Jimma Nursing Art: Infection Control and Patient Safety Practices

January,2023
Jimma university
Nursing Art

Objectives
 At the end of this session you are able to:
 Define infection prevention, patient safety precaution, cast application,
catheterization, IV therapy, wound care, oxygenation and
tracheostomy care
 Demonstrate infection prevention, patient safety precaution, cast
application, catheterization, IV therapy, wound care, oxygenation and
tracheostomy care

Infection prevention and patient safety
practices

Definition
 Infection prevention and control (IPC) is a practical, evidence-based
approach preventing patients and health workers from being harmed
by avoidable infections.

Definition
• Are control guidelines designed to protect workers from exposure to
disease spread by blood and other body fluids.
• Applied universally for all patients

Safety Precautions …
• Hand washing
• Before and after each patient contact
• Before and after each procedure
• Wear gloves if there is probability of contact
with
• Blood
• Body fluids
• Moist surfaces
• Non-intact skin

• Wear a mask if there is any possibility of
exposure to an infectious disease transmitted
by airborne droplets
• Isolation precautions
• Personal protective equipment
• Keep patients with possible infections separated
from other patients

• Discard all disposable equipment
and supplies appropriately
• Clean and disinfect the exam
room after each patient
• Sanitize, disinfect, and sterilize
equipment appropriately

Definition
A cast is a rigid, circumferential,
layered composite dressing
intended to immobilize a body
part, typically an extremity.
It is a noninvasive option for
immobilizing a broken bone.

Types of Casts
• Based on materials:
Plaster: is less expensive and more easily shaped.
Fiberglass: lighter, more durable and more comfortable due to
superior air flow.
• It is also easier to take effective X-rays through a fiberglass cast.

Equipment
 Stockinette
 Roll padding
 Plaster or fiberglass casting material
 Strong scissors and/or shears
 Lukewarm water and a bucket or other container
 Non-sterile gloves

Procedure
oChoose Stockinette of the appropriate width; it should be form fitting but not so tight
that it compromises circulation.
oApply Stockinette to cover the area (eg, about 5 to 10 cm) proximal and distal to the
anticipated extent of casting material.
oPlace several layers of padding (typically, 4).
oWrap the padding circumferentially, from distal to proximal, over the area to which the
cast will be applied. Overlap the underlying layer by half the width of the padding.
oApply the padding firmly against the skin without gaps but not so tightly that it
compromises circulation.

Procedure…
oExtend the padding slightly (about 3 to 5 cm) past the anticipated extent of
the plaster or fiberglass.
oSmooth the padding as necessary to avoid protrusions and lumps. Tear away
some of the padding in areas of wrinkling to smooth the padding.
oAdd separate, non-circumferential pieces of padding over and around bony
prominences.
oImmerse the casting material in lukewarm water.
oGently squeeze excess water from the casting material. Do not wring out
plaster.

Procedure…
o Apply the casting material circumferentially from distal to proximal,
overlapping the underlying layer by half the width of the casting material.
o Use 4 to 6 layers of plaster (typically) or 2 to 4 layers of fiberglass to
ensure adequate strength of the cast.
o Smooth out casting material to fill in the interstices in the plaster, bond
the layers together, and conform to the contour of the extremity. Use your
palms rather than your fingertips to prevent the development of
indentations that will predispose the patient to pressure ulcers.

Procedure…
oFold back the Stockinette before adding the last layer of casting material.
Roll back the extra Stockinette and cotton padding at the outer margins of
the cast to cover the raw edges of the splinting material and create a smooth
edge; secure the Stockinette under the casting material.
oHold the body part in the desired position until the cast material hardens
sufficiently, typically 10 to 15 minutes.
oCheck for distal neurovascular status (eg, capillary refill and distal
sensation) and motor function.

