Professional Documents
Culture Documents
Ipp File
Ipp File
How you should care for your hands on a day to day basis?
Wash my hands before and after contact with patient
Make sure that my nails are short
I will make sure that I wash my hands after I remove gloves before I use hand rub to
avoid sensitivity to the skin
Explain how you should care for your hands on a day to day basis?
Situations when you must wash with soap rather than spray hands
Gown: it covers torso from neck to knees; arms to end of wrist and wrap
around the neck. And fasten in the back of neck and waist.
Mask or respirator: secure ties or elastic bands at middle of head and
neck.
Fit flexible band to rose bridge
Fit snug to face and below chin.
Fit check respiratory.
Goggles or face Shield: place over face and eye adjust to fit.
Gloves: extend to cover wrist of isolation gown.
Sharps management
Define sharps
Anything that can penetrate to the skin
Do not place needles; syringes and sharps directly onto beds; bed linen or
lockers use a safe container e.g. receiver.
Do not shake container to create more space.
Do not empty one container to another container.
Do not remove anything from the sharps container.
Do not fill beyond the fill line.
The Dos
Check the fill up line on the sharps container , do not fill beyond fill line.
The container must have the hospital name the ward and a date.
This an item that is capable of cutting / puncturing the skin such as needles, syringes,
blades, clinical glass and similar articles.
All waste that should be handled and disposed in accordance with the nuclear energy
act.
Placenta
Foetuses
Foetus should be placed an appropriate sized, rigid walled and leak proof plastic
container.
Container is taken to storage area accompanied by a nurse after arrangements have
been made for receiving it with the HCRW transporter.
Appropriate documentation is completed.
Limbs
Surgeon must confirm that the limb isnt required for histological examination and the
statement must be recorded in the patients record.
Limb is to be placed in an appropriate sized rigid walled leak proof plastic container.
For storage you do the same as above.
Ensure documentation is completed.
Must be placed in refrigerator at a temperature of -2 c and must be cleaned disinfected
daily or after removal of waste if it cant be disposed of immediately.
1) Used linen
Linen roller containing appropriate bags identified with ward/unit name or
number is taken to bed side.
Bed linen to be placed in appropriate bag.
Linen is to be sorted, counted, bagged and sealed and sent to the laundry.
Ensure that workers are to wear protective clothing while doing this.
2) Soiled linen
All organic matter is to be removed by ward staff wearing the appropriate protective
clothing.
Linen should be placed in a yellow plastic bag counted and labelled and sealed. When
this bag is emptied into washing machine laundry worker must wear protective
clothing.
3) Contaminated linen
Yellow plastic bag to be kept in isolation room.
As items are placed in bag they should be counted and should be recorded either on a
label attached or on the bag itself with a permanent marker.
Bag to be sent to laundry with no further handling.
Urine specimen
Collect first morning specimen if possible.
Ensure that patient cleans genitals before passing the specimen.
Ensure that the bedpan you give the patient is clean to make sure that the
specimen doesnt get contaminated.
The specimen should be sent to lab within two hours of collection.
Label the container with patients name date and time of collection and clearly
state what the specimen is sent for.
When collecting mid-stream educate patient to first pass urine in to toilet then hold
then pass into specimen bottle until its half full then pass the rest of urine into toilet or
bedpan.
Use appropriate protective clothing when collecting urine.
Try to get the patients first urine in the morning if its possible.
Advise patient to wipe genitals before passing urine.
Ensure before you give the patient a clean bedpan.
Use a new clean specimen bottle to collect the urine and avoid touching the inside of
bottle to avoid contamination.
Correctly label bottle with patient sticker and note date and time of collection.
Stool specimen
Advise patient to pass urine first before passing stool and not to place toilet paper
together with stool.
Offer patient a clean bedpan for collection of stool.
Ensure when you put stool into container that you use a sterile spatula to scoop the
stools.
And do the same as you did for urine as to labelling the container.
Ensure that you use a clean container and avoid touching the inside of the bottle as
this could contaminate it.
Use protective clothing that is appropriate when collecting the stool.
Wound swab
Remove dressing from area to be swabbed.
Clean wound with normal saline.
Roll swab applicator around the wound area and place applicator in swab container
and ensure you find out from the lab which swab to use for the specific thing you are
swabbing for.
