Best Practice Avoid allowing the patient to see the soiled side of the dressing, as this may make the patient feel uncomfortable. Guided Tour Best Practice Arrange your equipment on the overbed table so you do not have to reach over or turn your back on your work area. Th y ork area. Best Practice A resident may feel dizzy for the fi rst few minutes of dangling, but this feeling should pass. If it doesn’t, return the resident to a lying position with the head raised and immediately notify the charge nurse. Step-by-step videos of procedures are available in the Online Learning Suite that accompanies this text. Procedure videos demonstrate the tasks nursing assistants will need to master and perform for the certifi cation competency examination. Procedures provide detailed, easy-to-follow instructions for performing nursing responsibilities, helping you master skills needed to pass the certifi cation competency examination. Every procedure contains a rationale, preparation instructions, procedure steps, follow-up actions, and information for reporting and documentation. Professional photographs and illustrations aid understanding. Copyright Goodheart-Willcox Co., Inc. Chapter 15 Infection Prevention and Control 347 Rationale Standard and transmission-based precautions require that healthcare staff members wear gowns during procedures in which they might be exposed to or transmit microorganisms. Gowns create barriers that protect healthcare staff. In some situations, such as caring for residents in isolation, gowning must occur prior to entering the room. Preparation 1. Select the appropriate gown. 2. Remove any watches or jewelry. 3. If wearing long sleeves, roll them up above your elbows. Best Practicepossible,atcarryentriesallThisand As often as out procedures that require a gown one time. avoids regowning for multiple into exits from the same room. The Procedure: Putting On a Gown 4. Wash your hands or use hand sanitizer to ensure infection control. 5. Hold the gown by the shoulders out in front of you. The back of the gown should face you. 6. Unfold the gown carefully. Do not shake it open. 7. Slide your hands and arms into each of the sleeves of the gown (Figure 15.20). Figure 15.20 8. Pull the top of the gown around your neck to cover your scrubs. 9. Reach behind the gown and tie the neck ties using a simple shoelace bow. 10. Reach behind the gown again. Grab the open edges of the gown and pull them together so they overlap. Your clothing should be covered completely. 11. Tie the waist ties in the back using a simple shoelace bow (Figure 15.21). Figure 15.21 12. Put on disposable gloves. Always put on gloves after putting on a gown. Pull the gloves up over the cuffs of the gown sleeves. The Procedure: Removing a Gown 13. Before removing your gown, fi rst remove and discard your gloves. Be careful not to contaminate yourself. Best Practice Do not touch the outside of the gown as you remove 14. Reach behind the gown and untie both the neck and waist ties. 15. Slide your hands back into the sleeves of the gown. Using one hand (still inside the sleeve), hold the cuff of the opposite sleeve and begin pulling your arm out of that sleeve (Figure 15.22). Be careful not to touch the outside of the gown. Figure 15.22 16. Repeat step 15 to begin pulling the other arm out its sleeve (Figure 15.23). Do not touch the outside of the gown with your hands as you pull the gown down off your shoulders and arms.. (continued)chin.orSecure Putting On and Removing Gownss Procedure C ies (F sp osa ter pu he cu dure: emovi card yo minate y actice touch th iit. t. ch behind k and wa e your ha wn. Us ingg ld the cuff lling your careful no gure 15.22 . Repof eat step out of its sl the outs ide you pull th and arms s C Fi a u uf : in yo y h d ai ha ff r o p sl e h 348 The Nursing Assistant Copyright Goodheart-Willcox Co., Inc. Putting On and Removing Gowns (continued) Figure 15.23 17. Turn the gown inside out as you remove it. 18. Hold the gown, turned inside out, away from your clothing. 19. Roll the gown so the contaminated outside faces inward toward the gown (Figure 15.24). Figure 15.24 20. The gown is now considered infectious waste. Dispose of the gown in the appropriate waste container before leaving the room. Do not wear the gown again. If the gown is a reusable cloth gown, it should be worn only once and should be handled as contaminated linen according to facility policy. Follow-Up 21. Wash your hands to ensure infection control.ensureyour Reporting and Documentation This is an accepted, standard procedure. It does not need to be reported or documented. Images courtesy of © Tori Soper Photography Rationale The proper application of a mask, respirator, goggles, or face shield provides a barrier that protects those who are giving and receiving care. In some situations, such as working with residents in isolation, this PPE must be put on outside the room. Preparation 1. Assemble the necessary equipment (the mask, respirator, goggles, or face shield). 2. Wash your hands or use hand sanitizer to ensure infection control. The Procedure: Putting On a Mask or Respirator 3. Pick up the mask or respirator by its ties or elastic band. Place the mask or respirator over your nose, face, and the ties or elastic band of the mask respirator behind your head and neck (Figure 15.25). Figure 15.25 4. Do not touch the portion of the mask or respirator that will cover your face. Only handle the ties or elastic band. 5. Adjust the mask or over your nose, mouth, and chin by pinching the fl exible portion over the bridge of the nose. The mask or respirator should fi t snugly over the nose and under the chin. If you wear eyeglasses, the mask must also fi t snugly under the bottom of your eyeglasses. Wearing Face Protection Procedure n p oo s y li in ta occ ntte ges c or tio cov elast r rrespirator es by piin bridgg uld fi fi in. If t snuu fi n p o s i n a c o v ti s fi fi f 648 The Nursing Assistant Copyright Goodheart-Willcox Co., Inc. Changing a Urinary Drainage Bag (continued) 11. Ensure safety during the procedure. If there are side rails, raise and secure the rails on the opposite side of the bed from where you will be working. Lower the rail on the side you are working. 