Hand hygiene

Who was the first man who insisted on hand washing?

Ingaz Philipp semmelweisis

What was the result of their hand washing?

It immediately reduced the incidence of fatal puerperal fever about 10 per cent

why do people not want to wash hands?

The method used
Work load
Lack of knowledge about guidelines and protocols
People forget to wash hands

How you should care for your hands on a day to day basis?
Wash my hands before and after contact with patient
Make sure that my nails are short
I will make sure that I wash my hands after I remove gloves before I use hand rub to
avoid sensitivity to the skin

What does BBE stand for?

Bare below elbows
Nails must short
Nail polish must be removed
All the cuts must be covered
 What does lads stand for?
On_ latex glove removal
After accidental contacts with blood or body fluids with no glove
When has diarrhoea or vomiting
When hands are very soiled

Explain the 5 moments of hands hygiene?

Before patient contact

Before aseptic task

After body fluids exposure risks

After patient contacts
After contacts with surrounding

Explain how you should care for your hands on a day to day basis?

Ensure that my nails are always short and clean

Ensure that after removing gloves I should wash hands instead of using hand rub
Avoiding using Bioscrub unnecessarily as over use of it damages skin
Treat skin that is visibly damaged
Check if I am not allergic to the hand rub or hand wash soap if I am to use an
alternative

What does BBE stand for?

Bare before elbow
It means that one should have short sleeves and should wear long sleeves.
Staff should take jerseys off while working.
No wrist watches should be worn.
Rings should be taken off while washing hands.
And no nail polish should be worn.

What does LADS mean?

Situations when you must wash with soap rather than spray hands

L on latex glove removal

A after accidental contact with blood or body fluids with no gloves
D when a patient has diarrhoea or vomiting especially if its c.difficle related
S When hands are visibly soiled

Explain the 5 moments of hygiene?

 Before patient contact
Before aseptic task
After body fluid exposure risk
After patient contact
After contact with patient surroundings

What are we using as hand rub?

Sani-touch Sani-Spray.

What are the contents of the hand rub solution?

Ethonal 50-80% & 0.01-1% chlorhexdene digluconate

What are we using as hand wash solution?

For social hand was Kimcare antibacterial hand cleanser.
For aseptic hand wash Bioscrub.

What are the contents of the hand wash solution?

Kimcare- aqua, citric acid, ethanolamine, sidiumcumenesulfonate, tea-lauryl

sulphate, cocamidopropyl betaine, hydroxyethycellulose, triclosan 0.8%,
methylchloroisothiazolonone, methylisothaizolinone, dmdm hydnation and
sodium benzoate.
Bioscrub-20ml chlorhexidine gluconate solution bp and 4% v/v Isopropyl
alcohol as preservative
Personal protective equipment
Explain the concept PPE

It is the equipment used to protect skin; clothing; mucous membrane; and

respiratory tract from infectious agents.

Explain the sequence of doing PPE

Gown: it covers torso from neck to knees; arms to end of wrist and wrap
around the neck. And fasten in the back of neck and waist.
Mask or respirator: secure ties or elastic bands at middle of head and
neck.
Fit flexible band to rose bridge
Fit snug to face and below chin.
Fit check respiratory.
Goggles or face Shield: place over face and eye adjust to fit.
Gloves: extend to cover wrist of isolation gown.

Explain the sequence of removing PPE.

Gloves: outside of gloves is contaminated.

Hold outside of glove with opposite gloved hand; peel off.
Hold removed glove in gloved hand.
Slide fingers of ungloved hand under remaining glove at wrist.
Peel glove off over first glove.
Discard gloves in waste container.
Goggles or face shield: gown front and sleeves are contaminated.
Unfasten ties.
Pull away from neck and shoulders touching inside of gown only.
Turn gown inside out.
 Fold or roll into a bundle and discard.
Mask or respirator: front of musk/respirator is contaminated DO NOT
TOUCH.
Grap bottom then top tie or elastics and remove.
Discard in waste container.

Explain why you cannot use hand lotion containing petroleum

jelly when using gloves

Sharps management
Define sharps
Anything that can penetrate to the skin

Explain the Dos and Donts of sharps management

The Donts

Do not place needles; syringes and sharps directly onto beds; bed linen or
lockers use a safe container e.g. receiver.
Do not shake container to create more space.
Do not empty one container to another container.
Do not remove anything from the sharps container.
Do not fill beyond the fill line.

The Dos

Special care to be taken with all intravenous infusions needles or stilettes.

Check the filling line on the sharps container.
When container is 2/3 full seal it and exchange for an empty one.
Ensure there are enough containers in stock over week ends and after
hours.
Ensure that all four corners are properly sealed to prevent spillage during
handling or changing containers.

Explain the dangers of needle stick injuries.

Infection: infect yourself with infectious disease e:g HIV.

Explain the management of sharps.

Sharps must be in a sharp container and sharps container must be of reach of
children.

Check the fill up line on the sharps container , do not fill beyond fill line.
The container must have the hospital name the ward and a date.

When the container is 2/3 full _ seal.

Classify hospital waste.

Class A: anatomical waste.

Human and animal anatomical material; such as tissue; organs; body part
products of conception and animal carecasses.

