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  1. 1. Shifa Muhammed Shaffi 2nd year bsc nursing Almas collage of nursing
  2. 2.  Barrier nursing is a largely ancient term for a set of strict infection control techniques used in nursing. The aim of barrier nursing is to protect medical staff against infection by patients and also protect patients with highly infectious diseases from spreading their pathogens to other non-infected people.  Barrier nursing was created as a means to maximize isolation care. Since it is impossible to isolate a patient from society and medical staff while still providing care, there are often compromises made when it comes to treating infectious patients. Barrier nursing is a method to regulate and minimize the number and severity of compromises being made in isolation care, while also preventing the disease from spreading.
  3. 3.  Barrier nursing or isolation techniques is intended to confined the microorganisms within a given and recognizing area. It is a set of infection control techniques used in nursing.  The nursing technique by which a patient with an infectious disease is prevented from infecting other people is called barrier nursing.
  4. 4.  Care and treatment of patient with deadly contagious diseases which have no treatment option; give control the main purpose of this practice.  Provides protection, for other patients and medical personnel, not infected with the virus.
  5. 5.  The patient should be nursed in a single room which has a washbasin and source of hot and cold water.  All surfaces in the single room should be washable. Hand washing should be emphasized by the people who are attending the patient.  The number of people entering the room should be reduced to minimum and all those who enter the room should be instructed to practice proper gown and mask techniques. special nurses should be assigned to look after the patient.  Protective clothing, preferably disposable gowns should be worn by all who visit or attend the patient.  There should be some kind of working surfaces, such as a trolley or table in the room to give facilities for nursing treatment.
  6. 6.  Clinical thermometer, sphygmomanometer, syringes, etc. should be left inside the room for the whole stay of the patient in the room. Clients chart should be kept outside.  In case of children, toys should be washable or disposable and paper bags which can be incinerated should be provided for adults.  The room should contain one big foot operation bin lined with the polythene bag so that articles which are to be incinerated may be placed within it. A second polythene lined bin should be provided for solid linen.  Cleaning of the room must be carried out under the supervision of the nursing staff.
  7. 7.  All surfaces should be washed with antiseptic solution is advised by the microbiology department using a proper towel or rags which should be incinerated.  Staff should know the methods advocated by the microbiology department for the sterilization or disinfection of equipment, excreta, linen or discharges from the patient.  If vacuum cleaner is used, the dust bag should be lined with a paper bag so that the dust can be removed for incineration and the external part of the vacuum cleaner must be washed well. It should be thoroughly cleaned when once the patient has been discharged.  Nothing from that room should be kept outside for general use without first being sterilized.
  8. 8.  Any instruction as regarded to the strength of disinfection and length of time required for their action must be followed precisely.  If possible all equipments in the room should be disposable such as linen, flannels, syringes, bedpans, plates etc. a washing towel should be used exclusively for the patient and left in his room throughout his stay there.  Recommended cleaning material antiseptics should be available in the room and kept exclusevely for the patient such as lotions, creams etc.
  9. 9. a) Standard precautions b) Transmission based precautions
  10. 10.  Standard precautions are used in the care of all hospitalized individuals regardless of their diagnosis or possible infection status.  They are used in any situations involving blood, body fluids, excretions, and secretions except sweat, non intact
  11. 11. Standard precautions include: 1) Perform proper hand hygiene after contact with blood, body fluids, secretions, excretions and contaminated objects. Whether or not gloves are worn.  perform proper hand hygiene immediately after removing gloves  Use a antimicrobial agent or an antiseptic agent for the control of specific outbreak of infection.  Use an non antimicrobial product for routine hand hygiene
  12. 12. 2) Wear clean gloves when touching blood, body fluids, secretions, excretions and contaminated item( that is, soiled gowns).  Clean gloves can be unsterile unless their use is intended to prevent the entrance of microorganisms into the body.  Remove gloves before touching uncontaminated items and surfaces.  Perform proper hand hygiene immediately after removing gloves.
  13. 13. 3) Wear a mask, eye protection, or a face shield, if splashes or sprays of blood, body fluids, secretions or excretions can be expected 4) Wear a clean, non sterile, water resistant gown if client care is likely to result in splashes or spray of blood, body fluids, secretions, or excretions. The gown is intended to protect clothing.  Remove a soiled gown carefully to avoid the transfer of microorganisms to others (that is, client to other health care workers_.  Cleanse hand after removing gown
  14. 14. 5) Handle client with equipment that is soiled with blood, body fluids, secretions or excretions carefully to prevent the transfer of microorganisms to other and to the environment.  Make sure reusable equipment is cleaned and processed correctly.  Dispose of single use equipments correctly. 6) Handle all soiled linen as little as possible. Do not shake it. Bundle it up with the clean side out and dirty side in and hold away from self so that the nurse’s uniform or clothing is not contaminated. Use appropriate laundry bags. Hazards of on-site ward based laundring. Treat all linen as contaminated so wear gloves.