12. Wash hands or use hand sanitizer to infection control. 13. Put on disposable gloves. 14. Position the resident on his back, if possible. Place the disposable protective pad under the resident’s buttocks. 15. Cover the resident with the bath blanket. Without exposing the resident, fanfold the top linens to the foot of the bed. 16. Fold the bath blanket to form a triangle on the side of the drainage bag. Turn the triangle up over the resident, exposing the catheter and drainage bag tubing. 17. Clamp the catheter to prevent urine from draining into the drainage tubing. 18. Let the urine below the clamp drain into the drainage bag. 19. Place a protective pad under the resident’s leg at the site where the catheter and drainage bag tubing connect. 20. Open the antiseptic wipes and place them on the paper towels on the overbed table. 21. Open the package with the sterile cap and catheter plug. Do not let anything touch the sterile cap or catheter plug. 22. Attach the new drainage bag to the bedframe. Lay the end of the new drainage bag tubing on top of the protective pad on the bed. 23. Disconnect the catheter from the old drainage bag tubing. Do not allow anything to touch the end of the catheter. 24. Hold the sterile catheter plug, but do not touch the end that goes inside the catheter. 25. Insert the sterile catheter plug into the end of the catheter. If the end of the catheter touches anything, wipe it with an antiseptic wipe before inserting the plug. 26. Place the sterile cap on the end of the old drainage bag tubing. Do not touch the end of the tubing. 27. Remove the cap from the end of the new drainage bag tubing (Figure 23.23A). 28. Remove the sterile plug from the catheter. 29. Insert the end of the new drainage bag tubing into the catheter. 30. Remove the clamp from the catheter (Figure 23.23B). Figure 23.23 Urinary catheter Drainage tube Assembled catheter Bsure Urinary catheter Sterile plug New drainage tube Sterile cap Catheter tubing and parts A 31. Coil and secure the remaining tubing. Be sure it is not twisted or bent. 32. Remove the old drainage bag from the bedframe and place it in the bedpan. 33. Remove and discard the protective pad. 34. Cover the resident with the top linens and remove the bath blanket. 35. Check to be sure the bed wheels are locked, then reposition the resident and lower the bed.stool Images courtesy of © Body Internationalal C Co opy yright Go odheart-Willcox Co., Inc. ew drainage bag tubing m the c atheter rainage tube ed catheter B ug Sterile ccatheter atheter pl in age tube erile c ap bing and parts A remaini ng tubin g. Be sure ben t. ainage bag from the e it in the bedpan. d the prot ective pad. with the top linens and anket. he bed wheels are locked, resident and lower the bed. Images courtes y of © Body ScScientifific ientifi c Internation 664 The Nursing Assistant Copyright Goodheart-Willcox Co., Inc. Providing Ostomy Care (continued) • bath blanket • 4 × 4 gauze pads or toilet paper • washcloths • towels • washbasin with warm water • soap or cleaning agent, as ordered • bedpan and cover • graduate • deodorant, if used The Procedure 9. Provide privacy by closing the curtains, using a screen, or closing the door to the room. 10. Lock the bed wheels and then raise the bed to hip level. 11. Ensure safety during the procedure. If there are side rails, raise and secure the rails on the opposite side of the bed from where you will be working. Lower the rail on the side you are working. 12. Wash your hands or use hand sanitizer to ensure infection control. 13. Put on disposable gloves. 14. Position the resident on his back, if possible. Place a disposable protective pad under the resident’s buttocks. 15. Cover the resident with a bath blanket. Without exposing the resident, fanfold the top linens and move clothing to expose the stoma. 16. Place another protective pad alongside the resident’s body and cover the resident with the bath blanket from the waist down. 17. Remove the clamp at the bottom of the ostomy bag and let the stool drain into a graduate. Make the drain and the end of the bag do not touch the graduate. Avoid any splashing of the stool or drainage. 18. Wipe the open end of the ostomy bag with an antiseptic wipe, following facility policy. Fold the end of the ostomy bag and close it with the clamp. 19. Note the color, amount, consistency, and odor of the stool and measure the stool and drainage, if recording I&O. 20. Empty the and drainage into the toilet or bedpan. 21. Remove and discard your gloves. 22. Wash your hands or use hand sanitizer to ensure infection control. 23. Put on a new pair of gloves. 24. Disconnect the ostomy bag from the ostomy belt, if used. Remove and inspect the belt. If the belt is soiled, dispose of it according to facility policy. 25. Remove the ostomy bag and skin barrier by gently stretching the skin and pulling the ostomy bag away from the skin. Use warm water or adhesive remover, if necessary. 26. Place the ostomy bag in the bedpan and cover the bedpan. Neutralize any odor, following facility policy. 27. Remove any stool or drainage by gently wiping the stoma with a 4 × 4 gauze pad or toilet paper (Figure 23.37). Discard the dirty gauze pads and your gloves in a disposable trash bag. Figure 23.37 28. Wash your hands or use hand sanitizer to ensure infection control. 29. Put on a new pair of gloves. 30. Wash the stoma and the skin around it using a 4 × 4 gauze pad or washcloth mitt, soap, and water or a cleansing agent (as ordered). 31. Rinse and thoroughly dry the skin around the stoma. 32. Observe the stoma and the skin around the stoma. Immediately report any skin irritation, breakdown, or bleeding to the licensed nursing staff. 33. Apply the correctly sized skin barrier, according to the manufacturer’s instructions (Figure 23.38). Image courtesy of © Body Scientifi c International Best Practice tips provide extra advice for delivering safe, quality care that meets residents’ physical, mental, and spiritual needs.