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6.3.1.x.2 Policies and Procedures on Prevention and Control of Nosocomial Infection or infection Control Manual 1.

The hospital personnel must equipped with knowledge on disease and methods of transmission. 2. Hand washing by all personnel and staff for infection control. 3. All patients receiving immunosuppressive drugs must be isolated under Protective Isolation. 4. All physicians and staff nurses shall employ strict medical and surgical asepsis for all diagnostic and therapeutic procedures: wound care, tracheostomy care, tube drainage, catheter insertion, IV therapy, and ventilator equipment. 5. Avoidance of prolonged IV therapy. It must be changed every 72 hours at least. All IV fluids must be anchored securely using splint and non-allergenic adhesive tape. 6. The nurse supervisors and head nurses must monitor the sterilization procedures and cleaning practices of all departments particularly the Operating and Delivery Rooms. 7. Regular scheduling of environmental and patient cultures test. 8. Render free from contamination when inserting IV fluids and indwelling catheter. 8. Avoid housing two (2) patients with indwelling catheter in the same room. 9. Use closed urinary drainage to indwelling catheter as drainage bag are highly contaminated. 10. All patients with staphylococcal infection shall be placed under Strict Isolation precautions until antibiotic treatment has rendered culture negative for staphylococci. Likewise, the same shall be applied to cases of burns, acute gastroenteritis, pneumonia, skin and wound infection. 11. The hospital shall conduct health education program on monthly basis to disseminate prevention and control of infection. 12. Make documentation of health educations with photos, venue, time and date, and lists of attendance. 13. All personnel shall have the knowledge and skills in handling all kinds of hospital acquired disease and methods of transmission from one person to another. 14. Screen all patients having all sorts of wounds during treatment to provide privacy. 15. All hypodermic syringes and needles should only be used once and discarded after. Do not leave aspirating needle after use from the distilled water vial. 16. Use IV ports in mixing medications. Do not puncture IV bottles.

Procedures on Prevention and Control of Nosocomial Infection 1. Review all patients diagnosis and presence of contraptions, treatment, and procedures patient are undertaking. 2. Religiously practice handwashing before, during and after touching any activity to the patients. 3. Strict aseptic technique must be rendered to the following: A. IV Fluids Do not puncture plastic IV bottle for adding medicines. Prepare IV fluids aseptically and shall put back the cap in place when not ready to insert. Clean the IV site from the center to outside in circular motion until visibly clean. Y tube used for IV bolus medication are highly contaminated and shall therefore be cleansed with alcohol swab (squeeze off excess alcohol) 2x and avoid touching the needle. All medicines shall be prepared free from contamination. Constant checking of the IV sites and regulation of flow. Do not try to push IV tubing with distilled water to remove blood clots. B. Indwelling Catheter Shall be inserted under aseptic technique. Render perineal washing before insertion. Insert catheter just once and not be pushed and pulled. Indwelling catheter must be connected to closed drainage. All outside of drainage and tube are highly contaminated and must practice asepsis when getting urine specimen from the port. Do not drop catheter on the bed not until the balloon is inflated. The urinary bag must be hanged under the bed of patients. All patients coming from OR/DR when transported to designated room shall always be accompanied by the staff nurse to make sure the urine bag is not dropped in the floor or at the foot part of the bed. Perineal shall be given to all patients with indwelling catheter. C. Wound Care Assemble all materials needed in dressing wound. Handwashing for infection control. Strict aseptic technique is applied to all surgical wound. A dressing tray must be complete with all sterile items including the forcep to be used. Have an absorbable bag available for receptacle. And discard properly.

