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CLABSI | Infection Prevention in the Imaging Environment... There is Always More to Consider
CLABSI | Infection Prevention in the Imaging Environment... There is Always More to Consider
carecentralchapterdrapefevergluconateinfectioninfectionsmaskNonepatientprepshieldskinsteriletechnologist
Hepatitis B (HBV) | Infection Prevention in the Imaging Environment... There is Always More to Consider
Hepatitis B (HBV) | Infection Prevention in the Imaging Environment... There is Always More to Consider
bloodchapterchronicfluidsheparinhepatitisinfectedinfectionjaundiceliverneedleNonerealizesyringetransmittedvial
Hepatitis C (HCV) | Infection Prevention in the Imaging Environment... There is Always More to Consider
Hepatitis C (HCV) | Infection Prevention in the Imaging Environment... There is Always More to Consider
bloodchaptercontaminateddiseaseshepatitisinfectedinfectionjaundiceliverneedlesNonepharmacologypracticingrisksusceptibletestedvessels
HIV/AIDS | Infection Prevention in the Imaging Environment... There is Always More to Consider
HIV/AIDS | Infection Prevention in the Imaging Environment... There is Always More to Consider
aidsattackschaptercurediseasefeverhepatitisimmuneinfectionmedicationsNonepathogenssarcomasymptomstreatment
Safe Infection Practices | Infection Prevention in the Imaging Environment... There is Always More to Consider
Safe Infection Practices | Infection Prevention in the Imaging Environment... There is Always More to Consider
chapterclinicdrugendoscopyhandshepatitisinfectedinfectionsinjectionmedicationneedleNonepatientpatientsphysicianphysicianspracticespreppullpuncturesolutionsyringesyringesvialvialswash
Point of Care Testing | Infection Prevention in the Imaging Environment... There is Always More to Consider
Point of Care Testing | Infection Prevention in the Imaging Environment... There is Always More to Consider
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Mobile Handheld Devices | Infection Prevention in the Imaging Environment... There is Always More to Consider
Mobile Handheld Devices | Infection Prevention in the Imaging Environment... There is Always More to Consider
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Implementation of Protective Practices | Infection Prevention in the Imaging Environment... There is Always More to Consider
Implementation of Protective Practices | Infection Prevention in the Imaging Environment... There is Always More to Consider
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Q&A- Infection Prevention | Infection Prevention in the Imaging Environment... There is Always More to Consider
Q&A- Infection Prevention | Infection Prevention in the Imaging Environment... There is Always More to Consider
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Transcript

the reason I'm talking about infection prevention is because I got tagged as the infection control person in my organization from my unit I work in an outpatient ambulatory surgery center and they decided I was the better person to do this there's a lot to learn there's a

lot to figure out and one of the things I learned is that it's so difficult to get your co-workers to realize how important this is so this may not be the lecture you were thinking about because of some of the topics I included but I

included them for a reason and it's because there's always more to consider okay so the objectives we're going to talk about three well-known sources of infection you're going to identify some not so obvious sources implement known

infection prevention practices and really it's about focusing on prevention for you especially for our patients especially and for your families because you're not going to realize things that you can take home with you I have

nothing to disclose so why is this important there H is or HIV IHI eyes are a significant source of complications and there are studies that show that prevention and when you put these practices into place that you can reduce

the cost of health care by up to 70% think about the individual who has to spend 30 more days in the hospital because they have infection a B or C because of a procedure or because of a contact that they had when you

coordinate your activities everybody benefits and with the proper education it's really it really does help and not only do you learn but your patients learn your co-workers learn the physicians learn and that's really what

Nursing is all about so let's talk about

the well known sources of infection and we're going to talk about blood-borne pathogens and I know you've heard about this and I know that you know this in many ways but I think it's important so

I need a show of hands of how many of you are like me in practice in the 60s and the 70s in nursing oh not to many of you so I have a very small group of individuals who remember the day when you didn't wear gloves the

bloodier you were when you went home the more awesome the day you had wash your hands probably when you use the 50th Estate facilities and you're gonna have lunch you probably washed your hands but

nothing like we do today so but it's a serious problem was a serious problem then and it became a serious problem in the mid-1980s when we looked at and when we found out about HIV and when AIDS and HIV came into play everything changed

including the fact that you were nervous from the minute you walked in till the minute you went home and I happened to work in the emergency department back in those early days we have actually been able to and we go back one second here

one of the things that we found is that you now have all these needleless systems that we have a needle box before I don't think so I don't remember so I'm going to say no we didn't have one we have all these devices everything with

your IVs now everything retracts your needles retract everything is is is put away as soon as you're finished with it because they you don't get stuck so there's not an issue and it's really important to keep everybody on that same

page there's something called the needle stick safety and Prevention Act of 2000 and it's put into play all those sharps containers all the safety caps again putting everything in place that we need it and as I said I worked in an

emergency department and so we had all kinds of things all over the place so what do we have in place today their exposure packets the minute you get stuck the minute you're exposed there's this packet you have to fill out whether

it's paper whether it's electronic you're filling all this information out you're getting tested the advent of the personal protective equipment like I said you're putting gallons on you're putting booties on sometimes hats and

masks gloves galore and so whoever was making the gloves if you bought stocking gloves back in the mid 80s it was a gold mine we now have hepatitis B vaccines and we've all probably had those there

vaccinating children now I had mine when I was probably in my late 20s early 30s because it was the time of of when all these things were coming about we now knew Hep C testing and we're going to talk a little bit about Hep C in a

