Basic procedures in healthcare 1 (SOL / VCA81) Topics: 1a) Asepsis and its principles in healthcare facilities 1b) Nosocomial infections 1c) Barrier care

Basic procedures in healthcare 1 (SOL / VCA81)Topics:1a) Asepsis and its principles in healthcare facilities1b) Nosocomial infections1c) Barrier care1d) Hand washing and disinfection1e) Using of gloves1f) Handling with sterile material1g) Preparation of sterile space for asepsis procedures

definition

related terms (antisepsis, disinfection, sterilization)

basic aseptic procedures

1a) Asepsis and its principlesin healthcare facilities


Definition

complete absence of microorganisms and germs,

antisepsis is achieved by means of sterilization (aseptic = sterile).

Related terms

Antisepsis

a set of measures and procedures,

the aim is to destroy infections on the surface of the body, mucous membrane and in tissues of the human body,

antisepsis is ensured by the application of antisepticon the surface of the body or into body cavities, into the wound.


Related terms

Disinfection

destruction of most microorganisms on inanimate objects, materials, surfaces, in the air or water,

the aim is to interrupt the path of infection from the sourceto susceptible individual,

unlike antisense during disinfection, we can use relatively toxic agents, since disinfection is not performed on living tissuesof the organism.

Sterilization

a set of measures leading to the removal or destruction of all microorganisms and higher organisms and / or its possible forms.


Asepsis technique

working method to prevent the spreadof infection and to achieve antisepsis.

Basic asepsis procedures

hygienic hand washing and disinfection of hands beforeand after direct contact with the patient,

use of protective equipment,

contaminated material stored in containers designed for this purpose,

careful handling of tools as the prevention of injuries,

provide a sterile environment during invasive procedures.

*


Basic asepsis procedures

observing of the skin surface of the patient and his vital signs,

pressure ulcer prevention and treatment,

isolation of patients with infectious diseases,

providing of optimal food and fluid intake,

education of the patient and family,

compliance of barrier care.

• definition

• division

• transmission routes

• etiology

• risk factors

• prevention

1b) Nosocomial infections


these infections are directly connected with the stay in a hospital environment,

they are an important indicator of quality of care,

nosocomial infections can affect not only patients' but also medical staff.

Division

by occurrence - specific X nonspecific,

by origin - exogenous X endogenous,

according to the clinical display.


Division by occurrence

Nonspecific nosocomial infections

infections that occur commonly outside the medical facilities,and the are also present in healthcare facilities due to the epidemiological situation in the region (e. g. flu),

infectious agents are usually well sensitive to antibiotics.

Specific nosocomial infections

they arise in a hospital environment in connection with diagnostic or therapeutic procedures,

they are characterized by the proliferation of specific, often highly resistant originator, different approaches to prevent and treat compared to hospital infections.


Division by origin

Exogenous nosocomial infections

the infectious agent is outside the body of the patient (staff, polluted air, material ...).

Endogenous nosocomial infections

they are caused by the patient's own microbial flora,

infectious agent is brought from the colonized organ or mucosal surface into the surrounding tissue or to another organ(e. g. intestinal microorganisms into the abdominal cavity).


Division according to clinical display

urinary tract infection (approximately 40 %),

infection spread to surgical wounds (approx. 25 %),

respiratory infection – pneumonia (approx. 20 %),

bloodstream infections – bacteremia (approx. 10 %),

others – e. g. gastroenteritis, sinusitis (to 10 %).


Transmission routes

Direct – source of infection is present:

direct contact – most hands of personnel,

droplet infection.

Indirect – source of infection is not present:

nonspecific carrier – air, water, food, clothes…,

specific carrier– surgical wounds, parenteral administrationof medication, catheterization, mechanical ventilation, etc.

*


Etiology:

bacteria,

virus,

fungus,

parasite.

bacteria

Source: http://cs.medixa.org/nemoci/escherichia-coli, downloaded 26. 4. 2015


Etiology – bacterial agents

Gram positive: Staphylococcus aureus, including strains MRSA, Streptococcus pyogenes, agalactiae, pneumoniae, Clostridium perfringens, tetani.

Gram negative: Escherichia coli, Haemophilus influenzae, Pseudomonas aeruginosa, Enterococcus feacalis, Klebsiella pneumoniae.


Etiology – virus agents:

adenoviruses,

RS viruses,

herpes viruses, EB viruses,

Coxsackie virus,

HAV, HBV, HCV,

HIV, AIDS.

*


Etiology – fungus

Candida albicans

Aspergillus species

Etiology – parasite

Pneumocystis carinii

Giardia lamblia


Risk factors

age (newborns, the elderly), basic disease (DM, liver and kidney disease, oncological

disease… ), nutritional status (malnutrition, obesity, alcohol, smoking, drugs..), diagnostic and therapeutic procedures (iv inputs, urine

catheterization. bladder, surgical drains, tracheotomy... ), trauma (injuries, burns, pressure ulcers... ), specific treatment (cytostatic, antibiotics, steroids... ), length of hospitalization.


