Week 1 - infection control and patient assessment Flashcards
Medical asepsis vs surgical asepsis
Medical asepsis = “clean technique” = procedures can limit or even prevent the transmission of microorganisms that can spread disease
* Involves hand washing, using PPE, reporting exposures, cleaning/disinfecting/sanitizing (NOT sterilizing)
Surgical asepsis = “sterile technique” = procedures that kill or eliminate microorganisms
Nosocomial infection
Nosocomial
= HAI = Hospital Acquired Infection
What are the most common types of HAIs in Canada (5)?
- MRSA = Methicillin Resistant Staphylococcus Aureus
- VRE = vancomycin-resistant Enterococci
- CDI/C. Diff = clostridioides difficile
- COVID-19
- Norovirus
MRSA
MRSA = Methicillin Resistant Staphylococcus Aureus
colonizes healthy ppl, non-specific (lungs, heart, bone…), spreads through direct and indirect contact)
VRE
VRE = vancomycin-resistant Enterococci
prefers weakened host, resides in intestinal/urinary tract, spread through contact
CDI / C. Diff
CDI/C. Diff = clostridioides difficile
resides in bowel, common cause of infectious diarrhea in healthcare setting, antibiotics don’t work, spreads through direct/indirect contact (really gets around)
COVID - 19
respiratory tract, spreads through droplets
Norovirus
GI tract, just a few particles can make you ill, spreads through direct/indirect contact
TIER 1: Std/Routine practices
vs
TIER 2: Additional precautions
TIER 1: Standard/Routine practices include precautions for the care of all patients (if wounds or blood, risk of splash to/from mucous membranes, coughing/exposure to respiratory secretions, invasive procedures)
*PPE: gloves and gowns
TIER 2: Additional Precautions include precautions that are necessary for certain patients who are known or suspected to have an infection.
(Contact, droplet or airborne)
Contact Precautions
- which infections?
- PPE?
MRSA, VRE, C Diff
PPE: gloves and gowns
Droplet Precautions
- which infections?
- PPE?
Influenza, Covid19, Pneumonia, Meningitis, mumps, rubella
PPE: Gown, gloves, mask, eye protection (face shield, goggles)
Airborne Precautions
(or droplet patients undergoing aerosol generating procedures)
- which infections?
- PPE?
SARS, TB, Measles
PPE: Gown, gloves, eye protection (face shield, goggles), N95 mask or respirator
Donning PPE: order?
- Wash hands
- Gown on
- Mask on
- Eye protection on
- Gloves on, cover gown cuffs
Doffing PPE: order?
Gloves, gown, goggles, mask with hand wash after each:
1. Gloves off
2. Wash hands
3. Gown off
4. Wash hands
*exit the room if you are not 2 m away from patient
5. Goggles or face shield off – only touch straps (clean)
6. Wash hands
7. Mask off
8. Wash hands
9. Exit room and wash hands again
*use gravity and remove things point at the floor, don’t shake anything
How do you greet a patient?
What do you tell them? What is NOD?
-Greet patient: call out “last name, Smith?”, watch out for “Do not acknowledge” (inmate)
Tell them my name, occupation, description of what I do (NOD), and ask permission
Initial assessment: ABCCS
vs
Secondary assessment
Perform initial assessment (ABCCS) when you greet patient, ~5-15s: Airway, Breathing, circulation, consciousness, safety
Do a secondary assessment (LOC, ability to respond, ability to transfer, pain) every time the situation changes, ~1-2 min: Patient’s understanding, awareness, mobility
Vital Signs: what is the TPR assessment?
TPR assessment: Temperature, Pulse, Respiration, BP (not technically a VS)
*Sonographers usually don’t measure Temp, but do measure BP
Temperature normal value?
37
> 38 is a fever
Pulse/HR normal value?
60-100 bpm
Respiration rate normal value?
10-20 breaths/min (adult)
Oxygen saturation target value for normal adult and COPD?
Target is 92-98% (normal adult)
<92% requires attention/monitoring
Target is 88-92% for COPD
BP normal value?
120/80
high BP >140/90
Low is only a concern if <90/60
Blood Glucose normal value?
4-7 mmol/L
How do you put on a BP cuff?
patient sits quietly for 3-5 min
cuff 1” above elbow
tighten until you can just fit 2 fingers under
Describe the auscultatory method to measure BP
AUSCULTATORY METHOD uses a stethoscope and sphygmomanometer. We listen for Korotkoff sounds as blood resumes flow through a gradually unconstrained artery.
Describe the oscillometric method to measure BP
OSCILLOMETRIC METHOD uses an automated electronic device that converts flow vibrations in the arterial wall into electrical signals and displays the results on a digital readout. We position the cuff, and press “start”. The device inflates the cuff, deflates it, and beeps when the result displays on the readout.
Does oxygen require a prescription?
Yes, oxygen is a drug and requires a prescription…..
BUT, hypoxia is an emergency and most hospitals have a policy for emergency use
Low flow versus High flow oxygen delivery equipment
Low flow = nasal cannula (prongs), simple face mask
*may be applied by healthcare worker
- lower flow than patient needs
- for stable patients
- not a precise amt
High flow = Venturi, partial rebreather, non-rebreather, star wars, nebulizer
*must be applied by respiratory therapist
- flow meets/exceeds patients needs
- unstable patients
- precise oxygen delivery (controlled)
- aerosolization can occur depending on device (ie deliver meds for asthma)
What is a pulse oximeter? when do you use it and what does it tell us?
Pulse Oximeter - used for all breathless or acutely ill patients
- Turn it on
- Clip it on finger, nail facing up
- See results: blood oxygen (SpO2) and pulse rate (PR)
(Need warm hands and no nail polish for it to work; can also try toe)
4 moments for hand hygiene are:
- Before initial patient / patient environment contact
- Before aseptic procedure
- After body fluid exposure risk
- After patient / patient environment contact
Steps to wash hands
- Wet hand with warm water
- Soap
- Rub palm to palm
- Rub between fingers
- Rub back of each hand
- Rub finger tips in palm
- Rub thumb and wrist
- Rinse
- Pat dry with paper towel
- Use clean paper towel to turn off tap
*don’t lean against sink or get shirt wet; never use patients personal sink
