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Infection Control, Vital Signs, Oxygen & Medical Emergencies
RTEC 93
Infection Control
• Microorganisms
• Infectious Disease
• Chain of Infection
• Nosocomial Infection
• Disease Control
• Environment
Standard Precautions
What do you think?
• What is the potential hazard to the patient when strict aseptic techniques is not used when administering intravenous medication or contrast?
Microorganismsthat cause disease Bacteria
Viruses
Fungi
Protozoa
Can grow in or on an animal or plant and cause diseases.
Host: animal or plant that provides life support to another organism.
Disease
• Disease occurs only when the microorganism causes injury to the host
Pathogen
A disease producing microorganism.
Multiply in large numbers and cause an obstruction
Cause tissue damageSecrete substance that produce effects in
the body Exotoxins ( high body temp, nausea, vomiting)
6 Steps of Infection
Encounter
Entry
Spread
Multiplication
Damage
Outcome
Chain of InfectionChain of Infection
HostHost
Infectious Infectious MicroorganismMicroorganism
Mode of Mode of TransmissionTransmission Vector/ FomiteVector/ Fomite
ReservoirReservoir
Nosocomial InfectionsNosocomial Infections
Infections Infections originating in the originating in the hospital; an hospital; an infection not infection not present before present before admittance to admittance to the hospital.the hospital.
Nosocomial InfectionsNosocomial Infections
Iatrogenic Iatrogenic InfectionInfection
Compromised Compromised PatientsPatients
Patient FloraPatient Flora Hospital Hospital
EnvironmentEnvironment Bloodborne Bloodborne
PathogensPathogens
Types of Nosocomial InfectionsTypes of Nosocomial Infections
Iatrogenic Infection – related to Iatrogenic Infection – related to physician activitiesphysician activities
Compromised Patients - weakened Compromised Patients - weakened resistance; resistance; immunosuppressedimmunosuppressed
Patient Flora - microbes in healthy Patient Flora - microbes in healthy peoplepeople
Contaminated Hospital EnvironmentContaminated Hospital Environment Bloodborne Pathogens – Hepatitis B Bloodborne Pathogens – Hepatitis B
and HIVand HIV
Third Degree BurnWho needs protection from infection if this is your patient?
Universal Precautions
Since there is no way you can know if a person is infected, you should ALWAYS use universal precautions:
Wash your hands Wear gloves Handle sharp objects carefully Properly clean all spills Wear mask, eye protection, and apron if
splashing is a possibility.
What are the 3 Transmission-based Isolation Precautions?
Contact
Droplet
Airborne
Airborne Precautions
Patients infected with pathogens that remain suspended in air for long periods on aerosol droplets or dust.
TB, Chickenpox, Measles Respiratory protection must be worn when
entering pt room. Pt should wear mask.
Droplet Precautions
Patients infected with pathogens that disseminate through large particulate droplets expelled from coughing, sneezing, or even talking.
Rubella, Mumps, Influenza Surgical mask must be worn when within 3
feet of the pt. Pt should wear a mask.
Contact Precautions
Patients infected with pathogens that spread by direct contact with the pt or by indirect contact with a contaminated object (bedrail, pt dressing).
Methicillin-resistant staphylococcus aureus (MRSA), Hepatitis A, Varicella, Flesh-eating Virus
All PPE should be used and equipment must be disinfected after use.
Controlling the spread of Disease
• Chemotherapy
• Immunization
• Asepsis– Medical– Surgical
• Disinfectants
Physical Methods of Controlling Diseases
• Handwashing• Standard
Precautions– Gloving– Gowns– Face masks– Eyewear
Hand washing
Single most important means of preventing the spread of infection.
7 to 8 minutes of washing to remove the microbes present, depending on the number present. Per JCAHO =10-15 seconds
Most effective portion of hand washing is the mechanical action of rubbing the hands together.
So What, and Who Cares?
Students and Techs are challenged both physically and mentally by the microbial world. In this world of newly found, life-threatening diseases, education has become the key to survival. Health care providers must be committed to infection control so that diseases can be conquered!
Infection Control per JCAHO
Fingernail Compliance
No more than ¼ inch long
No artificial nails
No chips on nail polish
When do you wash your hands?
When hands are visibly soiled Before and after patient contact After removal of gloves After using the toilet After blowing or wiping the nose Upon leaving an isolation area
When do you wash your hands?
Before Eating
How long do you wash?
10-15 Seconds
When should sharps boxes be emptied? When they are 2/3 full
What are some examples of proper usage of gloves? Wear gloves when you anticipate possible
contamination When handling chemicals like disinfectants for
cleaning Remove gloves immediately after performing
task and performing hand hygiene Hallways should be considered a
“glove free zone”
When do you use disinfectant jell?