  15. 15. 7) Place used needles and other sharps directly into puncture resistant containers as soon as their use is completed. Do not attempt to recap needles or place sharps back in their sheaths using two hands; use the one handed scoop technique or other safety devices. Using two hand can result in a needle stick puncture injury if the nurse accidently misses the cover. 8) Respiratory hygiene/ cough etiquette.  Informing personnel if they have any symptoms of respiratory problems.  Health educate patients and visitors to cover their mouth/ nose while coughing and sneezing.  Use surgical masks on coughing person when appropriate.
  16. 16.  Provide alcohol based hand rubbing dispensers and supplies for hand hygiene and educating patients and staff in their use.  Encourage hand hygiene after coughing or sneezing.  Separating coughing persons at least 3 feet away from others in a waiting room or have separate locality.
  17. 17.  Transmission based precautions are used to protect the nurse and others from acquiring the infectious organisms.  Transmission based precautions are used in addition to standard precautions for client with known or suspected infections that are spread in one of 3 ways: by airborne or droplet transmission or by contact.  The 3 type of Transmission based precautions may be used alone or in combination but always in addition to standard precautions.
  18. 18.  Used to prevent or reduce the transmission of microorganisms that are airborne in small droplet nuclei or dust particles containing the infectious agents  Place client in an airborne infection isolation room [AIIR]. An AIIR is a private room that has negative air pressure, 6- 12 air changes per hour, and either discharge of air to the outside or a filtration system for the room air.  If private room is not available, place client with another client who is infected with the same microorganism.
  19. 19.  Wear an N95 respirator mask when entering the room of a client who is known to have or suspected of having primary tuberculosis.  Susceptible people should not enter the room of a client who has rubeola (measles) or vericella (chickenpox). If they must enter, they should wear a respirator mask.  Limit movement of the client outside the room to essential purposes. Place a surgical mask on the client during transport.  Keep patient room door closed.
  20. 20.  Place client in a private room.  If private room is not available, place client with another client who is infected with the same microorganism.  Used to reduce the risk of transmission of microorganism transmitted by large particle droplet.  Droplets usually travels 3 feet or less within air and thus special air handling is not required, however never recommendations suggest a distance of 6 feet be used for safety.
  21. 21.  Use of respiratory protection such as mask when entering the room recommended and definitely if within 3 feet of patient.  Limit movement and transport of the patient.  Use mask on the patient if they need to be moved and follow respiratory hygiene / cough etiquette.  Keep at least 3 feet apart between infected patient and visitors.
  22. 22.  Contact precautions used for clients known to have or suspected of having serious illness easily transmitted by direct client contact with items in the client’s environment.  Place client as described in standard precautions  change gloves after contact with infectious material.  Remove gloves before leaving the client’s room.  Cleanse hands immediately after removing gloves. Use an antimicrobial agent. If the client is infected with C. difficile, do not use an alcohol based hand rub because it is not effective on these spores. Use soap and water.  After hand hygiene, do not touch possibly contaminated surfaces or items in the room.
  23. 23.  Limit movement of the client outside the room.  Dedicate the use of noncritical client care equipment to be single client or to clients with the same infecting microorganisms.  Make sure any infected or colonized areas are confined or covered.  Ensure that patient care items, bedside equipment and frequently touched surfaces, receive daily cleaning.
  24. 24.  Compromised clients (those who highly susceptible to infection) are often infected bt their own microorganisms, by microorganisms on the inadequately cleanse hands of health care personnel and by non sterile items (food, water, air, and client- care equipment).  Clients who are severely compromised include those who:  Have disease, such as leukemia, or treatment such as chemotherapy, that depress the client’s resistance to infectious organism.  Have extensive skin impairment, such as severe dermatitis or major burns, which cannot be effectively covered with dressing.
  25. 25.  Initiation of particles to prevent the transmission of microorganisms is generally a nursing responsibility and is based on a comprehensive assessment of the client.  This assessment takes into account the status of the client’s normal defense mechanisms, the client’s ability to implement necessary precautions, and the source and mode of transmission of the infectious agent.  The nurse then decides whether to wear gloves, gowns, masks and protective eye wears. In all client situations, nurses must cleanse their hands before and after giving care.
