STANDARD PRECAUTIONS
ISOLATION PRACTICES
STERILE TECHNIQUE
STANDARD PRECAUTIONS
1996, CDC developed a system of isolation to
provide guidelines on how to prevent spread of
infection (updated 2007)
………. practices are referred to as
Standard Precautions (a 2 Tiered system).
Standard Precautions include
wearing protective barriers
when risk of contact with any
body excretions, secretions,
and moist membranes
and tissues.
Acknowledges that all are potentially
infectious.
FIRST TIER
Precautions designed for care of all clients
regardless of their diagnosis or presumed
infection status.
Standard Precautions apply to:
1) Blood
2) All body fluids, secretions, and excretions
3) Non-intact skin
4) Mucous Membranes
SECOND TIER
It alerts the nurse to take additional precautions to
interrupt the transmission of a specified
infection or organism.
These Transmission-Based Precautions are for
patients known, or suspected of being infected
by a particular pathogen transmission:
(a) airborne precautions
(b) droplet precautions
(c) contact precautions
3 TRANSMISSION-BASED PRECAUTIONS
(must understand how the organism is transmitted)
Airborne Precautions: spread of microbes on small
droplet nuclei through the air (< 5 microns).
(ie) Measles; Chicken Pox; TB
*MASK important, door closed, negative air flow
ventilation, private room
Droplet Precautions: large particle droplets
(> 5 microns); which transmit 3 feet in air.
(ie) Mumps; Pertussis; Influenza; SARS
*Private room / or cohort clients, and mask worn if
within 3 feet
Contact Precautions: for prevention of disease
transmitted by either direct / or indirect, contact.
(ie) Impetigo, Scabies, Herpes Zoster, C Difficile.
*Gloves and gown worn, private room or cohort
clients
BUGS ARE GETTING SMARTER THAN THE
DRUGS!!
Some microorganisms that are particularly
difficult to destroy.
Some prevalent ones are:
~ Methicillin-Resistant Staphylococcus Aureus
(MRSA)
~ Vancomycin-Resistant Enterococcus (VRE)
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Skills Text p.197
– Box 8-1 & Table 8-2
– Guidelines for Standard Precautions (2
tiered system) published by the CDC in
1996
Standard Precautions
Fundamentals text, p.807
– READ *****
ISOLATION IS…….
Infection control and prevention methods
that are used to decrease the transfer of
microorganisms.
Barriers or PPE (protective personal
equipment)
may include:
 gowns
 gloves
 masks
 eyewear/ goggles.
“PROTECTIVE ISOLATION” aka
“REVERSE ISOLATION”
Protects the client with a compromised or
suppressed immune system; who is highly
susceptible to contracting an infection.
Private room needed, door closed, gowns,
masks, gloves (if direct contact), wash hands
immediately before entering / leaving the
room, no plants or flowers allowed.
PROCEDURE OF ISOLATION
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Prepare room for client; be organized!
Before entering room, wash hands & put on
the necessary barrier protection.
Place soiled linen & gown into an
impermeable laundry bag. If splatter a
possibility, nurses gown should also be
impermeable.
Wash hands & change gloves PRN during
care.
When care complete, PPE is removed inside
room.
In what order do you dress/undress PPE?
Must think critically, esp upon leaving
isolation…..may depend upon the
area in which you are working.
As a general rule:
~ gloves are last put on & 1st taken off
~ if airborne precautions, mask stays on until
out of room.
Consider your gloves, outside of your goggles, front of your
mask, sleeves & front of your gown all to be
contaminated. Remember to wash hands
once all PPE removed.
LEAVING ISOLATION ROOM
Remove your protective barriers in the
following order:
1) Remove gloves
2) Remove eyewear/goggles
3) Remove gown (pull off inside out)
4) Remove mask
5) Wash hands immediately
Leave mask on until after you leave room if
airborne
CLIENT CONCERNS RELATED TO
ISOLATION
Explain purpose of isolation & the
necessary precautions.
Sensory deprivation may be evident
by signs of loneliness or boredom.
S & S of depression - decreased motivation, anger,
lack of appetite, or difficulty sleeping.
What interventions can you plan, while working with a
client in isolation?
“STERILE TECHNIQUE” aka
“SURGICAL ASEPSIS”
What is the purpose of
STERILE TECHNIQUE ?
PURPOSE OF STERILE TECHNIQUE
To ELIMINATE all microorganisms from
objects that come into contact with
the tissues of the body that are
normally sterile.
Where do we use Sterile Equipment and
Implement Sterile Technique?
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Operating room
Labor and delivery
Major diagnostic / special procedure areas
At the bedside in 3 main situations:
1) Procedures requiring intentional perforation of the skin
ie. Inserting an IV or an injection
2) If the skin’s integrity is broken due to surgery or burns
ie. Dressing changes / cleansing wounds
3) During procedures involving insertion of devices, into
normally sterile body cavities
ie. Urinary catheter
HOW DO THINGS BECOME STERILIZED ?
Autoclave - moist heat under pressure for surgical
instruments
Radiation - for drugs & other heat sensitive items
Chemicals - disinfect instruments (chlorine bleach)
Ethylene Oxide Gas - for rubber and plastic
What about boiling water?
How do we know if an item is Sterilized?
If commercially prepackaged (disposable):
…….. check the integrity of the package
If reusable equipment (sterilized within the
facility):
…… check integrity / expiration date / &
also look for specially marked tape on the
package
AREAS WHERE STERILE EQUIPMENT IS
USED AND STERILE TECHNIQUE IS
NECESSARY
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Operating room
Labor and Delivery
Major diagnostic areas
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At the bedside in 3 main situations—
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– intentional perforation of skin (IV/injection)
– when skin integrity is broken (dsg change)
– inserting device into sterile body cavity
(catheter)
Principles of Surgical Asepsis
p 814 - 815Fundamentals text
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A sterile object remains sterile only when
touched by another sterile object.
Only sterile objects may be placed on a
sterile field.
A sterile object/ or field out of the range of
vision, or an object held below waist level, is
considered contaminated.
A sterile object/or field, becomes
contaminated by prolonged exposure to air.
…..Surgical Aseptic Principles
continued….
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If in contact with a wet contaminated
surface, the sterile object/ or field becomes
contaminated by capillary action.
Microbes move in the direction of gravity.
Edges of a sterile field are considered
contaminated….a 2.5cm border.
If ever in doubt - consider it unsterile!
Preparing a
a Sterile
Dressing Tray
Prepare the sterile field…..
Sterile Pack……
Add item to the sterile field……
Add liquid to the sterile field…….
When all of the above is complete……glove
STERILE GLOVES
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Dominant hand is gloved first. Do not touch outside of
1st glove, only the inside cuff (which is folded over)
Then with sterile gloved dominant hand, pick up 2nd
glove by reaching under cuff.
Keep thumb fully abducted & ensure hands remain
above the waistline.
Please refer to Skills testing schedule
N125 Exam December 16, 2008 (0900h)
@ Oland’s Center Gymnasium
GOOD LUCK !