Class B: infectious non_ anatomical waste

Non-anatomical human and animal material which is blood bags, IV containers
and tubes, colostomy or catheter bags bandages body fluids extracted teeth nail
clippings hair this waste is known or is clinically assessed to be at risk of being
contaminated with micro organisms

Class C Sharps and similar waste:

This an item that is capable of cutting / puncturing the skin such as needles, syringes,
blades, clinical glass and similar articles.

Class D Pharmaceutical and genotoxic chemical waste:

Vaccines, pharmaceutical products such as medicines, drugs and chemicals.

Class E Radioactive waste:

All waste that should be handled and disposed in accordance with the nuclear energy
act.

Explain when foetus is regarded as human tissue:

Foetuses born up to 26 weeks gestation and with the weight under 1kg are disposed as
anatomical waste.

Explain the legal requirements regarding the removal of human

tissue from the hospital premises:

Placenta

Should be examined and findings should be documented.

Should be placed in a rigid walled plastic leak-proof container which is lined with a
80 micron red plastic bag.
Daily container is closed and should be transported accompanied by a nurse to the
storage area.

Foetuses
 Foetus should be placed an appropriate sized, rigid walled and leak proof plastic
container.
Container is taken to storage area accompanied by a nurse after arrangements have
been made for receiving it with the HCRW transporter.
Appropriate documentation is completed.

Limbs

Surgeon must confirm that the limb isnt required for histological examination and the
statement must be recorded in the patients record.
Limb is to be placed in an appropriate sized rigid walled leak proof plastic container.
For storage you do the same as above.
Ensure documentation is completed.
Must be placed in refrigerator at a temperature of -2 c and must be cleaned disinfected
daily or after removal of waste if it cant be disposed of immediately.

Explain the disposal of the different types of waste:

Anatomical and infectious non-anatomical waste: To be placed in a red plastic bag at
least 100 micron strength sealed with a cable tie if no cardboard box used and
incinerated.
Sharps to be put in a sharps container and to be properly sealed and sent for
incineration.
Cylotoxic waste as per internal hospital standard.
o Food waste: waste is to be macerated if no macerator is available place in a clear
plastic and treat as medical waste.
o General waste: to be placed in clear plastic bag sealed with a cable tie and removed to
municipal dump.
o Glass containers: to be kept separate from other waste as per hospital policy

Explain the management of linen when making a bed:

Do not hold linen against you.
Do not place linen on the floor
Do not carry linen to sluice ensure that the round about is placed outside room and
linen is placed there
Ensure that you wear proper protective gear.
Ensure clean trolley is used to place clean linen.
Do not shake linen while making the bed.

Differentiate between the different types of dirty linen:

 Used linen: linen that has been on the patients bed but has not been soiled with
organic matter.
Soiled linen : linen that is soiled with organic matter e.g. faeces urine and blood
Contaminated linen: linen from patients nursed in isolation according to isolation
techniques.

Discuss the management of clean linen:

o Laundry staff must wash hands before handling clean linen.
o To be transported in a separate container from dirty, soiled or contaminated linen.
o Container to be cleaned daily using a detergent /hypochlorite solution.

Discuss the management of the types of dirty linen:

1) Used linen
Linen roller containing appropriate bags identified with ward/unit name or
number is taken to bed side.
Bed linen to be placed in appropriate bag.
Linen is to be sorted, counted, bagged and sealed and sent to the laundry.
Ensure that workers are to wear protective clothing while doing this.

2) Soiled linen
All organic matter is to be removed by ward staff wearing the appropriate protective
clothing.
Linen should be placed in a yellow plastic bag counted and labelled and sealed. When
this bag is emptied into washing machine laundry worker must wear protective
clothing.

3) Contaminated linen
Yellow plastic bag to be kept in isolation room.
As items are placed in bag they should be counted and should be recorded either on a
label attached or on the bag itself with a permanent marker.
Bag to be sent to laundry with no further handling.

4) Theatre and Labour linen

Theatre and labour linen is to be separated into blood stained and non-blood stained
linen.
To be treated as soiled and dirty linen respectively.
White and coloured items not to be mixed.
Specimen collection
Sputum specimen
Ensure that a sterile new container is used and while collecting specimen
ensure that u dont contaminate the inside of the bottle.
Ensure that the correct protective clothing is used.
On the outside of container label with patient name date and time.
You must try getting the first sputum specimen in the morning before the
patient eats.
Ensure that u encourage patient to give an adequate amount of sputum.
You should wear appropriate protective clothing when collecting the sputum.

Urine specimen
Collect first morning specimen if possible.
Ensure that patient cleans genitals before passing the specimen.
Ensure that the bedpan you give the patient is clean to make sure that the
specimen doesnt get contaminated.
The specimen should be sent to lab within two hours of collection.
Label the container with patients name date and time of collection and clearly
state what the specimen is sent for.

Mid-stream urine specimen

When collecting mid-stream educate patient to first pass urine in to toilet then hold
then pass into specimen bottle until its half full then pass the rest of urine into toilet or
bedpan.
Use appropriate protective clothing when collecting urine.
Try to get the patients first urine in the morning if its possible.
Advise patient to wipe genitals before passing urine.
Ensure before you give the patient a clean bedpan.
Use a new clean specimen bottle to collect the urine and avoid touching the inside of
bottle to avoid contamination.
Correctly label bottle with patient sticker and note date and time of collection.