Wound with portable suction must maintain its sterility when evacuating drainage. Cleanse opening of the above with alcohol sponge to maintain cleanliness of outlet. Use sterile scissors to cut sutures. Clean surgical wound starting from the center to the periphery in circular motion. Dirty wound should likewise be cleansed from the inner to outer and soiled dressing is placed in the receptacle and discarde properly. D. Tracheostomy Care Using clean glove, clean the secretions from the inner cannula with a swab or small brush, rinse using sterile normal saline, shake excess saline from cannula, reinsert it and secure the cannula in place. Replace the tracheostomy bib if it is soiled. Make 4x4 lintless gauze pads by folding it, cutting it and placing it around the tracheostomy plate. Change tracheostomy ties if soiled. Apply clean ties before removing soiled ones. Ties should fit snugly against the skin but should permit 2 fingers to be slipped beneath them. Secure the ties at the side of the patients neck, rather than in the back to prevent pulling up accidentally. Reports on Infection Control Activities Preventive Program for Rabies I. Rabies Treatment and Prophylaxis A. Local Wound Care Vigorously washing and flushing with soap and water for 10 minutes. Apply povidone iodine or any antiseptic. For lacerated wounds, suture only after Rabies Immunoglobulin infiltration if absolutely necessary. Do not apply garlic or use tandok or tawak on the bite site. Give anti-tetanus immunization if indicated. Antimicrobial are recommended for the following conditions: a) All frankly infected wounds b) All category III cat bites c) All category III animal bites that are either deep, penetrating multiple or extensive or located on the hand, face and genital area. Recommended antimicrobials a) Amoxicillin/Clavulanic b) Cefuroxime axetil

B. Pre-Exposure Treatment Prophylaxis (PEP)

Prophylactic immunization is recommended to individuals at high risk of exposures. 1. Personnel in rabies diagnostic laboratories 2. Veterinarians and veterinary students 3. Animal handlers 4. Health care workers directly involved in care of rabies patients 5. Individuals directly involved in rabies control 6. Children 2-10 years old 7. Field workers Pre- exposure Vaccination (PEV) Schedule Active Immunization General Principle a. Vaccines should be stored at 2 degree centigrade to 8 degree centigrade ( in a refrigerator, not freezer) b. Once reconstituted, vaccine should be kept in the refrigerator and used within 8 hours c. Injections should be given on the deltoid area of each arm adults or at the anterolateral aspect of the thighs of infant d. Vaccine should never be injected in the gluteal area as absorption is unpredictable. e. The potency of vaccine should be at 2.5 iu/Im Schedule PVRV Day 0 Day 7 Day 21/28 Intradermal (I.D.) Intramuscular 0.1ml 1 vial 0.5ml 0.1ml 0.1ml PCECV Day 0 Day 7 Day 21/28 0.1ml 0.1ml 1 vial 1 vial 1.0ml 1.0ml 0.1ml 1 vial 1.0ml

1 vial 1 vial 0.5ml 0.5ml

Tetanus Wound Management Hx of tetanus immunization doses Unknown or Clean Wounds Td Minor TIG All Wounds Td Other TIG

<3 doses 3 + doses





Td - Tetanus and Diptheria Toxoids Active TIG - Tetanus Immune Globulin, Human (passive) NOTE: When Tetanus Toxoid and TIG are given concurrently, separate syringes and separate sites should be used. Tetanus Toxoid is formalin inactivated tetanus toxin. Schedule: Duration: 3 or 4 doses plus booster every 10 years Every 10 years

Pre Exposure Vaccination Benefits 1. The need for passive immunization product (RIG) is eliminated. 2. PET vaccine regimen is reduced from 5 to 2 doses. 3. Protection against rabies is possible if PET is delayed. 4. Protection against inadvertent exposure to rabies is possible. 5. The cost of PET is reduced. C. Post Exposure Treatment (PET) Guide for Post exposure Prophylaxis 1. Apply local wound treatment immediately to exposures of all types of category. 2. Assess the category of wound and apply the recommended treatment. According to WHO, post exposure treatment of rabies varies according to the subjects vaccinal status and seriousness of the bite. In category III exposure, administration of Rabies Immune Globulin (RIG) is recommended by WHO.

DOH Guidelines for Post Exposure Category I a. Feeding/touching an animal b. Licking of intact skin (w/ reliable history thorough physical exam. c. Exposure to patients w/ signs & Management - Wash exposed skin and immediately with soap and water - NO vaccine or RIG needed - Pre exposure vaccination may be needed

symptoms of rabies by sharing, eating. Or drinking utensils Category II a. Nibbling/nipping of uncovered skin with bruising - Start vaccine immediately
1. Complete vaccination regimen til day 28/30 if:
a) animal is rabid, killed, died, or unavailable for 14 days observation or examination. b) Animal under observation died within 14 days and was Immuno Flourescent Antibody Test (IFAT) positive or no IFAT testing was done or had signs of rabies. 2. Complete vaccination regimen until day 7 if: a) animal is alive and remains & remains healthy after 14 days observation period. b) animal under observation died within 14 days, was IFAT negative and without any signs of rabies

