CLINICAL SKILLS LABORATORY STUDENT MANUAL. Nursing & Community Services.

Transcription

1 CLINICAL SKILLS LABORATORY STUDENT MANUAL Nursing & Cmmunity Services

2 INDEX INTRODUCTION 3 SCOPE 3 ADMITTANCE TO CLINICAL SKILLS LABORATORIES 4 GENERAL CONDUCT 4 RISK MANAGEMENT & INFECTION PREVENTION AND CONTROL 5 STANDARD PRECAUTIONS 5 1. HAND HYGIENE 5 2. APPROPRIATE USE OF PPE 6 3. USE OF ASEPTIC TECHNIQUE WHERE REQUIRED 8 4. APPROPRIATE REPROCESSING OF RE-USEABLE INSTRUMENTS AND EQUIPMENT 8 5. SAFE HANDLING AND DISPOSAL OF SHARPS AND POTENTIALLY INFECTIOUS MATERIAL 8 6. SAFE HANDLING OF WASTE AND LINEN 9 7. ENVIRONMENTAL CONTROLS INCLUDING CLEANING AND SPILLS MANAGEMENT 10 WHAT TO DO IF THERE IS A PROBLEM? 11 IN CASE OF AN EMERGENCY 11 STUDENT ACKNOWLEDGEMENT 11 WHO TO CONTACT 11 Page 2

3 Intrductin This Manual is intended t prvide yu with infrmatin, plicies and guidelines t ensure a safe envirnment fr everyne during yur Clinical Skills Labratry sessins. The infrmatin cntained in this Manual is based n Natinal Health and Medical Research Cuncil s Australian Guidelines fr the Preventin and Cntrl f Infectin in Healthcare (2010). It als draws n infrmatin frm SA Health s Guidelines fr the preventin and management f infectin in healthcare settings. All students using the Clinical Labratries will have electrnic access t this Manual and the Rules f Use. All students are required t acknwledge their understanding and acceptance f the Clinical Labratry Rules f Use via EQ-Online prir t participatin in labratry sessins. Scpe This Manual applies t all students enrlled in nursing and cmmunity services prgrams at EQUALS Internatinal. All nursing and cmmunity services students will participate in Clinical Skills Labratry ( Lab ) learning and assessment thrughut their prgram f study. EQUALS Labs are simulated healthcare envirnments and cmpliance with risk management and infectin cntrl plicies and prcedures is mandatry. Imprtant: The current versin f this Manual is available in electrnic cpy. Students may chse t dwnlad and/r print a cpy hwever they are respnsible fr cmpliance with the mst up t date versin at all times, available n EQ-Online. Page 3

4 Admittance t Clinical Skills Labratries All students using any EQUALS Lab must cmply with the fllwing requirements: Clean and irned EQUALS unifrm Hair neatly tied back Flat clsed-in shes N jewellery (wedding bands are permitted) N fd r drinks t be brught int the Lab Nursing kits must be brught t each Lab sessin (nursing students nly) General cnduct N student is t enter r remain in a Lab withut the supervisin f an Educatr Students must fllw all reasnable directins given by their Educatr at all times Students are expected t actively participate in Lab learning and assessment activities Students must demnstrate ethical and apprpriate cnduct at all times, as utlined in the EQUALS Student Cde f Cnduct In case f an emergency, students are t fllw emergency evacuatin prcedures under the directin f relevant staff members All equipment and materials in the Lab must be used slely fr their intended purpse, and must nt fr any reasn be remved frm the labratry All wrkspaces are t be left clean and tidy, including but nt limited t: All wrappers, glves and ther supplies are t be placed in bins All equipment t be switched ff All equipment and supplies t be returned t their designated strage areas as apprpriate Prper dispsal f sharps int designated cntainers Beds made and lwered Area t be left generally clean and free f clutter and paperwrk Imprtant: Failure t cmply with any f these directins may result in remval f access privileges t EQUALS Labs and/r disciplinary actin. Page 4