After the procedure
Determine functional status (eg, weight bearing on lower extremity or use of upper
extremity).
Advise the patient to elevate the casted extremity above heart level whenever possible
for the first 48 to 72 hours.
Advise the patient to keep the cast clean and dry.
Advise the patient not to insert any objects between the skin and the cast and not to cut
the cast.
Instruct the patient to watch for complications such as worsening pain, numbness, and
color change to the fingers.
Instruct the patient to seek care if pain cannot be controlled with oral drugs at home

Teaching patient crutch walking

Definition
 Crutches are a type of walking aid that
serve to increase the size of an
individual's base of support.
 It transfer weight from the legs to the
upper body and are often used by people
who cannot use their legs to support their
weight (from short-term injuries to lifelong
disabilities).

Crutch type
 Axilla or underarm
crutches
 Forearm crutches
 Gutter Crutches

Purpose
• For a person who lost a limb (it is either injured or amputated).
• Having problems with balance and impaired strength.

How to walk
When you walk using crutches, you will move your crutches forward ahead of
your weak leg.
1. Place your crutches about 1 foot (30 centimeters) in front of you, slightly
wider apart than your body.
2. Lean on the handles of your crutches and move your body forward. Use the
crutches for support. Do not step forward on your weak leg.
3. Finish the step by swinging your strong leg forward.
4. Repeat steps 1 through 3 to move forward.
5. Turn by pivoting on your strong leg, not by weak leg.

How to walk…
6.Go slowly. It may take a while to get used to this movement. There are options on
how much weight should be putted on the weak leg:
 Non weight-bearing. This means keep weak leg off the ground during walking.
 Touch-down weight-bearing. the ground can be touched with toes to help with
balance. Instruct the patient not bear weight with weak leg.
 Partial weight-bearing. Half weight of the patient can be put on the leg.
 Weight-bearing as tolerated. more than half of the body weight putted on the
weak leg as long as it is not painful.

Definition
A catheter is a hollow, partially flexible
tube used for injecting or removing fluids
from the body.
Urinary catheterization is the
introduction/insertion of a catheter into
the bladder for the purpose of collecting
urine and leads to a drainage bag.
2/24/2023 29

Catheter
 Catheter diameter and circumference sizes are measured
in Charriere (CH) also known as French Gauge (Fr).
 E.g. 1 Ch/Fr = 1/3 mm, 1mm = 3Ch/Fr
 Size 5-8 Fr is used for infants and young children.
 Children typically use 8-12 Ch/Fr
 Most adult women use catheter size 12-16 Ch/Fr.
 The average size tends to be around 14 to 18 Fr for
most male
2/24/2023 30

Catheter indication
 Performed only as the last resort, because it poses a risk of infection
in the urinary tract.
• Urinary incontinence
• Urinary retention
• In order to rinse the bladder and instillation of medication into the
bladder
• Provide a means to monitor accurate urine output
2/24/2023 31

Catheter indication …
 To assess the residual urine
 To obtain a urine specimen
 To empty the bladder prior to surgery
 Instilling contrast material into the bladder to study the bladder and urethra
2/24/2023 32

Equipment for Sterile Set
Catheter
2 Sterile drapes (fenestrated & square drape)
Sterile gauze
14 Cotton swabs
6 forceps in kidney dish
Receiver (kidney dish)
1 forceps in Sterile urine
receptacle (KD)
5-10 cc Sterile water in
galipot
Syringe (usually 10 cc)
Galipot
Sterile gloves
Specimen bottle
Urinary catheterization procedure
2/24/2023 33

Equipment for Clean Set
Cleansing solution (sterile NS)
Urine collection bag & tubing
Bed screen
Soap and 3 washcloths
Warm water in basin
Towel
Rubber sheet
Lubricant
Tape
Disposable gloves
Bath blanket
Urinary catheterization procedure…
2/24/2023 34