Urinary catheter urine specimen

Dont collect old urine from drainage bag.
Clamp catheter below aspiration point for 30 minutes.
Clean y port with alcohol swab and allow to dry.
Aspirate 5-10 ml of urine from catheter and put in specimen bottle.
Label outside of container with patient sticker and label date and time of collection
and mark as urine collected from drainage bag.
 Ensure that when collecting urine you use appropriate protective clothing example
gloves goggles etc.
Ensure a new clean bottle is used and avoid touching the inside as this will
contaminate it.
Urine should not be kept for longer than two hours before being sent to lab.

Stool specimen
Advise patient to pass urine first before passing stool and not to place toilet paper
together with stool.
Offer patient a clean bedpan for collection of stool.
Ensure when you put stool into container that you use a sterile spatula to scoop the
stools.
And do the same as you did for urine as to labelling the container.
Ensure that you use a clean container and avoid touching the inside of the bottle as
this could contaminate it.
Use protective clothing that is appropriate when collecting the stool.

Wound swab
Remove dressing from area to be swabbed.
Clean wound with normal saline.
Roll swab applicator around the wound area and place applicator in swab container
and ensure you find out from the lab which swab to use for the specific thing you are
swabbing for.
Ensure that you maintain an aseptic technique while dealing with the wound

Completion of laboratory slip

o Ensure that on slip correct time and date is filled in of collection.
o Ensure that you fill in patients details correctly and name of doctor who wants
specimen is correctly identified.
o Clearly indicate what the specimen is and what test is to be done on it.
o Ensure correct laboratory is used.

Environmental cleaning
Explain Spauldings classification of cleaning:
This way of cleaning entails classifying items that we use in crucial patient care and
classifying them into three categories:

Sterilization: (high risk)

These items confer a high risk of infection if contaminated with any microorganism.
So objects that are used to enter vascular system or tissues presumed to be sterile must
be sterile because if they are contaminated with any microorganism this could
transmit a disease.
This category of items include surgical instruments, cardiac and urinary catheters,
implants and ultrasound probes used in sterile body cavities.
These items should be sterilized and this will remove or destroy micro-organisms
including their spores.
And this should be done for all items that penetrate skin or mucous membrane and
those that enter sterile body areas.

Disinfection: (medium risk)

These are semi critical items that contact mucous membranes or non-intact skin.
These include respiratory therapy, anaesthesia equipment, some endoscopes,
laryngoscope blades, oesophageal manometry probes, cystoscopes, anorectal
manometry catheters and diaphragm fitting rings.
These medical devices should be free from micro-organisms but small number of
spores are permissible reason being intact mucous membranes and of the lungs and
GIT are generally resistant to infection by common spores but susceptible to other
organisms such as bacteria, mycobacteria and viruses.
These items minimally require high level disinfection using chemical disinfectants
and this reduces number of micro-organisms to a level that is not harmful and spores
are usually not destroyed.

Cleaning: (Low Risk)

These are non-critical items are those that are in contact with intact skin but not the
mucous membranes.
Intact skin acts as a barrier to most microorganisms so sterility of items is not critical.
Examples of noncritical patient-care items are bedpans, blood pressure cuffs, crutches
and computers.
Non-critical reusable items may be decontaminated where they are used they is no
need to be transported to a central processing area.
No risk has been documented for transmission of infectious agents to patients through
noncritical items.
Contamination and many micro-organisms must be physically removed with
detergent.
Explain the importance of effective cleaning:
Through cleaning is very important before high-level disinfection and sterilization
because if inorganic and organic materials remain on the surface of instruments it will
interfere on the effectiveness of process.
If soiled materials dry up or bake onto instruments removal of these materials will
become very difficult.
Disinfection/sterilization process is less effective or ineffective.
Surgical instruments must be pre-soaked or rinsed in order to prevent of blood thus
will soften blood or remove it.
Cleaning reduces bioburden and removes foreign material that interferes with
sterilization process acting as a barrier to sterilization agent.
Items used in patient-care that become heavily soiled with faeces, sputum or blood or
other materiel should be pre-cleaned.
If these items are sent to cssd without removing these materiel they may be difficult to
clean because these materials have dried up.
Cleaning and decontamination should be done immediately or as soon as possible
after the use of equipment to make the cleaning process effective or easier.

Explain how you would determine if a pack which has been

sterilized, can still be regarded as sterile:

A practice called event-related shelf-life is used.

This practice recognizes that an item should remain sterile until some event causes an
item to become contaminated.
The pack should be dry and not wet if its wet or has any indication that it was wet it
should be considered unsterile.
If they is any damage to the packaging of a pack it should be considered unsterile.
Chemical indicator must be affixed on outside and in the inside of the package to
indicate that the package has gone through sterilization.
The package should be kept in an environment that minimal amount of contamination.
If a pack has fallen it should be checked if its intact and checked for damage to
packaging and contents.

Explain the reasons that a pack can become unsterile

when still unopened:
If the packaging is damaged in any way you shouldnt use it.
If the package is wet or its visible that it was wet before.
If the packaging is soiled.
If the item has reached its date of expiry.
If on the outside they is no chemical indicator that the item has gone through
sterilization.
 If they is no date of when it was sterilized.
If it was not labelled of the items inside.
If the item inside is breakable and you can see or have evidence that it is broken.
If the packaging has stains on it .