5 Risk Management & Infectin Preventin and Cntrl EQUALS undertakes t cnduct regular risk assessments n Clinical Skills Labratries in line with ur risk management plicy. EQUALS risk management apprach seeks t identify and assess ptential risks, and t act swiftly in mitigating risk impact thrugh cnsultatin with key stakehlders and measurable actin. Infectin preventin and cntrl is integral t clinical care and the way in which it is prvided. It is nt an additinal set f practices. Yur participatin in Clinical Skills Labratry sessins simulate the wrk envirnment, and the infectin preventin and cntrl practices yu apply in the LAB are expected t meet the requirements f real healthcare settings. Standard Precautins Standard precautins are wrk practices required t achieve a basic level f infectin cntrl. The use f standard precautins fr all patients is the primary strategy fr minimising the transmissin f infectins in health care settings. The practices that frm part f standard precautins include: 1. hand hygiene accrding t the "5 mments" fr hand hygiene 2. apprpriate use f persnal prtective equipment 3. use f aseptic technique where required 4. apprpriate reprcessing f re-useable instruments and equipment 5. safe handling and dispsal f sharps and ptentially infectius material 6. safe handling f waste and linen 7. envirnmental cntrls including cleaning and spills management. 1. Hand Hygiene Hand hygiene is ne f the mst effective measures t prevent the spread f infectin. The mst cmmn way that harmful rganisms are spread between patients in health care settings is n the hands f health care wrkers. Studies shw that effective hand decntaminatin can significantly reduce the rate f healthcare assciated infectin. 5 Mments fr Hand Hygiene (Wrld Health Organisatin): 1. Befre tuching the patient 2. Befre a prcedure 3. After a prcedure r bdy fluid expsure risk 4. After tuching a patient 5. After tuching a patient s surrundings Page 5

6 Nn-clinical situatins where hand hygiene shuld be perfrmed: 1. Befre starting r leaving wrk r simulated wrk 2. Befre and after handling fd (yur wn r yur patient s) 3. Befre and after using a cmputer in a clinical area 4. After hands are visibly siled 5. After visiting the tilet 6. After remving glves 7. After handling laundry, equipment r waste 8. After blwing yur nse r wiping/tuching yur muth Use f alchl-based hand rub Apply the amunt f alchl-based hand rub recmmended by the manufacturer nt dry hands. Rub hands tgether s that the slutin cmes int cntact with all surfaces f the hand, paying particular attentin t the tips f the fingers, the thumbs and the areas between the fingers. Cntinue rubbing until the slutin has evaprated and the hands are dry. Using sap and water Wet hands under tepid running water and apply the recmmended amunt f liquid sap. Rub hands tgether fr a minimum f 15 secnds s that the slutin cmes int cntact with all surfaces f the hand, paying particular attentin t the tips f the fingers, the thumbs and the areas between the fingers. Rinse hands thrughly under running water, then pat dry with single-use twels. 2. Apprpriate use f PPE Persnal prtective equipment (PPE) refers t a variety f barriers, used alne r in cmbinatin, t prtect mucus membranes, airways, skin and clthing frm cntact with infectius agents. PPE used as part f standard precautins includes aprns, gwns, glves, surgical masks, and prtective eyewear and face shields. Selectin f PPE is based n the type f patient interactin, knwn r pssible infectius agents, and/r the likely mde(s) f transmissin. Surgical Masks Surgical masks are lse fitting, single-use items that cver the nse and muth. They are used as part f standard precautins t keep splashes r sprays frm reaching the muth and nse f the persn wearing them. They als prvide sme prtectin frm respiratry secretins and are wrn when caring fr patients n drplet precautins. Surgical masks can be placed n cughing patients t limit ptential disseminatin f infectius respiratry secretins frm the patient t thers. Page 6