Ensure that you maintain an aseptic technique while dealing with the wound
Environmental cleaning
Explain Spauldings classification of cleaning:
This way of cleaning entails classifying items that we use in crucial patient care and
classifying them into three categories:
These items confer a high risk of infection if contaminated with any microorganism.
So objects that are used to enter vascular system or tissues presumed to be sterile must
be sterile because if they are contaminated with any microorganism this could
transmit a disease.
This category of items include surgical instruments, cardiac and urinary catheters,
implants and ultrasound probes used in sterile body cavities.
These items should be sterilized and this will remove or destroy micro-organisms
including their spores.
And this should be done for all items that penetrate skin or mucous membrane and
those that enter sterile body areas.
These are semi critical items that contact mucous membranes or non-intact skin.
These include respiratory therapy, anaesthesia equipment, some endoscopes,
laryngoscope blades, oesophageal manometry probes, cystoscopes, anorectal
manometry catheters and diaphragm fitting rings.
These medical devices should be free from micro-organisms but small number of
spores are permissible reason being intact mucous membranes and of the lungs and
GIT are generally resistant to infection by common spores but susceptible to other
organisms such as bacteria, mycobacteria and viruses.
These items minimally require high level disinfection using chemical disinfectants
and this reduces number of micro-organisms to a level that is not harmful and spores
are usually not destroyed.
These are non-critical items are those that are in contact with intact skin but not the
mucous membranes.
Intact skin acts as a barrier to most microorganisms so sterility of items is not critical.
Examples of noncritical patient-care items are bedpans, blood pressure cuffs, crutches
and computers.
Non-critical reusable items may be decontaminated where they are used they is no
need to be transported to a central processing area.
No risk has been documented for transmission of infectious agents to patients through
noncritical items.
Contamination and many micro-organisms must be physically removed with
detergent.
Explain the importance of effective cleaning:
Through cleaning is very important before high-level disinfection and sterilization
because if inorganic and organic materials remain on the surface of instruments it will
interfere on the effectiveness of process.
If soiled materials dry up or bake onto instruments removal of these materials will
become very difficult.
Disinfection/sterilization process is less effective or ineffective.
Surgical instruments must be pre-soaked or rinsed in order to prevent of blood thus
will soften blood or remove it.
Cleaning reduces bioburden and removes foreign material that interferes with
sterilization process acting as a barrier to sterilization agent.
Items used in patient-care that become heavily soiled with faeces, sputum or blood or
other materiel should be pre-cleaned.
If these items are sent to cssd without removing these materiel they may be difficult to
clean because these materials have dried up.
Cleaning and decontamination should be done immediately or as soon as possible
after the use of equipment to make the cleaning process effective or easier.
Environmental cleaning
Explain terminal cleaning:
This is the disinfection programme that is implemented to prevent spread of infection
through effective cleaning of an isolation cubicle and the equipment when the patient
has left.
Is a specialized bodily fluid that delivers necessary substances to body cells such as nutrients and
oxygen and it is made of plasma, platelets, leukocytes and erythrocytes .
Body Fluids:
Any fluid that originates inside the body of a living person either excreted or secreted in the body.
Explain the nurses responsibility regarding the cleaning of blood and body
fluids:
It remains the nurses responsibility to clean the blood and body fluid spills
When liquid has been absorbed place paper towel in a red plastic bag .
Then you can call a cleaner to clean the area with a hypochlorite solution.
When liquid has been absorbed place the paper towel in a red plastic bag.
But the first three points are the responsibility of the nurse the cleaner only does it if they see
the spill and they is no nurse.
Education
Explain the importance of continuous education:
It is important if new policies are implemented, then you need to teach staff about it in to
implement it.
In order for new staff that are hired, if they are not familiar with the hospitals policies then if
you have this in place they can be educated.
Name the various ways in which you can ensure you up to date with new
develops in infection prevention:
It helps in maintaining standards in the wards as it ensures that staff members assess each
other in doing the right things.
It help the infection control sister in maintaining standards and thus it eases her work load.
It encourages fellow colleagues to keep themselves update on the latest infection prevention
developments as they need to know things before they evaluate each other.
It also encourage fellow colleagues to read up policies as they need to know there content
before they assess each other.
