ATI Fundamentals For Nursing Chapter 11 - Infection Control

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1

Airborne Precautions

measures taken to prevent the spread of diseases transmitted from an infected person by pathogens propelled through the air on particles smaller than 5 µm in size to a susceptible person’s eyes, nose, or mouth

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Antibody

a type of protein the immune system produces to neutralize a threat of some kind, such as an infecting organism, a chemical, or some other foreign body

3

Antimicrobial

able to destroy or suppress the growth of pathogens and other micro-organisms

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Antiseptic

a substance that reduces the number of pathogens present on a surface

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Asepsis

methods used to assure that an environment is as pathogen-free as possible

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Aseptic

as pathogen-free as possible

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Bacteriostatis

the inhibition of further bacterial growth

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chlorhexidine

an antibacterial compound with substantial residual activity that is used as a liquid antiseptic and disinfectant

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Contact precautions

measures taken to prevent the spread of diseases transmitted by the physical transfer of pathogens to a susceptible host’s body surface

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Contamination

the process of becoming unsterile or unclean

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Disinfectant

any chemical agent used to destroy or inhibit the growth of harmful organisms

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droplet precautions

measures taken to prevent the spread of diseases transmitted from an infected person by pathogens propelled through the air on particles larger than 5 µm in size to a susceptible person's eyes, nose, or mouth.

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endemic

prevalent in or characteristic of a particular environment

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endogenous

produced within an organism or system rather than externally caused

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epidemic

extremely prevalent or widespread

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exogegous

externally caused rather than produced within an organism or system

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flora

the aggregate of bacteria, fungi, and other micro-organisms normally found in a particular environment, such as the gastrointestinal tract or the skin

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hyperendemic

at an especially high level of continued incidence in a population

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immunosuppression

the inhibition of the body’s protective response to pathogenic invasion, usually as a result of disease, drug therapy, or surgery

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infection

invasion and proliferation of pathogens in body tissues

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isolation

the separation of an infected person from others for the period of communicability of a particular disease

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latex

a milky fluid produced by rubber trees that is processed into a variety of products, including gloves used for patient care

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medical asepsis

infection-control practices common in healthcare, such as basic handwashing

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Methicillin-Resistant Staphylococcus Aureus (MRSA)

a strain of the bacterium Staphylococcus aureus that has become resistant to the antibacterial action of the antibiotic methicillin, a form of penicillin

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pathogen

any disease-producing agent, especially a virus, bacterium, or fungus

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Personal Protective Equipment (PPE)

devices used to protect employees from workplace injuries or illnesses resulting from biological, chemical, radiological, physical, electric, mechanical, or other workplace hazards

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pneumococcal

pertaining to or caused by pneumococci, organisms of the species Streptococcus pneumoniae, a common cause of pneumonia and other infectious diseases

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retrovirus

any of a large group of RNA-based viruses that tend to infect immunocompromised individuals, including the human immunodeficiency virus and many cancer-causing viruses

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sepsis

the presence in blood or other tissues of pathogens or their toxins

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standard precautions

measures designed to prevent the transmission of organisms and used for all patients in healthcare facilities regardless of diagnosis or infection status

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stephylococcus

a genus of gram-positive bacteria that are potential pathogens, causing local lesions and serious opportunistic infections

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surgical asepsis

techniques used to destroy all pathogenic organisms, also called sterile technique

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transmission-based precautions

measures taken to prevent the spread of diseases from people suspected to be infected or colonized with highly transmissible pathogens that require measures beyond standard precautions to interrupt transmission, specifically, airborne, droplet, and contact precautions

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Vancomycin-Resistant Staphylococcus Aureus (VRSA)

a strain of the bacterium Staphylococcus aureus that has become resistant to the antibacterial action of the antibiotic vancomycin

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sensitivities and allergies

concerns to healthcare workers and patients due to the potential for high exposure to latex gloves and medical supplies that contain latex.