couple minutes and they taught us to make sure that the employees were involved in choosing some of the items that we use for protective equipment there was a committee it was made up of staff nurses staff lab people so it was

it was really a conglomeration of individuals so will okay talk about all that okay so let's look at some of the

specifics CLABSI we all know about CLABSI we all know with central line infections we all know that it it

results from not the most sterile technique sometimes sometimes it's just a dressing that is soaking wet that nobody's bothered to change and clean up but there's billions of dollars that go into preventing these infection or go

into the cost of treating these infections and so that's why we've put in all the CLABSI bundles and all of the pieces around that it's a strict protocol for inserting central lines and it's been this way for many many many

years and I can remember when we first went to that large patient drape where the whole patient was covered oh you looked at people who said to you well we always just put a smaller drape and it was okay we should we should just stick

with that because like what does anybody else know that's not what you do with a patient you need to take care of the patient because taking care of the patient also takes care of you we had stringent infection control

practices we had a practice what they said the way they said it and I don't know about in your organization but in mine we ended up with this paper we had to actually check off each step and observe the physician or the RPA who was

inserting the device to make sure that they did every step that they were supposed to do and if all else failed we had looked for signs and symptoms of these infections and so it was fever red and skin it was soreness and when you

think about it the fever can be almost anything but they've had that central line put in it's probably a good place to store between 2008 and 2013 there was a 46 percent decrease in infections across

the United States when it came to CLABSI and I believe it was probably summers around 2012 I didn't go back and check all this but maybe 2014 we actually did a symposium at the a Rin convention where we pulled in a team of experts we

had individuals from Cook medical we had our our experts we had a technologist and we talked about collapse II and what it meant but however there's still over 30 000 infections that occur yearly in acute care facilities and that's 30 000

too many recommended practices everything begins with hand hygiene if you think about it all goes back to washing your hands and so when your mother said to you go wash your hands for dinner maybe you kind of wet them

and wet them on your clothes but you sort of did what she asks but this is actually using soap along with the water using an appropriate skin antiseptic and we're talking about 70% alcohol the chlorhexidine gluconate or sometimes you

know for those patients that have an allergy you can look at the tincture of iodine the important thing about the prep and while you may not be the individual who's prepping this patients skin that prep has to fully dry and they

actually make us document right now where I work that the prep was performed by X person and that it was allowed to completely dry because if you touch it before it's wet your going to negate the fact that you've just cleansed that area

and everybody has to wear the same maximum barrier protection so you're putting if you're at the table side you have a on a cap on your head booties on your feet you have a sterile if sterile gloves obviously and a mask and many

times you're seeing people at the table side wearing the mask that has the shield on it because you want to prevent anything from splashing to your eyes where they use the glasses or you use the shield mask it doesn't make a

difference as long as you're protecting yourself and I would encourage you as the nurse who not scrubbed but it's up at the head of that bed talking to the patient checking them looking and make sure leads are on

whatever you have to do to troubleshoot you probably need to wear that same mask is it annoying probably is it annoying when you wear glasses absolutely but you need to protect your eyes you need to protect you because if you get infected

there goes your ability to work sometimes and where does that leave you then financially and then obviously when we finish putting in this central lines of ice we're gonna put a sterile dressing on it now we're gonna make sure

we tell the patient this needs to stay in tact and you hope for the best so

we're going to a quick review on hepatitis B which actually if my fingers were typing correctly when I fix this it should be H B V so if you flip the two

letters that Microsoft makes it better hepatitis is a viral infection attacks the liver we know that and it's potentially life-threatening people can die from hepatitis B because of the complications of cirrhosis or

hepatocellular CA so it's not a mundane type of illness it's transmitted by blood and body fluid there are 275 million individuals that are living with hepatitis B that's a lot of people that's a lot of opportunity to

become infected because I am sure as I'm standing here that we're all coming in contact with somebody that has hepatitis B on a daily basis there been over 800 000 deaths because of hepatitis B in 2015 and the vaccines been available

since 1982 and I think I probably have mine from like 1986 it was kind of the weirdest thing you know when you get to be like the guinea pigs because we were the ER and so we had them first so how's it spread hepatitis B is spread from

mother to child during childbirth it's a chronic infection it becomes a chronic infection than in infants exposure to infected blood think about the time that you have a blood splatter you may not even realize that that blood

has landed on your on your arm or on your face all that you probably realize it's on your face if it's a percutaneous procedure and something splashes if it's an abscess and for some reason you have a little bit of splatter if you're too

close and you don't have the proper shield on your face you can certainly become infected it's also important to realize that reuse of needles and syringes and we're going to talk about that a little bit too in a few minutes

you never want to reuse a needle and never once you re to reuse a syringe and I have to say I had a conversation last night with some colleagues while we were at the reception and she was talking about a question that came up off wall

how many times can I use this one in done safety syringe now if I said to you it's a one in done how many times do you think you could use it one exactly one Debbie's got it but at the same time why would you want to use the same syringe

and/or needle on more than one person syringe is not that expensive and truthfully if it was that expensive it is up to us in this room as nurses to take care of our patients and to protect them to the best of our ability and

certainly this is one that is very easy to do the other ways that you can contract hepatitis B if you have tattoos that you've received it a maybe not so clean environment or your friend decided hey I can tattoo that on your arm it

won't cost you anything well could cost you your life I guess you know depending if you share razors it can it transmits through body fluids saliva vaginal and seminal fluids so we really think about this dental procedure so there's all