Category III
a. Single or multiple transdermal bites or scratches (to include puncture wounds, lacerations and avulsions). b. Contamination of mucous membrane with saliva (licks) c. Exposure to rabies patient through bite, contamination of mucous membrane or open skin lesions with body fluids (except blood/feces) through splattering, mouth to mouth resuscitation, licks of eyes, lips, vulva, sexual activity, exchanging kisses on the mouth of others, direct mucous membrane contact with saliva). treatment same as above

Important Reminder!!! Do not delay initiation of post exposure treatment (PET) for any reason regarding of interval between exposure and consultation as it increases the risk of rabies and it is associated with treatment failure. Assess and classify according to the 3 categories of exposure and follow its corresponding management as previously discussed. Passive Treatment Regimen Give Rabies Immune Globulins (RIG) once only at the bite site by infiltration.

If the computed amount is not anatomically feasible for single infiltration, the remaining RIG is given by deep IM at a site distant from the vaccine injection.

Rabies Immune Globulin Human Rabies Immune Globulin (HRIG) F(ab1) 2 products/ Equine Rabies Immune Globulin (ERIG)



150iu/ml in 2 ml vial 200iu/ml in 5 vial/ml

20 iu/kg 40iu/kg

Post Exposure Vaccination Regimen 1. Pregnancy and infancy is not contraindicated to treatment. 2. Babies who are born of rabid mothers should be given vaccine and RIG as early as possible at birth. 3. Patients taking Chloroquine, anti epileptic drugs and systemic steroid as well as alcoholic patients should be given standard IM regimen. 4. Immunocompromised individuals should be given vaccine using standard IM regimen plus RIG for both category II and III. 2-site Intradermal Schedule (2-2-2-0-1) old Day of Immunization Day0 Day 3 Day 7 Day 14 Day 30 Day 90 PVRV 0.1.ml 0.1 ml 0.1 ml NONE 0.1 ml 0.1 ml PCECV 0.2 ml 0.2 ml 0.2 ml NONE 0.1 ml 0.1 ml Site of Injection Left & Right deltoid Left & Right deltoid Left & Right deltoid NONE Left & Right deltoid Left & Right deltoid

Updated 2 site Intradermal Schedule (2-2-2-0-2)

8 site Intradermal Regimen Day of Immunization Day 0 Day 7 Day 31 Day 90 PCECV 0.1 ml 0.1 ml 0.1 ml 0.1 ml No. of Dose 8 4 1 1 Site of Injection Deltoid(2), anterolateral(2) vetroglutel(2), suprascapular (2) Deltoid (2), antero lateral (2) Deltoid (1) Deltoid (1)

Note: Can be used when RIG is not available. Previously Immunized Animal Bite Patient Interval from Last Dose < than 1 month 1 6 months >6months >than 3 years GIVE NO BOOSTER DOSE 1 BOOSTER 2 BOOSTER DOSES (D0 and D3) Full course of active immunization, NO RIG

Rabies Prevention and Control 1. Vaccination of all dogs. 2. Enforcement of regulations for pick-up and destructions of stray dogs. 3. Confinement of any dog that has bitten a person for 10 to 14 days. 4. Availability of laboratory facilities for observation and diagnosis. 5. Providing public education especially among children, in avoiding and reporting all

animals that appear sick.

6.3.3.b.1. Infection Control Procedure on Isolation and Universal Precautions Procedures on Isolation 1. Check the type of isolation ordered for the patient in order to plan for care. 2. Identify the type of infection or the reason for protective precautions. 3. Check the equipment needed in disinfection outside the room. 4. Wash your hands for infection control. 5. Gather any equipment needed that is not outside or inside the room. 6. Identify the patient to make sure you are performing the procedure to the correct patient. Explain to the patient what youre going to do or it may not be necessary if the patient has been in the isolation room for an extended period of time. 7. Carry out the aspects of isolation technique necessary for the type of isolation ordered when entering the room and giving patient care. 8. Give necessary care as planned. 9. Before leaving the room, carry out isolation technique required. 10. Evaluate using the following criteria: a. All necessary equipment readily available. b. All aspects of particular isolation procedure correctly carried out. c. Patient cared for safely and made comfortable. 11. Document all care given accurately. Category of Isolation 1. Strict Isolation used for the identified pathogens that is transmitted through the air and by contact. Patient must be admitted in the private room and kept the door closed at all times. Visitors must report to the nurses station before entering the room. Gowns, masks and gloves must be worn by all persons entering the room. Hands must be washed on entering and leaving room. All articles must be placed in a bag, labeled for disinfection or sterilization. All disposables shall be wrapped and discarded according to hospital policy. All linens, gowns used must be double-bag, labeled before sending in the laundry. Upon discharge room must be disinfected and undergo UV light procedure for 12 hours.