  26. 26.  Use strict aseptic technique when performing any invasive procedure (eg. Inserting an IV needle or catheter) and when changing surgical dressing.  Change iv tubing and solution containers according to hospital policy ( every 48- 72 hours).  Check all sterile supplies for expiration date and intact packaging.  Prevent urinary infection by maintaining a closed urinary drainage system with a downhill flow of urine. Keep the drainage bag and spout off the floor.  Implement measures to prevent impaired skin integrity and to prevent accumulation of secretions in the lung.
  27. 27.  All health care providers must apply PPE according to the risk of exposure to potentially infective material.  The PPE include: 1) Gloves 2) Gowns 3) Face mask 4) Eye wear
  28. 28.  Gloves help to prevent the transmission of pathogens by direct and indirect contact.  Gloves protect the hands when the nurse likely to handle any body substances, for example, blood, urine, feces, sputum and non intact skin..  Gloves reduce the likelihood of nurses transmitting their own endogenous microorganisms to individuals receiving care.  Nurses who have open sores or cuts on the hand must wear gloves for protection.  Gloves reduce the chance that the nurses hand will transmit microorganisms from one client or an object to an other client.
  29. 29.  Clean or disposable water resistant gowns or plastic aprons are worn during procedures when the nurse’s uniform is likely to become solid.  Sterile gowns may be indicated when the nurse changes the dressing of client with extensive wound (eg. Burns).  Single use gown technique (use a gown only once before it discarded or laundered) is the usual practice in hospitals.  After the gown is worn, the nurse discards it or place it in a laundry hamper.
  30. 30.  Masks are worn to reduce the transmission of organisms by the droplet contact and airborne routes and by splitters of body substances.  Various types of masks differ in their filtration effectiveness and fit.  Single use disposable surgical masks are effective for use while the nurse provides care to most clients but should be changed if they become wet or soiled
  31. 31.  Disposable particulate respirators of different types may be effective for droplet transmission, splatters and airborne microorganisms.  Currently, the category ‘N’ respirator at 95% efficiency (referred to as an N95 respirator) meets tuberculosis, SARS, and influenza control criteria.  During certain techniques requiring surgical asepsis to prevent the droplet contact transmission of exhaled microorganisms to the sterile field or to a client’s open wound and to protect the nurse from splashes of body substances from the client.
  32. 32.  Protective eye wear (goggles, glasses or face shield) and masks are indicated in situations where body substances may splatter the face.  If the nurse wear the prescription eye glasses, goggles must still worn over the glasses because the protection must extend around the sides of the glasses.
  33. 33.  Many pieces of equipment are supplied fir single use only and are disposed of after use. Sometimes, however are reusable.  Appropriate handling of soiled equipment and reusable. Essential to prevent inadvertent exposure of health care workers to articles contaminated with body substances and to prevent the contamination of the environment.
  34. 34.  Articles contaminated, or likely to likely to have been contaminated, with infective material such as pus, blood, body fluids, feces, or respiratory secretions need to be enclosed in a sturdy bag impervious to microorganisms before they are removed from the room of ant client.  A single bag, if it is sturdy and impervious to microorganisms and if they contaminated articles can be placed in the bag without soiling or contaminating its outside.  Double bagging if the above condition is not met.
  35. 35.  Follow agency protocol, or use the following CDC guidelines to handle and bag soiled items.  Place garbage and soiled disposable equipment in the plastic bag and tie the bag. If the bag is sturdy and impermeable a single bag is adequate. If not, place the first bag inside another impermeable bag.  Place non disposable or reusable equipment that is visibly soiled in a labeled bag before removing it from the client’s room or cubicle, and send it to a central processing area for decontamination.  Glass bottles or jars and metal items placed in separating from rubber and plastic items.  Disassemble special procedure tray into component parts.
  36. 36.  Handle soiled linens as little as possible and with the least agitation possible before placing it in the laundry hamper.  This prevents gross microbial contamination of the air and individuals handling the linen.
  37. 37.  If placed in a leak proof container with a secure lid with a biohazard label, no need special precautions.  Use care when collecting specimens to avoid contaminating the outside of the container.  Containers are visibly contaminated on the outside should be placed inside a sealable plastic bag before sending them to the laboratory. This prevents personnel from having handle contact with potentially infective material.
