Self-Assessment Quiz Question #1 Standard precautions apply to the care of all patients, all the time, regardless of their clinical condition. These precautions apply when there is risk for potential exposure from all of these except: a. Blood. b. All body fluids, secretions, and excretions (with or without visible blood). c. Intact skin. d. Mucous membranes.
STANDARD PRECAUTIONS
The essentials of infection prevention include following a structured set of guidelines called standard precautions . If done correctly, this reduces the risk of transmitting pathogens (bacteria, viruses, and other microorganisms) that can cause disease (CDC, 2019). Infection control and prevention strategies are implemented to prevent the transmission of pathogens to the most vulnerable patients. Standard precautions include: ● Performing hand hygiene . ● Assessing the risk of transmission and using appropriate personal protective equipment (PPE). ● Minimizing potential exposure through respiratory hygiene and cough etiquette . ● Performing environmental cleaning and disinfection . ● Following injection and medication safety protocols.
Healthcare Consideration: Healthcare settings must follow federal requirements to receive Medicare and Medicaid payments. The State Operations Manual Appendix A describes hospital regulations, including a chapter on infection prevention and control as well as antibiotic stewardship programs (482.42) (Centers for Medicare & Medicaid Services [CMS], 2020). There is also a State Operations Manual Appendix PP for long-term care facilities and a chapter for the Infection Control Program (483.65) (CMS, 2007). CMS regulates other provider types: Ambulatory surgical centers, ambulance services, clinical labs, critical access hospitals, durable medical equipment operators, federally quality health centers, home health agencies, hospices, pharmacists, rural health clinics, and providers (CMS, n.d.).
HAND HYGIENE
Dr. Ignac Semmelweis (1818–1865), who is known as the father of hand hygiene and the father of infection control , implemented a performance improvement project to improve hand hygiene practices (Tyagi & Barwal, 2020; Vermeil et al., 2018; WHO, 2009a). He noticed a lack of hand washing after autopsies were performed and before assisting women in labor. To test his theory regarding the cause of puerperal fever (a maternal, Hand hygiene guidelines Since Semmelweis, hand hygiene has been a critical infection prevention strategy to reduce HAIs (CDC, 2002; Vermeil et al., 2018; WHO, 2009a). The CDC published the first handwashing (in hospitals) guideline in 1975, and it was updated in 1985 and 2002. The updated guidance, called Hand Hygiene in Healthcare Settings (CDC, 2002), introduced hand hygiene , citing the benefits of using alcohol-based hand rubs (ABHRs). Besides the benefits of improved compliance (convenience) and less skin irritation (due to emollient ingredients), ABHRs provide excellent germicidal activity against most gram-positive and gram-negative bacteria, fungi, and lipid-containing viruses (CDC, 2002; WHO, 2009a). For most clinical situations, an ABHR is preferred over soap and water if hands are not visibly soiled. Alcohol-based hand rubs (ABHRs) have challenged the traditional way we think of hand washing with soap and water (CDC, 2002). The CDC (2002) recommends using soap and water when hands are visibly soiled and when caring for a patient with C. difficile , a spore-forming bacteria. Hand hygiene (ABHR or soap and water) should be performed in the following clinical situations (CDC, 2002): ● Immediately before touching a patient. Hand contamination and potential transmission Transmission of pathogens by contaminated hands in healthcare requires four sequential steps: (1) Organisms are present on the patient’s skin or have shed in the immediate environment, and organisms are transferred to the hands of health care workers; (2) organisms must be capable of surviving for at least several minutes on healthcare workers’ hands; (3) hand hygiene is inadequate or entirely omitted, or the agent used in not
postpartum infection once commonly known as childbed fever ), he implemented a strict handwashing protocol for physicians and medical students before they entered a labor room. After a year of the strict handwashing procedure, maternal mortality dropped. Researchers are still discussing appropriate hand hygiene practices today and how they contribute to HAIs. ● Before performing an aseptic task (e.g., placing a urinary catheter) or handling invasive medical devices. ● Before moving from work on a soiled body site to a clean body site on the same patient. ● After touching a patient or the patient’s immediate environment. ● After contact with blood, body fluids, or contaminated surfaces. ● Immediately after glove removal. ● Before eating. ● After using the restroom. A review of the literature was done to determine how frequently nurses use an ABHR per shift per hour to determine a “maximum use” of ABHRs to ensure the safety of healthcare workers (Boyce et al., 2017). Boyce and colleagues (2017) reviewed two studies that used electronic compliance monitoring to measure ABHR usage and found that the majority of nurses used ABHRs approximately 140 or fewer times per shift and 15 or fewer times per hour. Higher hand hygiene events were found in a medical intensive care unit. The results of this study could be used to further evaluate maximum use trials (i.e., to measure detectable blood ethanol levels) for ABHRs. appropriate; and (4) the contaminated hand or hands of the caregiver must come into direct contact with another patient or an object that will come in direct contact of the patient (CDC, 2002; Pittet et al., 2006; WHO, 2009a). Pittet and colleagues (2006) suggested ongoing hand hygiene research that includes strategies to improve education for HCWs.
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Book Code: RPTTX2024
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