2. Respiratory Isolation It is necessary that patient is admitted at private room and keep door closed. Visitors must report to the nurses station before entering room. Gowns and gloves is not necessary. Articles contaminated with secretions must be disinfected. Caution should be discussed to persons susceptible to the disease, if contact is necessary strict wearing of masks should be advised. 3. Enteric Precautions All children must be placed in a private room. Visitors must report to the nurses station before entering room. Masks are not necessary. Gowns and gloves must be worn by all persons having direct contact with the patient. Hands must be washed before entering and after leaving the patients room. Articles contaminated with urine and feces must be discarded appropriately. 4. Wound and Skin Precautions A private room is also desirable. Visitors must report to the nurses station before entering room. Gowns and gloves are not that necessary. Articles contaminated with secretions must be disinfected. Caution all susceptible persons from entering the room, if contact is necessary advised to use mask. 5. Blood/Body Fluid Precautions A private room is desirable but not necessary. Masks are not needed since organisms are not airborne. Gowns and gloves are necessary only for direct contact with the patient or soiled linen or equipment. Meticulous handwashing is essential, and a special needle and syringe disposal box or plastic bottles should be used. Report all needle-stick injuries to ER. Wear gogglrs if contamination of eyes with secretions is likely A double-bagging technique is necessary only if soaked linen with secretions, labeled and send to the laundry. 6. Protective Isolation Private room must kept door closed. Gowns and gloves must be worn by all who enter the room.

Gloves should only be worn by persons who have direct contact with the patient. Handwashing on entering and leaving the room. All articles taken into the room should be evaluated for their potential to contaminate and harm the patient.

Procedure in Universal Precaution The following precautions apply to blood and to other fluids associated with the transmission of blood-borne pathogens. These precautions do not apply to saliva, sputum, nasal secretions, sweat, tears, feces, urine or vomitus unless they are visibly contaminated with blood. 1. Wear mask, goggles or face shields in situations like: wound irrigation where droplets of blood or other body fluids (containing blood) may spray onto the mucous membranes of the eyes, nose or mouth. 2. Wear gloves when in contact with blood or other body fluids and when handling supplies and equipment or surfaces soiled with blood or other body fluids. 3. Wear gowns in situations where it is likely that droplets of blood or body fluid will be sprayed. 4. Immediately and thoroughly or other skin surfaces that come into contact with blood or other body fluids. 5. To prevent needle-stick injuries, deposit used needles in a punctured resistant container that has a secured lid and has been placed near the area where the needles were used. Do not recap, break or bend needles after use. 6. Use mouth pieces, resuscitation bags or other ventilation equipment when providing resuscitation, this reduces the need for mouth-to-mouth contact. 7. Do not provide direct patient care when you have open or exudates skin lesions. Program for the Protection of Healthcare Workers 1. The hospital shall provide healthcare workers personal protective equipment such as: a) Gloves b) Gowns c) Bonnets d) Shoe cover e) Face shields f) CPR masks g) Goggles h) Surgical masks i) Respirators

2. If there is a reasonably anticipated exposure as blood or other infection materials, the above mentioned must be used by all workers. This would create physical barrier between the potential infectious materials and the healthcare worker. 3. The PPE requires immediate removal and disinfection or discarding it before leaving the work area where exposure to infectious material took place.