Prevention

washing and hand disinfection, use of protective equipment, adherence to the principles for handling laundry, decontamination of biological material, sanitary handling of food, individualization of equipment/tools, isolation of infectious patients, or those who are at risk of infection, prevention of infectious aerosols with appropriate cleaning

procedures, cleaning and disinfection of the environment.

• definition

• basic rules

1c) Barrier care

1c) Barrier care

regime measures and procedures that will defend the transmission of pathogens between patients or staff.

Basic rules of barrier care:

hygienic hand washing and hand disinfection,

use of protective equipment,

purity (personal, environmental, patient),

a small number of patients in the room,

use of individual devices for patients.

1c) Barrier care

Basic rules of barrier care:

decontamination of biological material, used equipment, instruments, medical supplies…,

adherence to aseptic procedures during dressing changes,

adherence to the principles for handling linen (clean and used),

sanitary handling of food,

isolation of infectious patients or vice versa patient who is significantly threatened by infection,

education of patient and family.

• definition

• steps

• surgical hand disinfection

• hygienic hand disinfection

1d) Hand washingand hand disinfection


Hand washing mechanical removal of impurities and partially transient microflora

from the skin of hands.

When to do it:

while visible fouling,

after using a toilet,

before and after meal.

We may use hygienic hand disinfection in all other clinical situations.

*


Hand washing

Steps:

moisten your hands with water,

apply a detergent and spread on the hands well,

foam with a small amount of water,

wash for 30 seconds,

rinse thoroughly with running drinking water,

dry wipe with disposable towel.


Hand washing technique

Source: http://www.howdonkey.com/56252-wash-yourself-the-proper-way/#.VSF65uHIqZg, downloaded 5. 4. 2015


Hand washing before surgical hand disinfection mechanical removal of impurities and temporary microflora

of the skin, hands and forearms before surgical disinfection.

When to do it

before the beginning of the surgical program.

Steps

it is identical to the procedure of hand washing for 1 minute, extended of mechanical washing of forearm,

in the case of visible dirt with using a brush at around nails, nail scratches and fingertips.


Surgical hand disinfection (SHD) reducing the amount of transient or permanent microflora

on the skin of hands and forearms.

When to do it

before the beginning of the surgical program,

between each operation,

while damage of integrity or replacement of gloves during surgery.


Surgical hand disinfection (SHD)

Steps rubbing an alcoholic disinfectant in about 10 ml for a period

of 3-5 minutes until the skin of hands and forearm is dry: from fingertips to elbows, from fingertips to mid-forearm, from fingertips to wrist.

rub until dry, hands must be moist throughout the exposure, hands are not rinsed or dried.

*


Hygienic hand disinfection (HHD) removing impurities and reducing the amount of transient

microflora on the skin of hands using washing detergentwith a disinfectant.

When to do it before and after contact with the patient, as part of the barrier nursing techniques, after taking off gloves, after contact with surfaces and objects in the immediate vicinity

of the patient, in the treatment of the contaminated parts of the body

and transferring to another body part, after accidental contamination of the hands with biological material.


Hygienic hand disinfection (HHD)

Steps

rubbing an alcoholic disinfectant in about 3 ml for a periodof 30-60 seconds until the skin of hands and forearm is dry,

hands are not rinsed or dried,

technique is the same as washing hands.


Source: http://blogyourdissertation.com/hand-hygiene/wash-hands-way-surewash-train/ downloaded: 5. 4. 2015


Most often neglected space when washing hands

Source:http://blog.gymlion.com/are-you-washing-your-hands-correctly/downloaded 5.4.2015

• rules of using disposable gloves

• the use of sterile gloves

• threading technique

1e) The use of gloves


The use of disposable gloves

- gloves are protective equipment that:

provides mechanical barrier, ↓ the risk of transmission of infection

from medical staff to patients and frompatients to medical staff,

↓ the risk of contamination of the hands of medical staffwith biological material.

Rules of the use of disposable gloves:

perform hygienic hand disinfection before sliding it ontothe glove,

put gloves after the disinfectant is dry.

*


Rules of the use of disposable gloves: always use gloves, if there is a potential risk of contamination

by biological material,

gloves do not replace hand hygiene,

clean pair of gloves for each patient,

changing gloves when contamination even when taking care of one patient (e. g. hygienic care before performing dressing... ),

gloves undress immediately after the activity for which they were used,

do not use damaged gloves,

used gloves dispose of as infectious material,

gloves do not provide complete protection against contamination,it is required to do sanitary disinfection and hand washing after using gloves.


The use of sterile gloves

Indication:

surgery,

invasive radiological procedures,

the provision of central vascular access,

performances regarding cavities (with the exception of naturally non-sterile body cavities), e. g. bladder catheterization,

preparation of parenteral nutrition and chemotherapeutic agents,

sterile bandages,

preparation of a sterile field.