 Before the procedure review careful history from the card about any
allergies to latex, indications and contraindications
1. Explain the procedure to patient
2. Wash hands, gather equipment and bring to the bed side
3. Provide privacy by applying bed screen.
4. Proper light source should be present.
5. Adjust the bed to a comfortable height and apply bath blanket.
2/24/2023 35

6. Place the patient in an appropriate position
Male: supine position with legs slightly spread and feet together.
Female: dorsal recumbent (supine position with flexed legs)
7. Don disposable gloves and wash perineal area with plain soap and
water (if not did).
8. Remove disposable gloves.
2/24/2023 36

9. Hang the urinary drainage bag on the side of the bed and place below
the level of bladder.
10. Open the sterile field and:
Pour cleansing solution in one galipot
Place lubricant in one sterile gauze
Open the Foley catheter and place it on the sterile field (if not placed)
11. Apply sterile gloves and fill the syringe with sterile NS (5-10ml)
from galipot.
2/24/2023 37

12. Check balloon for any leakage and symmetry then deflate and leave
the syringe attached.
13. Lubricate the catheter tip and place on the sterile urine receptacle
(kidney dish).
14. Place square (un-fenestrated) drape b/n thighs or under patient hip
(Women: Under the perineal area, Men: Across the thighs).
15. Place sterile supplies on the sterile square drape.
2/24/2023 38

16. Clean the area
 For male
 For circumcised male
 Clean the tip of the penis first using a circular motion from the meatus
outward.
 Clean the shaft of the penis using downward strokes toward the pubic area.
2/24/2023 39

 For uncircumcised male
 Retract the foreskin and clean the glans of the penis.
 Be sure to replace the foreskin after cleansing.
 For female
 Normal saline used as cleansing solution
 7 swabs and 3 forceps used in zigzag fashion.
2/24/2023 40

 Use one forceps for step 1, 2, and 3
1) Pubic area
2) Right groin
3) Left groin
 Use one forceps for step 4 and 5
4) Right labia (Periurethral mucosa)
5) Left labia
2/24/2023 41

 Use one forceps for step 6 and 7
6) From urethral orifice to vaginal orifice
7) From urethral orifice to anal orifice
17. Drying the area using 7 dry cotton balls and 3 forceps in the same way of
cleansing.
18. Place fenestrated drape on the client’s abdomen and thighs.
19. Pick up and hold end of catheter loosely coiled in palm of dominant hand
(still sterile).
2/24/2023 42

20. Expose the urinary meatus adequately by:
Male: holding the penis perpendicular using non-dominant hand.
Female: separate labia using non-dominant hand.
21. Identify the urinary meatus and gently insert:
5cm in females and 20cm in males or
Until urine comes.
22. Clamp the drainage lumen and inflate the balloon using 5-10cc
sterile NS.
2/24/2023 43

2/24/2023 44

23. Instruct the client to immediately report discomfort or pressure during
balloon inflation; if pain occurs:
Deflate the balloon
Insert the catheter farther into the bladder (1-2 inch)
Inflate the balloon again
24. Gently pull the catheter until the retention balloon is snagged against
the bladder neck (resistance will be met).
2/24/2023 45

25. Remove the fenestrated drape.
26. Connect the catheter with drainage bag tube.
27. Secure the catheter to the abdomen or inner thigh using tape.
28. Clean the perineal area using corners of sterile square drape to remove lubricant
and remove gloves.
29. Reposition the patient and return the bed to lowest position.
30. Wash hands and document type and size of catheter and balloon inserted. As
well as the amount of fluid used to inflate the balloon. The amount, color, odour,
and quality of urine.
2/24/2023 46

o Apply clean gloves.
o Slightly palpate over the pubic area to check the emptiness of
the bladder.
o Withdraw the solution from (deflate) the balloon using a
syringe.
o Remove catheter gently and discard.
Urinary catheterization removal
2/24/2023 47

