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Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always … More Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding. You do not currently have access to this chapter. Key messages•Standard precautions are the work practices required to achieve a basic level of infection prevention and control. Infection prevention and control uses a risk management approach to minimise or prevent the transmission of infection. The two-tiered approach of standard and transmission-based precautions provides a high level of protection to patients, healthcare workers and other people in healthcare settings. For further information regarding infection prevention and control practices in the healthcare setting see the National Health and Medical Research (NHMRC) Australian guidelines for the prevention and control of infection in healthcare (2010). The use of standard precautions is also applicable to and essential for many non-health care settings, such as personal care and body art industries. For further information regarding infection prevention and control guidelines for these industries see the department's Health guidelines for personal care and body art industries. All people potentially harbour infectious microorganisms. As such, it must be assumed that all blood and body fluids/substances are potentially infectious. Standard precautions are the work practices required to achieve a basic level of infection prevention and control. The use of standard precautions aims to minimise, and where possible, eliminate the risk of transmission of infection, particularly those caused by blood borne viruses. Standard precautions apply to all patients regardless of their diagnosis or presumed infection status. Standard precautions must be used in the handling of:
Standard precautions consist of the following practices:
Standard precautions are the minimum infection prevention and control practices that must be used at all times for all patients in all situations. Hand hygieneHand hygiene is considered one of the most important infection control measures for reducing the spread of infection. Hand hygiene is a general term that refers to any action of hand cleansing, such as handwashing or handrubbing. Microorganisms are either present on hands most of the time (resident flora) or acquired during healthcare activities (transient flora). The aim of hand hygiene is to reduce the number of microorganisms on your hands, particularly transient flora which may present the greater risk for infection transmission. Handwashing: Hands should be washed with soap and water when visibly soiled and after using the toilet. Handrubbing: Handrubbing with an alcohol-based hand rub (ABHR) is the preferred method for hand cleansing in the healthcare setting when hands are not visibly soiled. ABHRs are more effective against most bacteria and many viruses than either medicated or non-medicated soaps. ABHRs are also less drying on hands than washing hands with soap and water, and consequently cause less irritation to the skin. ABHRs should be applied to dry hands. The 5 Moments for hand hygiene, or times when hand hygiene should be attended to, was developed by the World Health Organisation (WHO). The 5 moments are:
See Hand Hygiene Australia for more information on hand hygiene and for ‘How to handwash’ and ‘How to handrub’ posters. Personal protective equipment (PPE)PPE protects the healthcare worker from exposure to blood and body fluids/substances. PPE that complies with relevant Australian Standards should be readily available and accessible in all health services. Gloves
Gowns and aprons
Masks, eye protection, face shields
Environmental control
Transmission-based precautionsTransmission-based precautions (TBPs) are used in addition to standard precautions when standard precautions alone may be insufficient to prevent transmission of infection. TBPs are used for patients known or suspected to be infected or colonised with epidemiologically important or highly transmissible pathogens that can transmit or cause infection. TBPs are not required for patients with bloodborne viruses, such as HIV, hepatitis B virus or hepatitis C virus. The type of TBPs applied is based upon the mode of transmission of the pathogen. For diseases that have multiple routes of transmission, more than one TBP category is applied. The following are the routes of transmission.
TBPs should be tailored to the particular
infectious agent involved and the mode of transmission. Table 1 outlines the TBPs to be taken for infections with airborne, droplet or contact transmission. Table 1: Transmission-based precautions required according to route of transmission
For information on infection prevention and control precautions required for carbapenemase-producing Enterobacteriaceae (CPE) see the Victorian guideline on CPE for health services (2017) or Victorian guideline on CPE for long-term residential care facilities (2017). For information on infection prevention and control precautions for other multi-resistant organisms see the Patient-centred risk management strategy for multi-resistant organisms (2011). For more information regarding which other infectious agents require transmission-based precautions, see the NHMRC Australian guidelines for the prevention and control of infection in healthcare (2010). SignageSignage should be positioned prominently outside the room of a patient in TBPs. This is to ensure staff and visitors do not enter without appropriate PPE. Note: visitors may not always be required to wear PPE when visiting patients in TBPs. Please consult local health service policies and procedures. Standardised TBPs signage has been developed by the Australian Commission on Safety and Quality in Health Care and are available in portrait style or landscape style. If a health service uses their own signage, ensure that signage clearly notes the type of TBPs and PPE required. Which action would the nurse take before administering a tube feeding to an infant?Correct placement of the tube should be confirmed prior to administration of an enteral feed by checking insertion site at the abdominal wall and observing the child for abdominal pain or discomfort.
Which procedure would the nurse use to elevate the head of an infant in a spica cast?Using the bedpan
Elevate your child's head and shoulders with pillows when he/she is placed on the bedpan. This will help prevent urine from running backward and inside the cast. A gauze or cloth pad or a small folded towel placed on the back rim of a bedpan will absorb any moisture and help keep the cast dry.
Which nursing plan of care best meets the needs of a neglected 6What is most important for the nurse to include in the plan of care to best meet the needs of a neglected 6-month-old infant? Provide consistent caregivers who will provide stimulation that is moderate and purposeful.
Which response would the nurse have when the mother of a 10 month old exclaims look how much weight she's gained even though he drinks only orange juice?She exclaims, "Look how much weight he's gained even though he drinks only orange juice! He won't drink any milk!" What is best response by the nurse? "He's a little overweight."
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