Policies on all Patient Admission/Referral, Isolation and Timely Case Reporting of Highly Transmissible and Notifiable Infectious Disease. Policies on Admission 1. All patients contracted with infectious disease shall be admitted in a private room. 2. The physician and other health workers must explain in full understanding the disease process. 3. After the patient and relatives has consented of admission, the danger of transmitting the disease is highly risk that a private room is needed for better protection of all workers and relatives. 4. The usual protocol as admission should be discussed and likewise oriented to all hospital policies and procedures and to the different department as well. 5. A sign board must be placed at the door and disinfectant solution outside the door, gowns and mask. 6. Visitors are strictly limited and must inform the nurses station for proper briefing of information of the patients illness. 7. Workers must be well organized on their activities inside and outside the room to minimize disturbance so comfort will be provided. 8. Follow the disinfection and proper disposal and sterilization of articles used. 9. Instruct family members of correct handling and disposal of articles used as well. 10. Open communication among all family members and friends must be exercised to prevent patient from emotional stress. 11. Have the patient and family members understand with ease why protective gadgets are safely used. Policies on Referrals If hospital authority thought of referring the patient for more sophisticated care and treatment the following must be carried: 1. Explain in their level of understanding the reason for referring the patient to more designed and equipped hospital in Manila. 2. The ROD must call the referring hospital for further evaluation and management. 3. The ROD shall make a referral letter to the referring hospital including all the treatment employed.

4. Offer the hospital ambulance but emphasize the corresponding fees required including the accompanying physician or nurses if so desired. They may also use a private vehicle if they wishes. Reporting of Highly Transmissible and Notifiable Infectious Diseases 1. All notifiable infectious diseases syndrome that falls on Category I like: Acute Flaccid Paralysis Advance Event Following Immunization (AEFI) Anthrax Human Avian Flu Measles Meningoccocemia Neonatal Tetanus Paralytic Shellfish Poisoning Rabies Severe Acute Respiratory Syndrome (SARS) Outbreak on: cluster of disease

2. All of the above must be simultaneously reported to PHO Cab., CHD, NEC within 24 hours of detection and send advance copy of the Case Investigation Form (CIF) as soon as possible. 3. All notifiable diseases syndrome that falls on Category II like: Acute Bloody Diarrhea Acute Encephalitis Syndrome Acute Viral Hepatitis Acute Hemorrhage Fever Syndrome Bacterial Meningitis Cholera Dengue Influenza like Viruses Leptospirosis Malaria Non-Neonatal Tetanus Pertussis Typhoid and Para Typhoid 4. All of the above must be reported every Friday of the week to the next higher level using Case Report Form (CRF). Submission should be ever Friday and should include the CRF. Hand Hygiene Procedure

Purposes: 1. To reduce the number of microorganisms on the hands. 2. To reduce the risk of transmission of microorganisms to patients. 3. To reduce the risk of cross-contamination among patients. 4. To reduce the risk of transmission of infectious organism to oneself. Procedure: 1. Make sure fingernails are cut not too short. 2. Remove all jewelries and fold long sleeves up to the elbow when required. 3. Pour around one teaspoon of liquid soap. If bar soap is used, hold the bar in your hands during the entire period. If the bar is dropped accidentally, start the procedure again. 4. Using firm rubbing and circular motion wash the palms and back of the hands and each finger, the knuckles and interdigital spaces. 5. Wash forearms and wrists. Wash up the forearms at least as high as contamination is likely to be present. Use firm rubbing and circular motion. Wash hands for 10 minutes or maybe extended to 30 seconds depending the degree of contamination. 6. Rinse the bar soap well under the running water and drop the soap into the soap dish without touching the dish. Rinse the forearms, wrists and hands well under running water. Keep the hands and forearms lower than the elbow. 7. Clean the subungual area with an orange stick carefully when hands are heavily contaminated and at least once a day before beginning to work. 8. Pat forearms, wrists and hands with a paper towel and turn faucet. Environmental Care and Healthcare Waste Management Hospital waste management is categorized according to: A. Biogradable includes: Food particles Packing materials (papers, cartons) B. Non-Biogradable includes: IV tubings IV bottles Plastic bags, cups, styro C. Infectious/Hazardous Soaked diapers Tissue wipes Phlegm wrapped in tissues Gloves, cotton D. Sharps includes: Needles, syringes Blades, Broken glasses

Ampules Staple wire E. Pathological Placental tissue Diseased organs F. Pharmaceuticals Expired drugs Contaminated articles

