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Safety and Health Topics | Personal Protective Equipment....click the link for more...

Safety and Health Topics | Personal Protective Equipment

What is personal protective equipment?

Personal protective equipment, commonly referred to as "PPE", is equipment worn to minimize exposure to serious workplace injuries and illnesses. These injuries and illnesses may result from contact with chemical, radiological, physical, electrical, mechanical, or other workplace hazards. Personal protective equipment may include items such as gloves, safety glasses and shoes, earplugs or muffs, hard hats, respirators, or coveralls, vests and full body suits.

What can be done to ensure proper use of personal protective equipment?

All personal protective equipment should be of safe design and construction, and should be maintained in a clean and reliable fashion. It should fit well and be comfortable to wear, encouraging worker use. If the personal protective equipment does not fit properly, it can make the difference between being safely covered or dangerously exposed. When engineering, work practice, and administrative controls are not feasible or do not provide sufficient protection, employers must provide personal protective equipment to their workers and ensure its proper use. Employers are also required to train each worker required to use personal protective equipment to know:

• When it is necessary
• What kind is necessary
• How to properly put it on, adjust, wear and take it off
• The limitations of the equipment
• Proper care, maintenance, useful life, and disposal of the equipment

If PPE is to be used, a PPE program should be implemented. This program should address the hazards present; the selection, maintenance, and use of PPE; the training of employees; and monitoring of the program to ensure its ongoing effectiveness.

Personal protective equipment is addressed in OSHA standards for Construction, General Industry, Shipyard Employment,Marine Terminals, and Longshoring. OSHA requires that many categories of personal protective equipment meet or be equivalent to standards developed by the American National Standards Institute (ANSI).

How to Safely Take off PPE, Selected Equipment: PAPR and Gown

How to Safely Put on PPE, Selected Equipment: N95 and Gown

Infection Control: Hand hygiene in the OR: Using evidence-based practices...

