RET 1024L Introduction to Respiratory Therapy Lab

1. RET 1024LIntroduction to Respiratory TherapyLab Module 3.0 Infection Control

2. Infection Control • Specialized Equipment Handling • Equipment Handling Procedure • Equipment handling procedures help prevent the spread of pathogens

3. Infection Control • Specialized Equipment Handling • Equipment Handling Procedure • Nebulizers • Large Volume Nebulizers • Always fill with STERILE water • Do not add fluid to partially filled reservoirs – discard old fluid first • Drain tubing condensate away from patient – not back into reservoir (considered contaminated waste)

4. Infection Control • Specialized Equipment Handling • Equipment Handling Procedure • Nebulizers • Small Volume Nebulizers • Between treatment on the same patient, rinse with sterile water and air-dry • Use only sterile fluids for nebulization and dispense these fluids aseptically • When possible, use single-use medication vials

5. Infection Control • Specialized Equipment Handling • Equipment Handling Procedure • Humidifiers • Whenever possible, prefilled, sterile disposable humidifiers should be used • With reusable humidifiers, fluid reservoirs should be filled with sterile distilled water • Do not add fluid to partially filled reservoirs – discard old fluid first

6. Infection Control • Specialized Equipment Handling • Equipment Handling Procedure • Humidifiers • Prefilled, disposable humidifiers can be used safely for up to 30 days • Prefilled, sterile, disposable humidifiers do not need to be changed between patients in high-use areas such as recovery room

7. Infection Control • Specialized Equipment Handling • Equipment Handling Procedure • Bag-Valve-Mask Devices • BVMs should be sterilized or high-level disinfected between patients • Exterior surface should be cleaned of visible debris and disinfected at least once a day

8. Infection Control • Specialized Equipment Handling • Equipment Handling Procedure • Ventilators and Ventilator Circuits • An inspiratory (high-efficiency particulate air/aerosol (HEPA) filter should be placed between the machinery and the external circuit • Expiratory filters also prevent pathogens from being expelled into the surroundings from the patient’s expired air • Use sterile water to fill bubble type humidifiers

9. Infection Control • Specialized Equipment Handling • Equipment Handling Procedure • Ventilators and Ventilator Circuits • Contaminated condensate in the patients breathing circuit needs to be drained away from the patient – not back into reservoir (considered contaminated waste) • Autogenous infection may result • Wash hands after draining tubing condensate or handling the fluid

10. Infection Control • Specialized Equipment Handling • Equipment Handling Procedure Condensation

11. Infection Control • Specialized Equipment Handling • Equipment Handling Procedure • Ventilators and Ventilator Circuits • Change HMEs according the manufacturers recommendation and/or whenever gross contaminants or dysfunction are observed • Do not routinely change HME breathing circuits while in use

12. Infection Control

13. Infection Control • Specialized Equipment Handling • Equipment Handling Procedure • Pulmonary Function Equipment • Tubing, connectors, rebreathing valve and mouth pieces should be subjected to high-level disinfection or sterilization between patients

14. Infection Control • Precautions To Prevent Transmission of Infectious Agents • Because of the nature of the hospital workplace, occupational exposure to blood and body fluids is expected. This repeated exposure means reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious body fluids

15. Infection Control • Barrier Measures • The major route for the spread of infections is by contacting infected persons. Thus measures that place “barriers” between the source and the host can help prevent the spread of infection.

16. Infection Control • Barrier Measures • Handwashing • Personal Protective Equipment (PPE) • Gloves • Masks • Goggles • Gowns • Patient Placement • Patient Transport

17. Infection Control • Barrier Measures • Handwashing • The most common route for transmission of nosocomial infection is hand contact • Careful, methodical handwashing before and after patient contact, is the single most effective way to reduce exposing patients to contagious disease

18. Infection Control • Barrier Measures • Handwashing

19. Infection Control • Barrier Measures • Handwashing You may not realize you have germs on your hands! The photo shows a blood agar plate 24 hours after an ICU nurse placed her hand on plate

20. Infection Control • Barrier Measures • Handwashing – Indications • Wash hands after touching blood, body fluids, secretions, excretions, and contaminated items, even if wearing gloves • Wash hands immediately after removing gloves, between patient contacts, and when otherwise indicated to avoid cross contaminations

21. Infection Control • Barrier Measures • Handwashing – Indications • Wash hand between tasks and procedures on the same patient if cross contamination of different body sites is possible (e.g., tracheostomy care following assistance with a bedpan) • Use plain soap for routine handwashing; use an antimicrobial soap or a waterless antiseptic if specified by the infection control program

22. Infection Control • Barrier Measures • Handwashing – Indications • When hands are visibly dirty, contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap and water • If hands are not visibly soiled, use an alcohol-based handrub for routinely decontaminating hands

23. Infection Control • Barrier Measures • Handwashing • Remove jewelry (rings, watches, bracelets), turn on water (avoid hot water) and thoroughly wet wrists and hands

24. Infection Control • Barrier Measures • Handwashing • Apply 3-5 mL of soap to hands and rub together for at least 15 seconds; cover all surfaces of the wrists, hands and fingers

25. Infection Control • Barrier Measures • Handwashing • Scrub the palm of the hand

26. Infection Control • Barrier Measures • Handwashing • Washing between digits and back of hand

27. Infection Control • Barrier Measures • Handwashing • Washing around the cuticle

28. Infection Control • Barrier Measures • Handwashing • Rinse wrists and hands with water and dry with a clean paper towel

29. Infection Control • Barrier Measures • Handwashing • Using paper towel, turn off faucet

30. Infection Control • Barrier Measures • Handwashing When using an alcohol-based handrub, apply product to palm of one hand and rub hands together, covering all surfaces of hands and fingers, until hands are dry. Note that the volume needed to reduce the number of bacteria on hands varies by product.

