Hand Washing and
Isolation Precautions
Healthcare Associated Infections
(HAIs) in the USA Today
• HAIs affect 5-10% of patients in US acute
care hospitals.
• HAIs affect nearly 2 million patients per
year.
• HAIs cost an estimated $5-10 Billion per
year.
• More than 70% of bacteria that cause
HAIs are resistant to at least one of the
drugs most commonly used to treat the
infections.
HAIs – The Human Cost
• 99,000 people will DIE this year from a
HAI.
• It’s equivalent to a 747 plane crash killing
all passengers and crew every other day.
• It’s one death every 6 minutes.
• IT IS PREVENTABLE!
Desired Goals
• Reduce hospital acquired infections
• Thereby reducing avoidable morbidity, mortality
and cost.
Key Factors:
• Hand hygiene
• Environmental decontamination
• Identification and isolation of colonized patients
• Education
Contaminated Surfaces tested positive for VRE (+)
in patient environment.
Hayden M. ICAAC,2001, Chicago, IL
Hand Hygiene
• Hand hygiene is the single most important
means of preventing the spread of
infection.
• It is to be performed before and after every
patient encounter, and after the removal of
gloves.
Wash Hands
Access the CDC Hand Washing Course
go to:
http://www.cdc.gov/handhygiene/training/int
eractiveEducation/
Personal Stethoscopes
• Personal stethoscopes should be cleaned
before and after each use. An EPA
registered hospital disinfectant
(disinfecting surface wipes) or alcohol
wipes may be used
Personal Protective Equipment
• Gowns, gloves, masks, goggles, face
shields, PAPRs
• Available on the nursing units
• Gloves should be in every patient room
• Types of PPE required for each isolation
category are identified on a sign posted on
the door to the patient room.
Key Points About PPE
• Don before contact with the patient,
generally before entering the room
• Use carefully – don’t spread contamination
• Remove and discard carefully, either at
the doorway or immediately outside
patient room; remove respirator outside
room
• Immediately perform hand hygiene
Sequence* for Donning PPE
1. Gown first
2. Mask or respirator
3. Goggles or face shield
4. Gloves
* Combination of PPE will affect sequence – be practical
How to Don a Gown
• Select appropriate type and size
• Opening is in the back
• Secure at neck and waist
• If gown is too small, use two gowns
– Gown #1 ties in front
– Gown #2 ties in back
How to Don a Mask
• Place over nose, mouth and chin
• Fit flexible nose piece over nose bridge
• Secure on head with ties or elastic
• Adjust to fit
How to Don a Particulate
Respirator
• Select a fit tested respirator
• Place over nose, mouth and
chin
• Fit flexible nose piece over
nose bridge
• Secure on head with elastic
• Adjust to fit
• Perform a fit check –
– Inhale – respirator should
collapse
– Exhale – check for leakage
around face
How to Don Eye and Face
Protection
• Position goggles over eyes
and secure to the head
using the ear pieces or
headband
• Position face shield over
face and secure on brow
with headband
• Adjust to fit comfortably
How to Don Gloves
• Don gloves last
• Select correct type
and size
• Insert hands into
gloves
• Extend gloves over
isolation
gown cuffs
“Contaminated” and “Clean”
Areas of PPE
• Contaminated – outside front
• Areas of PPE that have or are likely to have been
in contact with body sites, materials, or
environmental surfaces where the infectious
organism may reside
• Clean – inside, outside back, ties on head and back
• Areas of PPE that are not likely to have been in
contact with the infectious organism
Sequence for Removing PPE
1. Gloves
2. Face shield or goggles
3. Gown
4. Mask or respirator
Where to Remove PPE
• At doorway, before leaving patient room or
in anteroom
• Remove respirator outside room, after
door has been closed
How to Remove Gloves
• Grasp outside edge
near wrist
• Peel away from hand,
turning glove insideout
• Hold in opposite
gloved hand
How to Remove Gloves
• Slide ungloved finger
under the wrist of the
remaining glove
• Peel off from inside,
creating a bag for
both gloves
• Discard
Remove Goggles or Face
Shield
• Grasp ear or head
pieces with ungloved
hands
• Lift away from face
• Place in designated
receptacle for
reprocessing or
disposal
Removing Isolation Gown
• Unfasten ties
• Peel gown away from
neck and shoulder
• Turn contaminated
outside toward the
inside
• Fold or roll into a
bundle
• Discard
Removing a Mask
• Untie the bottom, then
the top
• Remove from face
• Discard
Removing a Particulate
Respirator
• Lift the bottom elastic
over your head first
• Then lift off the top
elastic
• Discard
Hand Hygiene
• Perform hand hygiene immediately after
removing PPE.
– If hands become visibly contaminated during PPE
removal, wash hands before continuing to remove
PPE
• Wash hands with soap and water or use
an alcohol-based hand rub
Protect Yourself and Your Patient
• PPE is available to protect you from
exposure to infectious agents in the
healthcare workplace
• Know what type of PPE is necessary for
the duties you perform and use it correctly
Donning and Removal of PPE
Video Review
Click on the link below.
http://www.siumed.edu/common/videoplay
er.php?f=mp4:oec/Student/PPE.f4v
CDC Guideline for Isolation
Precautions
• There are 4 isolation categories - The
name of each reflects how the infectious
organism/disease is transmitted.
