Health Skills I

1. HealthSkillsI Unit 101.3 Standard Precautions Sterile Field & Gloving Sterilization Packaging

2. Objectives • Identify practices of aseptic technique. • Demonstrate ability to implement infection control through hand washing, standard precautions, packaging, for sterilization, preparing a sterile field and sterile gloving.

3. Standard Precautions • designed to reduce the risks of transmission from both recognized and unrecognized sources of infection • Precautions apply to: • *all blood & body fluids • *all body secretions and excretions (except sweat) • *non-intact skin • *mucous membranes

4. Follow Standard Precaution Guidelines • when touching body fluids, or there is a potential of body fluid splatters, barriers must be worn • this is a standard written by Occupational Safety and Health Administration (OSHA)

5. OSHA • mandates that healthcare workers comply with all the safety standards • mandates that employers provide and comply with the safety standards

6. OSHA Standards • facilities are inspected for compliance & major fines are imposed for violations • healthcare workers are mandated to attend yearly bloodborne pathogens training • 29CFR Part 1910.1030 is the portion of the code pertaining to safety practices in the healthcare industry

7. Fundamentals of Standard Precautions • Handwashing • single most important measure to reduce the risk of transmitting microorganisms from person to person or site to site • OSHA mandates handwashing be done before and after each patient contact, and before applying gloves and after removal of gloves

8. Protective Barriers • to reduce the risk of bloodborne pathogen exposure, barriers are to be worn when appropriate: • gloves • gowns • boots • masks • protective eyewear • hats/caps

9. Protective Barriers

10. Gloves • worn for three reasons: • to provide a protective barrier • to reduce transmission of disease from hands to patients • to reduce likelihood of transmission of disease from patient to patient • wearing gloves does not replace need for handwashing

11. Gloves • 3 Types • sterile • worn during sterile procedures to maintain sterility and during invasive procedures to prevent contamination • exam • worn as a barrier • utility gloves • worn for custodial purposes

12. Protective Barriers Exam Gloves Latex Non-latex

13. Sterile Gloves Sterile Gloves worn during sterile procedures

14. Utility Gloves Utility gloves are worn for custodial activities. Disinfect gloves after each use. Replace when torn.

15. Masks • cover mouth and nose • worn when there is potential splatter of blood or body fluids to mucousmembranes of eyes, nose and mouth • reduces risk of transmission of bloodborne pathogens • specific types of masks for airborne diseases (wear the correct one)

16. Masks • if tuberculosis is suspected or diagnosed, NIOSH approved, Hepafilter or N95 mask is required Masks that meet standards

17. Goggles/Eye Shields • worn during procedures that are likely to generate splashes or sprays of blood or body fluids to the eyes

18. Protective Face Barriers

19. Gowns • worn to reduce the risk of contamination of clothing and skin from blood and body fluidexposures • the gown must be made with impermeable or fluid resistant material

20. Boots & Shoe Covers • Required in specialty areas: • surgery • special procedure rooms • trauma center during specific procedures that will produce splash & splatter of blood and other body fluids

21. Hats/Caps • Required in specialty areas of: • surgery • special procedure rooms • trauma center during specific procedures that produces splash & splatter of blood and other body fluids

22. Beware! • risk of transmitting nosocomial infections is often highest before a definitive diagnosis is made, therefore: • use standard precaution barriers for all patients • carefully monitor signs & symptoms • familiarize yourself with the isolation standards in your facility and use them appropriately. Work smart

23. Isolation in Hospitals • Purpose • to decrease the risk of transmission of microorganisms within the hospital by: • protecting infected patient from further infection • protecting uninfected patients, visitors & staff • minimizing the spread of infection • compliance with isolation standards is a must to minimize disease transmission

24. Psychological Effect of Isolating Patients • patient may feel dirty or contaminated • limits number of visitors • may elicit fear from relatives and friends • limits ability to move about freely • adds to cost of hospital bill • adds stress • may feel sense of hesitation from caregiver • elderly and children feel lonely

25. Waste Disposal • specimens of blood, tissue or other potentially infectious (OPI) materials shall be placed in a biohazard, leakproof bag for collecting, storage, handling, transporting and processing

26. Biohazard Wastes • Includes items that: • are dripping with blood • drip blood when squeezed, • unfixedbody tissue (know facility policies) • *biohazard wastes placed in red biohazard bags and labeled • *managed by a biological waste firm

