Nurse Aide Increased Infection Control
Module 4: Standard and Transmission-based Precautions

 

Hand sanitizer  

Welcome

Welcome to Module 4: Standard and Transmission-based Precautions. We are glad you're here!

 

What you learn in this class will help keep you, and your residents, safe. 

 

Module 4 will present you with information on standard precautions and transmission-based precautions.

 

 

 

System requirements

Before beginning this course, ensure that your computer meets the following system requirements:

 

  • To access the course, your Internet browser must be set to allow pop-ups.
  • Browser Requirements: Microsoft Edge, Google Chrome, Firefox or Safari.

 

At the end of this course, you will need to verify that you've fulfilled the course requirements and obtain a learning certificate.

 

 

Before we begin...

To navigate through the course, please continue to use the arrow keys in the upper left corner of each page or utilize the prompts on the bottom left of each page.

 

Previous Page - Go to the previous page

Next Page - Go to the next page

 

To access a specific page, click on the desired page number at the top of the screen.

 

Throughout the training, you will have the opportunity to click on highlighted words to view the definition, or to click on hyperlinks to view external sources.

Order of Modules

This course is designed to increase your infection control knowledge in long-term care environments. Information from this CBT can be directly applied to your daily activities as a nurse aide.

 

This course has five modules. You must save or print the certificate at the end of each module. Keep these certificates as proof of completion.

  • Module 1: Introduction to Pathogens
  • Module 2: Chain of Infection/Modes of Transmission
  • Module 3: PPE
  • Module 4: Standard and Transmission-based Precautions
  • Module 5: Cleaning and Disinfection

 

There is no way to create a lost certificate of completion without taking or retaking the course. If you do not keep a copy for your records, you will need to repeat this course.

 

Let's get started!

 

Lesson Objectives

Target

In this CBT, you will:

  • Identify standard precautions that should be take place with every resident interaction;
  • Identify transmission-based protocols that should take place based on the pathogen present; and
  • Identify practices to minimize transmission in shared spaces.

 

 

Standard Precautions

Standard precautions are a set of protocols that are aimed at breaking the chain of infection. These primary practices should be used during every interaction with a resident.

 

Standard precautions include:

  • Hand hygiene
  • Use of personal protective equipment (e.g., gloves, masks, eyewear)
  • Respiratory hygiene / cough etiquette
  • Waste disposal
  • Cleaning and disinfecting

 

View the document to the right to learn about the CDC's recommendations on standard precautions for all patient care

 

 


Hand Hygiene

One of the most important infection prevention measures is hand hygiene. It is important to understand the when, why and how to perform hand hygiene to get the maximum effect on mitigating disease transmission.

 

Hand hygiene should occur:

 

  • Before and after contact with a resident
  • After contact with blood, body fluids or visibly contaminated surfaces
  • After contact with objects and surfaces in the residents environment
  • After removing PPE
  • Before performing an aseptic task (ex. wound care)
  • Before and after eating
  • After smoking

 

Routine hand hygiene can be performed using soap and water or an alcohol-based hand rub (ABHR). Some facilities will place ABHR dispensers at the door of each room, while others encourage you to carry a bottle of ABHR on you at all times.

 

 Be sure to read your facility policy on hand hygiene. Follow the rules set forth by your employer.

 

Hand Hygiene: Soap and Water

While it may seem instinctual, there IS a proper way to wash your hands.

 

The following steps will ensure that your hands are properly cleansed and devoid of as many pathogens as possible that may be transmissible.

  1. Wet your hands with clean, running water and apply soap
  2. Lather your hands by rubbing them together with the soap
  3. Lather the backs of your hands, between your fingers, and under your nails
  4. Scrub your hands for at least 20 seconds
  5. Rinse your hands well under clean, running water
  6. Dry your hands using a clean towel or air dry them

 

 

Hand Hygiene: Alcohol-based Hand Rub

There are times that you will use ABHR (alcohol-based hand rub) more frequently than soap and water.

 

To use ABHR effectively, you should apply a liberal amount of ABHR and rub your hands in the same manner as if you were using soap and water until the ABHR dries. This should take around 20 seconds.

 

It is important to note that you MUST wash your hands with soap and water if your hands are visibly contaminated. ABHR will not be effective.

 

You should also be aware that ABHR DOES expire. Please be sure to check bottles of ABHR in your possession or your work area to ensure that the product is in date.