This is after you have studied something and after doing it you evaluate yourself on what you
have done.
In this you always asses if you are doing the right and if not then you rectify what you are
doing.
This concept ensures that you always keep yourself updated about things you do in the
hospital setting.
Patient placement
Explain the concepts quarantine, cohorting, isolation, single room and
social isolation:
Quarantine:
Period of isolation of an infectious or suspected case to prevent the spread of disease. For
contacts this is the longest incubation period known for the specific disease.
Cohorting:
Two people being isolated together because they both have the same disease or infection
caused by the same microorganism.
Isolation:
Single room:
This is when a person with an infectious disease is separated from non-infected people and is
placed in a room alone away from other patients.
Social isolation;
This is when a patient is isolated for social purposes not to disturb other patients or to protect
patient from other people.
The indication would be for patients that require isolation and they is not enough rooms
available for isolation but both patients have to have the same infection before they can be
isolated together.
Contact precautions:
These are used for patients who have severely impaired resistance to prevent contact with
potentially pathogenic micro-organisms. This used for patients who have gone for a
transplant, extensive breakdown of the skin, severe and extensive non-infected vesicular,
eczematous dermatitis, immune-suppressive therapy, certain lymphomas and leukaemia and
certain therapeutic regimens, total body irradiation, steroids and chemotherapy.
This is the disinfection programme that is implemented to prevent spread of infection through
effective cleaning of an isolation cubicle and the equipment when the patient has left.
Staff protection
Explain the importance of staff protection:
This ensures that staff dont get exposed to highly contagious diseases.
Where it is possible if staff is exposed by means of vaccination they are protected from
viruses that vaccines are available.
If staff maintain health then less of them will be away from work thus company wont lose
money to a lot of sick leave being taken.
If staff members are protected it also means patients will be protected as they will not transfer
these infections to patients.
Immunity is only guaranteed if the above pattern of administration is followed and three
vaccines are given.
Then a booster injection should be given every five years after original course.
Let the injury bleed freely under running water then wash thoroughly with antibacterial soap ,
wipe with alcohol impregnated swabs, cover with water proof dressing if needed. If its in the
case of an eye splash wash face with soap and eye with saline water.
Report immediately to person in charge and infection control nurse or occupational health
nurse.
This person should obtain informed written consent from the source patient blood for testing
and decide treatment action.
Complete net care needle stick injury or exposure to blood/body fluids form.
The unit manager, person in charge, ipcn or occupational health nurse must complete the
netcare incident report and the coid form.
Incident must be reported immediately so that informed consent may be obtained from the
source patient and testing may be completed in order to allow a decision to be made regarding
prophylaxis for staff member.
The prophylaxis if indicated must be commenced within one hour of the exposure.
Explain the concept of a contact list:
It is used to contain infection by ensuring that all persons that where in contact with the
patient are treated as in given prophylaxis treatment where possible or to be isolated from
other people to prevent transmission of infections , so a list is compiled of all people who
came in contact with patient and who they came in contact with.
Respiratory hygiene
Explain the concept respiratory hygiene and motivate why it should be implemented:
This concept is used to prevent the transmission of respiratory illness and should be
implemented to prevent the transmission of respiratory illnesses and to create awareness
around this and thus to reduce the rate of infection of such diseases this includes doing the
following:
.
One should cover their nose or mouth when coughing or sneezing with a tissue or
their hand.
Dispose of the tissue used into a dustbin and wash their hands or use a hand sanitizer
and if hand was used to do the same.
See their doctor if the cough lasts for more than a week.
If people are in the waiting area encourage them to sit a meter away from other
patients or offer them a surgical mask to wear.
Safe injection practices
Explain the components of safe injection practices:
Use fluid infusion and administration sets for one patient only and dispose appropriately after
use.
Do not administer medications from single dose vials or ampules to multiple patients or
combine leftover medication for later use.
If multi-dose vials are used both needle and syringe used must be sterile.
Multiple dose vials must not be kept in immediate patient treatment and they should be stored
in accordance to manufactures recommendations.
Do not use bags or bottles of intravenous solution as common source of supply for multiple
patients.
Ensure before using it an appropriate alcohol solution is used to clean the top of it and in the
correct procedure is used.