kinds of ways that this can this can be transmitted signs and symptoms really don't necessarily occur in the very beginning it may take several weeks to several months before you realize and then trying to backtrack is even more

challenging I can tell you back in the day when I worked in that emergency department we're supposed to one of the best jobs I've ever had we had a code and as I said this is before the event of gowns

and gloves and so there I was the gentleman was a gunshot and of course we were weary resuscitating him it was blood all over the place but all over my hands and they decided because that wasn't back in the day when they did

blood gasses on everybody and the heparin was not in the syringe you had a little vial of heparin you broke the vial because of course it was glass and you pulled us at the heparin op heparinized a syringe and and shot the

heparin out well as I did that apparently I cut my finger unbeknownst to me because there's so much blood on my hands had and I know at the end of the code and I washed my hands I found the cut and so now we're debating this

man is deceased so it can't ask him so we got permission to draw his blood or all my blood he did come back with hepatitis B and I was very unfortunate that I was negative and I stayed negative but you just never know so

things that you think are innocent things you're doing because the patient comes first sometimes we do have to come first so the illness can last several weeks and the symptoms are going to see they

become jaundice their skin and eyes they have dark urine they have light stools their fatigue the nausea vomiting and if you take the jaundice out of that equation it sounds like the flu you know you might have some some body aches if

you know you a little little sick to your stomach and would you really think hepatitis first because I would not but you need to start thinking about what you're starting to see some people have acute liver failure which can lead to

death talk a little bit about hepatitis

C hepatitis C is an interesting character it is a viral infection also that causes liver inflammation which can lead to very severe liver damage and it spreads through contaminated blood so

hepatitis spreads the same way regardless of which letter of the alphabet it is and over 50% don't even realize that they're infected so I have another poll question how many of you are baby boomers in this room

you don't have to put your hand up if you don't want to have you been tested for hepatitis C because the recommendation is that you are tested at least once because you could have hepatitis C because we're in that age

population and I'm in that age population where hepatitis C is something that you could have contracted and the reasons for that is it can spread through contaminated blood which you may or may not have been around

especially if you've been practicing as long as I have you can also have if you received a blood transfusion because prior to 1992 they didn't screen for a lot of these things if you had an organ transplant early on in your life they

didn't screen they didn't have the mechanisms they didn't know about these diseases so they're finding a lot in baby boomers so I know there's a recommendation and I forget exactly who puts it out there if it's the CDC or who

it is but I remember I've had my primary physician say to me you need to have this done we also are tested every year where I work because I work with dialysis patients and there's there always the risk of all the blood that's

going back and forth that there's a potential that we have is so we could test it yearly from my organization and I said it can't be a one-time screening and we talked a lot about this the baby boomers are more susceptible though not

exactly why but if you look at some of of the things that have occurred in our lifetime I should say the blood borne infections increase between 1960 and 1980s and so if you were brown in the 1960s you remember there was a not that

there is it nail but it was I was a high that was a big thing then you know there was a lot of IV drug abuse there still is a lot of IV drug abuse but back in the day when you didn't realize that hepatitis C was or could be an issue

very easy to get caught up in some of that you didn't have infection control practices you didn't have protective equipment I talked about the gloves so we never you didn't we use gloves for anything you could have easily been

infected and no net share needles contaminating needles and I said the virus wasn't eliminated until 1992 from blood products if your labs are negative they come up negative if it's positive you

have a hepatitis C antibody and not necessarily and you have been infected now there is a treatment for hepatitis C there are a number of drugs you see them on every commercial for every television show that you watch and this wasn't

about pharmacology for anything but it was to highlight the fact that these are illnesses these are diseases that we can be susceptible are exposed to them we do a lot of blood work we do a lot of things with people and blood in IR and

so we really need to make sure that we're taking care of ourselves so the risk factors that we talked about on about this HIV is is a risk factor piercings and tattoos blood transfusions before 92 if your mother had hepatitis C

very likely was passed on to you so hence and I'm not sure now if they are testing so probably not they're probably not testing children I don't think I've seen that anywhere but clearly in that age range we need to be

tested the finds and symptoms take about a month or so a month or three months to appear they're the same as everything else you kind of feel lousy you feel fatigued you have a little bit of a fever no appetite and then the jaundice

comes the the change in your urine and in your bowel movements if it's skin because the jaundice does make your skin very itchy you develop a slight ease like swelling and that's spider like blood vessels that I've never had

hepatitis C but I have a little spider blood vessels so I think I need to get rid of that and you can see the picture up there you see a normal liver and then you see the liver that has hepatitis C

those talk a little bit about HIV and

AIDS the history of this is it's it's an illness that came from chimpanzees in Central Africa and it was the simian immunodeficiency virus so SIV is when it was called and this was too covered in the late 1880s took a long

time to come to the United States at least that we ever saw signs and symptoms of and it was the late 70s and I know that I've seen it probably the late 70s for sure and definitely in the eighties it spreads through through

certain body types and what's on the top so you think there are blood these are all blood-borne pathogens it attacks and destroys your immune system so with the T cells that are fighting infection and this is the disease that then attacks

your T cells so that you're not able to fight off infections and so you see these people that down the road are going to come up with the sarcoma the Kaposi's sarcoma they have they have a lot of lung disease that comes up with

this and they body's not able to fight off infection this is where the we're dying comes into this it's an opportunity it's an opportunistic infection so again it takes that weakened immune infection and it really