Healthcare-associated infections (HAIs) account for an estimated 1.7 million infections and 99,000 associated deaths each year.1 The number one way to prevent these infections is hand hygiene, according to the CDC and the World Health Organization (WHO) (see A brief history of hand hygiene). The Joint Commission advocates following current CDC or WHO hand hygiene guidelines to improve hand hygiene compliance and decrease the incidence of HAIs.2-4 This article describes the current evidence-based practices for hand hygiene in the perioperative setting. Hand hygiene in the perioperative setting consists of two components: * hand washing, which decontaminates the hands and reduces transmission of HAIs. According to the Association of periOperative Registered Nurses (AORN), soap and water, antiseptic and water, or an antiseptic hand rub (if the hands aren't visibly soiled) may be used. * surgical hand scrub, which is performed before a surgical or other invasive procedure before sterile gloves are donned. This scrub can be done with water-aided brushless surgical hand antiseptics, waterless and brushless surgical hand antiseptics, or traditional surgical hand scrub using a sponge.5 As evidence-based practices are published, nurses need to become familiar with them so that they can provide optimal safe patient care. For example, the AORN board of directors revised one of its recommended practices for hand hygiene in 2009.6 The revised recommendation called for performing a surgical hand scrub before donning sterile gloves, and noted that healthcare providers could use an antimicrobial surgical scrub agent or an alcohol-based antiseptic surgical hand rub that met FDA requirements for surgical hand antisepsis.5 (Previous guidelines didn't allow the option of an FDA-approved alcohol-based antiseptic surgical hand rub.) However, a year after this recommendation was released, some facilities appear to still be following older guidelines: In the August 2010 issue of AORN Journal, an anonymous reader asked why AORN's new standards no longer called for a traditional surgical hand scrub using a brush at the beginning of the day, a practice still reflected in the facility's policy manual.7 AORN's standards note that the use of a brush for surgical hand scrub isn't necessary and that scrubbing with a brush can damage skin, creating microcrevices that encourage bacterial growth and increased bacterial load.5 The key evidence-based points for hand hygiene in the perioperative setting can be summarized as follows: Figure. No caption available. * Keep natural fingernails short (one-quarter inch or less) and avoid wearing fingernail polish or artificial nails. Chipped nail polish can contaminate the sterile environment of the OR when glove integrity is compromised; artificial nails, including gels, acrylics, and resins, have been shown to harbor microorganisms that cause surgical site infections.5 * Avoid wearing rings, and remove watches and bracelets before washing hands. * Use hand lotions that are facility provided and approved. Some hand lotions contain substances that impair the efficacy of the hand hygiene products or compromise the integrity of latex gloves. Your facility infection prevention specialist and the product evaluation committee must review the product information for all of the facility-approved hand hygiene agents, hand lotions, and gloves to be sure that all products are compatible. * Use a standardized procedure for hand washing on entering the perioperative area, before and after each patient contact, before donning personal protective equipment (PPE) or gloves and after removing PPE or gloves, after contact with blood or potentially infectious materials or surfaces, before and after eating, before and after using the restroom, and whenever hands are visibly soiled. If your surgical patient has or is suspected of having Clostridium difficile, wash your hands with soap and water-alcohol-based hand hygiene products don't eradicate C. difficile spores. * Wash hands between every surgical procedure. * Follow the manufacturer's directions for use of hand hygiene products, alcohol-based hand rubs, and surgical hand scrub. Efficacy is best when these products are used correctly. * Healthcare workers should receive education and competency assessment on surgical hand hygiene products. * When performing a traditional surgical hand scrub, use a sponge instead of a brush. * Written surgical hand hygiene policies should be readily available and reviewed annually by a multidisciplinary team that includes OR staff, infection prevention specialist, and the employee health nurse.5 By staying up-to-date on evidence-based hand hygiene practices, you can help reduce the transmission of HAIs. A brief history of hand hygiene 1847-Austrian physician Ignaz Semmelweis provides the first evidence that HAIs can be reduced if healthcare providers wash their hands with an antiseptic agent between patients. 1867-Joseph Lister advocates applying carbolic acid to surgeons' hands before procedures, and demonstrates a positive association between this practice and a decrease in surgical site infections. 1900s-The importance of hand washing and gloving gain widespread acceptance. Guidelines published in 1975 and 1985 by the CDC advocate the use of alcohol-based antiseptic products when sinks aren't available. 2002-The CDC publishes a guideline for hand hygiene in healthcare settings. The guideline is the first to recommend use of alcohol-based hand gels for hand hygiene when the healthcare provider's hands aren't visibly soiled, and is the first to recommend that healthcare providers avoid artificial fingernails and keep their fingernails short and free from nail polish. 2009-The WHO publishes guidelines on hand hygiene in healthcare, including surgical hand preparation. 2010-AORN publishes recommendations for hand hygiene in the perioperative setting. These recommendations concur with the 2002 CDC and 2009 WHO guidelines

Originating Source Borrowed From....http://www.nursingcenter.com/library/journalarticleprint.asp?Article_ID=1136019

Clostridium difficile: Trouble for adults and children....

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CLOSTRIDIUM DIFFICILE ...infections (CDIs) aren't new. Historically, CDIs were diagnosed in older adults who were taking antibiotics, had gastrointestinal surgery or manipulation, were hospitalized for long periods, had a serious underlying illness, or were immunocompromised.¹

What is new, however, is a recent study that shows the rate of hospital-acquired CDI in children almost doubled (from 7.24% to 12.80%) from 1997 through 2006.² But in contrast to trends in adults, the researchers found no increasing trend in the severity of CDI in children.³

Other studies have identified a decrease in nosocomial CDIs and an increase in community-acquired CDIs in adults. More adult patients with CDIs hadn't previously received prescribed antibiotics, suggesting that C. difficile can now be found outside of the hospital setting.^2–5