Procedures: 1. All containers must be coded with colors, labeled according to each category. 2. Hospital personnel must strictly follow proper disposal to prevent spread of the disease. 3. All utility workers are directed to collect waste materials 3x every shift and 6x in 24 hours. 4. All garbage containers must be lined with plastic bag and well covered. 5. Each time garbage container is emptied it should be washed with soap and water and sprayed with Lysol solution then dry. 6. All infectious and biogradable materials must be thrown to designated landfill of the hospital. 7. All disease abdominal organs removed and placed in the container with formalin and shall be given to the family member. 8. All placental is preserved in sealed plastic and in closed container and to be collected once a week by the Safety Waste Incorporated. 9. All expired drugs must be returned to drug distributors while contaminated articles shall be subjected for autoclaving. 10. All syringes, sharp needles, ampules and broken glasses should be placed in a plastic proof container and to be collected by the Safety Waste Inc. once a week. 11. All nurses must diligently disposed waste appropriately. Procedure on Recycling and Reuse of Equipment 1. The cloth mask, bonnet and gowns used in the OR, Dr, NICU should be washed separately and dry under the sun. 2. Plastic IV bottles should be cut below the neckline and cleanse with soap and water, rinse upside down to be used in measuring urine output for 24 hours use only and dispose. 3. Large vials should be soaked in water and soap to remove label, cleanse, rinse and drip dry. When dry put rubber cap and seal with autoclave tape with the date. This is used for saving the tissue specimen.

4. The mouth piece and cup of nebulizer and nasal canulla, rubbing and glass tubing should be washed with soap, rinse in water and drip dry. This may be used by indigent patient. 5. Bedpans and urinals must be washed with soap, rinse in warm water, dry and sprayed with Lysol solution as often as needed.

6.3.4.x.1. Policies and Procedures in Cleaning, Disinfecting, Drying, Packing and Sterilizing of Equipment, Instrument and Supplies 1. All hospital employees must have knowledge on medical and surgical asepsis. 2. Instruments used in the OR/DR must be cleansed thoroughly and dried ready for packaging. 3. All items purchased in a sterile packages is is designed for disposal after use. Gauze like materials when opened and contaminated may be re-wrapped for autoclaving. 4. All instrument and supplies in the OR/DR must be packed accordingly labeled and autoclave under 250 degree Farhenheit under 20 lbs pressure approximately 2 hours. 5. Do not remove sterilized item the autoclave unless cool and dry as moisture enhances movement of microorganism. 6. The cleaning of OR/DR must be from wall to wall, dry, disinfect with Lysol solution and placed in UV light for 8 hours. 7. Cleaning and disinfection of OR/DR must be done once every week during Sunday preferably. 8. Daily dusting must be done by night duty nurses using damp cloth material and disinfect with Lysol solution. 9. Minor instruments used at the ER must be cleansed by washing all debris under cold water, soak in soap and water, dry, and place in covered tray with disinfectant solution. Monthly changing of solution is required. 10. Plastic tubing like nasal canulla, nebulizer kit, and ambu bag mask must be washed with soap and water, drip dry. However, when used by infectious patient must be discarded but ambu bag must be washed and disinfected. Policies on Decontamination, Disinfection, Sterilization, Disinfectants for Specific Medical Equipment/Items and Area 1. Surgical asepsis must be applied by all staff nurses at all times when giving injections, handling sterile dressing and in the OR/DR to prevent the entrants of pathogenic microorganisms.

2. All instruments and equipments after meticulous cleaning must be packed in double lining, label with autoclave indicator with name and date. Dark line appearance on the indicator would determine sterile processed. 3. All supplies not indicated for autoclaving like rubber, plastic and glass tubing shall be soaked in disinfectant solution after thorough cleaning and drying for at least 12 hours to ensure item are disinfected. 4. Maintain autoclave temperature as high as 250 degree Farhenheit under 20 lbs pressure for approximately 2 hours. 5. All food trays and utensils used by patients must be washed thoroughly with detergent soap and rinse in warm water, dried and covered with muslin cloth. Utensils used by infected patients must be washed separately. The dietary must be informed that the latter must used the same utensils during his/her course of confinement. 6. All rooms vacated must be disinfected immediately upon patients discharge. All linens placed in the laundry hamper. However, linen used in infected patient must be placed in double-bag, labeled before sending to the laundry department. 7. Concurrent disinfection of rooms occupied by infectious patient including bathroom and articles therein using Lysol solution. 8. The laundry department after thoroughly washing and drying linen, gowns must be ironed and folded accordingly. 9. All items used in the OR/DR soaked with blood must be washed separately. Remove blood using cold water then follow usual procedure. Housekeeping Procedures in Specific Patients Areas Daily Routine Cleaning of Patients Room 1. Knock at the door before entering the room. Knock should be done very lightly, without disturbing the patient inside. 2. Show service and courtesy by greeting patients and watchers. 3. Refrain from making conversation with patients and watchers. Never discuss any problems regarding their sickness, problems about jobs etc. which will aggravate their conditions. 4. Dont clean the room if treatment is being given to the patient by the doctor or nurse. Return when treatment has been completed to clean the patients room. 5. All patient room must be cleaned daily. Any room messed by unusual reason will be cleaned first by the next shift assignment. 6. Gather and empty all traschcans clean it and return them to the room. 7. Clean patients room by sweeping the floor and wet mop with cleaning solution. 8. Arrange bedside table. 9. Clean the patients bathroom, scrub the sink and toilet with a separate mop, cloth or brush and a disinfectant solution. Rinse with water and dry. Routine Cleaning of a Discharged Room 1. Open all windows and door to air the room and tie the curtain.