affects every part of your body there's no cure but it can be controlled I can remember when we had these patients coming in and if they said to us that they had a fever we had it we had a room in my emergency department that we would

put them in and you were afraid to go in there was like walking in there you were going to be it's weird because you don't know enough about it there's nothing lit there's no literature out there yet there's not a lot of things coming down

from CDC so you're really winging it you know you don't have a lot of things we had gloves but you didn't have a lot of the gowns that you that would be nice and so all that started to come as we started to see this excuse me there's

really not that many symptoms you can see them wasting away so you can see they have you know that there's something obviously going on and HIV is actually the third stage of of AIDS as you go down the continuum without the

treatment people can look in layers for decades probably not the best of health with treatment they can lay us longer but they can always transmit the disease it's not something that is ever contained

I think we talked a lot about this finding symptoms when you get into the stage three we're looking at chills fever talked about the CD of the t-cell count the treatment for for age we're looking at the antiretroviral therapy

which is the author it's not a cure but it helps they contain the symptoms it helps that individual live a longer more healthy life and I know we see a lot of these patients that have hepatitis B hepatitis C few that have AIDS and if

you look at them they look pretty healthy so if you didn't know their history you know you might think that they have it but really what happens is until you ask them and some people like we ask they look at you kind of funny

but then eventually if they have the illness that they will definitely tell you yes these are the categories of medications and I hope this came out where you can you can read this so there's a lot of different regiments of

medications that you can choose for hep for for HIV and AIDS and this is the listing of them so let's talk a little

bit about those not so obvious sources that you're going to say well they really are obvious to me but I would

challenge you with are they really so the goal is to look at things that we do every day how we do them what we don't do what we do do what we should do and recognize that we are all setting each other up including our patients for

infections and I don't mean that in a nasty way I don't mean that in a malicious way because they're thinks that we should do that we just forget a small percentage of the time so we'll talk about safe injection practices

since 2001 there been over 150 000 patients impacted by not looking at safe injection practices and I'll give you a few examples in a few minutes between 2001 and 2011 there have been at least 18 outbreaks of viral hepatitis and so

what about those that never showed a sign or symptom they probably were never tested they probably were never looked at so that number may actually be low it's leads to infection transmission we need to notify everybody of what of what

happened because you notice all those incident reports and corporate reports and what's that's the thing you do and almost like a risk assessment I guess of why it happened but the names escaping me and you can have a malpractice suit

if you've infected somebody based on something you did and they can trace it back you know why wouldn't the family sue so it's important to break down what it is that we are doing with infection prevention we talked a little bit about

syringe reuse between patients for inferential medication and administration I cannot for the life of me figure out why you would do this and I guess some people look at it well you know it's money crunching time it's

budget times so let's you know not use three syringes for three different doses of something we have to give either the same patient or somebody else it's easy to contaminate medication vials you need to follow a basic basic common sense I

guess is what it is you know when you open up a vial do you take the alcohol prep and actually rub over the rubber stopper and let it dry before you actually puncture it this is part of what the safe break injection practices

are and are we looking at how we maintain or glucometers and our bedside testing devices and we'll talk a little bit about that so a couple things that we do know we know that in 2001 in a New York endoscopy clinic and

anesthesiologists infected 19 patients with hepatitis C because he was improperly or he or she was improperly reusing syringes and contaminated the multi-dose vial now the other piece a piece about multi-dose vials is you can

only use a multi-dose vial as a multi-dose vial on a number of patients if you prepare it in a medication preparation area which is not to say you can do that in your eye our procedural suite because that's not a yes you do

pull up meds there but it's not a a clean environment for multi-dose vial continue to access it so we need to so we need to keep an eye on that so there were 19 patients who were infected in 2002 in Nebraska there were 100 hema

patients that were infected with hepatitis C the patients with with episode as he had their blood drawn they used the same syringe and needle to obtain sailing from a flush solution so what they did was they would they would

prepare this in the morning they had two bags of IVA of IV fluids they would take their heparin solution and they would pull it up althought multi-dose vial and they would inject it into the bag the bag a then

they took Bagby pulled it up again same syringe and went into bags B so now they have an A and a B it was their morning bags every afternoon bag and they used this for multiple patients and what happened is

they reused another syringe that had been attached to a patient's IV who happened to be infected with hepatitis C so when they went back into the bag to pull more and more of the solution out they infected the bag so every other

solution pulled that they did from that bag infected a patient now some patients had full-blown infections and some did not but at the same time not good practice in 2008 in Nevada in an endoscopy clinic there they reused

syringes and they were sharing needles for single-use medications again it's a single-use file it's one and done and it's everything that's contained with it it's the it's the alcohol prep it's the bottle of solution

it's the syringe in the needle there were 63 thousand patients potentially infected now think about that 63 000 potentially infected and there were of the hundred of the twelve thousand that they did test only 115 actually tested

positive but that's still 115 patients lives of people's lives individuals life somebody's family's life that were effective in Arizona they had an outpatient pain management clinic where they had immersed the outbreak actually

both of these are mersa outbreak and so when they're looking at diluting contrast media for these individuals and again they're reusing syringes and they end up contaminating the vial so each time that they they they pulled the drug

each time they injected a patient here's I have the patient with with MRSA so again and there's and the other one is 2012 in Delaware and now patient orthopedic equipment patients that they affect that the Mercer was contracted by

