Standard (universal) Precautions
Standard (universal) precautions:
- assumes that blood or body fluids by ANY client can be infectious
-
PPE: gloves, goggles, gown, and mask
- use your judgment on what to wear
- use a sharps container
- hand hygiene
- keep 3 feet away and cover mouth when coughing or sneezing
- offer mask to clients with respiratory symptoms
All clients are on standards precautions.
Transmission-based Precautions
Transmission-based precautions are beyond standard precautions because the disease is highly contagious:
- Airborne precautions
- Droplet precautions
- Contact precautions
Airborne Precautions
Airborne precautions are taken for highly contagious diseases that are transmitted by airborne droplet nuclei that go over long distances and remain suspended in the air for long periods.
-
PPE: N95 particulate respirator mask
- possible gown, gloves, goggles
- negative pressure isolation room with at least 6 air exchanges per hour
- client wears a surgical mask if leaving room
This includes dried droplets and dust particles containing infectious material.
Which diseases use Airborne Precautions?
Use the mnemonic MTV to remember the most common.
Diseases that use Airborne precautions:
- measles (Rubeola)
- tuberculosis
- varicella-zoster / chickenpox
- shingles/herpes zoster
These diseases are also contact precautions.Use the mnemonic MTV: measles, TB, varicella to remember the most common airborne diseases.
Droplet Precautions
Droplet precautions are taken for highly contagious diseases that are transmitted by large-particle droplets that travel up to 3 feet or less through the air.
-
PPE: surgical mask if within 3 feet of client
- possible gown, gloves, and goggles
Droplets come from sneezing, coughing and talking.
Which diseases use Droplet Precautions?
Use the mnemonic SPIDERMAN to remember.
Diseases that use Droplet Precautions:
- scarlet fever
- sepsis
- streptococcal pharyngitis
- pertussis
- parvovirus
- pneumonia
- pneumonic plague
- influenza
- diphtheria
- epiglottis
- rubella
- meningitis
- mumps
- mycoplasmal pneumonia
- adenovirus
Use the mnemonic SPIDERMAN to remember.
Contact Precautions
Contact precautions are taken for highly contagious diseases that are transmitted by direct or indirect contact.
- always wear gown and gloves
- if splashing is expected, wear goggles and mask
Common sources of indirect contact are the stethoscope and keyboard.
Which most common diseases use Contact Precautions?
Most common diseases that use Contact Precautions:
-
multidrug-resistant organisms
- VRE, CRE, MRSA (will have the word "resistant" in the name)
-
diarrhea/enteric (in the gut)
- C. diff, E. coli, Shigella, hepatitis A & E, rotavirus
- any type of diarrhea or diaper changes for children and adults
- enteroviral
-
skin and wound infections
- cutaneous diphtheria, herpes simplex virus, impetigo, abscesses, cellulitis, decubitus ulcers, pediculosis, smallpox, staphylococcal furunculosis, scabies, zoster
Most students will not memorize this list, but be able to recognize the disease as contact precautions.
Which additional diseases use Contact Precautions?
Additional diseases that use Contact Precautions:
-
eye infections
- viral or hemorrhagic conjunctivitis
-
viral blood infections
- Ebola, Lassa, Marburg
- respiratory syncytial virus, parainfluenza virus
Enteric precautions
Enteric precautions are taken to prevent infections that are transmitted by fecal material. Enteric precautions include:
- Contact Precautions
- washing hands with soap and water (no alcohol)
- PPE: gloves and gown (googles and mask if splashing is expected)
Which diseases use Enteric Precautions?
Diseases that use Enteric Precautions:
- Infectious diarrhea
- Clostridium difficile
- gastroenteritis
- rotavirus
- norovirus
What type of room does a client on transmission-based precautions get?
Transmission-based precautions
- preferably put all clients with an infectious disease in their own private room to prevent cross-infection.
Clients with the same exact infectious disease can be roomed together. It is sometimes referred to as "room like with like".
Where do needles go after being used?
Place used needles in a sharps container/puncture-resistant container designated for needles.
What can the nurse use to prevent needle sticks?
Needleless devices
What type of bag does hazardous waste and blood go into?
A biohazardous waste bag
Nosocomial infection
A nosocomial infection is an infection acquired while in the hospital.
What are the most common nosocomial infections?
Most common nosocomial infections:
- C diff. - clostridium difficile
- VRE - vancomycin-resistant enterococci
- MRSA - methicillin-resistant staph aureus
- CRE - carbapenem-resistant Enterobacteriaceae
When is the N95 / particulate respirator removed?
Take off the N95 respirator mask outside of the client's room after their door has been closed.
What does the client wear when leaving the room when they are on airborne precautions?
The client wears a surgical mask.
What is a sterile field?
A sterile field is an area that is kept sterile in order to prepare for a procedure on the client.
What distance of the border of a sterile field is NOT considered sterile?
The outer 1 inch (2 cm) is NOT considered sterile.
What are the steps to apply sterile gloves?
The steps are as follows:
- Wash hands
- Open package
- Lift glove by cuff
- Apply glove
- Lift other glove
- Apply 2nd glove
- Do not touch the inside of the glove
What are the steps to take off dirty gloves?
The steps are as follows:
- Pinch glove at top
- Peel glove off inside out
- Put fingers under the glove
- Peel glove off inside out into other glove
- Throw in trash
- Wash hands
What are neutropenic precautions?
Neutropenic precautions are also called "protective isolation":
The client is at risk of getting an infection and needs to be in a private room:
- no fresh fruits or flowers in room
- freshwater for drinking
- avoid ill people
- meticulous hand hygiene and wear gloves
- no live vaccines
- avoid invasive procedures
- fruits and vegetables need to be washed and cooked before eating
- assess for signs and symptoms of infection
- WBC count and temperature
What types of clients are on neutropenic precautions?
Clients on neutropenic precautions:
-
Immunosuppressed
- AIDS
- burns
- organ transplants
- on immunosuppression meds
- on chemotherapy
In what order is personal protective equipment put on?
Put PPE on in this order:
- gown
- mask
- goggles
- gloves
The easiest way to remember is to put your hands over your head and start from the bottom up.
In what order is personal protective equipment taken off?
Take PPE off in this order (it's in alphabetical order):
- gloves
- goggles
- gown
- mask
OR
- take off gown and gloves at same time
- goggles
- mask
When is personal protective equipment removed?
Remove PPE at the doorway before leaving the room. If the client is on airborne precautions, take the PPE off in the anteroom.
The anteroom is a small room between the client's main room and the hallway.
What is medical asepsis?
Medical asepsis is a procedure that is considered clean and clean gloves and clean technique is used.
What are some common procedures that use medical asepsis?
Medical asepsis procedures:
- NG tube insertion
- enema
- removing old dressing
What is surgical asepsis?
Surgical asepsis is a procedure that is considered sterile and sterile gloves and sterile technique is used.
What are some common procedures that use surgical asepsis?
Surgical asepsis procedures:
- foley insertion
- trach suctioning
- wound care
- IV insertion (clean gloves are used, but the area stays sterile)
- CVAD dressing change
What is the teaching to prevent an infectious disease from spreading at home?
Teaching to prevent spread of infectious disease at home:
- Wash all bedding, pillowcases, and towels in hot water
- dry on the hot setting in the dryer
- frequent handwashing