 

 

Case Study

Mrs. Tamara Van Winkle is a resident in your charge. Recently, she has had some major digestive distress, which includes vomiting and incontrollable diarrhea. In addition, she has a persistent, productive cough.

 

You know that when you enter her room you must take precautions to protect her, and yourself, by using proper PPE and following standard precautions.

 

Today, as you entered Mrs. Van Winkles room and greeted her, you placed your gloved hand on her bed rail while you chatted. You were then called away to assist with an emergency in a different area of the facility.

 

What is the proper protocol for leaving the room?

 

 

PPE

As discussed in module 3, PPE is an effective tool at preventing the transmission of different pathogens.

Personal protective equipment (PPE) refers to wearable equipment that is designed to protect you from exposure to or contact with infectious agents.

PPE is a standard first line of defense against communicable disease.

 

PPE Selection

Appropriate Use

goggles

Goggles

To be worn when there is potential for splash or spray from bodily fluids

Face sheild

Face Masks/Face Shields

To be worn when there is potential for splash or spray from body fluids

n95 mask

Respirators

To be worn when there is contact with airborne pathogens

gloves

Gloves

To be work when there is potential with blood or body fluids, mucous membranes, or non-intact skin

gown

Gowns

To be worn when there is a risk of your skin or clothing being exposed to blood or body fluids

 

 

 

 

Respiratory hygiene and cough etiquette

 

According to the CDC, the following measures to contain respiratory secretions are recommended for all individuals with signs and symptoms of a respiratory infection:

 

  • Cover your mouth and nose with a tissue when coughing or sneezing.
  • Use in the nearest waste receptacle to dispose of the tissue after use.
  • Perform hand hygiene (e.g., hand washing with non-antimicrobial soap and water, alcohol-based hand rub, or antiseptic hand wash) after having contact with respiratory secretions and contaminated objects/materials.
  • Healthcare facilities should ensure the availability of materials for adhering to Respiratory Hygiene/Cough Etiquette in waiting areas for patients and visitors.
  • Provide tissues and no-touch receptacles for used tissue disposal.
  • Provide conveniently located dispensers of alcohol-based hand rub; where sinks are available, ensure that supplies for hand washing (i.e. soap, disposable towels, etc.) are consistently available.

 

 

Waste Disposals

Medical wastes require careful disposal and containment before collection and consolidation for treatment.

Health-care facilities are instructed to dispose medical wastes regularly to avoid accumulation.

 

Medical wastes requiring storage should be kept in labeled, leak-proof, puncture-resistant containers under conditions that minimize or prevent foul odors.

The storage area should be well ventilated and be inaccessible to pests.

 

Any facility that generates regulated medical wastes should have a regulated medical waste management plan to ensure health and environmental safety as per federal, state, and local regulations.

 

Waste Disposals: Non-Sharps

OSHA created guidance on how medical-waste items should be discarded. The steps used are designed to protect workers who use and create the medical waste and those who dispose of it.

 

Non-sharp disposable items saturated with blood or body fluids (i.e., fluid can be poured or squeezed from the item or fluid is dripping from the item) should be discarded into biohazard bags that are puncture-resistant, leak-proof, and labeled with a biohazard symbol or red in color. Such items may include used PPE and disposable rags or cloths.

 

A single, leak-resistant biohazard bag is usually adequate for containment of regulated medical wastes, provided the bag is sturdy and the waste can be discarded without contaminating the bags exterior.

 

The contamination or puncturing of the bag requires placement into a second biohazard bag. All bags should be securely closed for disposal.

 

med waste

Waste Disposals: Sharps

The OSHA standard provides that regulated waste containing contaminated sharps be discarded in containers which are:

 

a) closable,

b) puncture resistant;

c) leak proof on sides and bottom; and

d) labeled or color-coded.

 

sharps

To prevent needle stick injuries, needles and other contaminated sharps should not be recapped, purposefully bent, or broken by hand.

 

The CDC has published general guidelines for handling sharps.

 

Transporting and storing regulated medical wastes within the health-care facility prior to terminal treatment is often necessary.

 

Both federal and state regulations address the safe transport and storage of on- and off-site regulated medical wastes

 

Cleaning and Disinfecting

Resident care areas, common areas, and other areas where residents may have potentially contaminated surfaces or objects that are frequently touched by staff and residents (doorknobs, sinks, toilets, other surfaces and items near residents) should be cleaned routinely with EPA registered disinfectants.