seven patients who were hospitalized an average of six days and they did this because of a drug shortage now I get it we've all had drug shortages and there are things that you would never think would be short you know I would never

think he wouldn't have lidocaine you would never think he wouldn't have her said and fentanyl he would never think you didn't have pepperin I mean because we've always had it well we don't and we're all and we're all experienced in

this but we still need to be sure that we are taking care of the patient so we know about these about all of this is that these are these are potential infections but they're real infections and it's our job to make sure that we

prevent them and we can do this that everybody in this room every nurse who lives and breathes and walks and sees a patient can protect their patients and so we never have this again as one of the physicians said and I forget if it

was this morning or yesterday cuz I've sat through too many lectures right now our first job is to do no harm it might not be a Florence Nightingale pledge that we take but at the same time we are not to harm a patient and we need to

realize what's at stake not just for the patient but for us too the ramifications when you think about it to your organizational licensure may be at stake if this continues to happen you know Department of Health comes in OSHA comes

in CDC comes in there's a lot that happens when you are having a lot of infections that all of a sudden pop up and there's a lot of investigation that happens so what I'm asking you to do is to commit to appropriate practices read

the labels single dose vials you puncture them you throw them out multi-dose vials you have to if you I'm a multi-dose vial and you're prepping it in a patient prep in a medication prep area look at the

expiration date on it make sure it's valid and make sure that the beyond use date is valid because you have to mark those files 28 days out well sometimes these things might sit there and you don't realize it you pull it out and you

just think oh I don't know it's all good it's here why would you think but if you don't think that's the time that you're going to have the issue if you don't know if it's if there's no label on it toss it just toss it because the

patient's life is much more it's much more important than making sure that you have this vial here new needles and syringes hand hygiene we're going to talk about disinfect the medication vials so you have that that rubber

diaphragm or on it make sure that you're rubbing it put a little elbow grease behind it and yes so some of them are really small and it's easy to have your finger fly right off it but do your best to make sure that you're cleaning that

off and then discard everything as soon as you use it I would encourage you to ask your patients did you wash your hands to you to ask you did you wash your hands and I will tell you the story some of you know that my husband was a

lot of well man he has since passed but he's in the hospital and I'm watching all of these physicians and I was shocked because every physician washed their hands and I could see them walking in the hall I could see the other

patient rooms and they don't there was a sink outside they washed her hands they went in like I was duly impressed they come in one day to see my husband and the surgeon making rounds and his entourage and I had seen most of them

wash their hands but I never saw the surgeon wash his hands I don't know if he did it or not so I politely say to him dr. so-and-so did you wash your hands well you would have thought I said the worst thing in

the world to this man because I don't know there's six people with them they all like stopped their faces just went blank they were pale I really said that he said to me as calm as could be mrs. green I did wash my hands but I'm

gonna go back out and do it again he went back outside took the sink that was closest where I could see him washed his hands I came in and we started all over again and everything was fine physician does his thing examines them

does whatever leaves the room the entourage of nurses who came in because in that three seconds from when he left the room so when they came in the whole floor knew that so and so the patient in whatever room he was in his wife

actually dared to ask doctor such-and-such did he wash his hands like well wouldn't you do the same thing especially in this day and age and in a hospital setting where you know everything they do everything you touch

and it's not your fault but you have to touch things you have to wash your hand so that's my did you wash your hands story so I give you permission to say to anybody did you wash your hands and

maybe you want to use gloves and is that the IV tubing that you really want to use you'd be surprised the things I've fed the people but I've not had a patient say to me did you ever use a clean needle and syringe to draw up that

medication but you know I think that may come to that and I think we need to take it in the right vein I think we need to be able to say to them yes I did you know and I'm not saying it nasty and not say it you know being all the things

that we can be on a negative side because that's not right if I can ask it you can ask it and if you say it nicely and you say it professionally and all you have to do is just answer them in that same tone of voice it does build a

much more trusting relationship I doubt they're ever going to ask you if this medication is from a single dose vial but I can tell you I'd be the one that asked that you know and I and I bet a lot of you may start may yes but

occasionally I'm not saying to it every time but you never know what kind of little things you might spark in somebody so my favorite thing that we're

having some difficulty with is portable handheld devices and when you think

about it we use a lot of handheld devices we use them in our personal life we use them in our professional life and so I don't think this is not coming up right and I apologize this was supposed to have glucometers on it and for some

reason my picture was coming up on my computer and it was it didn't translate but so if you have taking a patient's blood sugar in the organization so you have your glucometer and all your little things you ever wipe them off between

patients you ever disinfect them that never occur to you to disinfect them okay so point of care testing is testing that's performed near or at the site of the patient with the result leading to

possibly changing the care of the patient that's what point of care testing is if you have a patient who is a diabetic and you take their blood sugar and it's 10 and you now you know why they're a little confused and why

they might be a little diaphoretic but you can now treat them if you it same way if you have a patient whose glucose is 570 maybe you need a little insulin so you know you're treating them appropriately but you wouldn't know that

if you didn't have the point-of-care devices and they're used all over the place people have them in their homes their youth in pharmacies paramedics have them patients self-tests and they have they little I forget what it's

called but there's a device with actually stick in their arm and they just waved a little wand over it we have a patient who comes in and it's like if I checked your blood sugar and he's gone I'll do it for you pull cycles little

device wipes it over his arm and I'm like not taking that blood sugar why would I want to stick them in he has this device in this is what it sits for but you see them in nursing homes you see them on med surg units you see them

