Spatial separation of catheterized patients Technique
4.4.1 Introduction
Enteral Feeding is nutrition provided through the gastrointestinal tract, which includes feeding given via tube and oral. Enteral Feeding preparation and formulation is very complex and should be individualized according to patient’s disease conditions and needs. Contaminated formulas may cause gastrointestinal complications such as diarrhea and vomiting. Colonization of feeding tubes may cause tube occlusion and degradation while colonization of the stomach as been associated with nosocomial infections. Therefore, minimizing potential microbial contamination is crucial to ensure patient achieve optimal nutrition and prevent serious infection and complications related to enteral feeding. This will promote faster recovery rate, shorten hospital stay and reduce overall cost. The risk of contamination occurs during preparation, administration, and storage of the formula and the design of feeding system used. Powder or liquid concentrates prepared on-site poses high infection risk and commercially prepared feeds are known to have lower infectious complications. Bacterial contamination of enteral feeds most commonly arises from exogenous sources.4.4.2 Routes Of Feeding
1. Oral 2. Tube Feeding a. Nasogastric - short term feeding for 4 to 6 weeks b. Enterostomy postpyloric - Long term feeding for 6 weeks c. GastrostomyDuodenostomyJejunostomyPercutaneous endoscopic gastrostomy Percutaneous endoscopic jejunostomy - Long term feeding4.4.3 Causes Of Microbial Contamination And Preventive Measures
Personnel Causes of Contamination Preventive Measures 1. Health care worker with active diarrhea should not handle enteral formula until they have been cleared. 2. Open skin lesions should be covered to prevent potential contamination with bacteria.4.4 Enteral Feeding
Policies and Procedures on Infection Control Ministry of Health Malaysia 49 Physical facility Touch contamination during preparation and administration Formula preparation Adding water or other substances, or using procedures that increases handling of formulas or administration systems increases the potential for contamination. A d m i n i s t r a t i o n a n d prolonged hang time Regardless of administration system, all tube-feeding formulas have risk of microbial growth. Prolonged hang time is associated with unacceptable microbial levels. Causes of Contamination Preventive Measures 1. There should be a room equipped with the necessary facilities for the preparation of enteral feeds following aseptic technique for the whole hospital and proper delivery system to the wards. 2. The preparation area should be clean and hand washing facilities must be made available. 1. Practice hand hygiene before handling formula or administration system. 2. Use disposable gloves. 3. Sanitise all equipments and surfaces used for formula preparation 4. When using decanted formula, sanitise the container before opening. 5. Avoid touching any part of container or the administration system that will come into contact with the formula e.g: the container feeding port, piercing pin on the feeding set. 1. Use commercial formulas and avoid blenderised foods. 2. Avoid adding water, colorants, medications or other substances directly to formula. 3. Use clean technique to add medication to the feeding tube if cannot be given by other route. 4. Use full strength formula. For GI intolerance, reduce administration rate instead of diluting the formula. 5. Reduce handling by using closed feeding system. 6. Label product, date and time of preparation on the container. 1. Limit hang time of refilled formula to 24 hours. 2. Limit hang time of decanted formula to 8 – 12 hours. 3. When using decanted formula, allow feeding to empty completely and rinse before adding fresh formula. 4. Avoid topping up freshly prepared formula until all the previous formula in feeding bag is completely administered. 5. Flush feeding tube with sterile boiled water. 6. Change feeding set every 24 hours.Parts
» Bacaan Penuh ( bersaiz 5.5 MB)
» Roles of Hospital Infection and Antibiotic Control Committee
» Infection Control Doctor ICD
» Chairman of HIACC Bacaan Penuh ( bersaiz 5.5 MB)
» HOSPITAL INFECTION AND ANTIBIOTIC CONTROL COMMITTEE
» Frequency of meetings Circulation of minutes
» Emergency meetings and outbreak control
» Duties and responsibilities of the infection Control Nurse
» HEALTHCARE ASSOCIATED INFECTION SURVEILLANCE
» Types of Surveillance Bacaan Penuh ( bersaiz 5.5 MB)
» Data Collection Tabulation of Data
» Analysis and interpretation of data
» Preparation and dissemination of reports
» ISOLATION PRECAUTION Standard Precautions
» Respiratory hygienecough etiquette: Instruct symptomatic persons and health
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» Dishes, Glasses, Cups, Eating Utensils and Medications
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» Natural ventilation Personal Protective Equipment PPE
» Use of mechanical ventilation
» Minimizing bacteria at entry points
» Maintaining sterility of instruments disposable items during a procedure
» Catheter change interval Urinary Catheter Care
» General principles of wound care 1.
» Spatial separation of catheterized patients Technique
» Environment Urinary Catheter Care
» Wound Care Bacaan Penuh ( bersaiz 5.5 MB)
» Procedure for insertion of catheter
» A dedicated lumen used for PN line should be identified and not be used for
» Nursing considerations for PN
» Storage Replacement of PN tubing and filters
» General Principles. Replacement of PN tubing and filters
» Specific practices transport, storage, transfusion, dispose
» Blood and Blood Products Transfusion
» Hand hygiene Urinary Tract Infection
» Catheter Insertion Urinary Tract Infection
» Closed Sterile Drainage Urinary Tract Infection
» Irrigation Urinary Tract Infection
» Specimen Collection Urinary Tract Infection
» Urinary Flow Urinary Tract Infection
» Meatal Care Urinary Tract Infection
» Catheter Change Interval Urinary Tract Infection
» Critical items - instruments or objects that enter directly into the vascular
» Semi-critical items - instruments or objects that come into contact with
» Developed a good surveillance system to study the incident of SSI.
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» Introduction INFECTION CONTROL IN SPECIFIC HEALTHCARE SETTING
» Personal Protective Equipment Personnel .1
» Neonatal Intensive Care Unit
» Outer zone: This zone should contain:
» Laminar Flow Ventilation Ultra Clean Ventilation
» Wall Mounted Air Conditioners:
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» Gowning Free-standing Air Conditioners:
» Gloving Free-standing Air Conditioners:
» Draping Free-standing Air Conditioners:
» Establishing a Sterile Field
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» Instrument processing area in the dental clinic
» Instrument cleaning refer to CSSD chapter
» Cleaning and Disinfection of Treatment Room 1.
» Dental Radiology Asepsis Components permanently attached to dental unit waterlines
» Dental Laboratory Materials and Equipment
» Storage and preparation rooms
» Movement of instruments Safety
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» Care Givers For Patient In The Burn Unit 1.
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» Personel protective equipment PPE
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» Infection control in specific area .1
» HOSPITAL OUTBREAK MANAGEMENT Steps in Outbreak Investigation and Management
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» Establish a system Bacaan Penuh ( bersaiz 5.5 MB)
» Monitoring antimicrobial use using aggregated data on Defined Daily
» Each hospital shall send report on DDD every 6 months to National Infection
» However, individual local data shall be reported according to discipline
» It is recommended to have a national benchmark data specifically for Intensive
» It is also beneficial if each state have their own benchmark data from their
» A report of local monitoring data for hospital compared with national
» The aggregate benchmark data included numeric presentation of pooled
» Correlation between antimicrobial use and resistance rate
» Costquantity of empiric antimicrobial administered in a specified period.
» Antimicrobial management programstrategies Antimicrobial policy
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