7 Cnsideratins when using a surgical mask include: masks shuld be changed when they becme siled r wet masks shuld never be reapplied after they have been remved masks shuld nt be left dangling arund the neck tuching the frnt f the mask while wearing it shuld be avided hand hygiene shuld be perfrmed upn tuching r discarding a used mask Glves Glves can prtect bth patients and healthcare wrkers frm expsure t infectius agents that may be carried n hands. As part f standard precautins, they are used t prevent cntaminatin f healthcare wrkers hands when: anticipating direct cntact with bld r bdy substances, mucus membranes, nnintact skin and ther ptentially infectius material handling r tuching visibly r ptentially cntaminated patient-care equipment and envirnmental surfaces When glves are wrn in cmbinatin with ther PPE, they are put n last. Internatinal guidance suggests that changing f glves is necessary: between episdes f care fr different patients, t prevent transmissin f infectius material during the care f a single patient, t prevent crss-cntaminatin f bdy sites if the patient interactin invlves tuching prtable cmputer keybards r ther mbile equipment that is transprted frm rm t rm Precautins: Prlnged and indiscriminate use f glves shuld be avided as it may cause adverse reactins and skin sensitivity. Hand hygiene shuld be perfrmed befre putting n glves and after remval f glves. Healthcare wrkers with latex allergies shuld infrm their managers t ensure that their wrk areas can be latex free. Glves (ther than utility glves) shuld be treated as single-use items. They shuld be put n immediately befre a prcedure and remved as sn as the prcedure is cmpleted. When remving glves, care shuld be taken nt t cntaminate the hands. After glves have been remved, hand hygiene shuld be perfrmed Page 7

8 3. Use f aseptic technique where required Aseptic technique prtects patients during invasive clinical prcedures by emplying infectin cntrl measures that minimise, as far as practicably pssible, the presence f pathgenic micrrganisms. Aseptic Nn-Tuch Technique (ANTT) was develped in the UK in the 1990s and is becming widely used internatinally. It is a framewrk f principles fr aseptic technique. The use f ANTT is based n a risk-assessment apprach t clinical prcedures. Cmplex, invasiveness, size f key sites and duratin f prcedure all influence hw ANTT is emplyed. The ANTT Apprach includes 6 Actins fr Safe Aseptic Technique: 1. Risk assessment: either standard r surgical ANTT 2. Manage the envirnment: avid r remve cntaminatin risks 3. Decntaminate and Prtect: hand cleaning, PPE, disinfecting equipment/surfaces/key parts 4. Use Aseptic Fields: general, critical and micr critical aseptic fields and prtect keyparts and key-sites 5. Use Nn-Tuch Techniques: key-parts must nly cme int cntact with ther keyparts and key-sites 6. Prevent Crss Infectin: safe equipment dispsal, decntaminatin and hand-cleaning 4. Apprpriate reprcessing f re-useable instruments and equipment Items marked "single use nly" must nt be reprcessed. Hwever, if the item is labelled "single patient use", then it can be safely re-used n the same patient with sme frm f reprcessing accrding t the manufacturer s instructins. Health care wrkers must ensure that reusable equipment is nt used fr the care f anther patient until it has been cleaned and reprcessed apprpriately. Cleaning is the essential first step fr any frm f reprcessing: thrugh cleaning shuld cmmence as sn as practicable after use if an item cannt be thrughly cleaned, it cannt be adequately reprcessed failure t achieve adequate cleaning may result in ineffective disinfectin r sterilisatin f instruments r equipment. 5. Safe handling and dispsal f sharps and ptentially infectius material The use f sharp devices expses healthcare wrkers t the risk f injury and ptential expsure t bldbrne infectius agents, including hepatitis B virus, hepatitis C virus and human immundeficiency virus. Sharps injuries can ccur in any healthcare setting, including nn-hspital settings such as in ffice-based practices, hme health care and lng-term care facilities. Page 8