27. Biohazard Wastes • *DO NOT pick up broken glass with hands. Wear utility gloves & use dustpan w/broom or forceps Contaminated broken glass

28. Contaminated SharpsBiohazard Waste • must be placed in punctureresistance container immediately after use • must be clearly labeled in accordance with OSHA standards Sharps Containers

29. Biohazard Waste Disposal • all regulatedwaste shall either be incinerated, treated with chemicals or decontaminated by an autoclave to destroy bloodborne pathogens

30. Linen • contaminated laundry to be handled as little as possible • minimum agitation • bagged in appropriately labeled bags prior to transport to laundry facilities If soaked, must be placed in leakproof laundry container

31. Blood Spills • contaminated work surfaces shall be decontaminated immediately or as soon as feasible after any spill of blood or infectious material with appropriate disinfecting solution

32. Blood Spills • Must be cleaned with: • *professional disinfecting solution or • *10% bleach solution (made fresh daily)

33. Housekeeping • workplace must have appropriate written schedule for housekeeping: • based on activity and soil present • cleaned immediately after blood spill • broken glass must be picked up with mechanical device and placed in sharps container • this is an OSHA regulation

34. Biohazard Signs • when this label is present, there is a potential risk of bloodborne pathogen contamination within the container or area designated

35. Biohazard Signs • OSHA mandates the following when signs are present: • no eating/drinking in designated area • no smoking in designated area • no application of make up and lip balm in designated area • no handling of contact lenses in designated area • no storage of food/drink in coolers/refrigerators that are preserving biohazard products

36. Sterile Field • Definition • a designated area prepared with sterile drape & equipment from which a sterile procedure will be conducted. This area is free of all microorganisms Sterile drape serves as sterile field Sterile gauze Sterile instrument

37. Sterile Field • How to determine if an item is sterile: • disposable items have manufacturer’s endorsement, & must be free of holes, wetness or stains

38. Sterile Field • How to determine if an item is sterile: • indicator (arrows, dots, bars), change color when sterilized • wrappers must be free of holes, wetness, stains • check expiration dates when appropriate • INDICATORS that have changed color DO NOT INSURE STERILITY Indicator arrows

39. Indicators and Biological Monitors

40. Shelf LifeSterile Equipment • “Timed Shelf Life” standards are frequently usedwhen packages are sterilized in-house (reusable items) • when pharmaceuticals are inside of a sterile package, the Timed Shelf Life standards must be used and consider the expiration date of the pharmaceutical when labeling

41. Shelf LifeSterile Equipment • Timed Shelf Life considers: • type & configuration of package • number times package is handled • Manufactures recommend only 3 touches: • remove from sterilizer to storage shelf • remove from storage shelf to procedure site • open to use • storage area (open or closed shelves) • environmental conditions (cleanliness, temperature, humidity) • use of dust covers (or not) • date indicated

42. Shelf LifeSterile Equipment • “Event-Related Shelf Life”: • recognizes that product remains sterile until some event causes item to be contaminated • commercial manufactures of sterilized items use Event-Related standards • sterile items should be placed on shelf in order to ensure the oldest item isused first when using Event-Related standards

43. Shelf LifeSterile Equipment • products such as latex gloves and specialized catheters may degrade over a period of time. It may become hard, dry and crack. This must be taken into account, as quality of the item may no longer be effective • don’t stock-pile these types of products

44. Shelf LifeSterile Equipment • regardless of standard used to determine sterility, the assessment process is the same: • *check for wetness, tears, stains, soil, cracks! • *check date when appropriate! • *check indicator when appropriate! • there must be consistent policies & procedures throughout facility to satisfy the accreditation boards

45. Preparing and Wrapping • purpose of wrapping is to prevent recontamination during storage and handling • material used for wrapping should not tear or puncture easily, or allow for penetration of organisms • materials should open easily to prevent contamination

46. Materials used to Wrap Equipment for Sterilization • double thickness disposable paper/or reusable cloth with sealed plastic dust cover • rigid containers • manufacturer’s wrap • paper peel pouches

47. How to Wrap • wear exam gloves • check items for cleanliness • wrap on clean and dry surface • wrap according to procedure • label package and date according to procedure

48. Examples of Materials

49. Examples of Materials

50. What is Sterile? • inside 1” border of sterile package • contents of package if not contaminated by improper technique Red line indicates 1” border of each package