• The next few slides will detail the
requirements of each category and show
examples of the signs posted on patient
doors to communicate these requirements
to all who enter.
4 CDC Categories
• Standard
• Contact
• Airborne
• Droplet
STANDARD PRECAUTIONS
• Assume that every person is potentially infected
or colonized with an organism that could be
transmitted in the healthcare setting.
• Wear PPE according to the level of anticipated
contamination, when handling patient-care
equipment and instruments/devices that are
visibly soiled or may have been in contact with
blood or body fluids.
CONTACT ISOLATION
Protects from diseases spread by contact.
Including:
Clostridium difficile (C-Diff)
Scabies, lice, impetigo
Patients with multiple drug
resistant organisms
(MDRO) like MRSA, VRE,
and MDRO gram negative
organisms
(i.e.Pseudomonas,
Acinetobacter).
•Private room
required
•Gown required
•Gloves required
Contact Isolation:
Patient transport:
Patient: Patient wears clean gown.
Cover any open wounds.
Cover patient with clean sheet prior to transport.
HCW:
(Healthcare
Worker)
Wear Personal protective equipment (PPE) when touching patient.
Remove and dispose of PPE and perform hand hygiene prior to
transporting patient.
Don clean PPE to handle patient at transport destination.
Visitors: Visitors who are not providing direct care to patients in contact
precautions will not need to wear gown and gloves. This does not
apply to students, residents or other healthcare providers.
Equipment:
Clean glucometers, thermometers or any other equipment
used for or on a patient. Dedicate stethoscope, B/P cuff to
each patient.
For patients with spore-forming
organisms, such as Clostridium difficile
(C. diff), you must wash hands with
soap and water. Alcohol-based hand
cleaners are less effective.
Memorial Medical
Center ONLY
AIRBORNE PRECAUTIONS
Protects from disease spread by air/respiratory tract.
• Primarily used for suspected or diagnosed TB.
• A special ventilation room (negative airflow) is
required. Door is kept closed.
• A Powered Air-purifying Respirator (PAPR) is
required to enter the room.
• Some areas (surgery, MRI) wear a N-95 mask.
An annual fit-test is required for N-95 users.
Airborne Isolation:
Patient transport:
Patient: Patient wears surgical mask when out of room.
Follow respiratory hygiene/cough etiquette.
If skin lesions are present—cover lesions with clean sheet
HCW:
(Healthcare
worker)
Wear PAPR when entering room and handling patient
May remove PAPR once out of the room and patient is wearing
mask
Hand hygiene prior to transport
HCW does not need to wear PAPR during transport
Equipment: Clean stretchers/wheelchairs after use
Clean glucometers, thermometers, or any other equipment
used for patient
AIRBORNE/CONTACT
PRECAUTIONS
• Used for other occasions when a special
ventilation room (negative airflow) is needed,
i.e. varicella (chickenpox), measles, shingles
(varicella) in an immunocompromised
patient, or disseminated shingles.
• These conditions are also spread by contact
so Contact precautions are required also.
• A PAPR, gown and gloves are required to
enter the room.
DROPLET PRECAUTIONS
Protects against diseases spread by respiratory droplets.
Including suspected or known:
Neisseria meningitidis (meningococcemia),
Meningitis of unknown origin (bacterial vs.
viral)
Influenza
Pertussis (whooping cough).
A surgical type mask is required to
enter the room.
Droplet Isolation:
Patient Transport:
Patient: Patient wears surgical mask when out of room.
Follow respiratory hygiene/cough etiquette
HCW: Wear mask when entering room
(Healthcare
May remove mask once patient is wearing a mask
Worker)
HCW does not need to wear mask during transport
Equipment: Clean stretchers/wheelchairs after use
Clean glucometers, thermometers or any other
equipment used for patient
SUMMARY
• Standard: Wear PPE according to the level of
anticipated contamination, when handling pt-care
equipment and instruments/devices that are visibly
soiled or may have been in contact with blood or
body fluids.
• Contact: A gown and gloves are required to enter the
room.
• Airborne: A PAPR is required when entering the
room.
• Droplet: A surgical type mask is required to enter the
room.
• Airborne/Contact: A PAPR, gown and gloves are
required to enter the room.
Equipment Decontamination
If extra equipment is taken into an
isolation room and used such as a
reflex hammer, tuning fork,
ophthalmoscope etc., be sure to
decontaminate the equipment
afterward with the PDI Surface
Wipes located in a canister on the
infection control cart or plastic wall
hanger outside the patient room.
Wash your hands after
decontaminating the items.
Note Taking in an Isolation Room
For droplet or airborne isolation do not take notes in the room.
For contact isolation, if you must, follow these steps.
• don all appropriate PPE
• take paper and a pen into the room
• take and record the history information without touching any
equipment or the patient.
• place the paper and pen in the anteroom or outside the door. Take
care to cover the information with a blank paper or turn the forms
upside down so the information is not visible to those in the hall.
• perform the physical exam, remove the PPE, wash hands and
record this information after leaving the room..