2. Clean with damp cloth and the bed by raising the head and board exposing the mechanism to dust, including bedside table and drawer, table, cabinet, chairs and mattress. Pillow and mattress after disinfecting must be dried under the sun when necessary. 3. Wash filter and cover of the air condition. 4. Sweep the floor to remove any solid dirt and push the bed away from the walls and corners of the walls. 5. Mop floor with cleaning solution and allow to dry. 6. Prepare and arrange the bed properly. 7. Close all windows and fix curtain. Have UV light for 6 hours. Cleaning and Disinfecting OR/DR 1. The general cleaning is scheduled every Sunday of the week. NO DECKING shall be accepted except for emergency cases. 2. Begin with dusting using damp cloth including all fixtures and devices. Mayo trays must be washed with soap and water, dry. 3. Using a clean cloth and a pail of water with soap and bleaching agent wash all surrounding walls. The last to scrub is the floor rinse and let dry. Wipe with cloth using Lysol solution mix in water and run with UV light for 8 hours. 4. The sink in the scrub area must cleansed with scotchbrite using dutch cleanser leaving it dry and shiny. 5. The autoclave room and shelves must be cleansed and free from dust. 6. All slippers used shall be scrubbed. Slippers that get soaked with blood during the operation must be cleaned immediately after the procedure. 7. Every after each procedure regular cleaning using soap, bleach and water must be rendered..

General Cleaning of a Room 1. Prepare first all materials such as broom, mop, liquid disinfectant, soap and rag. 2. Remove the curtain first and bring down to the laundry room. Then open all windows. Start cleaning the window glass with soapy water. Then proceed to the ceiling and remove the cobweb by using the long broom. 3. Scrub walls with soapy water and rinse any stain on the wall. Wipe with dry cloth. 4. Clean the bed by raising the head and foot part. Clean also the mattress, chairs and refrigerator. 5. Empty the cabinet and shelves of bedside table then wipe them with damp cloth. 6. Sweep the floor to remove any dirt and push the bed away from the walls. 7. Start cleaning the floor with cleaning solution and rinse thoroughly and allow floor to dry. 8. Sweep again the floor for the left over solid particles and hair. 9. Return the bed, cabinet, chair, refrigerator and bedside table to their respective

places and arrange them properly. Clean the bathroom and disinfect. 10. Lock the door and be ready for admission.

6.3.5.x.1. Policies and Procedures on Reporting Infection to Personnel and Public Health Agencies Policies: 1. All notifiable infectious diseases must be reported to the public health authorities according to each category and shall keep a record of the same. 2. All infectious diseases must be disseminated among health workers of the hospital. 3. Those personnel having direct contact with the patient shall receive prophylactic treatment. 4. The wearing of mask must be maintained by all personnel and practice universal precaution as necessary. 5. All personnel with susceptibility to identified illness must be assigned for safety precautions. Procedure: 1. The hospital physician after confirming through laboratory tests that patients is having infectious disease must be reported to public health authority. 2. Inform all hospital personnel regarding disease threats to warn them and exercise precautionary measures. 3. Identify and record those personnel who had direct contact with the patient for prophylactic treatment. 4. Always protect self by wearing mask appropriately and keep distance when talking to patient and employ meticulous handwashing. 5. All personnel must subject for routine blood and Chest X-ray at least 2x a year to monitor health status . 6.4.3.x.1.

