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example for all people you need to do the proper hand washing and this
sticker ( refer to slide 15 ) will tell you how to do the proper hand
washing, when to wear gloves, when to wear masks and eye protection,
when to wear gowns, patient-care equipment for example it is not wise to
use one blood pressure machine for a whole Work so you can’t keep
using it for patient after patient after patient and the best thing to do is to
Medicate one blood pressure machine to each room so only that patient
will use that machine and so on.
Environmental control: you need to observe certain ways how to clean
beds, tables and so on.
Occupational health and blood borne pathogens; there are certain
guidelines how to eliminate and discard sharps such as needles, how to
dispose contaminated material and finally there are guidelines for how
and when to place people in private rooms .
So here are example of ways or we can use prevent infection so you
might to wear a sterile gown, mask, and gloves.
Gloves in general have a special way to take or remove from your hand
so let’s say you have used it with a patient and now obviously
contaminated with skin normal flora or bacteria taken from a surgical
site with infection or blood so you don’t want to contaminate your hand
with these bacteria so the way to take them out is using your right hand
to grape the edge of the other glove and take out and then from the inside
of the glove you try to grape it and then you take it out without touching
your hand.
Transmission-Based Precautions
So they are used are used for patients who are known or suspected to be
infected or colonized with highly transmissible or epidemiologically
important pathogens, for example someone with Evola or Swine flu you
obviously want to guarantee on these people and make that you don’t
transmit the diseases to other people , so these precautions are divided to
three categories :
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1. Contact Precautions
2. Droplet Precautions: basically are utilized so when we have someone
coughing (for particles > 5 µm in diameter)
3. Airborne Precautions: are for people who sneeze and create very
small particle witch diameter is less than 5 µm.
The particle that are more than 5 µm cannot spread or staminate for large
distances usually 1 meter, whereas the other particles witch smaller in
size ( less 5 meters ) can spread for large distance ;so these two types
have different ways of precautions .
Contact precautions again these are common sense so whenever
possible you have to place the patient in private room, if you don’t have
a private room for every patient you have to group patients with similar
disease in one sterile room, whenever you have to deal with patient you
obviously have to wear gloves and discard these gloves from patient to
patient, wash your hands before and after dealing with these patients.
Wear gown if necessary, limit transport patient from location to location,
and finally try to keep one medical instrument for each patient if
possible, so by doing these things we can prevent direct transmittion
from surface to surface or from body surface to body surface and you
can also prevent the indirect transmition pathogen through contaminated
object to another patient.
Almost there is a lot of bacteria and microorganism can transmitted
directly through contact and this is just a small list of such pathogens and
I don’t want you to memorize these but you can read them for your own
interest ( ya3ni btetsallo feehom b aw8at l fara3’ :P ) .
Droplet precaution :Are for particle that larger than 5 µm witch cannot
spread for large distance and usually for 1 meter and then there are not a
problem .
So a health care professionals needs to wear a mass around these patients
and if you transporting the patient outside his/her room try or you should
basically put a mass around the patient himself because if he coughs
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outside the room there is a little chance to transmit the pathogen to other
people . And again there’s some examples of such pathogens and skip
them.
And finally airborne precaution :So these are for particles which have
size less than 5 µm so if you sneeze you can generate these particles and
these can be carried in air conditioning unit, in rooms, in large hallways
for large distances, so you have to use special type of masks for these
called an N95 respirator and for the patient himself if you transporting
him outside a typical surgical mask can be enough.
And again we have some examples of some pathogens that you need to
observe these types precautions (skip the slide) and if you look to these
pathogens you will notice that some of them need contact precaution,
some airborne precaution, and some it need all of the precautions, so it’s
not exclusive; we can have contact and airborne precaution for one
bacteria and virus.
SARS is caused by a virus it’s called corona viruses and most corona
viruses caused upper tract infection and there are no other corona
viruses cause lower tract infection except for SARS and I think the
mortality rate for the SARS = 10% so it’s fatal .
Here is an example for the N95 respirator. We have something called
Airborne Infection Isolation Room or ( AIIR) , so let’s say someone has
SARS , SWINE flu and you want to protect people from being affected
with these pathogens so what you do is replace this person in a small
private room and the goal of this room is to prevent the pathogens from
going outside the room , and basically this room is equipped with vent
and this vent respect has a very tight filter attached to it , this filter
called a keeper filter or highly efficiency particular filter so this filter can
isolate all type of bacteria , so basically first station in this room you set
the air outside the room and all the air will pass through the filter so all
the air leaving the room will be sterile and basically when you draw the
air out you leave negative pressure inside the room so the negative
pressure will lead to the air in the hallway to enter the room , so basically
when we do this no air will exit the room and so you keep the people
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outside the room protected from this pathogens, and the air exit from the
room will be sterile because it pass through the filter . So we will do this
for people infected with highly infection pathogens again such as SARS,
SWINE flu and so on.
The opposite scenario happens with something called the protective
environment, so some people are severe immune-compromised and
susceptible to many pathogens even components of the normal flora,
example of that people with leukemia, transplant or immuno-suppressed
patients, patients receiving radiation treatment, leukopenic patients,
premature infants. So these people are susceptible to most bacteria and
most viruses and can be easily infected , so one way to protect them is to
place them in a private room but now you using event to put air inside
the room so all air entering the room is sterile and this will create a
positive pressure inside the room so air will exit the room and will not
enter the room from the hallway , so this patient will never experience
any pathogen from outside , all the air he/she exposed to will be sterile
air .
Handling Fomites
So when you working with healthcare professions you will generate a lot
of inanimate wastes , for examples gowns, cotton , wooden sterile ,
surgical instruments, needle, and gloves , all of these can be
contaminated with pathogens , so you have to handle these fomites with
special guidelines , so for example it’s preferable to use something that’s
disposable than it’s reusable, Disinfect or sterilize equipment soon after
use, Use individual equipment for each patient, Use disposable
thermometers or thermometer covers for each patient .
Needles and sharp materials have special guidelines for the disposal, so
if you have broken glass you have to place the broken glass in a special
container, if you have needle you have to place them in especial puncture
proof container, and usually each hospital should have guidelines how to
handle the sharps and other material.
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the patient in the hospital or killing the patient , and HAIs can be avoided
through proper education and disciplined compliance with infection
control practices.
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