Explain the concept of contact time:

This is the time a disinfectant is in direct contact with the surface or item to be disinfected
and for surface disinfection it is the period framed by application to surface until complete
drying has occurred.

Explain the concept biofilm:

These are microbial communities that are tightly attached to surfaces and cannot be
easily removed.
Once they have formed microbes within them can be resistant to disinfectants by
multiple mechanisms .
Bacteria within biofilms are up to 1000 times more resistant to antimicrobials than the
same bacteria in suspension.
Chlorine and mono-chloramines can effectively inactivate biofilm bacteria.
Their presence can have serious implication for immune-comprised patients and also
patients who have indwelling medical devices.

Environmental cleaning
Explain terminal cleaning:
 This is the disinfection programme that is implemented to prevent spread of infection
through effective cleaning of an isolation cubicle and the equipment when the patient
has left.

Explain the importance of a clean ward:

It reduces the potential contribution of environmental surfaces to the incidences of

hospital-acquired infections.
Proper hand hygiene is essential for minimizing transfer of microorganisms between
patients and contaminated surfaces.
It helps in the control of cross-infections in essence to minimize it.
It minimizes the risk for patients to get hospital-acquired infections .
It helps in promoting a safe and clean environment that patients can be treated in so it
promotes healing in patients.

Management of blood and body fluids

Define blood and body fluids:
Blood:

Is a specialized bodily fluid that delivers necessary substances to body cells such as nutrients and
oxygen and it is made of plasma, platelets, leukocytes and erythrocytes .

Body Fluids:

Any fluid that originates inside the body of a living person either excreted or secreted in the body.

Explain the nurses responsibility regarding the cleaning of blood and body
fluids:

It remains the nurses responsibility to clean the blood and body fluid spills

Nurse should wear protective clothing.

Cover spill with paper towels to absorb the moisture.

When liquid has been absorbed place paper towel in a red plastic bag .

Then you can call a cleaner to clean the area with a hypochlorite solution.

Explain the general assistants responsibility regarding the cleaning of

blood and body fluid spills:

Wear protective clothing including gloves.

Cover spill with paper towel to absorb the moisture.

When liquid has been absorbed place the paper towel in a red plastic bag.

Clean the area thoroughly with a hypochlorite solution.

But the first three points are the responsibility of the nurse the cleaner only does it if they see
the spill and they is no nurse.

Education
Explain the importance of continuous education:
 It is important if new policies are implemented, then you need to teach staff about it in to
implement it.

In order for new staff that are hired, if they are not familiar with the hospitals policies then if
you have this in place they can be educated.

It is important for in order to remind staff of policies that are in place.

To ensure that policies are maintained in the wards.

To ensure that everyone knows about standards in place.

Name the various ways in which you can ensure you up to date with new
develops in infection prevention:

Always read up on new policies that are put in place.

Always attend infection control meetings.

Attend lectures that are given on new developments.

Always read up on new developments in infection prevention.

Ensure that you always go on training and update your education.

Explain the concept of peer assessment:

This is when you assess your fellow colleagues.

It helps in maintaining standards in the wards as it ensures that staff members assess each
other in doing the right things.

It help the infection control sister in maintaining standards and thus it eases her work load.

It encourages fellow colleagues to keep themselves update on the latest infection prevention
developments as they need to know things before they evaluate each other.

It also encourage fellow colleagues to read up policies as they need to know there content
before they assess each other.

Explain the concept self-assessment:

This is after you have studied something and after doing it you evaluate yourself on what you
have done.

In this you always asses if you are doing the right and if not then you rectify what you are
doing.
 This concept ensures that you always keep yourself updated about things you do in the
hospital setting.

This concept realise on oneself to maintain standards.

It is ones responsibility to maintain standards in the wards.

Patient placement
Explain the concepts quarantine, cohorting, isolation, single room and
social isolation:

Quarantine:

Period of isolation of an infectious or suspected case to prevent the spread of disease. For
contacts this is the longest incubation period known for the specific disease.

Cohorting:

Two people being isolated together because they both have the same disease or infection
caused by the same microorganism.

Isolation:

Separation of a person with an infectious disease from those non-infected.

Single room:

This is when a person with an infectious disease is separated from non-infected people and is
placed in a room alone away from other patients.

Social isolation;

This is when a patient is isolated for social purposes not to disturb other patients or to protect
patient from other people.

Provide indication for cohorting:

The indication would be for patients that require isolation and they is not enough rooms
available for isolation but both patients have to have the same infection before they can be
isolated together.

Name and define the types of isolation:

Contact precautions:

Used for patients known or suspected to be infected or colonized with epidemiologically

important micro-organisms that can be transmitted by direct contact with patient or indirect
contact with environmental surfaces or patient care items. Patients that should be isolated are
anthrax, Congenital rubella syndrome, herpes Zoster(shingles), rabies, major skin infections,
gas gangrene, puerperal sepsis, wound and skin infection not covered by a dressing , multi
drug resistant bacteria, clostridium difficile, shigella, hepatitis a, b &c, herpes simplex,
Impetigo, pediculosis, scabies and conjunctivitis.