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  1. Irritant contact dermatitis
  2. Allergic contact dermatitis (delayed hypersensitivity)
  3. Latex allergy

The three most common reactions to latex products are:

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Signs :

  • dry
  • itchy
  • irritated

Sites:

  • usually hands

Causes:

  • using gloves
  • exposure to other workplace products and chemicals.
  • repeatable handwashing
  • incomplete hand drying
  • use of cleaners and sanitizers
  • exposure to powders add to the gloves

Irritant contact dermatitis (Not a true allergy)

Signs, sites and causes

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Signs:

  • (similar to poison-ivy)
  • rashes (usually begins 24-48 hrs after contact)
  • it may progress to oozing skin blisters

Sites:

  • anywhere

Cause:

  • exposure to chemicals added to latex during harvesting, processing, or manufacturing.

Chemical Sensitive Dermatitis

Signs, sites and causes

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Signs:

  • reaction usually begins in minutes, but can occur hours later and can produce various symptoms.
  • skin redness (mild reaction)
  • hives (mild reaction)
  • itching (mild reaction)
  • runny nose ( severe reaction)
  • sneezing ( severe reaction)
  • itchy eyes ( severe reaction)
  • scratchy throat ( severe reaction)
  • asthma ( severe reaction)

Sites:

Causes:

  • protein/powder in gloves
  • airborne protein/powder inhaled into the respiratory tract

Latex allergy ( most serious reaction to latex )

Signs, sites and causes

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  • precautions must be take to prevent exposure
  • replacing latex-containing gloves and supplies with non-latex items is essential

Actions needs to be taken once a healthcare or patient has been identified with a latex sensitivity or allergy.

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  • Use non-latex gloves for activities that do not involve exposure to infectious materials.
  • Request non-latex gloves that provide protection against infectious materials.
  • Avoid oil-based creams or lotions while using latex gloves. This may cause break down of the gloves.
  • Wash hands with a mild soap, and dry hands completely after using gloves.
  • Request reduced-protein, powder-free gloves if your facility supplies latex gloves.
  • Recognize symptoms of a latex allergy.

Preventing a latex allergy

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hand hygiene

refers to both handwashing with an antimicrobial or plain soap and water as well as alcohol-based products such as gels, foams, and rinses

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- Upon arrival to work, inspect the surface of your hands for breaks or cuts in the skin or cuticles. If lesions are found, apply dressing prior to providing care to patients.

- Perform hand hygiene:

  • before caring for a patient and after contact with anything in the room.
  • after touching blood, body fluids, secretions, excretions, and contaminated items, whether or not gloves are worn.
  • immediately after gloves are removed, between patient contacts, and when otherwise indicated to avoid transfer of micro-organisms to other patients or environments.
  • between tasks and procedures on the same patient to prevent cross-contamination of different body sites.

- Avoid artificial nails

- keep nails trimmed

- avoid wearing rings whenever possible

- If the areas under fingernails are soiled, clean them with the fingernails of the other hand or with an orangewood stick.

- Wash hands with soap and water when hands are visibly soiled.

Hand hygiene (must do and check)

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  1. Turn on the water and adjust it to a comfortable, warm temperature.
  2. Wet the hands, keeping the hands lower than the elbows.
  3. Apply 3 to 5 mL of soap to the hands, coating all surfaces.
  4. Rub the hands vigorously together, working up a lather, for at least 15 seconds.
  5. Rinse thoroughly, pointing the fingers down to allow water to run off the hands.
  6. Dry the hands from the fingers to the wrist.
  7. Turn off the water with a clean paper towel.

Proper steps in Soap and water handwash

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  1. Apply 3 to 5 mL (per manufacturer) of antiseptic gel to the palm of one hand.
  2. Rub the hands together, coating all surfaces, and rub vigorously until the gel disappears and the hands are dry.
  3. Apply gloves.

