By Luwana Walton, RN

Gayco Nurse Consultant

INFECTION CONTROL DURING THE MEDICATION PASS 

• Hand Hygiene: a general term that applies to hand washing, antiseptic hand wash, and alcohol-based hand rub. Hand Hygiene is to be performed before and after each resident medication pass and after touching any high touch area such as door handles bedframes, bed remotes, over the bed tables, bedside tables etc.
• The facilities’ hand hygiene policies promote preferential use of alcohol-based hand rub (ABHR) over soap and water in most clinical situations.

 

Note: Soap and water are used when hands are visibly soiled (e.g., blood, body fluids) and is also preferred after caring for a resident with known or suspected C. difficile or norovirus during an outbreak, or if rates of C. difficile infection in the facility are persistently high.

 

• Hand washing: the vigorous, brief rubbing together of all surfaces of hands with soap and water, followed by rinsing under a stream of water. Guidance require staff follow hand hygiene practices consistent with accepted standards of practice.

 

• Hand washing:

1. Wet your hands with running water, apply soap
2. Lather your hands by rubbing them together with soap. Lather the backs of your hands, between your fingers, thumbs and under your nails.
3. Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end TWICE.
4. Rinse your hands well under running water.
5. Dry your hands using a clean paper towel.
6. Turn off running water with a clean, non-wet paper towel.

 

• Hand sanitizer :

1. Apply the gel product to the palm of one hand.
2. Vigorously rub your hands together.
3. Rub the gel over all the surfaces of your hands and fingers until your hands are dry. This takes approximately 20 seconds.

 

Hand hygiene practices include oral assessment of ability to describe proper handwashing and hand sanitizing technique.

 

 

 

Proper PPE utilized/discarded during Infection control for direct resident care:

 

1. Eye drops: Hand washing with soap and water then donning of gloves is recommended for administration of eye drops. Avoid touching the eye or eye lid with the eye drop bottle tip when administering the eye drops. Hand sanitizer warnings state do not use in or around the eyes, in case of contact rinse eyes thoroughly with water.
2. Gloves are worn when using harsh cleaning products, follow manufacturer recommendations on your products label.
3. Gloves are worn when breaking tablets or opening capsules.
4. Gloves are worn for any injection that can cause exposure to blood.
5. Gloves are worn when obtaining blood samples for Finger Stick Blood Sugar and INR monitoring.

 

• Clean barriers:

When having to place an item that is coming back to the medication cart down in the residents room on the over the bed table or bedside table; there must be a clean barrier, paper towel or a tissue under the item.  A clean cup may be utilized if the item will fit inside, remembering to throw this cup away in the resident’s room before returning to the medication cart as placing the cup on top of the medication cart will break the infection control barrier resulting in an infection control issue. At no time items that will return to the medication cart are placed on the resident’s bed. At no time are items returning to the medication cart be placed inside of nursing uniform pockets.

 

• Sanitizing the medication cart after each medication pass:

After EACH medication pass the medication cart is to be cleaned/sanitized using an EPA approved high-level chemical disinfectant following its manufacture recommendations and utilizing gloves. The product will address the contact time on its label. The contact time is the wet time it takes to kill the microorganisms listed on the label.  The top of the medication cart is your work surface and is to be cleaned and disinfected after each medication pass or when soiled or liquid spills noted.  Inside the medication cart any liquid spills are to be cleaned up, any loose pills are to be removed.

Computer monitors, mouse, scanners and keypad are also cleaned and disinfected after each medication pass.

 

• Nurses are to add an open date for items used for the medication pass such as apple sauce, pudding, supplements, thickeners e.g., and any other item with a shorten expiration date using manufacture recommendations for the expiration dates after opening. Discard these items before expired or when this expiration date is reached. Water pitchers and/or containers are clean per schedule according to facility policy.

 

• Point of care equipment:

Glucometers and INR Monitors

Nebulizer Mask

Nebulizer machines

Blood pressure cuffs

Stethoscopes

Pulse oximeter

IV poles

Suction machines

 

• Cleaning and disinfecting glucometers and INR Monitors :

 

Glucometers and INR monitors are cleaned and disinfected before and after each use. This is a two-step process:

1. Clean the meter/monitor with one wipe of disinfectant, then discard this wipe.
2. Disinfect the meter/monitor with a second wipe of disinfectant then discard this wipe.

Resident personal glucometers are clean and disinfect per manufacture recommendations and store in manufactured dispensed pouch. Glucometers/INR monitors are never be transported in nursing uniform pockets. Gloves are used for the cleaning and disinfecting procedure.

 

Ensure supplies necessary for appropriate cleaning and disinfection procedures are available. EPA-registered for use in healthcare facilities, including products labeled as effective against C. difficile and norovirus, following manufacture instructions for use.

 

• Storage of nebulizer mask when not in use:

Jet nebulizer mask are to be clean after each use rinsing with water, after air drying the mask is stored inside a plastic bag or other method to prevent contamination. New nebulizer mask are assigned weekly or per facility policy with a change date applied or indicated documentation noted to ensure change out schedule is followed.  Un-clean mask are cleaned or replaced immediately.

 

• Nebulizer machine filters are to be changed per manufacture recommendations. A schedule is to be followed as for checking and changing the filter with documentation to support the schedule and changing.

 

• Blood Pressure Cuffs:

If blood pressure cuffs are shared between residents they are cleaned and disinfected between each use using an EPA approved disinfectant.

 

• Stethoscope:

Stethoscopes are cleaned and disinfected before and after each use. They are never be placed on resident beds or areas not covered with a clean barrier.

• Thermometer:

When using a probe thermometer, wipe it down with alcohol wipes and let it dry completely before applying a probe cover. Cleaning is done before and after use.

• Pulse oximeter:

Effective cleaning methods for pulse oximeters are included in the manufactures recommendations. Keep in mind that in the LTC setting pulse oximeters are shared equipment requiring cleaning and disinfecting between each resident. Follow your facility P&P.

• IV pole and machine:

IV poles and IV machines are to be cleaned and disinfected per facility policy. Shared equipment is always cleaned and disinfected between each resident use.

• Suction Machines:

Suction machines are to be cleaned after each use using manufacture recommendations and facility policy.

 

• Injection practices and Sharps Safety

 

1. Injections are prepared using clean (aseptic) technique in an area that has been cleaned and is free of contamination.
2. Insulin pens are used for only one resident.
3. The rubber septum on any medication vial, whether unopened or previously accessed, are disinfected with alcohol prior to piercing.
4. Medication vials labeled for single dose is only used once and for only one resident.
5. Bags of IV solutions are used for only one resident, not as a source of flush solution for multiple residents.
6. Tuberculin Purified Protein Derivative (Mantoux) PPD must be stored refrigerated at 36-46 degrees. Avoid fluctuations in temperature; DO NOT store in the refrigerator door. Avoid exposure to light. Syringes must be filled immediately prior to administration. Once punctured a vial may be used up to 30 days, or until expiration date noted on the vial, whichever comes first. Always write the open date on the vial.

 

• All sharps are disposed of in puncture-resistant sharps containers. Sharps containers are replace when the fill line is reached. Over filled sharps will be an infection control issue and an OSHA concern. Sharps containers are disposed of appropriately as Bio hazard waste.

 

Proper language and terminology is expected when describing donning and doffing of PPE.

CDC Mini Webinars:

Sparkling Surfaces         https://www.youtube.com/watch?v=70H80Rr5lg

Donning of PPE              https://www.youtube.com/watch?v=of73FNO86E8

Doffing of PPE               https://www.youtube.com/watch?v=PQxOcI3DxvQ