Most disinfectants are not effective in the presence of dirt and organic matter. This means that you must first remove any dirt, debris, or blood/bodily fluids before disinfection occurs.

Because cleaning and disinfection is a vital component to an effective infection control plan, we will discuss these practices in more detail in Module 5.

 

Transmission Based Precautions

Transmission-based precautions are a second-level of infection control. They are used in addition to standard precautions.

 

Typically, transmission-based precautions are utilized for residents who may be infected with communicable diseases that are spread through direct contact, droplet-transmission, or airborne-transmission.

 

 

 

 

 

 

 

 

 

 

Implementing Transmission-based Precautions

Transmission-Based Precautions for a potentially communicable disease should be initiated even before a specific pathogen has been identified.

 

YOU as front-line nursing staff have the power to initiate precautions. Should the illness turn out to be non-communicable, precautions can be adjusted or discontinued.

 

Once a need for transmission-based precautions has been identified, a sign should be placed on the residents door to alert staff who need access to the room. The type of precautions needed will vary on the type of transmission that is possible.

 

Contact Precautions

Contact precautions should be used when there is a risk of passing pathogens from one person to another through direct contact. This includes contact with infected skin or open wounds or body fluids.

 

Contact precautions should also be used when there is bedding or clothing that is contaminated with body fluids.

 

Contact precautions include:

  • Washing your hands before entering the room
  • Washing your hands after exiting the room
  • Wearing proper PPE (gloves and gown) and removing the PPE when exiting the room.
  • Limiting transport of residents outside of the room (Only moving the resident when it is medically necessary)
  • Using disposable or dedicated patient-care equipment, like blood pressure cuffs.
  • Prioritizing the cleaning and disinfection of a residents rooms on contact precautions to ensure a more frequent schedule.

 

Contact Precautions Scenario

 

Scenario: MRSA

Risk Assessment Questions

Infection Prevention Measures

MRSA

Examples include:

  • Does this person have an active infection?
  • What type of care am I providing?
  • Where am I providing care?
  • What PPE should I wear?

 

Example:

Let's pretend he has a skin infection that has been diagnosed as Methicillin Resistant Staphylococcus Aureus. You are taking him medication.

What precautions should you take?

 

 

 

 

Droplet Precautions

Droplet precautions are used to help prevent the spread of pathogens that travel short distances through respiratory droplets. You should utilize droplet precautions when a resident has a known or suspected illness that is transmitted through coughing, sneezing, and/or talking.

 

To help minimize the spread of droplet-transmission, utilize source control by having the resident wear a mask when others are in the room.

 

Droplet precautions include:

 

  • Washing your hands before entering the room
  • Washing your hands after exiting the room
  • Wearing a face covering
    • Mask
    • Goggles
  • Face shield
  • Limit transport of residents outside of the room. Only move the resident when it is medically necessary.
    • Should transport be necessary, the resident must wear a mask and follow respiratory hygiene and cough etiquette.

 

Unknown Respiratory Illness

For a resident with an undiagnosed respiratory infection, follow standard, contact, and droplet precautions (facemask, gloves, isolation gown) with eye protection when caring for a resident.

For example, SARS-CoV-2 is thought to transmitted through droplet transmission but has the potential to spread through aerosols under certain circumstances. For this reason, you would don PPE as if you were entering an airborne confirmed room.

Once the pathogen is identified, precautions can be adjusted.

For the most up to date information, check the CDC or WHO web sites.

 

Droplet Precautions Scenario

 

Scenario: Possible Influenza

Risk Assessment Questions

Infection Prevention Measures

 coughing

 

 

Examples include:

  • Does this person have a fever?
  • Does this person practice respiratory etiquette?
  • What type of care am I providing?
  • Where am I providing care?
  • What PPE should I wear?

 

 

 

Example:

Lets pretend that he has a fever and is not practicing respiratory hygiene.

He does not have a diagnosis yet, but all signs point to the flu.

You are tasked with bringing him lunch.

What precautions should you take?

 

Airborne Precautions

Airborne precautions are used to help prevent the spread of pathogens that can remain suspended (and infectious) in the air for long periods of time.

 

You should utilize airborne precautions when a resident has a known or suspected illness such as, but not limited to:

  • Tuberculosis (active cases)
  • Measles
  • Chicken pox

 

To help minimize the spread of airborne transmission, utilize source control by having the resident wear a mask when others are in the room.