Droplet precautions: (Green Card)

Used for patients known or suspected to be infected with micro-organism transmitted by

droplets. These infections are meningococcol meningitis, mumps, pertussis, rubella,
Haemophilias influenza type B, Diptheria, mycoplasma, pneumonia, Streptococcal
 Pharyngitis, pneumonia, scarlet fever, influenza, respiratory syncytial virus, parainfluenza
virus, plague, and herpes zoster.

Airborne precautions: (Red Card)

It is used for patients known or suspected to be infected with micro-organism transmitted by

airborne droplet nuclei, small particle residue of evaporated droplets containing micro-
organism that remain suspended in the air that can be dispersed widely by air currents within
a room or over a long distance. Patients that are isolated are Tuberculosis isolate for 3 weeks
after initiation of appropriate therapy, measles, chicken pox, sever acute respiratory syndrome
and h5n1 influenza.

Protective Precautions: (Blue Card)

These are used for patients who have severely impaired resistance to prevent contact with
potentially pathogenic micro-organisms. This used for patients who have gone for a
transplant, extensive breakdown of the skin, severe and extensive non-infected vesicular,
eczematous dermatitis, immune-suppressive therapy, certain lymphomas and leukaemia and
certain therapeutic regimens, total body irradiation, steroids and chemotherapy.

Explain terminal cleaning:

This is the disinfection programme that is implemented to prevent spread of infection through
effective cleaning of an isolation cubicle and the equipment when the patient has left.

Staff protection
Explain the importance of staff protection:

This ensures that staff dont get exposed to highly contagious diseases.

Helps staff to maintain optimal health.

Where it is possible if staff is exposed by means of vaccination they are protected from
viruses that vaccines are available.

If staff maintain health then less of them will be away from work thus company wont lose
money to a lot of sick leave being taken.

If staff members are protected it also means patients will be protected as they will not transfer
these infections to patients.

Explain the hepatitis B vaccination schedule:

Vaccine is to be given on the first day.

Then given on day 30 from the first one.

Then given on day 150 from the first one.

Immunity is only guaranteed if the above pattern of administration is followed and three
vaccines are given.

Then a booster injection should be given every five years after original course.

Explain the process to follow if exposed to blood and body fluids:

Let the injury bleed freely under running water then wash thoroughly with antibacterial soap ,
wipe with alcohol impregnated swabs, cover with water proof dressing if needed. If its in the
case of an eye splash wash face with soap and eye with saline water.

Report immediately to person in charge and infection control nurse or occupational health
nurse.

This person should obtain informed written consent from the source patient blood for testing
and decide treatment action.

Complete net care needle stick injury or exposure to blood/body fluids form.

The unit manager, person in charge, ipcn or occupational health nurse must complete the
netcare incident report and the coid form.

Incident must be reported immediately so that informed consent may be obtained from the
source patient and testing may be completed in order to allow a decision to be made regarding
prophylaxis for staff member.

The prophylaxis if indicated must be commenced within one hour of the exposure.
Explain the concept of a contact list:

It is used to contain infection by ensuring that all persons that where in contact with the
patient are treated as in given prophylaxis treatment where possible or to be isolated from
other people to prevent transmission of infections , so a list is compiled of all people who
came in contact with patient and who they came in contact with.

Respiratory hygiene
Explain the concept respiratory hygiene and motivate why it should be implemented:

This concept is used to prevent the transmission of respiratory illness and should be
implemented to prevent the transmission of respiratory illnesses and to create awareness
around this and thus to reduce the rate of infection of such diseases this includes doing the
following:
.
One should cover their nose or mouth when coughing or sneezing with a tissue or
their hand.

Dispose of the tissue used into a dustbin and wash their hands or use a hand sanitizer
and if hand was used to do the same.

See their doctor if the cough lasts for more than a week.

Encourage cough etiquette or respiratory hygiene with patients and visitors.

If people are in the waiting area encourage them to sit a meter away from other
patients or offer them a surgical mask to wear.
Safe injection practices
Explain the components of safe injection practices:

Use aseptic technique to avoid contamination of sterile injection equipment.

Do not administer medications from syringe to multiple patients.

Use fluid infusion and administration sets for one patient only and dispose appropriately after
use.

Consider a needle/cannula or syringe contaminated once it has been used to enter or to

connect to patients intravenous infusion bag or administration bag.

Use single dose vials for parental medication if its possible.

Do not administer medications from single dose vials or ampules to multiple patients or
combine leftover medication for later use.

If multi-dose vials are used both needle and syringe used must be sterile.

Multiple dose vials must not be kept in immediate patient treatment and they should be stored
in accordance to manufactures recommendations.

Should be discarded if sterility is compromised or in question.

Do not use bags or bottles of intravenous solution as common source of supply for multiple
patients.

Explain the safe use of multi dosage vial medications:

Ensure that the needle and syringe used are sterile.

Ensure before using it an appropriate alcohol solution is used to clean the top of it and in the
correct procedure is used.

It should be stored according to the manufactures recommendations.

It should be discarded if sterility is compromised or in question.

They should not be kept in immediate patient treatment.

Ensure date of opening is clearly written on the bottle to ensure that it is not used past date of
expiry.

Do not reuse needles to enter the same vial.

Ensure that u make sure that the vial is reusable.

Make sure to check with manufacture how long it can be kept for use.


Transmission based precautions

Explain the concept:

This isolates patient according to how their infection is transmitted thus it ensures that
infections dont get transmitted to other patients and reduces the rate of infection.

