PATIENT TRANSPORTATION

 

PATIENT TRANSPORTATION 

A. Nursing will notify Receiving Departments of any patients on Special Organism Precautions.

B. Patients may walk in hail wearing a clean cover gown if they have been instructed in hand washing, are continent, and able to cooperate with procedures.

C. For patient transport, the following guidelines apply:

•   Wear gloves only if you are physically moving the patient from the bed or gurney.

•   Wear gloves and a gown only if the patient is incontinent, or has diarrhea or a draining wound.

•   You must remove the gown and gloves in the room, wash your hands,    and then. bring the patient to the receiving unit.

•   After transportation is complete, the gurney or wheelchair must be wiped with a disinfectant.

D. For staff of procedure/diagnostic areas the following guidelines apply:

1.     Hand washing:

Hand washing, for at least 10 seconds with an antimicrobial soap, is required:

a. Between patient contacts,

b. Following removal of gloves/other protective equipment in the room.

2.     Personal protective equipment

a. Wear gloves for all contact with the patient, the patient’s bedside equipment, and the patient’s environment. Change gloves between distinctive tasks (for example, wound care, perianal care, suctioning). Gloves must always be removed before leaving the room.

b. In the patient setting, wear a disposable gown for direct contact with the patient, If the patient is incontinent, or has diarrhea or a draining wound. (Cloth gowns may be substituted if there is no risk of splash).

c. As per Standard Precautions, wear a mask and protective eyewear when performing procedures that generate aerosols

3.     Provide the patient with his or her own equipment. The equipment should not be shared (unless it is disinfected properly) between patients. Examples include but are not limited to electronic thermometer, blood pressure cuff, manometer, stethoscope, IV pole, wheelchair, or gurney.

4.     Decontaminate all the equipment that may have come in contact with patient with the hospital approved detergent/disinfectant.

SPECIMEN HANDLING AND TRANSPORT

 

SPECIMEN HANDLING AND TRANSPORT

A.    Standard Precautions will be used to obtain, transport, and handle all specimens. It is not necessary to label specimens as biohazardous.

B.    Specimens of blood or other potentially infectious materials will be placed in a well sealed primary container and a secondary plastic bag (ziplock) to prevent leakage during handling, processing, storage, transport or shipping. During transport, gloves are not required because the specimen already in a secondary plastic bag.

Exception: Within the Hospital premises, blood specimens in vacutainer tubes may be transported in the phlebotomist’s tray without a secondary container, provided that the exterior of the tube is not visibly contaminated with blood. If the exterior is visibly soiled, then it will be wiped clean.

C.    Specimens in syringes should be capped off (needle removed) before transporting to the laboratory. The exception to this is a fine-needle aspirate.

D.    Specimen containers for transport or shipping outside of the Hospital premises will be packed in a box contained in a zip lock plastic bag labeled with the universal biohazard symbol.

 

Spill Management

 

Spill Management

Wear gloves and wipe the spill with gauge which is discarded in the yellow bag. Now cover the area with 1%  freshly prepared sodium hypochlorite for 15 minutes. Then mop dry. A second decontamination may be done if required. Wash the area with detergent and water. Gloves must be worn during cleanup and decontamination procedures.

