air from syringes filled with hazardous drugs Administering by IM, SQ, or IV routes Counting out individual, uncoated oral doses and tablet from multi-dose bottles
Crushing tablets to make oral liquid doses Contracting measurable concentrations of drugs present or drug vial exteriors, work surfaces, and floors Generating aerosols during the administration of drugs Priming the IV set with a drug containing solution at bedside
linens and other materials. chemical or hazardous waste containers Removing and disposing PPE
. Decontaminating and cleaning drug preparation or clinical areas. Transporting infectious. dressing. Handling body fluids or body fluid contaminated clothing.
.Preparing Hazardous Drugs
Use a ventilated cabinet designed to reduce workers exposure while preparing hazardous drugs Practice proper technique and use of equipment Wear PPE (double gloves and protective gowns while reconstituting and administering drugs.
Administering Hazardous Drugs
Use protective medical devices (needless) and techniques (under the luminar hood) Wear PPE for all activities associated with drug administration (opening to disposing) Place disposable items directly in a chemotherapy waste container and close the lid
Administering Hazardous Drugs
Double bag the chemotherapy waste before removing the inner gloves Consider double bagging all contaminated equipment Wash hands with soap and water before leaving the administration site
Keeping Safe at Work
Dealing with Aggression How to Respond to this Behavior? 1. Call for assistance (supervisor or another staff to assist)
. 2. Remain calm – be polite and do not raise your voice.
Keep out of reach 4. Do not antagonize – let the aggressor leave and do not attempt to detain the person 5. and finally. report the incident to your supervisor or SHO.
.Keeping Safe at Work
2. aprons. Ensure appropriate handling and disposal of sharps and other clinical waste (avoid recapping. boots) 3. N95 mask. reuse.needless)
. wear PPE appropriate to the task (gloves. ensure that you follow Standard practices.Keeping Safe at Work
INFECTION CONTROL 1. goggles. mask.
. MRSA). ensure contaminated waste is disposed of in line with the client’s waste disposal procedure (city ordinance of color coded waste disposal.4. wash your hands frequently
Can affect individuals health and well being as well as their ability to perform their duties safely. Can also compromise clinical care
– – –
nurses often work long hours through shift work and rotation.
Tips to help Prevent Fatigue
Ensure that you have had adequate sleep (7-9 hours is recommended for adults) Manage your shifts and workload (rest. naps) Take at least a 30 minutes break after 6 hours work
It is recommended that working hours does not exceed 48 hours/week 5.4. Maintain health and fitness at a good level. Take care when driving home after a night shift (consider alternate transport methods)
Precautions to Prevent other Transmissions
STANDARD PRECAUTIONS – a group of infection precaution that apply to all patients regardless of suspected or confirmed infection status in any setting 1. use medical mask)
. Respiratory hygiene and cough etiquette (cover mouth and nose. throw right away. Personal Protective Equipment 3. hand hygiene (5 moments) 2.
Prevention of injuries from needles and other sharps instruments 5.4. Cleaning the patient care environment (avoid aerosolisation) 7. Cleaning and disinfection of respiratory equipment (between use) 6. Linen and waste management (bags)
.g.they should be applied whenever providing care to a patient suspected or confirmed of having disease spread by droplets . meningococcemia.e.DROPLET PRECAUTIONS . pneumonia.organism floats in the air up to 3 feet away .
Medical mask by staff Limit the patient movement if needed. let the patient wear mask
.DROPLET PRECAUTION GUIDELINES: Private room if possible but can open the door Maintain spatial separation of at least 3 feet between infected patient and other patients.
eyes or mouth
Use clean gloves and gown when performing direct care Perform hand hygiene after removing PPE Dedicate specific equipment for use with a single patient and ALWAYS clean and disinfect shared equipment between patient use avoid touching face.
Measles .Chickenpox .nurses who have had chickenpox before should be the one to be assigned with such case.
.Tuberculosis (PTB or EPTB) .AIRBORNE PRECAUTIONS .
Isolation. always close the door Organism can float in the air 3 meters away Can open the windows Wear N95 mask
gowns when touching the patient Isolation but can practice co-horting MRSA cases should have dedicated equipment for the patient
Wounds. MRSA Wear gloves. diarrheal patients.
What is a BUNDLE?
A group of things fastened together for convenient handling ( Webster ) A group of interventions related to a disease that when instituted together give better outcomes than when done individually.
A BUNDLE IS :
Small and straightforward Group of best practices Scientifically grounded Protocol based Executed collectively and reliably “ All or Nothing “ indicator
accessing. or dressing an intravascular catheter
. HAND HYGIENE – when caring for central lines. repairing. strictly comply to the following : Before and after palpating catheter insertion sites Before and after inserting.Preventing Catheter Related Bloodstream Infections
FIVE COMPONENTS OF CARE 1. replacing.