Proper steps in Alcohol-based handrub

46
  • properly dispose patient-care equipment contaminated with blood, body fluids, secretions, and excretions
  • Do not use reusable equipment for the care of other patients until it has been cleaned and reprocessed appropriately
  • Dispose of sharp instruments such as needles, syringes, and scalpels in a puncture-resistant container.
  • Dispose of blood, body fluids, suctioned fluids, and excretions by flushing them into the sewage system or per agency protocol.
  • Do not splash potential infectious fluid
  • Dispose of the emptied container in the appropriate receptacle.

Waste management - Medical Equipments

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  • handle it carefully away from your body
  • transport them in a leak-resistant bag
  • avoid shaking or tossing
  • do not place soiled linens on floor
  • if clean linen touch the floor, immediately place them in the soiled linen container

Waste management - Linens

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Personal protective equipment (PPE)

such as gloves, gowns, masks, and eyewear may be necessary to avoid contact with blood, body fluids, secretions, and excretions and the transmission of infectious material found in these substances.

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  1. Perform hand hygiene until the product disappears and the hands are dry.
  2. Select the appropriate size glove.
  3. Holding the glove at the opening, slip the fingers into the glove and pull tight.
  4. With the gloved hand, hold the second glove at the opening and slip the ungloved fingers into the glove and pull tight.
  5. Pull gloves to the wrists of both hands.
  6. Remove the gloves by grasping the cuff of the other gloved hand.
  7. Avoiding skin contact, roll the glove inside out and place it in the palm of the gloved hand.
  8. Grasp the glove on the inside of the cuff and pull inside out.
  9. Dispose of the gloves.
  10. Perform hand hygiene.

Proper steps when using gloves

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  1. Some masks have ties and some have elastic to secure the mask to the face. One is flexible and one is molded.
  2. Both have a flexible nose piece that is adjusted by pinching at the bridge of the nose.
  3. Place and hold the mask over the nose, mouth, and chin while stretching the band over the ear or tying the ties behind the head and at the base of the neck.
  4. Adjust the mask so it is snug with no gaps. The mask should not be touched or readjusted during use.
  5. After properly removing and disposing of gloves, carefully remove the elastic from the ear or untie the mask from the back of the head, bottom tie first.
  6. Dispose of the mask.
  7. Perform hand hygiene.

Proper steps when using mask

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Surgical masks

come in two basic types: One type is affixed to the head with two ties, conforms to the face with the aid of a flexible adjustment for the bridge of the nose, and may be flat/pleated or duck-billed in shape. The second type of mask is pre-molded, adheres to the head with a single elastic band, and has a flexible adjustment for the bridge of the nose.

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Procedure masks

are flat/pleated and affix to the head with ear loops. They are used for any nonsterile procedure.

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Respirators

Current OSHA standards require that respirators used for airborne precautions for suspected and confirmed pulmonary tuberculosis (TB) minimally filter 95% of 0.3 µm-size particles.

The N95 respirator and the HEPA respirator meet these requirements.

are used for case-specific procedures where particulates and secretions create a high risk of infection for the healthcare worker. Agencies typically have special procedures for these devices and provide special training and clearance for use.

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N95 respirator mask

  • is intended to be used for protection against solids.
  • is extremely durable and has a soft and comfortable inner surface, an adjustable nosepiece, and secure headstraps to provide proper fit.
  • A person using this respirator must be fit-tested before use.
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should not be placed below the nose.

should not be worn around the neck

should be changed if they become wet

should be changed between patient procedures

Proper way to wear Masks

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  1. Grasping the ear or head pieces of the appropriate device, spread and slowly apply the device over the ears.
  2. Adjust for comfort as needed.
  3. Using ungloved hands, grasp the ear pieces and lift away from the face.
  4. Discard disposable devices in the appropriate receptacle. If the device is designed to be reused, process it according to agency protocol.