 

Airborne precautions include:

 

  • The door to the residents room should remain closed.
  • Washing your hands before entering the room
  • Washing your hands after exiting the room
  • Wearing an N95 or higher-level respirator prior to entry of the room
  • Respirators should be properly fit and seal-tested prior to room entry.
  • Respirators should only be removed upon exit of the room with the door shut behind you
  • Limit transport of residents outside of the room. Only move the resident when it is medically necessary.
    • If transport or movement is necessary, instruct patients to wear a surgical mask, if possible, and observe Respiratory Hygiene/Cough Etiquette.
    • Healthcare personnel transporting patients who are on Airborne Precautions do not need to wear a mask or respirator during transport if the patient is wearing a mask and infectious skin lesions are covered, per the CDC.

 

Airborne Precautions Scenario

 

Scenario

Risk assessment Questions

Infection prevention measures

  TB

 

 

 

 

 

 

Examples include: 

  • Does this person have a fever?
  • Does this person practice respiratory etiquette?
  • What type of care am I providing?
  • What PPE should I wear?
  • Did this person travel recently? And where to?

 

 

 

 

Example:

Let's pretend that she has a fever, is not practicing respiratory hygiene, and is a recent admission to the facility.

Prior to her admission, she has just returned from an international trip and has been diagnosed with an active TB infection.

You are tasked with taking her vital signs.

What precautions should you take?

Addressing Resident Movement and Participation in the Facility

Residents with active signs and symptoms of infection from a highly communicable pathogen should minimize their contact with uninfected residents. This can be achieved by placing residents in single rooms or in cohorts of similarly infected residents. Limitations should be stopped once the acute illness has resolved and potential for transmission has decreased.

 

Signage placed at the entry point of room should convey the type of Transmission-Based Precautions employed and appropriate PPE. Signs should not identify specific indications for precautions or personal health information.

 

Room Placement

Ideally, all residents on Transmission-Based Precautions are placed in single-person rooms.

 

When limited single-person rooms are available, prioritize single-person rooms for residents known or suspected to have highly communicable pathogens (e.g. COVID-19, influenza or norovirus) or conditions that would facilitate the transmission of infectious material to others (e.g. Draining wounds, stool incontinence, or uncontained secretions).

 

You will tailor the room placement to the type of transmission-based precaution needed.

 

Please follow all instructions given by the facility for room placement of your residents.

 

Minimizing Transmission in Shared Rooms

There may be times when an ill resident may have to share a room with someone who is not infected.

 

To minimize transmission between residents:

  • Maintain separation of at least three feet between beds
  • Use the privacy curtain to limit direct contact and spread of droplets
  • Dedicate equipment
  • Increase frequency of environmental cleaning and disinfection
  • Promote staff adherence to hand hygiene and PPE use

 

Cohorting

There are times when an outbreak situation may occur and there is evidence of community spread transmission. Cohorting isolates infected residents to a separate wing or area of the facility and designates staff to work in their assigned cohort only.

 

Cohorting is generally used when the number of residents infected with a communicable disease, like COVID-19 or norovirus, is greater than the number of single-person rooms available.

 

Quarantine and Isolation

When disease outbreaks like COVID-19 occur, you may need to quarantine residents or place them in isolation to prevent the spread of highly infectious diseases.

 

Quarantine restricts the movement of residents who may have been exposed to a pathogen but is not yet showing symptoms. The duration that a resident must be quarantined will depend on the pathogen to which they have been exposed.

 

Isolation restricts the movement of residents who have tested positive for an illness and is actively showing signs and suffering from symptoms. Residents will stay in isolation until recovered from their illness.

 

Objectives Review

So far in module 4, you have:

 

  • Identified standard precautions that should be take place with every resident interaction;
  • Identified transmission-based protocols that should take place based on the pathogen present; and
  • Identified practices to minimize transmission in shared spaces.

The following slides will include a short concept check to help you demonstrate your understanding of the content provided.

 

 

 

 

   

 

 

CONGRATULATIONS!

You have successfully completed Module 4: Standard and Transmission-based Precautions

 FINAL STEPS

Please review your score.

Save or print your certificate for your records.

Remember, there is no way to create a lost certificate of completion without retaking the course. If you do not keep a copy for your records, you will need to repeat this course.

THANK YOU!

Next up:

Module 5: Cleaning and Disinfecting