all over the place it's important to have staff involved when you're choosing a device and so if you're working in a hospital setting and if you're working in an outpatient type setting hopefully somebody that is would be using the

equipment is part of the group that takes a look at the equipment this is how we've always chosen IV pumps this is how we choose IV catheters why not have we choose testing devices now I give you some times they're chosen by the

hierarchy organization above you and this is what you have to use but if you're buying your own you want to make sure that it's something that's going to do the job that you want and more importantly that is it is meant to be

used on multiple patients because the home device that you have to check your blood sugar is not supposed to be used on your next-door neighbor who's feeling a little weird it's supposed to just be used for you

okay so we need to make sure that we're buying the appropriate devices you want to look at the the if' use it's important to take a look at how all of these things function and is this really what you want and we have what we talked

about multiple patients um and any of the self testing devices so I can't say to this gentleman who comes in to us who has the little device in his arm Oh could you take that out of your arm and stick it in this person's arm for me and

we'll just wand him not good because remember this is sticking into him it is testing blood from him and there's one good way to spread all the things that we just talked about so the protocol that we want to make sure is that you

have your little Tandy dandy box of gloves now I will venture that the majority of you use gloves when you do point-of-care testing but there are some of you who do you wash your hands before you put the

gloves on and for those of you who do neither wash your hands or put the gloves on you're really taking things into your own hands the wrong way and so you need to stop and think about this you need to do hand hygiene when your

hands are dry put the gloves on look at the gloves you ever put a glove on and all of a sudden your finger goes through it not that's not what you want to do you don't want to put the glove one and pull that finger off your index finger

because you can feel the vain when you're trying to stick an IV because what is the point of that yeah may as well not wear them and I'm not saying don't wear the gloves too don't take that that way when you're finished

remove the gloves and you know how to take them off so that everything's on the inside and you have to wash your hands again and patients may not say to you oh thank you for washing your hands but I don't know but the film inside the

gloves by the end of like ten minutes and I've washed my hands too many times with that you know those those gel solutions my hands feel like gel I can't wait for soap and water so when you have these glucometers or anything that's a

shared device there's a potential for a blood-borne pathogen transmission especially if you're not cleaning them you're sharing this with all these patients in the hospital you're going from room to room if you have if you

work up on one of the units you have the nursing assistant or the patient care tech whatever they call them in your organization goes down there to vital signs they're probably not wiping any of that off either but they're going then

to the taking the blood sugars and they go from bed a to bed B I know that there's wipes of some sort in that room but are they cleaning it all has somebody taught them that and do they understand to do it because it's very

easy then to subject organisms to other individuals we have inappropriate cleaning do you ever see the patients and I will tell you I had I had like a hot I've all these personal stories I went to have blood work drawn and so I

stick my arm out of a great vein and this arm she can't miss this no matter how hard she tries she puts the tourniquet or me she takes an alcohol prep and as she preps my arm one little half of a swipe she looks away now my

vein is more lateral so what does she swipe more medial where she's going to put that needle is nowhere near where the alcohol was so I said to her you might want to swipe one more time over here

just because you know if you're gonna do this do it right so you need to so disinfect what needs to be disinfected whether it's somebody's fingers somebody's arm or the de medical device that you're using and how do you

disinfect the device you do not put it in soap and water you do your hand hygiene you put the gloves back on and you take Santa wipes or whatever you happen in your whatever you product you have in your organization some of them

are larger some of them are smaller wipes you pull one out of the little container make sure they're wet I have a habit of turning it upside down for a few seconds because they dry out turn it up my gun and then turn it right-side up

pull one out and it's wet and make sure that you wipe all the nooks and crannies especially where you put the little strip that's where the blood is so make sure that you're wetting the things that are appropriate let them let it dry take

off your contaminated gloves before you touch anything else make sure you wash your hands and this is what you want to do to clean the machine each and every time and I will venture to say if you look at the machine it looks a little on

the yucky side clean it before you use it because you're it's not dedicated to you okay there's some other devices out there that we probably never think about cleaning but maybe you do and I'm not trying to say that you don't do this

stethoscope sner cesare known for wearing that stethoscope around there necklace it's easier some people might fold them up and put them in a in a lab jacket or the the AOR you know coats that you can put over if it's cold but

we're seeing so much more the use of iPads and tablets and organizations we're looking at we're showing patients how things are done because you can pull these up whether it's YouTube or a doctor has a picture they want them to

see or whatever so we're looking at all these devices there were a lot of non I'm going to say nurses because we're in the room here when I worked in the hospital setting I carried a phone which was the worst thing I could have done

because they know how to get me what he did was call so you're being interrupted a lot but there's a phone that I have against my face late at times I would sit down on the table if I tell you to hold on I might you know set

it down and I pick it back up and it's going back to my face or I'm holding it with my shoulder so think about the things think about your own personal cell phone and how often do you clean that and I don't mean just wipe off some

of these smudge marks that are on there you also need to look at cleaning thermometers others the thermometer up there so look at those you know the ear thermometers if you're using them if you need to clean these off you know they

tells you we have little stickers on ours touch of exactly what to do you have to wipe around where you put the little ear probe it makes perfect sense when you start to think about this so if

you look at mobile handheld devices now

this is obviously we're talking about the phones and we're talking about personal or professional phones depending on where you are and we're talking about the handheld devices the the iPads the tablets and so forth up to