Proper steps when using goggles

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Direct-vented goggles

Goggles must fit snugly to provide adequate protection from splashes, sprays, and respiratory droplets.

have the potential for allowing the penetration of splashes and are not as reliable as indirect-vented goggles.

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Face shields

are sometimes used as an alternative to goggles because it has a larger surface area, it provides protection to other facial areas.

do not fit snugly against the face, making them vulnerable to splash and spray going under the shield.

typically used with other forms of protection and should not be considered the best protection.

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Safety glasses

are excellent for providing impact protection. However, they do not protect adequately from splash, spray, and respiratory droplets. Thus, they are not typically used for infection-control purposes.

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Gowns

is adequate for protecting skin and preventing soiling of clothing during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, or excretions.

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  1. Select the appropriate type and size of gown.
  2. With the gown opening in the back, pull the arms through the sleeves one at a time and pull it over the shoulders. Secure at the neck and waist.
  3. If the gown is disposable and designed to be removed quickly, the gloves may be removed with the gown and rolled together to prevent contamination.
  4. If not using a breakaway gown, untie the waist tie before removing the gloves. Remove gloves and with ungloved hands, untie the gown at the neck and pull it away from the shoulders. Roll it into a bundle while avoiding contact with the outside of the gown.
  5. Dispose of the gown.
  6. Perform hand hygiene.

Proper steps when using gowns

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  • covering the mouth and nose during coughing and sneezing
  • using facial tissues to contain respiratory secretions, with prompt disposal into a hands-free receptacle
  • wearing a surgical mask when coughing to minimize contamination of the surrounding environment
  • turning the head when coughing and staying at least 3 feet away from others, especially in common waiting areas
  • disinfecting hands after contact with respiratory secretions

The components of respiratory hygiene/cough etiquette include:

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  1. standard precautions
  2. transmission-based precautions.

two tiers of CDC precautions to prevent transmission of infectious agents

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Standard precautions

are applied to the care of all patients in all healthcare settings, regardless of suspected or confirmed presence of an infectious agent.

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Transmission-based precautions

addresses isolation precautions, which are based on the mode of transmission of a disease.

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  1. contact precautions
  2. droplet precautions
  3. airborne precautions

3 categories of transmission-based precautions

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  • Direct contact refers to the care and handling of contaminated body fluids.
  • Indirect care refers to the transfer of an infectious organism through a contaminated intermediate object, such as contaminated instruments or hands of healthcare workers.
  • include the use of personal protective equipment: gloves and gowns.
  • patients should also be in a private room to prevent cross-contamination.

Contact precautions

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  • are used when a disease is transmitted by large droplets expelled into the air and travels 3 to 6 feet from the patient.
  • requires the use of a surgical mask when within 3 feet of the patient, proper hand hygiene, and some dedicated care equipment. The mask should be applied prior to entering the patient’s room.

Droplet precautions

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used with patients who have diseases that are transmitted by smaller droplets.

These droplets remain airborne for longer periods of time.

This form of isolation requires a negative airflow to filters air through a high-efficiency particulate air (HEPA) filter and then directs the air to the outside of the facility.

requires the use of an N95 respirator

Airborne precautions

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  • Thorough perform hand hygiene prior to entering and leaving the room of a patient in isolation.
  • Properly dispose of contaminated supplies and equipment according to agency policy.
  • Apply knowledge of mode of infection transmission when using personal protective equipment.
  • Protect all persons from exposure during transport of an infected patient outside of the isolation room.

With all of these types of transmission-based precautions, certain basic principles should be followed.

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Protective Environment

designed for patients who have undergone transplants and gene therapy

reduces the risk of environmental fungal infections.

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  • essential component of patient care essential component of patient care
  • use in legal proceedings, reimbursement, education, research, and quality assurance.

uses of documentation include:

73
  • infection control measures used
  • clean or sterile gloves used
  • if the patient has a latex sensitivity or allergy
  • the patient’s response to care
  • any specimens and cultures obtained and sent to lab
  • disposal precautions used
  • type of isolation protocol used

Types of documentation (charting) should include:

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View attached photo: Example Nurse's Notes (Documentation/Charting)

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Its use takes less time than washing with soap and water does.

