intermittent suction is turned on. The nurse removes her gloves and secures the NG tube to the patient’s nose. While the patient is resting, the nurse cleans up the used supplies on the bedside table and tidies the room. Leaving the patient to rest, the nurse exits the room and shuts the door behind her. Question Following the WHO’s five moments of hand hygiene, how many times should the nurse have performed hand hygiene? Discussion The nurse should have performed hand hygiene at least five times. The nurse should perform hand hygiene after she enters Mrs. Grange’s room (after touching the door) and after shaking the patient’s hand, (before patient contact and after patient The nurses’ aide is making her rounds, stopping in to see if Mrs. Grange is ready for a bedside bath and linen change. The aide knocks on the door and enters the room, saying hello to Mrs. Grange. Mrs. Grange feels better after her NG placement, so she can get up to a chair next to the bed. The aide assists Mrs. Grange to the chair. The aide gathers the bathing supplies and sets them up on the bedside table next to Mrs. Grange. While Mrs. Grange is bathing independently, the aide changes the linens on the bed. While wearing gloves, she gathers the dirty linen and deposits it in the laundry hamper. The aide removes her gloves, gathers clean linen, and makes the bed. After the bed is made, the aide adjusts the bed, touching the bedrails, and remembers to place the call bell on the bed. The aide helps Mrs. Grange with the rest of her chairside bath and dons gloves. After the bath, she deposits the used towels in the linen hamper. The aide removes her gloves and puts away the bathing supplies. The aide then helps Mrs. Grange back to bed and dons a pair of gloves to clean the bedside table after it was used during the bathing procedure. The aide removes her gloves and exits the room, leaving the door open. Question Following the WHO’s five moments of hand hygiene, how many times should the nurses’ aide perform hand hygiene? Discussion Case study #2 Mrs. Grange: Bathing and Changing Linens The nurses’ aide should perform hand hygiene at least nine times. The aide should perform hand hygiene before assisting Mrs. Grange up to a chair and after she is in the chair (before and after patient contact). With clean hands, the aide gathers bathing supplies and sets them up for Mrs. Grange, and the aide should perform hand hygiene after touching Mrs. Grange’s surroundings (after touching patient environment). With clean hands, the aide dons gloves to change the bed linens, and after she deposits the linens in the hamper and removes her
contact). With clean hands, the nurse gathered her supplies and used the bedside table to prepare for the procedure. The nurse should perform hand hygiene after touching the patient’s bedside table (after touching the patient’s surroundings) and before she dons gloves to insert the NG (before aseptic technique). Note: Hand hygiene could be performed once for these two moments if the nurse immediately dons gloves. After the procedure, the nurse removes her gloves and should perform hand hygiene (after glove removal). After the nurse touches items in the patient’s environment (cleaning up), hand hygiene should be performed (after touching the patient’s surroundings), paying close attention to moving from clean to dirty areas and not cross-contaminating surfaces. dirty gloves, she should perform hand hygiene (after removal of gloves). With clean hands, she now makes the bed. When she is done making the bed, she should perform hand hygiene after touching the bedrails and call light (contact with the patient environment), and now she is ready to help Mrs. Grange finish her bath. After depositing the dirty linen and removing her gloves, she should perform hand hygiene (after removal of gloves). She should also perform hand hygiene after she puts the bathing supplies away (after contact with patient surroundings). With clean hands, she can assist Mrs. Grange back to bed. After Mrs. Grange is tucked back into bed, the aide should perform hand hygiene (after patient contact). With clean hands, the aide dons gloves to clean and disinfect the bedside table that was used during the bathing procedure, and when she is done, she removes her gloves and should perform hand hygiene (after glove removal). Evidence-Based Practice! A study in Hungary examined the survival rate of selected multidrug-resistant organisms (MDROs) in textiles (sheets and towels; Hanczvikkel & Toth, 2018). Different strains of bacteria were tested in the textiles at different intervals on day one (multidrug-resistant Klebsiella pneumoniae [MRKP]), day three (methicillin-resistant Staphylococcus aureus [MRSA]), and day seven (multidrug- resistant Acinetobacter baumanii [MACI] and vancomycin- resistant Enterococcus [VRE]). The results showed that MDROs could survive in textiles. Specifically, MACI and VRE had the highest survival rate even after seven days. Having feces and blood in the textiles provides nutrients, increasing the bacteria’s survival rate. This study concluded that the cotton towel had a 100% pathogen survival rate compared with the sheets. A good laundry process in healthcare to prevent transmission of MDROs from textiles is critical. Further investigation is recommended to study other textiles, such as bedside partition curtains.
PLANNING AND STRATEGIZING FOR PREVENTION
Pathogens can spread in many ways in a healthcare setting. The CDC has published guidelines that provide a roadmap of diseases, and the infection prevention measures (i.e., vaccination, transmission-based precautions, personal protective equipment) to implement to prevent spread. An essential component of preventing the spread of MDROs is HCW training Vaccine-preventable diseases A great resource on vaccine-preventable diseases is The Epidemiology and Prevention of Vaccine-Preventable Diseases , which is also called the Pink Book (CDC, 2021). It is a wealth of information regarding general vaccine recommendations, Epidemiologically important pathogens The CDC recently published Antibiotic Resistance Threats in the United States (CDC, 2019), providing detailed information regarding 18 antimicrobial-resistant bacteria and fungi. This report serves as a resource highlighting recent research and
and competency validation to ensure adherence to standards and guidelines. The pandemic taught us a lot about planning and strategizing to prevent pathogen spread with limited resources. Healthcare facilities should have a strategy in place for how to deal with new threats from epidemiologically important pathogens.
including safe storage, handling, administration, and disease- specific information. The CDC’s Vaccines and Immunizations webpage (2021) provides a good resource for vaccine information for healthcare professionals and the community.
areas of concern. The threats list includes three categories— urgent, serious, and concerning—and a “watch list.” The Centers for Medicare & Medicaid Services requires hospitals and long- term care facilities to have an antimicrobial stewardship program
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Book Code: RPTTX2024
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