9 It is imprtant that all staff are aware f the inherent risk f injury assciated with the use f sharps such as needles, scalpels and lancets. When handling sharps the fllwing principles apply: the persn using the sharp is respnsible fr its safe dispsal dispse f the sharp immediately fllwing its use and at the pint f care dispse f all sharps in designated puncture resistant cntainers that cnfrm t relevant Australian Standards dispse f sharps dispsal cntainers when they are ¾ full r reach the specified fill line, seal apprpriately and place in the clinical waste stream never pass sharps by hand between health care wrkers never recap used needles unless an apprved recapping device is used never bend, break r therwise manipulate by hand a needle frm a syringe. 6. Safe handling f waste and linen Waste It is imprtant that all staff dealing with waste adpt prcedures that minimise risk t bth themselves and t their envirnment. Medical waste is defined as waste cnsisting f all sharps, human tissue including bne, any liquid bdy fluid, and labratry specimens. Apprpriate persnal prtectin equipment (PPE) must be wrn when handling all waste, with due care t prtect against expsure t bld and bdy fluids, and injury. Dressings and bandages, materials that are nly stained r have had minimal cntact with bdy substances, dispsable nappies, incntinence pads r sanitary napkins are nt regarded as medical waste and can be dispsed f in general waste. Linen All used linen shuld be handled with care t avid dispersal f micrrganisms int the envirnment and t avid cntact with staff clthing. The fllwing principles apply fr linen used by all patients regardless f their infectius status: all used linen is cnsidered cntaminated therefre minimal handling is recmmended apprpriate PPE must be wrn during the handling f siled linen t prevent skin and mucus membrane expsure t bld and bdy fluids dispse f all linen int an apprpriate linen cntainer at the pint f care linen which is heavily cntaminated with bld and/r ther bdy fluids which culd leak must be cntained by a leak-prf bag and secured prir t transprt hand hygiene must be perfrmed fllwing the handling f all used linen. Page 9

10 7. Envirnmental cntrls including cleaning and spills management Bld and bdy fluid spills Prmpt remval f spts and spills f bld and bdy substance fllwed by cleaning and disinfectin f the area cntaminated is a sund infectin cntrl practice and meets ccupatinal health and safety requirements. Strategies fr decntaminating spills f bld and ther bdy substances (e.g. vmit, urine) differ based n the setting in which they ccur and the vlume f the spill: in patient-care areas, healthcare wrkers can manage small spills by cleaning with detergent slutin fr spills cntaining large amunts f bld r ther bdy substances, wrkers shuld cntain and cnfine the spill by: remving visible rganic matter with absrbent material (e.g. dispsable paper twels) remving any brken glass r sharp material with frceps saking up excess liquid using an absrbent clumping agent Apprpriate PPE shuld be wrn at all times. If spillage has ccurred n sft furnishings, a detergent slutin can be used t clean the area thrughly. Alchl slutins shuld nt be used t clean spillages. Rutine envirnmental cleaning General surfaces can be divided int tw grups thse with minimal hand cntact (e.g. flrs and ceilings) and thse with frequent skin cntact ( frequently tuched r high risk surfaces). The methds, thrughness and frequency f cleaning and the prducts used are determined by risk analysis. Frequently tuched surfaces in patient-care areas shuld be cleaned using a detergent slutin and mre frequently than surfaces with minimal hand cntact. EQUALS uses a risk-assessment apprach t identify frequently tuched surfaces and then crdinates an apprpriately thrugh in-huse cleaning strategy. Page 10

11 What t d if there is a prblem? Students wh bserve nn-cmpliance with standard precautins in Clinical Skills Labratries are asked t immediately ntify their supervising Educatr in the first instance. Alternatively cntact the Clinical VET Crdinatr (details belw). Supervising Educatrs and/r the Clinical VET Crdinatr may require students t cmplete a Critical Incident reprt. Critical Incident frms are als available frm Receptin. In case f an emergency Nrmal emergency evacuatin prcedures apply. Student acknwledgement All students must cnfirm their understanding and acceptance f the Clinical Labratry Rules f Use via EQ-Online prir t participatin in labratry sessins. Any students wh fail t d s will be prevented frm attending Clinical Skills Labratry sessins until such time as the acknwledgement and acceptance is recrded. Wh t cntact EQUALS Clinical VET Crdinatr Yvette Williams, R.N. E: ywilliams@equals.edu.au P: Page 11