31. Infection Control • Barrier Measures • CDC Guideline for Fingernails “Health care personnel should avoid wearing artificial nails and keep natural nails less than one quarter of an inch long if they care for patients at high risk of acquiring infections (e.g. Patients in intensive care units or in transplant units)”

32. Infection Control • Barrier Measures • Gloves • Three major reasons for wearing gloves • Protects caregivers from contacting a patient’s contaminated blood, body fluids, secretions, excretions, mucous membranes, nonintact skin, and other potentially infectious material • Protection of patients from colonized healthcare workers during invasive procedures • Reduce the likelihood of cross contamination between patient’s via caregivers’ hands

33. Infection Control • Barrier Measures • Gloves • Wash hands before putting on gloves • Clean, non-sterile gloves are satisfactory for most purposes; however, caregivers must wear sterile gloves during invasive procedures • Should be changed between each patient contact

34. Infection Control • Barrier Measures • Gloves • Should be changed after direct contact with infectious material, even if in the middle of a procedure • Hands must always be washed after removal of gloves • Invisible defects in gloves • Contamination occurs when removed

35. Infection Control • Barrier Measures • Gloves • Learn to recognize the symptoms of latex allergy: skin rash, hives, flushing, itching, nasal, eye, or sinus symptoms, asthma

36. Infection Control • Barrier Measures • Masks, Goggles, Face Shields and Respiratory Protection • Provide protection of eyes, nose, and mouth against contact transmission of pathogens • Should be worn during procedures that can generate splashing or sprays of blood, body fluids, secretions or excretions

37. Infection Control • Barrier Measures • Masks, Goggles, Face Shields and Respiratory Protection • Masks become ineffective when moist • Should be discarded after each use • N95 respirators must be worn for protective use with TB • National Institute for Occupational Safety and Health (NIOSH)

38. Infection Control • Barrier Measures • Gowns, Aprons, and Protective Apparel • Prevent clothing contamination • Protect skin from blood and body fluids

39. Infection Control • Barrier Measures • Gowns, Aprons, and Protective Apparel • Worn when caring for patients with contagious disorders • May help reduce cross contamination • Should be removed before leaving patient’s room • Worn only once, then discarded • Sterile gowns should be worn when caring for patients with burns or wounds

40. Infection Control • Barrier Measures • PPE - Putting It All On • Put on isolation gown – opening in the back • If needed, shoe covering would go on first • Place mask / respirator on face • Need to be “fit-tested” for N95 respirator mask • Put on goggles or face shield • Don correct type / size gloves

41. Infection Control • Barrier Measures • Using PPE Effectively • Work from “clean to dirty” areas • Touch as few surfaces and items with your PPE as possible • Keep gloved hands away from face

42. Infection Control • Barrier Measures • Using PPE Effectively • If gloves become torn or heavily soiled, remove them, wash hands, and replace them even if you are working with only one patient • Avoid touching or adjusting other PPE

43. Infection Control • Barrier Measures • PPE - Taking It All Off Remove all PPE, except respirators, at the doorway, before leaving the patient’s room. Respirators are to be removed outside of the patient’s room and discarded in the designated waste receptacle

44. Infection Control • Barrier Measures • PPE - Taking It All Off • Gloves • Outside of gloves are contaminated! • Grasp the outside edge of one glove near the wrist and peel the glove away from hand • While holding the removed glove in your gloved hand, slide the ungloved finger under the wrist of the remaining glove and peel it off. Dispose of your gloves in the appropriate biohazard container (red bag)

45. Infection Control • Barrier Measures • Taking It All Off – PPE • Goggles/Face Shield • Outside of goggles or face shield are contaminated! • To remove, handle by clean head band or ear pieces • Place in designated receptacle for reprocessing or in waste container

46. Infection Control • Barrier Measures • PPE - Taking It All Off • Gowns • Gown front and sleeves are contaminated! • Unfasten neck, then waist ties • Remove gown by peeling it away from your neck and shoulders • Turn the contaminated outside of the gown toward the inside • Hold the gown away from your body and fold it into a bundle • Discard it in the appropriate biohazard container (red bag).

47. Infection Control • Barrier Measures • Taking It All Off – PPE • Mask or Respirator • Front of mask/respirator is contaminated! • Untie the bottom and then the top ties of mask, remove it from your face and discard it in the appropriate biohazard container (red bag)

48. Infection Control • Barrier Measures • Taking It All Off – PPE • Perform hand hygiene immediately after removing PPE

49. Infection Control • Barrier Measures • Patient Placement • Private rooms help prevent … • Contact transmission • Droplet transmission • Airborne transmission (negative pressure room)

50. Infection Control • Barrier Measures • Transport of Infected Patients • Transporting infected patients should be limited • The patient being transported needs to wear appropriate PPE • Masks, gowns, impervious dressings