Preventing Catheter Related Bloodstream Infections
When hands are obviously soiled or if contamination is suspected. Before and after invasive procedures Between patients Before donning and after removing gloves After using the bathroom
Steps of Effective Hand Hygiene
Palm to palm Right palm over dorsum and vice versa Palm to palm with fingers interlaced Back of fingers to opposing palms fingers interlocked and vice versa Rotational rubbing of thumb Tip of fingers rub to palm Wrist
MAXIMAL BARRIER PRECAUTIONS – Strict compliance with: Hand hygiene Cap Mask Sterile gown Sterile gloves The patient should be covered with a sterile drape from head to toe with small opening for the site of insertion.Preventing Catheter Related Bloodstream Infections
. CHLORHEXIDINE SKIN ANTISEPSIS –
proven to provide better skin antisepsis than other antiseptic agents such as povidone-iodine solutions Allow antiseptic solution time to dry completely before puncturing the site.Preventing Catheter Related Bloodstream Infections
with subclavian vein as the preferred for adults. Daily review of central line necessity with prompt removal of unnecessary lines.Preventing Catheter Related Bloodstream Infections
4. Optimal catheter site selection. The risk of infection increases over time as the line remains in place.
To improve patients’ ventilation.
Elevation of the head of the bed 30-45 degrees Decreases the risk of aspiration of gastrointestinal contents oropharyngeal or nasopharyngeal secretions.PREVENTING VENTILATOR ASSOCIATED PNEUMONIA
FOUR COMPONENTS OF CARE
1. Aid in ventilatory efforts and minimize atelectasis.
PREVENTING VENTILATOR ASSOCIATED PNEUMONIA
2. Daily “ sedation vacation ” and daily assessment of readiness to extubate Lightening sedation decreases the amount of time spent on mechanical ventilation Weaning patients from ventilator becomes easier when patients are able to assist themselves at extubation with coughing and control of secretions.
. > “H2 receptor inhibitors are more efficacious than sucralfate and are the preferred agents.
Peptic Ulcer Disease Prophylaxis > This is an appropriate intervention in all patients who are sedentary > Decreasing the pH of gastric contents may protect against a greater pulmonary inflammatory response to aspiration of GIT contents.PREVENTING VENTILATOR ASSOCIATED PNEUMONIA
. studies have shown that DVT prophylaxis is applied as part of a package of interventions for ventilator care. the rate of pneumonia decreases precipitously.PREVENTING VENTILATOR ASSOCIATED PNEUMONIA
4. Deep Venous Thrombosis ( DVT )
Prophylaxis > While it is unclear if there is any associated between DVT prophylaxis and decreasing rates of VAP.
This program targets interventions known to decrease complications W – Wean patient from the ventilator as soon as possible H – Meticulous Hand hygiene A – Aspiration precautions P – Prevent contamination of respiratory therapy equipment
.PREVENTING SURGICAL SITE INFECTION
FOUR COMPONENTS OF CARE 1. > Reassign dosing responsibilities to holding area nurse to improve timeliness. Appropriate use of prophylactic antibiotics > Antibiotics within one hour before surgical incision > Discontinuation of prophylactic antibiotics within 24 hours after surgery.
or no hair removal at all.PREVENTING SURGICAL SITE INFECTION
2. it has been known that the use of razors prior to surgery increases the incidence of wound infection when compared to clipping.
. Appropriate Hair Removal > For many years. depilatory use.
Other articles have demonstrated that stringent glucose control in surgical intensive care unit patients reduces mortality.
. Maintenance of Postoperative Glucose Control
> Review of medical literature shows that the degree of hyperglycemia in the postoperative period was correlated with the rate of SSI in patients undergoing major cardiac surgery.PREVENTING SURGICAL SITE INFECTION
collected once on each of the first two postoperative days. Establishment of Postoperative Normothermia Literature indicates that patients undergoing surgery have a decreased risk of surgical site infection if they are not allowed to became hypothermic during the postoperative period.PREVENTING SURGICAL SITE INFECTION
“ Glucose Control ” is defined as serum glucose level below 2oomg/dl. 4.
and skin exposure in cold operating rooms can cause patients to became clinically hypothermic during surgery.
. anxiety. wet skin preparations.PREVENTING SURGICAL SITE INFECTION
PREVENTING SURGICAL SITE INFECTION
Use warmed forced – air blankets preoperatively. during surgery and in Post Anesthesia Care Unit ( PACU ) Use warm fluids Increase the ambient temperature in the operating room Use hats and booties on patients postoperatively
CATS Decrease Surgical Site Infection
C – Clippers – Hair removal: If hair must be removed from the surgical site. clippers are the best option.
. Never use a razor A – Antibiotics – Prophylactic Antibiotics: Antibiotics consistent with national guidelines should be administered within 1 hour of incision time and discontinued within 24 hours. in most cases.
8 – 100.4 F ) within the first hour surgery.
.Glucose Control: Cardiac surgery patients should have controlled 6 am serum glucose ( <200mg/dl ) on postoperative Day 1 and 2. S – SUGAR.CATS Decrease Surgical Site Infection
T – TEMPERATURE – Normothermia: > Colorectal surgery patients should be normothermia ( 96.
. Foley Trapped to Leg > All urinary catheter must be secured to decrease movement of catheter.PREVENTING URINARY TRACT INFECTION
SIX COMPONENTS OF CARE 1. 2. Foley Bag Below Bed > Drainage bag must be kept lower than patients bladder at all times.
insert silver coated catheter.PREVENTING URINARY TRACT INFECTION
3. Daily Review for Necessity > Can urinary catheter be removed? 4. Pericare daily and after each Bowel Movement
. Strict Hand Hygiene 6. 5. Clarity of Urine > Change out catheter if patient having symptoms.