For The CDC recommends antimicrobial hand cleansing agents the following situations; 1. 2. 3. 4.

When there are known multiple resistant bacteria Before invasive procedures In special care units, such as nurseries and ICUs Before caring for severely immunocompromised clients

Hand Washing Purposes: To To To To reduce reduce reduce reduce the the the the number of microorganisms on the hand risk of transmission of microorganisms to clients risk of cross contamination among clients risk of transmission of infectious organisms to oneself

Assessment: Presence of factors increasing susceptibility to infection and possibility of undiagnosed infection (HIV) Use of immunosuppressive medications Recent diagnosed procedures or treatments that penetrated the skin or a body cavity Current body status Signs and symptoms indicating the presence of an infection; Localized signs, such as swelling, redness, pain or tenderness with palpation or movement, palpable heat site, loss of function of affected body part, presence of exudates Systemic indications, such as fever, increased pulse and respiratory rates, lack of energy, anorexia, enlarged lymph nodes. Planning Determine the location of running water and soap or soap substitutes Equipment Soap Warm running water Disposable or sanitized towels Implementation Preparation o Assess the hands Nails should be kept short o Rationale: short, natural nails are less likely to harbor microorganisms, scratch a client, or puncture gloves. Remove all jewelry

Rationale:

microorganisms can lodge in the settings of jewelry and under rings. Removal facilitates proper cleaning of the hands and arms.

Check hands for any breaks in the skin, such as hang nails or cuts o Rationale: a nurse who has open sores may require a work assignment with decreased risk for transmission of infectious organisms due to the chance of acquiring or passing on an infection.

Performance: 1. If you are washing your hands where the client can observe you, introduce yourself and explain to the client what you are going to do and why it is necessary 2. Turn on the water and adjust the flow There are 5 common types of faucet control o Hand operated handles o Knee levers. Move these with the knee to regulate flow and temperature. o Foot pedals. Press these with the foot to regulate flow and temperature. o Elbow controls. Move these with the elbows instead of the hands. o Infrared control. Motion in front of all the sensor causes water to start and stop flowing automatically. Adjust the flow so that water is warm. o Rationale: warm water removes less of the protective oil of the skin than hot water. 3. Wet the hands thoroughly by holding them under the running water and apply soap to the hands. Hold the hands lower than the elbows so that the water from the arms to the finger tips. If the soap is liquid, apply 2 to 4 ml (1tsp). If it is a bar soap, granules or sheets, rub them firmly between the hands. o Rationale : The water should flow from the least contaminated to the most contaminated area; the hands are generally considered more contaminated than the lower arms. 4. Thoroughly wash and rinse the hands. Use firm, rubbing and circular movements to wash the palm, back, and wrist of each hand. Be sure to include the heel of the hand. Interlace fingers and thumbs, and move the hands back and forth. Continue this motion for at least 15 seconds.

o Rationale: helps

the circular movements action creates friction that

remove microorganisms mechanically. Interlacing the fingers and thumbs cleans the inter-digital spaces . 5. Rub the finger tips against the palm of the opposite hand. o Rationale: the nails and fingertips are commonly missed during hand washing. 6. Thoroughly pat dry the hands and arms o Rationale: moist skin becomes chapped readily as does dry skin that is Rubbed vigorously, chapping produces lesions. 7. Turn off the water. Use a new paper towel to grasp a hand operated control. o Rationale: this prevents the nurse from picking up microorganisms from the faucet handles. Isolation Precautions Refers to measure designed to prevent the spread of infections or potentially infectious microorganisms to health personnel, clients and visitors.

Guidelines used by hospitals and other health care settings; 1. Category specific precautions a. Strict isolation b. Contact isolation c. Respiratory isolation d. Respiratory isolation e. Tuberculosis isolation f. Enteric precautions g. Drainage/secretions precautions and h. Blood/body fluid precautions 2. Disease-specific isolation precautions - Provides precautions for specific diseases. Example: - Use of private rooms with special ventilation - Having client share a room with other clients infected with the same organism - Gowning Universal Precaution (UP) - Techniques to be used with all clients to decrease risk of transmitting unidentified pathogens. Body Substance Isolation

A system that employs generic infection control precautions for all clients except those with the few diseases transmitted through air. Based on three (3) premises; o All people have an increased risk for infection from microorganisms placed on their mucus membranes and non-intact skin. o All people are likely to have potentially infectious microorganisms in all their moist body sites and substances. o An unknown portion of clients and health care workers will always be colonized or infected with potentially infectious microorganisms in their blood and other moist body sites and substances. Body substances includes, blood, some body fluids, urine, feces, wound drainage, oral secretions, and any other body products or tissue.

Isolation Precautions Recommended Isolation precautions in Hospitals A. Standard Precautions: Designed for all clients in hospital These precautions apply to blood, all body fluids, excretions, and secretions except sweat, non-intact (broken) skin, and mucous membranes. Designed to reduce risk of transmission of microorganisms from recognized and unrecognized sources. 1. Perform proper hand hygiene after contact with blood, body fluids, secretions, excretions, excretions and contaminated objects whether or not gloves are worn. a) Perform proper hand hygiene immediately after removing gloves. b) Use a non-antibacterial product for routine hand cleansing. c) Use an antimicrobial agent or an antiseptic agent for the control of specific outbreaks of infection. 2. Wear clean gloves when touching blood, body fluids, secretions, excretions and contaminated items (i.e. soiled gowns). a) Clean gloves can be unsterile unless their use is intended to prevent the entrance of microorganisms into the body. See the discussion of sterile gloves in this chapter. b) Remove gloves before touching non-contaminated items and surfaces. c) Perform proper hand hygiene. 3. Wear a mask, eye protection, or a face shield if splashes or sprays of blood, body fluids, secretions, or excretions can be expected.

4. Wear a clean, non-sterile gown if client care is likely to result in splashes or sprays of blood, body fluids, secretions, or excretions. The gown is intended protect clothing; a) Remove soiled gown carefully to prevent the transfer of microorganisms to others (i.e. clients or other health care workers) b) Cleanse hands after removing gown. 5. Handle client care equipment that is soiled with blood, body fluids, secretions, or excretions carefully to prevent the transfer of microorganisms to others and to the environment. a) Make sure reusable equipment is cleaned and re-processed correctly. b) Dispose of single-use equipment correctly. 6. Handle, transport, and process linen that is soiled with blood, body fluids, secretions or excretions in a manner to prevent contamination of clothing and the transfer of microorganisms to others and to the environment. 7. Prevent injuries from used scalpels, needles, or other equipment, and place in puncture-resistant containers. B. Transmission-Based Precautions a. Airborne Precautions i. b. Droplet Precautions c. Contact Precautions