Policy and Procedures on Safe Reuse of Items Policies: 1. Vials from antibiotic drugs must be cleansed with soap and water, dry and autoclave. 2. IV plastic bottles should be cut below the neckline for use to measure urine output. 3. Clean spoiled office forms shall be used to wrap supplies for sterilization. 4. Digital thermometers must be washed and disinfected using 75% alcohol. 5. Urinals and bedpans must be washed with soap and hot water and sprayed with Lysol solution. 6. Help hospital to lessen expenditures in some material Procedures: 1. Soaked all large vials in detergent soap to clean and remove labels. 2. Clean the inside using sponge with soap and rinse thoroughly using warm water and drip dry. 3. Put cover and wrap individually with paper and arrange in a box for autoclaving. 4. Save all spoiled office forms in a box and label for wrapper use. 5. Digital must have holder of container lined with gauze or cotton. Wash with soap and disinfect with 75% alcohol. 6. Each time the room is clean urinals and bedpans must be cleansed as well and sprayed with Lysol solution.

Code of Ethics for Nurses 1. The nurses provides services with respect for human dignity and the uniqueness of the client unrestricted consideration of social or economic status, personal attributes or the nature of health problems. 2. The nurse safeguards a clients right to privacy by judiciously protecting information of a confidential nature. 3. The nurse acts to safeguard the client and the pubic when health care and safety are affected by the incompetent, unethical, or illegal practice of any person. 4. The nurse assumes responsibility and accountability for individual nursing judgments and actions. 5. The nurse maintains competence in nursing. 6. The nurse exercise informed judgment and uses individual competence and qualifications as criteria in seeking consultation, accepting responsibilities and delegating activities to others. 7. The nurse participates in activities that contribute to the on going development of the professions body of knowledge. 8. The nurse participates in the profession effort to implement and improve standards of nursing. 9. The nurse participates in the profession effort to establish and maintain conditions of employment conducive to high quality of care.

10. The nurse participates in the profession effort to protect the public from misinformation and misrepresentation and to maintain the integrity of nursing. 11. The nurse collaborates with members of the health professionals and other citizens in promoting community and national efforts to meet the health needs of the public.

Problem Solving and Decision Making 1. The patient came in because he accidentally stepped on a broken glass an hour ago causing the wound to bleed moderately. As the nurse assigned in the treatment room, what are the steps youre going to undertake and number it accordingly. a. Prepare the equipment needed. b. Wash hands for infection control. c. Put a lining to where the foot is to be cleansed. d. Removed the wrapped cloth on the affected part cautiously. e. Inspect the wound for any presence of glass fragments. If there is glass fragments cover the wound sterile gauze and wait for the doctor to see and have it remove. If there is none start cleansing the wound using hydrogen peroxide and povidone iodine solution from the center to the periphery applying aseptic technique. f. Have the doctor see the wound for assessment. g. Cover with sterile dressing. Apply light pressure then fasten with plaster. h. Do after care. i. Give the tetanus toxoid as ordered. j. ATS should be skin tested for 3o minutes by mixing 0.9 distilled water plus 0.1ml ATS. Use the volar surface of the forearm and label what time will it be due. k. Have ST read by the staff or the ROD and if negative inject IM. Do not allow the patient to leave, wait for 15 minutes for any delayed reaction. l. Give health teachings. 2. To test your ability on communications, explain your health teachings to this patient. Take the prescribed antibiotics regularly. Cleanse wound daily but wash hands first before doing so.

Stay away from crowded places, in the backyard where animal manure are present. Have balance nutrition reach in protein, vegetables and those rich in vitamin C and fruit juices. After a week come back for follow-up visits. 3. Using ADPIE document all your care A > Verbalized he accidentally stepped an hour ago on a broken glass and sustained wound on his right sole of foot. >Wound appeared clean about 1 inch length, slightly bleeding, no dizziness >No fever; BP 120/80 D> Risk for infection related to sustained wound P>After 1 week, the wound will be free from infection and will completely heal on the second week. I>Wound cleanse with hydrogen peroxide and povidone iodine solution from the center to the periphery under aseptic technique. >Applied sterile dressing with light pressure and fasten with plaster. >Tetanus toxoid I ampule injected IM at right deltoid muscle. >ATS 4,500 u given IM at left deltoid muscle after negative skin test > Health teachings well instructed E> After 1 week patient came back for follow-up visits and assessed wound free from infection and almost dry.