TYPE OF SPILL	CLEANING RECOMMENDATIONS
SPOT CLEANING	·       Wipe up spot immediately with a damp cloth, tissue or paper towel.  An alcohol wipe may also be used. ·       Discard contaminated materials.  ·       Wash hands
SMALL SPILLS (Up to 30ml )	·       Collect cleaning materials and equipment.  ·       Wear disposable cleaning gloves and other personnel protective equipments. ·       Put the absorbent paper on spill. Put the freshly prepared 1%  sodium hypochlorite ·       Wipe up spill after 10-15 minutes with absorbent material (e.g. paper hand towel).  Place contaminated absorbent material into yellow bag for disposal.  Clean the area with water and detergent using a disposal cleaning cloth or sponge. ·       Where contact with the bare skin is likely disinfect the area by wiping with sodium hypochlorite 10000ppm (1%) available chlorine or other suitable disinfectant solution) and allow to dry. ·       Discard contaminated materials (absorbent toweling, cleaning cloths, disposable gloves and plastic apron) to yellow bag ·       Wash hands ·       Reusable eye-wear should be cleaned and disinfected before use
LARGE SPILLS (> than 30ml of fluid)	·       Collect cleaning materials and equipment.  ·       Wear disposable cleaning gloves, eye wear and plastic apron should be worn if there is a likelihood of splashing occurring.  ·       Cover area of the spill with paper towel, blotting paper, newspaper. ·       Cover area of the spill with granular chlorine releasing agent or similar product in which 10000ppm available chlorine) (1%) and leave for 3-10 minutes depending on formulation labeling and instructions. ·       Use disposable scrapper (e.g. cardboard) scraper to scope up granular disinfectant.  ·       Discard contaminated materials (absorbent toweling, cleaning cloths, disposable gloves and plastic apron) in infectious waste bag which should be incinerated. ·       Wipe area with absorbent paper toweling to remove any remaining blood.  Wash hands ·       Use clinic cleaning materials to mop area with warm water and detergent.  Where contact with the bare skin is likely disinfect the area by wiping with sodium hypochlorite 10000ppm available chlorine (or other suitable disinfectant solution) and allow to dry. ·       Clean and disinfect bucket and mop, dry and store appropriately ·       Reusable eye-wear should be cleaned and disinfected before use ·       Wash hands

 

PERSONAL PROTECTIVE EQUIPMENT (PPE)

 

PERSONAL PROTECTIVE EQUIPMENT (PPE)

A.       Gloves

Disposable (single use) gloves shall be readily available in patient care and specimen handling areas.

1.  Gloves must be worn for

•    Anticipated contact with moist body substances, mucous membranes, tissue and non-intact skin of all patients.

•    Contact with surfaces and articles visibly soiled /contaminated by body substances.

•    Performing venipuncture and other vascular access procedures (IV Starts, phlebotomy & in-line blood draws & in-line medication)

•    Handling specimens when contamination of hand is anticipated.

2.  Don gloves at bedside, immediately prior to task.

3.  Replace torn, punctured or otherwise damaged gloves as soon as patient safety permits.

4.  Remove and discard gloves after each individual task involving body substance contact, before leaving the bedside.

5.  Wash hands as soon as possible after glove removal or removal of other protective equipment. Gloves are not to be washed or decontaminated for reuse (exception: utility gloves)

6.  Caution: Gloves do not provide protection from needle sticks or other puncture wounds caused by sharp objects. Use extreme caution when handling needles, scalpels, etc.

7.  Gloves should not be worn

•    Away from the bedside or lab bench

•    At the nursing station

•    To handle charts, clean linen, clean equipment or patient care supplies

•    In hallways or elevators.

 

B.       Masks, Eye Protection and Face Shields

Wear masks in combination with eye protection devices (goggles or glasses with side shields) or chin-length face shields during procedures that are likely to generate droplets, spray or splash of body substances to prevent exposure to mucous membranes of the mouth, nose and eyes. Masks are also worn to protect personnel from the transmission of infectious droplets during close contact with the symptomatic patient.

Situations that may increase risk of splash/splatter include the following

1.  Trauma care

2.  Surgery or delivery of newborn

3.  Intubation/ suctioning /extubation (including code situations)

4.  Bronchoscopy / Endoscopy

5.  Emptying bedpans / suction canisters into hopper/toilet

6.  Code blue

7.  Patient care of coughing patient with suspected infectious etiology

C.       Aprons, Gowns, and Other Protective Body Clothing

The appropriate type of garment shall be based on the task and the degree of exposure anticipated. Gowns are worn to prevent contamination of clothing and protect the skin of personnel from blood/body fluid exposure.

1.  Wear plastic aprons or gowns during patient care procedures that are likely to soil clothing with body substances.

2.  Wear lab coats in laboratory settings.

3.  Remove protective body clothing before leaving the immediate work area.

4.  In surgical areas, additional protective attire may include surgical caps or hoods and shoe covers or boots.

Antiseptic Hand Hygiene Technique

 

Antiseptic Hand Hygiene Technique  

Step 1 - Palm to palm

Step 2 - Palm over dorsum

Step 3 - Palm to palm, fingers interlaced

Step 4 - Back to fingers to opposing palms

Step 5 - Rotate thumbs in palm

Step 6 - Rotate fingers in palm

Step 7 - Rotate Fingers around wrists

ISOLATION PRECAUTIONS

 

ISOLATION PRECAUTIONS

Standard (Body Substance Isolation) Precautions must be applied in each circumstance.