Name the disease which requires specific precautions:

Airborne precautions:

Tuberculosis

Measles

Chicken pox

Severe acute respiratory syndrome

H5N1 influenza

Droplet precautions:

Meningococcal meningitis

Meningococcemia

Mumps pertussis

Rubella

Haemophilias

Diphtheria

Mycoplasma pneumonia

Streptoccol pharyngitis

Influenza

Respiratory syncytial

Parainfluenza virus

Plague

Herpes zoster
Contact precautions:

Anthrax

Congenital rubella syndrome

Herpes zoster

Rabies

Major skin infections

Gas gangrene

Puerperal sepsis

Wound and skin infection not covered by a dressing.

Multi drug resistance bacteria

Clostridium difficile

Shigella

Hepatitis A, B & C

Herpes simplex

Impetigo

Pediculosis

Conjunctivitis

Protective precautions

Transplant patients

Extensive breakdown

Severe and extensive non-infected vesicular, eczematous dermatitis.

Immune-suppressive therapy.

Certain lymphomas and leukaemia

Certain therapeutic regimens.

Explain the ppe required for specific precautions:

Airborne precautions:

Wear respiratory protection when entering the room and a N95 for pulmonary tuberculosis.

An apron to cover clothing.

Wear gloves when entering the room.

Contact precautions:

Clean unsterile gloves.

Plastic Apron or gown.

Droplet precautions:

You wear gloves.

You wear a surgical mask.

You wear plastic apron or gown.

Explain the visitor patient education for patients in specific isolation:

Limit the number of patients that visit the patient.

Visitors that at high risk of getting infections should not visit the patient.

The visitors should adhere to the precautions put in place.

They should insure that they wash their hands when leaving and before they come in.

Children should not visit as they high risk to getting infections.

The staff that work with isolation patient should not work with patients that are not in
isolation
MRSA precautions
Explain the concept MRSA, VRE and ESBL:

MRSA

Multi resistant staphylococcus aureus: its a staphylococcus aureus that is resistant to multiple
antibiotics.

VRE

Vancomycin resistant Enterococcus: this is an enterococcus that is resistant vancomycin.

ESBL

Extended spectrum beta lactamase bacteria

Name conditions that require MRSA precautions:

Patient that has been transferred from another hospital.

Patient that is being re-admitted into hospital.

Patient that has been on a prolonged use of an antibiotic.

Patient that has been on different antibiotics in a short period of time.

Patient that has suffered major trauma.

Explain the Ppe required for MRSA:

Gown should be worn.

Gloves should be worn.

Hand hygiene must be monitored and improved and hand rub to be made available for use.

Contact isolation must be used.

Explain patient placement for MRSA precautions:

Patient should be isolated and contact precautions should be placed.

Patient should be placed in a private room.

If private room is not available should be placed with a patient that has mrsa.

If that is not possible consult with infection control sister to place patient.

Explain the visitor and patient education for patients in MRSA isolation:

Limit number of visitors.

Visitors that are at high risk of infection should not visit patient.

Hand hygiene should be empathised with the visitors.

Ppe should be worn when entering the room.

If visitors have small children at home should rather change clothing before picking them up.

Children should be advised not to visit the patient.

Visitors not to visit other patients.

Explain how the transmission of MRSA is prevented from admission to

discharge:

The infection control sister must be notified.

Patient to be isolated in a private room if possible.

Contact isolation technique to be followed.

Swabs must be taken from the patient from the groin, throat and nose.

Bed linen to be treated as contaminated.

Patient to bath, shower, or bed bath using chllorhexdine gluconate 4% solution and solution to
be used as a liquid soap and not a bubble bath after the swabs have been taken. Soap to be
applied to skin and left for 1 minute before rinsing.

Hair must be washed.

Night clothes and bed linen to be changed.

 These baths, clothes and linen changes to continue for 5 days or until swabs results are
negative.

Visitors to comply with isolation precautions and not to visit other patients.

Terminal cleaning to be done once patient has been discharged.

Out Break of Infection

Define an outbreak of infection:

This is when a group of people have been infected with the same infection and now is
been transmitted to other people.

Explain the measures one should put in place to prevent the outbreak of
infections in the unit:

Highly infectious patient should be isolated in the right way.

When they is a patient with an infection or is suspected of having one the infection
control sister must be notified.

Even if a patient is suspected of having an infection that is highly infectious they

should be isolated until it can be proven that they do not have it.

Proper hand hygiene should be practiced in ward.

Proper aseptic techniques should be followed in the ward.

Hand spray should be available in ward.

Contaminated linen should not be mixed with the other linen of way.

Staff looking after infectious patients should not look after other patients in the ward.

Waste management should be followed properly in ward.

Educate staff on proper infection measures.

Advice visitors that fall in high risk groups not to visit ward.

Limit number of visitors to ward.

Advise visitors not to move in between patients.

Teach visitors hand hygiene.

 Educate doctors on hand hygiene.

Educate them to clean stethoscopes between patients.

Advice doctors to see isolated patients last.

Advise visitors not to bring small children in the hospital.

Ensure everyone follows the isolation protective clothing.

Ensure that isolation cards are put up at the patients door where they are isolated.

Patient care procedures

Explain the components of each of the different BCA Bundles:

VAP

Stands for ventilator associated pneumonia.