Before and after patient care when hands are not visibly soiled
Before performing invasive procedures for hand decontamination
To decontaminate hands after contact with patient’s intact skin, i.e., after taking vital signs
What can you use for cleaning equipment and surfaces? Disinfectant wipes
How do you know equipment is clean? Clean equipment is covered with plastic A clean bed or gurney is dressed Medical equipment is cleaned between
patients or when soiled Not sure ? Always clean and disinfect.
What are examples of Standard Precautions?
What are examples of Standard Precautions? Use of PPE (personal protective
equipment) Protective housekeeping Practicing good hygiene
Review
Microorganisms Disease Pathogen Bacteria Viruses Fungi Protozoan 6 Steps of Infection
Chain of Infection Nosocomial Infection Controlling Disease Physical Methods of
Controlling Diseases Handwashing Standard Precautions Universal Precautions
Questions?
• Infection Control
Vital Signs
Vital Signs
Oxygen Therapy
Oxygen Devices
Chest Tubes and Lines
Vital Signs
Indication of Homeostasis
Primary Mechanisms Heart beat Blood pressure Body temperature Respiratory rate Electrolyte
balance
Physical assessment include measurement of vital signs
Body Temperature
Pulse
Respiration
Blood Pressure
Mental Status
Body Temperature
Normal average body temperature: 98.6 F
Humans can survive between 106 F and 93.2 F.
Hypothermia Hyperthermia
Measuring Body Temperature
Oral Rectal Axillary Tympanic
Pulse
Pulse rate: Adult = 60 to 100 beats per minute
Children under 10 = 70 to 120 beats per minute
Tachycardia Bradycardia
Respiratory Rate
Breaths per minute: Adult = 12 to 20 Children under 10 = 20 to 30 per min
Tachypnea Bradypena Dyspnea Apnea
Pulse Oximeter
• Normal Pulse Oximeter = 95% to 100%
Blood Pressure
• Blood Pressure • Systolic pressure =
95-140 mmHg• Diastolic pressure =
60-90 mmHg
• Hypertension• Hypotension
Oxygen
Oxygen constitutes 21% of atmospheric gases
If O2 levels in the body drop below 21% homeostasis is altered.
Hypoxia: Inadequate amount of oxygen at the cellular level.
Oxygen Devices
Nasal Cannula Masks
Nonrebreathing mask Aerosol mask Air-entrainment mask
Tent and Oxyhood
Chest Tubes and Lines
• Endotracheal Tube (ET)
– Ventilator• Chest Tubes
• Nasogastric tube (NG)
• Central Lines
Central Line Injections by RT
• The California Law does not address arterial injection by RT
• Employers policies
• Saline flush
Review
Vital Signs Homeostasis Body Temperature Pulse Respiration Blood Pressure Mental Status
Electrolyte balance Pulse Oximeter Oxygen Oxygen Devices Chest Tubes Chest Lines
Questions?
• Vital Signs
Medical EmergenciesMedical Emergencies
Medical Emergencies
• Definitions
• What should the RT know?
• Common Radiology Emergencies
Medical Emergencies
Definition: Sudden change in medical status requiring immediate action.
For RT’s medical emergencies are rare, however as medical personnel we must be prepared to recognize emergencies.
What an RT should know…..
How to….. Avoid additional harm to the patient Obtain appropriate medical assistance
quickly
Recognize emergency situations
Remain calm and confident
Anaphylactic Reaction
An immune response to foreign materialBronchospasm – wheezing and
edema in the throat and lungsCan lead to shockRequires prompt recognition and
treatment from the technologistWhy do RT’s care about Anaphylactoid
RXN’s….? See Pg. 336
Water Soluble Iodine• High atomic # 53• Radiopaque• Used to radiograph
– Vessels– Arteries– Veins– Function of internal
organs
Iodine Contrast Material
• Ionic Iodine Contrast– Anion -– Cation +– More patient allergic
reactions
• Non-Ionic Contrast– Less patient allergic
reactions
Patient Assessment Check List
• Information update !!
Medications containing metformin
Glucophage
Glucovance
Glyburide
Glipizide
Rosiglitazone
Metaglip
Avadment
Fortamet
Creatinine clearance vs Creatinine
In general, creatinine clearance is the removal of creatinine from the body.
In renal physiology, creatinine clearance (CCr) is the volume of blood plasma that is cleared of creatinine per unit time.
The result of this test is an important gauge used in assessing excretory function of the kidneys
Creatinine clearance vs Glomerular filtration rate (GFR) Clinically, creatinine clearance is a useful
measure for estimating the glomerular filtration rate (GFR) of the kidneys.
creatinine clearance overestimates actual GFR by 10-20%.