65 percent of healthcare workers are using these to educate a patient you know this is fantastic the fact that we have these at our fingertips you can go visit a patient on the floor you can explain the procedure to them you can

show them things and it's really awesome the problem is you need to clean this at some point you get cross contamination because you put the phone in your pocket if you have a big enough pocket maybe you put the iPad or the tablet in your

pocket if you have one of those smaller whatever they are three by eights or whatever and one of the studies that I read said that 8 percent of physicians clean their phones ok well the nurses weren't a whole lot better because only

10 percent of them clean their phones and not that you put it in soap and water again you don't get these sopping wet but there are wipes that you can use on the phone most of you probably have that place to cover or whatever it's

made out of that it goes over the phone and so you're protecting it but you need to you need to really take a look at this and clean them off there was a 9 to 25% cross contamination with bacteria on these devices when they cultured them

the organisms that they found Brady did a study and one of the organisms they found were mersa affinia bacter VRE and Pseudomonas so if you're like me you have your phone it with you at work and you have it in your pocket and you use

it for whatever reason you're looking up something you're answering your text message from your kid whatever and then you go pick your grandson up for dinner and inevitably my mum can I play on your phone so we hand it to them what am i

handing to this child if I don't wipe it off and I'll be honest I don't always wipe I don't think about it reading all of this and doing all this has made me so much more aware of cleaning off what seemed like everyday devices like you

know you'll buy washer your silverware at home or then you wash very wipe off your phones there's another study out there by Boyer that says the bacteria on physicians and nurses hands is the same as what's on their devices now that

makes sense so they're looking at there was a 10% incidence of CO contamination with the cinah bacter so we're not doing proper hand hygiene or we've already infected the phone and we haven't if we haven't cleaned the phone we keep

reinfecting ourselves with the assent of actor or the mersa or whatever else happened to culture out so we have to break the cycle and wash everything Brady this is a different study by Brady they studied the relationship between

mobile phones and health care workers in the o.r and they found that almost 95% of their phones were contaminated with bacteria mostly MRSA and the last one was looking at touchscreen mobile phones are less

contaminated than keypads and maybe because they after we smudge them up enough when we're using the you know the mobile touch tone that we have to wipe that off so we could see where a keypad if you're looking at your computers at

work how many times is that keyboard cleaned off like do we make it a habit of cleaning it off at least every morning you know so that we're starting at at least fresh now if you've been in some of these sessions that I've been in

there's a bundle for that well there's an app for this there's really a bundle what I decided to call it app because there's an app for everything if you think about it so we need to take a look at having a

waterproof barrier or protection over the phone or over this handheld device so that you can clean it much more easily you need to decontaminate it you need to have automatic reminders whether you set

it on your device that you know how you set your reminder to go to launch you set your reminder to get up you put the alarm on you need to set an alarm to clean the device ok and I cannot stress a hand hygiene enough and I think that

we we know in the back of our minds we should do it and we do it if our hands feel kind of scuzzy or we do what if there's like something on our hands but do we do it routine because that's the right thing to do so we're going to

implement those those practices that we know we need to use personal protective equipment when it's appropriate gloves are always appropriate no matter what there's probably a few instances where they're not and it's not that many of

them and if you're shaking hands with the patient maybe you don't have a glove one because that's probably a little tacky but go from that to pumping so you can wash your hands because you know if you have Joint Commission come in and

they shake your hands that's what they want you to do they want you to go right to the pump before you touch anything else and clean your hands it sounds a little tacky it's like oh you're you know you've just contaminated me but how

do you know how do you know that you haven't contaminated them ok so we want to take a look at we need to use the protective gowns and we need to use and we need to put caps on our head the appropriate type mask on our face and if

it's if it's a procedure where there's going to be splattering or the potential or you're at the table side much more than what you would have been for another patient put the mask one that has the shield

protect yourself there's an anachronism boards that they have and they call it snap and it stands for scrub nail and protect you can probably change that to whatever you want it it's a it's a helpful way of reminding

your co-workers exactly see I can't snap my fingers like that but you did it very well you don't have to say anything or you could say something like oh snap to it and get that done the snap is supposed to trigger in their mind I have

to wash my hands so if you can if you look at something like this and I actually am going to go back to my group and we're gonna start doing some of this so how much of RIS gonna take us because I work with the group that's gonna be a

little odd some days but a good odd a good ID we have a lot of fun there but it's important to make sure that you're pumping in pumping out of the rooms most people if not everybody has the pumps you know one on one side of the door or

the other so make sure that you're washing your hands you can you can say things like snapping your fingers is the easiest thing if you're one of those that can really get their fingers to snap and mine don't work your hands are

a germ form I just talked about MRSA and Ascenta bacter and and the like on your hand so when you touch anything and everything you're picking up some organism some are much more infectious than others but put them all together

and you have a problem so scrub your hands there are five hand hygiene moments you've probably have seen this this is from the World Health Organization and essentially the five I know you can't read all this little

verbage I don't think on their touch before you touch a patient before you are cleaning at you know things up for a procedure before you touch a body dressing and or I'm sorry after you touch the body's resting after you touch

a patient and you should do them before you touch the patient and anything that's in that patient surrounding all needs to be cleaned you need to wash your hands wash your hands wash your hands this talks about how to use the

pumps and it talks about you know when your hands going in like this getting your thumbs like you know it's really a big project and yours they know nine steps in order to get your hands clean but it's important because you are

protecting yourself your family and your patients I thank you very much for your attention I thank you for your smiles and your little laughing at my jokes