During an 8 hour shift, an estimated 1 hour of an intensive care unit nurse's time is saved by hand rubbing with an alcohol-based gel

Which of the following is an advantage of using alcohol-based gel?

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The gloves

Gloves are considered the most contaminated and should be removed first, followed by face/eye protection, gown, and mask/respirator.

after completing a procedure that requires donning personal protective equipment consisting of a gown, an N95 respirator, a face shield, and gloves, which of the following should the nurse remove first when removing PPE separately?

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Continue for at least 15 seconds

Hand washing with nonantimicrobial soap and water for at least 15 seconds reduces bacterial counts and can remove loosely adherent transient flora. The CDC recommends rubbing hands together vigorously for at least 15 seconds, covering all surfaces of hand and fingers

You are washing your hands with a nonantimicrobial soap and water prior to repositioning a patient in bed. During the hand washing procedure, it is important to

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Protect your eyes

Droplet transmission involves contact of infectious, large particle droplets with the conjunctivae or the mucous membranes of the nose or mouth of a susceptible person. Droplets are generated by the patient during coughing, sneezing, or talking, and during procedures such as suctioning and bronchoscopy.

You are caring for a patient diagnosed with mycoplasmal pneumonia. Droplet precautions have been instituted, so you must

79

Infectious diarrhea

Contact precautions are essential for preventing the spread of certain enteric infections. These precautions mean no direct touching of the patient, the environment, the equipment, or the supplies used. The patient should be in a private room.

Contact precautions would be mandated for a hospitalized adult patient diagnosed with

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Wash your hands with soap and water

The Centers for Disease Control and Prevention recommends washing with soap and water whenever hands are visibly dirty. In this case, it is the combination of friction, running water, and the properties of soap that remove the soil form the hands

After assisting a newly admitted patient in removing hoes and outerware, you notice what appears to be soil or grime on your hands. You?

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Disinfecting hands immediately after removing gloves

Although it might seem as though hands covered by intact gloves would be as clean as they were when you donned the gloves, it is an essential component of standard precautions to disinfect your hands immediately after glove removal. This often concludes a patient-care procedure, and hand hygiene is mandated between patient contact. Also you cannot assume that the integrity of each glove has not been breached, that no powered or other residue remains on your hands, and that your hands have not been contaminated during glove removal.

Standard precautions mandate

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A face shield

A face shield protects face, mouth, nose and eyes from potential splashes of blood or other body fluids. Irrigating a wound certainly has the potential for splashing irrigating fluid containing blood, body fluids, and tissues particles onto your face.

You are about to irrigate a patient's open wound. Besides gloves, which other item of personal protective equipment (PPE) must you wear?

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Drying provides the full antiseptic effect

A dry environment offers better protection against the proliferation of pathogens than a moist environment does. The bactericidal alcohol components of these gels further enhance their superiors antiseptic effect.

To decontaminate your hands with an alcohol based gel, you rub them together until all of the gel has evaporated and your hands are dry. The primary reason you do this is that

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Acquired the infection while hospitalized

A nosocomial infection is one that is acquired in a hospital. Most nosocomical infections are caused by pathogens transmitted from one patient to another by healthcare workers who do not practice good hand-hygiene technique or do not disinfect their hands between patient contacts. Note that the term CDC prevention now uses for infections associated with health care delivery in any setting (hospital, long-term care facilities, ambulatory setting, home care) is healthcare- associated infection.

A patient has a nosocomial infection also called Healthcare-Associated Infection (HIA). This terminology means that the patient

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Petroleum-based hand lotion

The use of petroleum-based hand lotions or creams can impair the integrity of latex gloves, weakening them and increasing their permeability.

Which product affect the permeability of gloves?