Aim of this bundle is to prevent ventilator associated pneumonia by doing the following:

Sedation vacation this helps reduce mechanical ventilation by 2 days.

Peptic ulcer prophylaxis this will result in a reduction in upper gastrointestinal bleed.

DVT prophylaxis this will result in 50 % reduction in DVTs.

Tilting of bed up to 30 degrees -45 degrees this should result in 70% reduction in
ventilator associated pneumonia.

Mouth care 6 hourly using antiseptic mouth wash I adults and lemon sticks sterile
water or saline in neonates to minimize bacteria in mouth.

Tracheal aspirate sample taken and sent for MC&S at first suctioning after admission
to ICU to check if patient has any infection and if has to be dealt with immediately.

CLABSI:

This stands for central line associated bloodstream infections.

This trys to prevent or minimize central line associated bloodstream infections by:

Handwashing procedure must be followed.

Maximal barrier precautions must be used by doctor.

Chlorhexdine and alcohol skin prep should be done and allowed to dry before
insertion of central line.
 Central line should in adults be sited in the subclavian vein and in neonates an
umbilical line.

A daily review should be done on the need of keeping the line.

Line should be properly secured with a dressing, stitched or a special device used.

The dressing should be visibly clean and intact.

CAUTI:

It stands for catheter associated urinary tract infections.

It is used to reduce and prevent catheter associated urinary tract infections by:

When inserting a catheter a sterile catheter pack should be used.

Catheter should be properly secured to avoid pulling of the catheter.

Catheter care should be done twice a day and after every bowel action using
antiseptic soap and water, preferably chlorhexidine- based soap.

A disposable cloth/cotton wool gauze may be used.

Daily review to be done of the need to keep the catheter insitu.

SSI:

It stands for surgical site infections.

It is used to reduce and prevent surgical site infections by:

If hair is to be removed before surgical procedure to be done with clippers or

depilatory cream.

Antibiotics to be given within an hour of incision.

Blood glucose to be maintained above 4 and below 8 for major surgical procedure
post-operative.

Temperature to be maintained at above 36.5 and below 37.2 for colorectal and open
abdominal surgery.

Antibiotic stewardship:

Explain the clinical markers of infection:

 These are used to determine when a patient has an infection and they are:

Temperature above 38 degrees indicates infection.

If heart rate is above 90 beats a minute for adult can also indicate infection

If patients CRP is high.

CRP takes a while to rise so PCT develop.

PCT rises within 6 hours of bacterial infection.

If PCT is between 2- 10 start broad spectrum antibiotic or prescribe as per culture result.

If PCT is <1 its unlikely bacterial but if above 1 its likely bacterial and is used to distinguish
between bacterial and viral infection.

PCT < 0.5 Systemic infection unlikely.

PCT 0.5 2.0 infection or sepsis possible.

2.0- 10 severe bacterial infection likely.

>/= 10 Severe bacterial infection, septic shock likely.

If CRP < 8 is normal.

If CRP >25 think bacterial infection.

If CRP >8 this abnormal.

FBC-WCC > 12,000 cells/ul

Lymphocytosis

Eosinophilia indicates parasite or allergy.

And low platelets indicate acute sepsis.

Aseptic technique
Explain wound healing:

Its dived into three phases:

Inflammation phase:

When tissue injury occurs inflammatory phase is set in motion.

Trauma causes injured tissue cells to release inflammatory chemicals which causes capillaries
do dialate and become very permeable which allows neutrophils, monocytes and plasma into
the injured area.

Leaked clotting proteins construct a clot which stops the loss of blood; this holds the edges of
the wound together.

Effectively walls in or isolate the injured area thus preventing bacteria, toxins, or other
harmful substances from spreading to surrounding tissues.

Part of clot exposed to air quickly dries and hardens forming a scab.

Inflammatory events leave behind excess fluid, bits of destroyed cells and other debris which
eventually are removed via lymphatic vessels or phagocytized by macrophages.

Organization restores blood supply:

While inflammatory process is going on first phase of tissue repair called organization.

Blood clot is replaced by granulation tissue.

Granulation tissue is a delicate pink tissue composed of several elements.

Contains capillaries that grow in from nearby areas and lay down a new capillary bed.
 Proferating fibroblast in granulation tissue produce growth factors as well as new collagen
fibres to bridge the gap.

Some of these fibroblasts have contractile properties that pull the margins of wound together.

Granulation tissue destined to become scar tissue which is highly resistant to infection
because it produces bacteria-inhibiting substances.

Once enough matrix has accumulated to the injured area the fibroblast either revert to the
resting stage or apoptosis.

Regeneration and fibrosis effect permanent repair:

During organization the surface epithelium begins to regenerate growing under the scab
which soon detaches.

Fibrous tissue beneath matures and contracts.

Regenerating epithelium thickens until it finally resembles that of adjacent skin.

The scar may be invisible or visible as a thin white line depending on the severity of the
wound.
Diagnosis and control of infection
Explain the action of antibiotics on bacteria:

Cell wall Synthesis inhibitors:

They block the ability of microorganisms to synthesize their cell wall by inhibiting the 67
psynthesis of peptidoglycan.

Once the cell wall synthesises inhibited, enzymatic autolysis of the cell wall can occur.