  38. 38.  Dishes require no special precautions.  Some agencies use paper dishes for convenience, which are disposed of in the refuse container.
  39. 39.  Blood pressure equipment need no special precautions unless it become contaminated with infective material. If does not become contaminated, follow agency policy to decontaminate it.  In some agencies, a disposable cuff is used for clients placed on contact precautions.
  40. 40.  Generally disinfect after each use
  41. 41.  Place needles, syringes, and sharps into a puncture resistant container.  To avoid puncture wounds, use approved safety or needleless systems and do not detach from the syringes or recap the needle before disposal.
  42. 42.  Avoid transporting clients with infections outside their own rooms unless absolutely necessary. If the client must be moved, the nurse implements appropriate precautions and measures to prevent contamination of the environment.  In addition, the nurse notifies personnel at the receiving area of any infection risk so that they can maintain necessary precautions.
  43. 43.  When a patient requires isolation to the private room, a sense of loneliness sometimes develops because normal social relationships become disrupted. This situation can be psychologically harmful, especially for children.  Isolation disrupts normal social relationships with visitors and care givers.  take the opportunity to listen to a patient concern or interest. If you rush care or show a lack of interest in a patient’s needs, he or she feels rejected and even more isolated
  44. 44.  Take measures to improve the patient’s sensory stimulation during isolation.  Make sure the room environment is clean and pleasant.  Providing comfort measures such as repositioning, a back massage, or a warm sponge bath increase physical stimulation.  Depending upon the patient condition, encourage him or her to walk around the room or sit up in a chair .  Recreational activities such as board games or cards are an option to keep the patient mentally stimulated.
  45. 45.  An object is sterile when it is free from all microorganisms.  It is well known that sterile techniques is practiced in operating rooms and special diagnostic areas.  Less known perhaps is the sterile technique is also employed for many procedures in general care areas.  In these situations, all the principles of surgical asepsis are applied as in the operating or delivery rooms; however, not all of the sterile techniques that follow are always required.
  46. 46.  A sterile field is a microorganism free area.  Nurse often establish a sterile field by using the inner most side of a sterile wrapper or by using a sterile drape.  When the field is established, sterile supplies and sterile solution can be placed on it.  Sterile forceps are used in many instances to handle and transfer sterile supplies.  Sterile liquids are preferably packaged in amounts adequate for one use only because once a container has been opened, there is no assurance that it will remain sterile.
  47. 47.  Sterile gloves may be applied by the open method or closed method.  Open method is most frequently used outside the operating room because the closed method requires that the nurse wear a sterile gown.  Gloves are worn during many procedures to enable the nurse to handle sterile items freely and to prevent clients at risk from becoming infected by microorganisms or unsterile gloves or the nurse’s hands.
  48. 48.  Sterile gowning and closed gloving are chiefly carried out in operating or delivery rooms, where surgical asepsis is necessary.  The closed method of gloving can be used only when a sterile gown is worn because the gloves are handled through the sleeves of the gown.  Before these procedure, the nurse applies a hair cover and a mask and perform a surgical hand wash.
  49. 49.  Using proper precaution with general medical asepsis, appropriately using PPE and avoiding carelessness in the clinical area will place the care giver at significantly less risk of injury.  Hepatitis C, a worldwide epidemic greater then HIV, has become a significant concern to all health care workers because no vaccine against the virus or post exposure prophylaxes currently exists.  Prevention remain the primary goal.  The hepatitis B vaccine and vaccination series available to all employees.
  50. 50.  An infection prevention nurse also known as infection control nurse, helps prevent and identify the spread of infectious agents like bacteria, viruses in a health care environment.  ICNs are meticulous and detail oriented individuals who can effectively communicate best practices to their colleagues to ensure the safety of patients in an institutions care.  Their knowledge of the risks of various infectious agents is crucial when dealing with both contained infectious and broader outbreaks.
  51. 51.  Gathering and analysing infection data to make evidence based decision.  Educating medical and public health professionals on infection prevention protocols to facilitate emergency preparedness.  Isolating and treating infected individuals to contain the spread of infectious diseases.  Assisting with the development of action plans in case of a community or hospital outbreak to minimize the potentially devastating impact.
  52. 52.  Collaborating with government agencies such as the CDC to ensure that infection control practices are implemented and enforced.  Studying pathogens to determine origin in order to prevent future outbreaks.  Assisting scientists and physicians with developing treatments and vaccines to ensure the health and safety of patients and the community.