Take a closer look

C. difficile is a Gram-positive anaerobic spore-forming, toxin-producing bacillus that commonly causes antibiotic-associated diarrhea. The major reservoirs are infected patients, both symptomatic and asymptomatic, and items or surfaces contaminated with feces. C. difficile is often transferred to patients via the hands of healthcare personnel who have direct contact with infected patients or who have touched a contaminated surface or item.¹ Signs and symptoms of CDI include watery diarrhea, fever, anorexia, nausea, and abdominal pain. Untreated, CDIs may lead to pseudomembranous colitis, toxic megacolon, colonic perforation, sepsis, and, rarely, death.¹

A CDI is diagnosed through history and physical assessment, stool cultures, and polymerase chain reaction (PCR) assays. Unfortunately, stool culture results may not be available for 48 to 96 hours. PCR assays can be run with a high degree of sensitivity within 1 to 2 hours. If stool specimens won't be processed or picked up by the lab within 2 hours, they must be refrigerated because the toxins rapidly deteriorate at room temperature.¹

According to the CDC, 20% of CDIs resolve after discontinuation of the antibiotic that inadvertently created the bacterial imbalance. For the remaining 80%, antibiotic therapy is necessary. Children with moderate-to-severe illness or persistent diarrhea after the inducing antibiotics have been stopped should receive antimicrobial treatment.⁷ Oral vancomycin and metronidazole are most commonly used.⁸

Unique risk for children

The increasing trend of CDIs in young children may be the result of a new hypervirulent strain of C. difficile that is resistant to quinolones. Hospitalized children with medical conditions such as inflammatory bowel disease and immunosuppression or conditions that require antibiotics are at a higher risk for CDI.^3,6

Young children are also at an increased risk of contracting and spreading CDIs due to oral exploration of their environment, hand-to-mouth behaviors, limited experience with hand washing, and poor elimination hygiene. Diaper-changing stations may be another source of infection, especially if protective coverings aren't available and surfaces aren't sanitized after each use. Childcare centers are another reservoir for community-acquired CDIs. Toys, toileting, and changing facilities as well as caregivers' hands may all contribute to inadvertent CDI transmission.

Reduce the risk

Some steps you can take to lower the risk of spreading CDIs in your facility include the following.

* Move patients who need contact precautions into a single-patient room if possible. If not, consult with infection control personnel to assess the risks associated with having another patient in the room. Separating beds by 3 feet or more can help reduce sharing of items.⁹

* Wear a gown and gloves for all interactions that may involve contact with the patient or possible contaminated areas in the room. Put them on when entering the patient's room and discard them before leaving.⁷

* Follow hand hygiene protocol before and after patient care and after removing gloves. Alcohol rubs aren't effective with C. difficile because they're not sporicidal. Use soap and water and vigorously scrub to clean hands.⁷

* Clean and disinfect nondisposable equipment with sodium hypochlorite diluted 1:10 with water.⁷ Use equipment dedicated to the patient whenever possible.

* Make sure toys provided for pediatric patients aren't plush or porous.

* Visit www.cdc.gov/hicpac/pdf/guidelines/eic_in_HCF_03.pdf for specific health facility cleaning guidelines.

Patient education

Educate patients and caregivers on the importance of frequent and proper hand hygiene. Teach patients and caregivers that soap, water, and vigorous scrubbing for at least 15 seconds is the best method for getting rid of bacteria on hands.¹

Emphasize the importance of perineal care after toileting, incontinence, or diaper changing. Tell parents to wash toys and air dry them daily with sodium hypochlorite (household bleach) diluted 1:10 with water.⁷

Advise patients and parents of children who've been diagnosed with a CDI to take antibiotics as prescribed and to avoid antidiarrheal medications because they may prolong a CDI. Supportive care includes maintenance of hydration and nutritional status.⁷ Remind them to contact their healthcare provider if the diarrhea persists or returns.

The recent increase in CDIs in children emphasizes the need for additional education in proper hygiene for these younger patients. Taking extra steps to prevent CDIs in your facility can help avoid complications.

REFERENCES

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