and I think we probably have a couple minutes for question if anybody has one

oh I see Cathy brown coming up not the question but a comment from way back in the last century when I took microbiology when we swapped environments the dirtiest thing we found around ourselves was our eyeglasses so

when was the last time you actually clean the arms of your eyeglasses oh and one other thing if a patient ever says to you did you wash your hands etc the correct answer whether yes or no is also and thank you for saying that just to

empower them to say it to every other healthcare provider that's good could you hear what she said I know that bet that microphone is a little shaky sometimes but your eyeglass says I'm one who I don't do this anymore but I used

to take them off I actually lost them at work one one time for two weeks I could figure where I put them because I couldn't see the gut it was too close for the computer screen I would take them off and when you take them off the

clay layer they're getting infected yes I just went up and firm it that 257 million living infected hepatitis B patients is that a US data or the worldwide data because that's alarming number 257 million I have to check that

because off the top of my head I don't remember and the other question is what can you say about because there are increasing numbers of parents who are refusing vaccinations for their children and the common vaccinations we one of

those is the hepatitis B vaccination to my knowledge the parents have a right to refuse the vaccinations and we've seen this you know for many things I think what the health care provider needs to do is to try to give them as much

information as they can as to why it's important and hopefully it does protect the child and perhaps you can persuade them in a you know in a positive way to accept having it done I don't I know years ago I remember calling Child

Protective Services because the child was not up to their vaccines and this is a long time ago so I don't know that this is the case right now they said if the parents don't want it there's nothing you can do

so unfortunately could you use the microphone please with I can hear currently in the news there's a lot of controversy related to vaccination requirements and the school some of the schools refused to accept the students

anymore and some it depends on the parents but I think with so much infection going on there's really a big movement that it will be required so it depends on where you live and who to follow

thank you yes ma'am my question is about the gel pumps everybody that comes out of that room has potentially had MRSA can I ask you to just start over again okay um my question is about the gel pumps you know they're outside of the

rooms of patients with Mercer or whatever kind of infection and that person may have been much dirtier than me when they come out and they're touching that pump then I go and touch that pump and I don't know that they're

cleaned I've seen one time a pump that was automatic where you put your hand under them do you know if there's any Studies on those pumps that all the dirty hands are touching and then we wash it and rub it all over our hands

attention so gross I think what you're asking me is because it's just that that microphone is not good when you're pumping so you don't know if the person before you was infected with well it's anybody the pump that you know they have

to put their dirty hands on then I go and put my hands on or I'm you know I mean they has there been any study to clean to see how clean these pumps are or how clean they are after we're using them I didn't see any of my research but

remember when you put your hands on that your hand is dirty also or it's infected well shall we say 4:00 p.m. so you're touching the same thing so what happens is if you rub your hands appropriately you're going to clean your hands the

only way that that pump solution is not going to be effective is if you're around c-diff because you have to use soap and water and I would suggest that after you pump on your hands a few times think you need to go use soap and water

because it's just the film that it leaves but when your hands are starting out contaminated so we say you're pumping it you're leaving whatever's on your hand on that pump also it's just the washing of your hands that's going

to clean it I work in a procedure area where every single patient gets a finger stick before the test is done and I thought I had top-notch infection control techniques before I do a blood sugar I cleaned the device I washed my

hands I let them dry I put my gloves on I use the alcohol swab so I thought I was all good but there was something really unusual that happened to me and I'm curious if it's happened to anybody else and that's when I did the finger

prick I initially didn't get any blood which happens from time to time I gave it a gentle little squeeze I don't want to squeeze too much because I don't want to mix serum in with the with the blood gave it a little gentle squeeze and

blood shot into the air like a stream arced out and landed on my face so first of all who knew that could happen with a finger stick I'm curious has it happened to anyone else okay I saw buddy buddy in the back

has had it happen I saw one arm go up so the lesson I learned is I don't hold the finger up right when I'm looking for blood I hold it to the side or down towards the Chuck or somewhere else so that just in case that spurts out it's

not on me unfortunately is this how we learn some things I never would have thought that blood would shoot up like that and I'm sorry you had that happen to you so I have a concern about the DIA foam the gel we notice whenever it

spills on the ground like on the linoleum floors it actually eats up the linoleum so I'm wondering what are those chemicals doing to our hands and are we absorbing the chemicals in that gel in that film

to our bodies and is it safe for us to be using it because when I see what happens to the floor it makes me kind of concerned and I tend to use more soap and water now after seeing this and even using the gel and I don't disagree with

you that using soap and water you know in that instance but what I would do is I'd go back to your product managing individuals and ask them to find out from the company you know that this is what you've observed and what does the

company say about this whoever manufactures the solutions that you're using right because we would hope that when they put things out like that there I'll test it through the FDA and everything and so that when you're using

a solution it's being used appropriately because you're I use the solutions and then I go immediately to a to a sink and I wash my hands to get that solution off because I just see what it does to linoleum if it's doing that to linoleum

what's it doing to me yeah you know you may just have sensitive skin where you can't use it so that would be something I would talk to your purchasing department about or your products evaluation committee and let them know

and see what they say because it may be that you have to have something special or you have to just use soap and water but you need something that's closer to you when you're at a patient bedside stretcher side or chair side and it's

not always convenient to have sinks in all these places depending on where you work all right thank you you're welcome to meet with you and to answer your question for you thank you so much for attending I appreciate your attention

[Applause] [Music]

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