Ensure date of opening is clearly written on the bottle to ensure that it is not used past date of
expiry.
Make sure to check with manufacture how long it can be kept for use.
This isolates patient according to how their infection is transmitted thus it ensures that
infections dont get transmitted to other patients and reduces the rate of infection.
Airborne precautions:
Tuberculosis
Measles
Chicken pox
H5N1 influenza
Droplet precautions:
Meningococcal meningitis
Meningococcemia
Mumps pertussis
Rubella
Haemophilias
Diphtheria
Mycoplasma pneumonia
Streptoccol pharyngitis
Influenza
Respiratory syncytial
Parainfluenza virus
Plague
Herpes zoster
Contact precautions:
Anthrax
Herpes zoster
Rabies
Gas gangrene
Puerperal sepsis
Clostridium difficile
Shigella
Hepatitis A, B & C
Herpes simplex
Impetigo
Pediculosis
Conjunctivitis
Protective precautions
Transplant patients
Extensive breakdown
Immune-suppressive therapy.
Wear respiratory protection when entering the room and a N95 for pulmonary tuberculosis.
Contact precautions:
Droplet precautions:
Visitors that at high risk of getting infections should not visit the patient.
They should insure that they wash their hands when leaving and before they come in.
The staff that work with isolation patient should not work with patients that are not in
isolation
MRSA precautions
Explain the concept MRSA, VRE and ESBL:
MRSA
Multi resistant staphylococcus aureus: its a staphylococcus aureus that is resistant to multiple
antibiotics.
VRE
ESBL
Hand hygiene must be monitored and improved and hand rub to be made available for use.
If private room is not available should be placed with a patient that has mrsa.
If that is not possible consult with infection control sister to place patient.
Explain the visitor and patient education for patients in MRSA isolation:
Visitors that are at high risk of infection should not visit patient.
If visitors have small children at home should rather change clothing before picking them up.
Swabs must be taken from the patient from the groin, throat and nose.
Patient to bath, shower, or bed bath using chllorhexdine gluconate 4% solution and solution to
be used as a liquid soap and not a bubble bath after the swabs have been taken. Soap to be
applied to skin and left for 1 minute before rinsing.
Visitors to comply with isolation precautions and not to visit other patients.
This is when a group of people have been infected with the same infection and now is
been transmitted to other people.
Explain the measures one should put in place to prevent the outbreak of
infections in the unit:
When they is a patient with an infection or is suspected of having one the infection
control sister must be notified.
Contaminated linen should not be mixed with the other linen of way.
Staff looking after infectious patients should not look after other patients in the ward.
Advice visitors that fall in high risk groups not to visit ward.
Ensure that isolation cards are put up at the patients door where they are isolated.
VAP
Aim of this bundle is to prevent ventilator associated pneumonia by doing the following:
Peptic ulcer prophylaxis this will result in a reduction in upper gastrointestinal bleed.
Tilting of bed up to 30 degrees -45 degrees this should result in 70% reduction in
ventilator associated pneumonia.
Mouth care 6 hourly using antiseptic mouth wash I adults and lemon sticks sterile
water or saline in neonates to minimize bacteria in mouth.
Tracheal aspirate sample taken and sent for MC&S at first suctioning after admission
to ICU to check if patient has any infection and if has to be dealt with immediately.
CLABSI:
This trys to prevent or minimize central line associated bloodstream infections by:
Chlorhexdine and alcohol skin prep should be done and allowed to dry before
insertion of central line.
Central line should in adults be sited in the subclavian vein and in neonates an
umbilical line.
Line should be properly secured with a dressing, stitched or a special device used.
CAUTI:
It is used to reduce and prevent catheter associated urinary tract infections by:
Catheter care should be done twice a day and after every bowel action using
antiseptic soap and water, preferably chlorhexidine- based soap.
SSI:
Blood glucose to be maintained above 4 and below 8 for major surgical procedure
post-operative.
Temperature to be maintained at above 36.5 and below 37.2 for colorectal and open
abdominal surgery.
Antibiotic stewardship:
If heart rate is above 90 beats a minute for adult can also indicate infection
If PCT is between 2- 10 start broad spectrum antibiotic or prescribe as per culture result.
