Infection prevention and control - Royal Marsden Manual of Clinical ...

Recommendations

Info

118 Infection prevention and control Procedure guideline 3.12 Source isolation: leaving the isolation room Essential equipment ■ Orange waste bag ■ Hand hygiene facilities Action Rationale Procedure 1 If wearing gloves, remove and discard them in the orange waste bag. 2 Remove apron by holding the inside of the apron and breaking the ties at neck and waste. Discard it into the orange waste bag. 3 Clean hands with soap and water or alcohol handrub. Do not use alcohol handrub when patients require enteric precautions: wash with soap and water. To avoid transferring any contamination on the gloves to other areas or items ( Pratt et al. 2007 , C ). To avoid transferring any contamination on the apron to other areas or items ( Pratt et al. 2007 , C ). Hands must be cleaned after contact with the patient or their immediate environment ( WHO 2009 ); alcohol is less effective against Clostridium diffi cile spores and some enteric viruses and in the presence of organic material such as faeces ( Fraise and Bradley 2009 , E ). 4 Leave the room, shutting the door behind you. To reduce the risk of airborne spread of infection ( Kao and Yang 2006 , R1a ). 5 Clean hands with soap and water or alcohol handrub. If the patient requires enteric precautions, hands should be cleaned with soap and water. Hands must be cleaned after contact with the patient or their immediate environment ( WHO 2009 , C ). Alcohol is not effective on all organisms that cause enteric infections ( Fraise and Bradley 2009 , E ). Procedure guideline 3.13 Source isolation: transporting infected patients outside the source isolation area Action Rationale Procedure 1 Inform the department concerned about the procedure required, the patient’s diagnosis and the infection control precautions required at the earliest opportunity. 2 If possible and appropriate, arrange for the patient to have the last appointment of the day. 3 Inform the portering service of the patient’s diagnosis and the infection control precautions required; ensure that this information has been passed to any porters involved in transfer and reinforce the precautions required. To allow the department time to make appropriate arrangements. E The department concerned and any intervening areas will be less busy, so reducing the risk of contact with other vulnerable individuals, and additional cleaning required following any procedure will not disrupt subsequent appointments. E Explanation and reinforcement will minimize the risk of cross-infection through failure to comply with infection control precautions ( Fraise and Bradley 2009 , E ). 4 Escort the patient if necessary. To attend to the patient’s nursing needs and to remind others of infection control precautions if required. E
5 If the patient has an infection requiring droplet or airborne precautions that may present a risk to people encountered in the other department or in transit, they will need to wear a mask or respirator of the appropriate standard. Provide the patient with the mask and explain why it is required and how and when it is to be worn (i.e. while outside their singleoccupancy room) and assist them to don it if necessary. Protective isolation Evidence-based approaches Rationale Protective isolation is used to minimize the exposure to infectious agents of patients who are particularly at risk of infection. Although the evidence that protective isolation successfully reduces the incidence of infection is limited ( Wigglesworth 2003 ), probably because many infections are endogenous (i.e. caused by the patient’s own bacterial fl ora), it is used to reduce the risk of exogenous infection (cross-infection from other people or the environment) in groups who have greatly impaired immune systems ( Fraise and Bradley 2009 ), such as autologous and allogenic bone marrow transplant patients. Patients who have compromised immune systems often have greatly reduced numbers of a type of white blood cell called a neutrophil; this condition is known as neutropenia and those people suffering from it are described as neutropenic. Neutropenia is graded from mild to severe according to how few neutrophils are in the circulation and hence how much the risk of infection is raised. Single-occupancy rooms used for protective isolation should have neutral or positive air pressure with respect to the surrounding area. High-effi ciency particulate air (HEPA) fi ltration of the air in the room may reduce exposure to airborne pathogens, particularly fungal spores. A room with positive pressure ventilation must not be used for any patient infected or colonized with an organism that may be spread through an airborne route; in this circumstance if an immunocompromised patient has such an organism, they should be nursed in a room with neutral air pressure or with a positive pressure lobby. Principles of care Diet for the immunocompromised patient ■ Educate the patient in the importance of good food hygiene in reducing their exposure to potential pathogens; they should choose only cooked food from the hospital menu and avoid raw fruit, salads and uncooked vegeta- Protective isolation To prevent airborne cross-infection. E Providing the patient with relevant information will reduce anxiety. bles. Stress the importance of good hand hygiene before eating or drinking. Uncooked foods are often heavily colonized by micro-organisms, particularly Gram-negative bacteria ( Moody et al . 2006 ); potential pathogens on the hands may be inadvertently consumed while eating or drinking. ■ Educate the patient’s family in the importance of good food hygiene, particularly good hand hygiene, and advise that any food brought in for the patient should be in undamaged, sealed tins and packets obtained from well-known, reliable firms and within the expiry date. Correctly processed and packaged foods are more likely to be of an acceptable food hygiene standard. ■ Provide the patient with fi ltered water or sealed cartons of fruit juice (not fresh) to drink ( Vonberg et al. 2005 ). Do not supply bottled water. Tap water may occasionally be contaminated with potential pathogens; long-life fruit juice has been pasteurized to remove micro-organisms; bottled water very often contains more micro-organisms than tap water. Discharging the neutropenic patient ■ Crowded areas, for example shops, cinemas, pubs and discos, should be avoided. Although the patient’s white cell count is usually high enough for discharge, the patient remains immunocompromised for some time ( Calandra 2000 , E ). ■ Pets should not be allowed to lick the patient, and new pets should not be obtained. Pets are known carriers of infection ( Lefebvre et al . 2006 ). ■ Certain foods, for example take-away meals, soft cheese and pâté, should continue to be avoided. These foodstuffs are more likely to be contaminated with potential pathogens ( Gillespie et al . 2005 ). ■ Salads and fruit should be washed carefully, dried and, if possible, peeled, to remove as many pathogens as possible ( Moody et al . 2006 ). ■ Any signs or symptoms of infection should be reported immediately to the patient’s general practitioner or to the discharging hospital. Any infection may have serious consequences if left untreated. 119
Page 1 and 2: Infection prevention and control Ov
Page 3 and 4: Box 3.1 Terms used when discussing
Page 5 and 6: Bacteria Bacteria are probably the
Page 7 and 8: Table 3.2 Medically signifi cant ba
Page 9 and 10: the appearance of a sponge, hence t
Page 11 and 12: many of these organisms may be less
Page 13 and 14: of regular visits to clinical areas
Page 15 and 16: Assessment and recording tools Asse
Page 17 and 18: 1 2 3 4 5 6 Infection prevention an
Page 19 and 20: Procedure guideline 3.3 Putting on
Page 21 and 22: Procedure guideline 3.4 Putting on
Page 23 and 24: Procedure guideline 3.5 (Continued)
Page 25 and 26: Procedure guideline 3.7 Donning ste
Page 27 and 28: Action Figure 5a Slide the fi ngert
Page 29 and 30: Postprocedure 11 At the end of the
Page 31 and 32: Action Figure 8d Push your hand thr
Page 33 and 34: ■ Traceability system for any reu
Page 35 and 36: Source isolation Evidence-based app
Page 37 and 38: Linen Place infected linen in a red
Page 39: Postprocedure 11 Assess the patient
Page 43 and 44: Prevention and management of inocul
Page 45 and 46: Box 3.3 Actions to take in the even
Page 47 and 48: Table 3.7 (Continued) Management of
Page 49 and 50: DH/HPA ( 2008 ) Clostridium diffi c

Infection prevention and control - Royal Marsden Manual of Clinical ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?