*


Putting on sterile gloves technique

Source: http://e-safe-anaesthesia.org/sessions/13_02/d/ELFH_Session/370/tab_542.html, downloaded 5.4.2015

• ways of handling sterile material

• principles of handling sterile material

1f) Handling with sterile material


We distinguish between two ways of handling sterile material:

1. Administered way– surgical instruments are placed in sterile packs, they are pulled out with sponge holding forceps.

2. Non-administered way– surgical instruments or materials are individually packaged.


Rules: the manipulation of sterile material is treated after hygienic hand

washing or disinfecting hands and in clean work clothes,

sterile material is removed from a drum or container right before its using,

we pull out sponge holding forceps from quivers in the middle of the quiver, we can not touch the quiver,

we administer the tools with grasping part,

we hold a tampon in sponge holding forceps on the edge,

we must never put hands into the cassette,

we hold the sterile sponge holding forceps above the waist,

sterile material is added into the sterile field from a height of 10-15 cm.


Rules:

a cap of cassette is put down the outer pad and it is closedas quickly as possible,

swabs are soaked into a sterile solution only once,

sterile material, that is removed from the drum or container,we can not get back even if it was not used.

• indications for preparing sterile field

• basic tools

• the procedure for preparing sterile field

1g) Preparation of sterile spacefor asepsis procedures

Indications for preparing sterile field:

the introduction of vascular inputs (central venous catheter, arterial catheter),

tracheostomy,

thoracic drainage,

minor surgical interventions,

more extensive wound dressing,

surgeries etc.


stainless steel containers for surgical instruments

Basic tools:

surgical mask + hat,

sterile gloves,

sterile gown,

basic surgical instruments (tweezers,hemostats, scissors),

sterile swabs and squares,

2 syringes (10 ml),

needle and suture,

bowl for saline.

Other tools depending on the type of performance.



Steps:

check the integrity of the table and if it is possible to adjustthe height of the desktop,

mechanically clean the table and disinfect it,

Put surgical mask back to front on the table,

Put needed tools on the set table from a height of 10 - 15 cm,

2.5 cm from the edge masks are considered non-sterile,

if you need to move a cart, touch only the lower part,

if needed (a surgery is not performed immediately), coverthe prepared table with a sterile drape, which is put front to back.


What is a barrier care?

Describe / demonstrate the technique of hand washing.

What is the basic equipment of a sterile table?

What is the difference between direct and indirect transmission of nosocomial infections?

When do we perform hygienic hand disinfection?

What is asepsis? What are nosocomial infections?

Please list at least five principles for the use of disposable gloves.

Please, name the principles of barrier care.

What methods of disinfection and sterilization do you use at home?

How much water and how much concentrate do you use to prepare 5 liters of 2 % solution if the concentrate is 100%?

Revision:

KAPOUNOVÁ, Gabriela. Ošetřovatelství v intenzivní péči. Vyd. 1. Praha: Grada, 2007, 350 s., [16] s. barev. obr. příl. Sestra (Grada). ISBN 978-80-247-1830-9.

KELNAROVÁ, Jarmila. Ošetřovatelství pro střední zdravotnické školy - 2. ročník. 1. vyd. Praha: Grada Publishing, 2009, 228 s. ISBN 9788024731063.

ROŠKOVÁ, Phdr. Silvia. Význam dezinfekce a sterilizace. Sestra [online]. 2012 [cit. 2015-04-07]. Dostupné z: http://zdravi.e15.cz/clanek/sestra/vyznam-dezinfekce-a-sterilizace-464371.

ROZSYPALOVÁ, Marie, Alena ŠAFRÁNKOVÁ a Renata VYTEJČKOVÁ. Ošetřovatelství I: pro 1. ročník středních zdravotnických škol. 2., aktualiz. vyd. Praha: Informatorium, 2009, 273 s. ISBN 978-80-7333-074-3

VÍT, Mudr. Michael. Metodický návod na mytí rukou MZ. [online]. 2005. vyd. [cit. 2015-04-07]. Dostupné z: http://www.mzcr.cz/kvalitaabezpeci/obsah/metodicky-navod-na-myti-rukou-mz_2377_20.html

VOKURKA, Martin a Jan HUGO. Velký lékařský slovník: Martin Vokurka, Jan Hugo a kolektiv. 9., aktualiz. vyd. Praha: Maxdorf, 2009, 1147, [12] s. ISBN 9788073452025

VYTEJČKOVÁ, Renata. Ošetřovatelské postupy v péči o nemocné II: speciální část. 1. vyd. Praha: Grada, 2013, 272 s., xvi s. obr. příl. Sestra (Grada). ISBN 978-80-247-3420-0.

ZOUHAROVÁ, Klára. Bariérová péče, zásady aseptického chování a postupů. [online]. 2011. [cit. 2015-04-07]. Dostupné z:http://www.szsmb.cz/admin/upload/sekce_materialy/Barierova_pece.pdf

ZOUHAROVÁ, Klára. Nozokomiální nákazy. [online]. 2011 [cit. 2015-04-07]. Dostupné z: http://www.szsmb.cz/admin/upload/sekce_materialy/Nozokomialni_nakazy.pdf

PICTURES * (if not specified differently): pinterest.com, google.com + using keywords („glowes“, „wash hands“…)

References:

Documents

Basic procedures in healthcare 1 (SOL / VCA81) Topics: 1a) Asepsis and its principles in healthcare facilities 1b) Nosocomial infections 1c) Barrier care