If PCT is <1 its unlikely bacterial but if above 1 its likely bacterial and is used to distinguish
between bacterial and viral infection.
Lymphocytosis
Inflammation phase:
Trauma causes injured tissue cells to release inflammatory chemicals which causes capillaries
do dialate and become very permeable which allows neutrophils, monocytes and plasma into
the injured area.
Leaked clotting proteins construct a clot which stops the loss of blood; this holds the edges of
the wound together.
Effectively walls in or isolate the injured area thus preventing bacteria, toxins, or other
harmful substances from spreading to surrounding tissues.
Part of clot exposed to air quickly dries and hardens forming a scab.
Inflammatory events leave behind excess fluid, bits of destroyed cells and other debris which
eventually are removed via lymphatic vessels or phagocytized by macrophages.
While inflammatory process is going on first phase of tissue repair called organization.
Contains capillaries that grow in from nearby areas and lay down a new capillary bed.
Proferating fibroblast in granulation tissue produce growth factors as well as new collagen
fibres to bridge the gap.
Some of these fibroblasts have contractile properties that pull the margins of wound together.
Granulation tissue destined to become scar tissue which is highly resistant to infection
because it produces bacteria-inhibiting substances.
Once enough matrix has accumulated to the injured area the fibroblast either revert to the
resting stage or apoptosis.
During organization the surface epithelium begins to regenerate growing under the scab
which soon detaches.
The scar may be invisible or visible as a thin white line depending on the severity of the
wound.
Diagnosis and control of infection
Explain the action of antibiotics on bacteria:
They block the ability of microorganisms to synthesize their cell wall by inhibiting the 67
psynthesis of peptidoglycan.
Once the cell wall synthesises inhibited, enzymatic autolysis of the cell wall can occur.
Without the restraining influence of the cell wall the osmotic pressure inside the cell bursts
the inner and/or outer membranes of bacteria.
A protein eynthesis inhibitor is a substance which stops or slows the growth or perforation of
cells by disrupting the processes that lead directly to the generation of new proteins by
ribosomes.
They disrupt the integrity and structure of cell membranes thereby killing them.
They bind to the proteins that are required for processing DNA and RNA thus blocking their
synthesis and thereby affecting the growth of cells.
Competitive inhibitors:
They competitively inhibit the important metabolic pathways occurring inside the bacterial
cell.
Antibiotic resistance develops through mutation or plasmid exchange between bacteria of the
same species.
If bacterium carries several resistance genes its called multi-resistant or informally superbug.
The link nurse should do clinical rounds with microbiologist and doctors and/or written
comments on patients bed charts by microbiologists. They should do antibiotic rounds and
surveillance.
Link nurse should implement surveillance to determine the efficacy of current antibiotic
protocols.
They should educate patient and staff on importance of antibiotic course completion.
Educate patients and staff on importance on giving/tacking antibiotics at correct time intervals
to maintain correct therapeutic levels.
Ensure all specimens are sent fresh and are sampled and labelled correctly as this will ensure
quicker availability of results which again will ensure quicker and correct antibiotic treatment.
Support infectious disease treatment with adequate nutrition, hydration, rest & other physical
therapy.
Microbiology
Define macro and microorganism and name examples of each:
Micro
Its a parasite that multiplies directly within their host, usually inside the host.
They can complete a full cycle inside a single host and cannot be seen with the naked
eye.
Example of it is salmonella and HIV.
Macro
Exotoxins:
They are toxic in minute amounts.
They are Specific to a cell type.
They stimulate antitoxins.
They are not stimulated by fever.
They are secreted from live cells.
These are unbound toxin molecule secreted by a living cell into infected
tissues.
Endotoxins:
They are not secreted but are released only after the cell is damaged or lysed.
They are toxic in high amounts.
They are systematic to fever and inflammation.
They do not convert to toxoid.
They do not stimulate antitoxins.
They are stimulated by fever.
They released by cell during lysis.
And they are all gram-negative.
Nutrients:
Temperature:
Range of 25-45 degrees Celsius and optimal growth temperature for human pathogens
is 37 degrees Celsius.
Oxygen needs:
Define prions:
An infectious agent that is composed primarily of protein.
All such agents that have been discovered propagate by transmitting a misfolded
protein state.
Conclusion