This margin of error is acceptable considering the ease with which creatinine clearance is measured
Radiology Department
Patients are usually sent to the radiology department only after they have been stabilized.
However……
Become familiar with………..
• In your work environment:– Emergency assistance protocol (how to
get help)– Emergency Cart/Crash Cart Location
Important Conditions to be Aware of……
Level of Consciousness: ALOCAltered Level Of Consciousness
Anaphylatic Shock: vasogenic shock
Hypoglycemic/HyperglycemiaNPO – Nothing by Mouth
Radiologic Technology
• You never know when a medical emergency may occur.
• Helping your patients depends on your abilities to stay calm and perform you duties!
Questions?
• Infection Control
• Vital Signs
• Medical Emergencies
Vascular System
Vascular access is legal for RT’s where? upper or lower extremity ?
• What are characteristics of arteries?
• What are characteristics of veins?
• Rapid flow, Contain valves, Dark red blood, Flows away from heart, Flows toward the heart, Pulsating
Venipuncture Anatomy
• Most Common sites for IV introduction in Radiology– Anticubital space– Anterior forearm– Dorsum of the
hand– Radial wrist (ouch)
Anticubital Space & Anterior Forearm
• Cephalic Vein– Accessory cephalic
• Basilic Vein• Median veins• Antecubital Vein• Median cubital
– Most common site for extravasation
– Pg. 316
Anticubital Space
• Are located over an area of joint flexion: therefore any motion can dislodge the cannula and cause infiltration.
• A flexible IV catheter is the needle of choice for placement of a venous access in the antecubital space.
Posterior Hand & Radial Wrist
• Cephalic Veins
• Basilic Veins
• Radial Vein
Pharmacology for the Pharmacology for the Radiologic Radiologic TechnologistTechnologist
Drug ClassificationsDrug Classifications
Name – generic or brand Name – generic or brand
Action Action
Method of legal purchase Method of legal purchase (prescription or non-prescription)(prescription or non-prescription)
Classification by NameClassification by Name
Chemical name – actual chemical Chemical name – actual chemical structurestructure
Generic name – when it becomes Generic name – when it becomes commercially available (never commercially available (never capitalized) – capitalized) – nonproprietary nonproprietary namename
Brand name – give by a drug Brand name – give by a drug manufacture – manufacture – trademark, trade trademark, trade name, proprietary namename, proprietary name
ExampleExample
Chemical name – 7 chloro-1,3-Chemical name – 7 chloro-1,3-dihydro-1-methyl-5-phenyl-H-1,4-dihydro-1-methyl-5-phenyl-H-1,4-benzodiazepin-2-onebenzodiazepin-2-one
Generic name – diazepamGeneric name – diazepam
Brand name - ValiumBrand name - Valium
Drug Reactions Drug Reactions
Anaphylaxis Anaphylaxis
– VSVS
AnaphylactoidAnaphylactoid
Principles of Drug Principles of Drug AdministrationAdministration ““The golden rules of drug The golden rules of drug
administration”administration” The five rights of drug The five rights of drug
administrationadministration
Right drugRight drug Right amountRight amount Right patientRight patient Right timeRight time Right routeRight route
Drug RoutesDrug Routes
Oral – by mouthOral – by mouth Sublingual – under the tongueSublingual – under the tongue Topical – directly onto the skinTopical – directly onto the skin
– transdermaltransdermal Parenteral – by injection or other Parenteral – by injection or other
than oral - than oral - intramuscular, intramuscular, subcutaneous, intravenoussubcutaneous, intravenous
Charting Drug Charting Drug InformationInformation Any time a drug is administered to Any time a drug is administered to
an inpatient it must be chartedan inpatient it must be charted Information includes: Information includes:
– Drug nameDrug name– Dose of the drugDose of the drug
– Route of administration (if Route of administration (if parenterally, then the side of injection)parenterally, then the side of injection)
– Date & TimeDate & Time
Legal ConsiderationsLegal Considerations
Errors with drug administration is Errors with drug administration is the most common legal problems the most common legal problems for radiologic technologistsfor radiologic technologists
Techs must follow charting Techs must follow charting protocols and document all errors protocols and document all errors in drug administrationin drug administration
Pg. 319Pg. 319
Do Not Use Do Not Use – abbreviationsabbreviations
Questions?Questions?
"The pessimist sees difficulty in every opportunity. "The pessimist sees difficulty in every opportunity. The optimist sees the opportunity in every The optimist sees the opportunity in every difficulty." difficulty."
Winston Churchill Winston Churchill