 

Infection, Condition or Organism	Duration of Precautions	Precautions
Adenoviruses (Respiratory Infection)	For 7 days after onset of symptoms	Respiratory secretions
Chickenpox & Disseminated Herpes Zoster are caused by the same virus from the Herpes family Varicella Zoster or Herpes Zoster.	Persons susceptible to Varicella should not enter the room	Airborne
Chickenpox	Until all lesions are crusted. For exposed, susceptible patients from 10 until 21 days after last day of exposure (up to 28 days if VZIG given).	Airborne
Disseminated Herpes Zoster	Duration of hospitalization	Airborne
Localized Herpes Zoster (Shingles) (Immunosuppressed Patient)	Duration hospitalization	Airborne
Localized Herpes Zoster (Shingles)		Standard
C. difficile		Hand washing sign
Diphtheria (pharyngeal)	Until after 2 cultures, taken at least 24 hrs apart, are negative (following appropriate therapy)	Respiratory secretion
Hepatitis A, B, and C		Standard
Herpes simplex		Standard
HIV, AIDS		Standard
Influenza (Type A, B, C,)	For 7 days after onset of symptoms	Respiratory secretion

 

 

Contact Isolation Category

 

Contact Isolation Category

1. Acute respiratory infections in infants and young children including croup, cold , bronchitis, bronchiolitis caused by respiratory syncytial virus, adenovirus, influenza virus including H1N1, parainfluenza viruses and rhinovirus. Conjunctivitis (gonococcal and viral), endometritis (gp.a streptococci), furunculosis and other staphylococcal infections, impetigo and herpes zoster. Also, infections with bacteria resistant to multiple antibiotics.
2. Diseases requiring contact isolation
3. Gram negative bacteria resistant to all antibiotics
4. Staphylococci resistant to methicillin/oxacillin
5. Pneumococcus resistant to penicillin
6. H. Influenzae resistant to ampicillin or chloramphenicol
7. Vancomycin resistant enterococci
8. A separate/isolation room is usually necessary .however; patients infected with the same organism may occupy the same room. During outbreaks, infants and young children with the same respiratory clinical syndrome may share the room
9. Masks are indicated for all persons coming close to the patient.
10. Gowns are indicated if soiling is likely
11. Gloves are indicated for touching infected material
12. Hands must be washed or decontaminated after touching the patient or potentially contaminated articles and before taking care of another patient

 

Tuberculosis Isolation Category

 

Tuberculosis Isolation Category

1. Patients with AFB positive sputum or chest x-ray suggesting open pulmonary tuberculosis should be cared for in the isolation ward. Patients should wear masks when being moved within the hospital .
2. Masks are indicated when the patient is coughing and does not reliably cover the mouth.
3. Gowns are indicated only if gross contamination of clothing is likely.
4. Gloves are not indicated.
5. Hands must be washed after touching the patient or potentially contaminated articles
6. Articles, must be discarded, cleaned, or sent for decontamination and reprocessing.

Respiratory Isolation Category

 

Respiratory Isolation Category

1. Infectious diseases involving respiratory tract with transmission through the airborne route come in this category. The spread of infection is usually through droplets resulting from cough or sneeze .contact with respiratory secretions either by hand or fomites is another important mode of transmission.
2. Diseases requiring respiratory category isolation and admission in the isolation ward
3. H.influenzae respiratory  disease
4. Measles
5. Meningococcal meningitis
6. Mumps
7. Rubella
8. Masks are indicated for those who come close to the patient
9. Gowns are not indicated
10. Gloves are not indicated
11. Hands must be washed after touching the patient or potentially contaminated articles and before taking care of next patient.
12. Articles contaminated with infective material must be discarded or bagged and labelled before being sent for decontamination and reprocessing.