Without the restraining influence of the cell wall the osmotic pressure inside the cell bursts
the inner and/or outer membranes of bacteria.

Interfering with protein synthesis:

A protein eynthesis inhibitor is a substance which stops or slows the growth or perforation of
cells by disrupting the processes that lead directly to the generation of new proteins by
ribosomes.

Cell membrane inhibitors:

They disrupt the integrity and structure of cell membranes thereby killing them.

They disorganize the structure or inhibit the function of bacterial membranes.

Effect on nucleic acids:

They bind to the proteins that are required for processing DNA and RNA thus blocking their
synthesis and thereby affecting the growth of cells.

Competitive inhibitors:
 They competitively inhibit the important metabolic pathways occurring inside the bacterial
cell.

Explain the concept antibiotic resistance:

It is the ability of a microorganism to withstand the effects of an antibiotic.

Antibiotic resistance develops through mutation or plasmid exchange between bacteria of the
same species.

If bacterium carries several resistance genes its called multi-resistant or informally superbug.

Explain the role of the link nurse in preventing antibiotic resistance:

The link nurse should do clinical rounds with microbiologist and doctors and/or written
comments on patients bed charts by microbiologists. They should do antibiotic rounds and
surveillance.

Link nurse should implement surveillance to determine the efficacy of current antibiotic
protocols.

They should educate patient and staff on importance of antibiotic course completion.

Educate patients and staff on importance on giving/tacking antibiotics at correct time intervals
to maintain correct therapeutic levels.

Ensure all specimens are sent fresh and are sampled and labelled correctly as this will ensure
quicker availability of results which again will ensure quicker and correct antibiotic treatment.

Document and control antibiotic usage by patients.

Monitor and document drug reactions.

Infection prevention practices and hand washing.

Support infectious disease treatment with adequate nutrition, hydration, rest & other physical
therapy.

Reduce transmission of infection.

Health care associated infections
Define health care associated infections:

An infection acquired by a patient during hospitalization.

It was not present at admission or was incubating.
Usually develops at least 48 hours after admission and my manifest after discharge.

Explain the risk for acquiring an hai:

It lengthens the patients stay in hospital.

It can contribute to patient to being readmitted to hospital.
Can contribute to patient not being able to be healed.
Can lead to death of patient.
Can lead to loss of time and money for hospital.
Can lead to disability of patient.
Patient can lose their job and also lose a lot of sick leave
Additional costs to patient and hospital due to prolonged use of antibiotics
Pain and suffering of patient.
Patient can lose faith in the nursing staff and hospital.

Explain the impact on the patient:

Patient loses their sick leave.

Patient can lose employment thus also lose earnings due to prolonged stay in hospital.
Can lead to disability of patient.
 Pain and suffering of patient.
Additional costs to patient due to prolonged stay in hospital.

Explain the impact on the hospital:

Additional days of hospitalization patient occupies bed and in some hospitals beds are
scares.
Prolonged use of antibiotics.
Additional equipment needle.
Additional tests.
Loss of faith in nursing staff and hospital.

Microbiology
Define macro and microorganism and name examples of each:

Micro

Its a parasite that multiplies directly within their host, usually inside the host.
They can complete a full cycle inside a single host and cannot be seen with the naked
eye.
Example of it is salmonella and HIV.

Macro

These are large enough to be seen by the naked eye.

They grow in the host but multiply by producing infective stages that are released
from the host thus allowing the parasite to spread to other hosts.
Examples are ticks, mites, nematodes, and flatworms.

Explain the gram stain with regard to its purpose:

Its used to differentiate between gram positive and gram negative.

By exploiting characteristic difference in their cell wall nature.
Gram positive bacteria have techoic in their walls.
Gram negative ones contain lipopolysaccharides.
Was discovered by Christian gram.

Explain the effect of endotoxins and exotoxins on the body:

Exotoxins:
 They are toxic in minute amounts.
They are Specific to a cell type.
They stimulate antitoxins.
They are not stimulated by fever.
They are secreted from live cells.
These are unbound toxin molecule secreted by a living cell into infected
tissues.

Endotoxins:

They are not secreted but are released only after the cell is damaged or lysed.
They are toxic in high amounts.
They are systematic to fever and inflammation.
They do not convert to toxoid.
They do not stimulate antitoxins.
They are stimulated by fever.
They released by cell during lysis.
And they are all gram-negative.

Define biofilm and explain its importance in infection

prevention:
Composed of populations or communities of micro-organism adhering to
environmental surface.
They are encased in an extracellular polysaccharide that they themselves synthesize.

Explain the conditions required for the growth of bacteria:

Nutrients:

Carbon is the fundamental building block of all organic compounds.

Nitrogen.

Temperature:

Range of 25-45 degrees Celsius and optimal growth temperature for human pathogens
is 37 degrees Celsius.

Oxygen needs:

Need for oxygen for metabolism

They require moisture to grow because they obtain their nutrients from aqueous
environment.

Define prions:
 An infectious agent that is composed primarily of protein.
All such agents that have been discovered propagate by transmitting a misfolded
protein state.

Conclusion

It was not easy,very challenging,needed a lot of time which I

didnt get due to a work load but it made me to gain more
knowledge regarding Infection preventative and analyzing
blood results. We needed extra time actually to be done in both
Bc1 and Bc2.