Enteric Isolation Category

 

Enteric Isolation Category

1. Infectious diseases, predominantly of the gastrointestinal system and usually transmitted by the faeco-oral route .
2. Diarrhoeas requiring admission in the isolation section of the ward-
3. Cholera
4. Bacillary dysentery
5. Amoebic dysentery
6. Salmonella and staphylococcal enteritis
7. Hepatitis a and e
8. Poliomyelitis
9. Typhoid and paratyphoid fever
10. Other infectious diarrhoeas.
11. Enteric precautions

Strict Isolation Category

 

Strict Isolation Category

·       Diseases that are highly contagious and of a severe nature, often fatal, like diptheria plague, varicella, anthrax are included in this category.

·       The patient is placed in a single room with door closed. Gowns,  masks, and gloves are to be used. All articles in the room are to be placed in impervious plastic bags.

CDC Categories Of Isolation

 

CDC Categories Of Isolation

·       Strict Isolation

·       Respiratory Isolation

·       Enteric Precautions

·       Contact Isolation

·       T. B. Isolation

·       Drainage/Secretion Precautions

·       Blood And Body Fluid Precautions

 

A .Strict Isolation Category

·       Diseases that are highly contagious and of a severe nature, often fatal, like diptheria plague, varicella, anthrax are included in this category.

·       The patient is placed in a single room with door closed. Gowns,  masks, and gloves are to be used. All articles in the room are to be placed in impervious plastic bags.

B  Enteric Category

It Includes

1. Infectious diseases, predominantly of the gastrointestinal system and usually transmitted by the faeco-oral route .
2. Diarrhoeas requiring admission in the isolation section of the ward-
3. Cholera
4. Bacillary dysentery
5. Amoebic dysentery
6. Salmonella and staphylococcal enteritis
7. Hepatitis a and e
8. Poliomyelitis
9. Typhoid and paratyphoid fever
10. Other infectious diarrhoeas.
11. Enteric precautions

C  Respiratory Category

1. Infectious diseases involving respiratory tract with transmission through the airborne route come in this category. The spread of infection is usually through droplets resulting from cough or sneeze .contact with respiratory secretions either by hand or fomites is another important mode of transmission.
2. Diseases requiring respiratory category isolation and admission in the isolation ward
3. H.influenzae respiratory  disease
4. Measles
5. Meningococcal meningitis
6. Mumps
7. Rubella
8. Masks are indicated for those who come close to the patient
9. Gowns are not indicated
10. Gloves are not indicated
11. Hands must be washed after touching the patient or potentially contaminated articles and before taking care of next patient.
12. Articles contaminated with infective material must be discarded or bagged and labelled before being sent for decontamination and reprocessing.

 

D  Tuberculosis Isolation

1. Patients with AFB positive sputum or chest x-ray suggesting open pulmonary tuberculosis should be cared for in the isolation ward. Patients should wear masks when being moved within the hospital .
2. Masks are indicated when the patient is coughing and does not reliably cover the mouth.
3. Gowns are indicated only if gross contamination of clothing is likely.
4. Gloves are not indicated.
5. Hands must be washed after touching the patient or potentially contaminated articles
6. Articles, must be discarded, cleaned, or sent for decontamination and reprocessing.

E  Contact Isolation Category

1. Acute respiratory infections in infants and young children including croup, cold , bronchitis, bronchiolitis caused by respiratory syncytial virus, adenovirus, influenza virus including H1N1, parainfluenza viruses and rhinovirus. Conjunctivitis (gonococcal and viral), endometritis (gp.a streptococci), furunculosis and other staphylococcal infections, impetigo and herpes zoster. Also, infections with bacteria resistant to multiple antibiotics.
2. Diseases requiring contact isolation
3. Gram negative bacteria resistant to all antibiotics
4. Staphylococci resistant to methicillin/oxacillin
5. Pneumococcus resistant to penicillin
6. H. Influenzae resistant to ampicillin or chloramphenicol
7. Vancomycin resistant enterococci
8. A separate/isolation room is usually necessary .however; patients infected with the same organism may occupy the same room. During outbreaks, infants and young children with the same respiratory clinical syndrome may share the room
9. Masks are indicated for all persons coming close to the patient.
10. Gowns are indicated if soiling is likely
11. Gloves are indicated for touching infected material
12. Hands must be washed or decontaminated after touching the patient or potentially contaminated articles and before taking care of another patient