Definition
 It is the administration of a large amount of fluid (>=50ml),
electrolytes, nutrients, or medications into the system
through a vein.
 Purpose:
To maintain fluid & electrolyte balance
To introduce medication particularly antibiotics.
49

50
Peripheral veins used in iv therapy

• IV fluid as ordered
• Vigo
• Rubber & towel sheet
• Receiver
• Alcohol swabs
51
Equipment
 Sterile gloves
 Adhesive tape
 Tourniquet
 IV pole
 Medication chart

1. Explain the procedure to the patient. Be sure you have right
patient.
2. Take equipment to the patient's bedside
3. Place the pt in a comfortable position.
4. Set IV bag and tube (Remove air from the tubing)
52
Procedure

• Prepare the IV solution bag for administration
 Remove outer wrapper around IV bag of solution.
 Inspect bag for tears or leaks by noting any moisture on the protective covering.
 Apply gentle pressure and observe for leakage.
 Examine solution for discoloration, cloudiness, or particulate matter by holding the
bag against a dark and light background; if there is any evidence of contamination,
and do not use.
 Hang IV bag on the IV pole.
53
Procedure…

• Prepare the IV tubing (administration set )
 Remove administration set from the package and close the roller clamp on the
IV tubing.
 With your dominant hand, remove the protective cap from the nonvented IV
tubing spike.
 Grasp the port of the IV bag with your nondominant hand.
 Insert the full length of the spike into the bag’s port
54
Procedure…

55
 Squeeze and quickly release
pressure on the drip chamber of
the IV tubing until the chamber
is one-third to one-half full.
 Open the roller clamp on the
tubing to allow the fluid to enter
the tube and expel the air.
Procedure…

5. Place rubber & towel under the arm
6. Select the vein and apply tourniquet about 15 cm above the intended
site of entry.
7. Observe & palpate for suitable vein
8. Apply sterile gloves & cleanse the skin with alcohol swabs
thoroughly.
56
Procedure…

9. Use thumb to retract down the vein & soft tissue 4 cm below
the intended site of injection.
10. Hold needle (Vigo) at 25°-45° angle line with the vein
11. Pierce the skin and puncture the vein
12. Check if you are in the vein by drawing back with the metal
stylet. (blood returns if you are in the vein)
57
Procedure…

13. Release the tourniquet immediately & apply pressure over the
end of cannula.
14. Attach IV tube with Vigo & Start flow of solution by opening the
clamp.
15. Support needle (Vigo) with adhesive tape to keep it in proper
position in the vein.
16. Anchor the IV tubing with the adhesive tape to prevent pull on
the Vigo.
58
Procedure…

17. Adjust the rate of flow by the following formula.
59
ml of solution X drop/min (drop rate factor)= drops per min
Hours to administer X 60 (min/hr)
1ml= 15-20 drop, this is the drop rate factor.
For example, if you are ordered to administer 1L of solution over 8hours:
Drop rate = 1000ml x 15-20drops/ml
8hrs 60(min/hr)
= 1000ml x 20drops/min
8hr 60 (min/hr)
= 41.67drops/min.
•Therefore, you have to allow the fluid to flow at a rate of 42 drops/min.
Procedure…

 A wound is any disruption in the skin’s intactness.
 It may be accidental or intentional.
 Accidental: it can be abrasion (rubbing off the skin’s surface); a puncture wound
(stab wound), laceration (a wound with torn or ragged edges).
 Is usually contaminated
 Intentional: such as surgical incision (a wound with clean edges).
 They are made under sterile conditions.
61
Definition

Equipment for dressing of
wound
 Pick up forceps in a container.
 Three sterile forceps.
 Sterile bowl or kidney dish.
 Sterile cotton balls.
 Sterile gallipots.
 Sterile gauze.
 Rubber sheet with its cover.
62
Antiseptic solution as ordered.
Adhesive tape or bandages.
 Scissors.
Ointment or other types of drugs as needed.
Receiver.
 Spatula if needed.
 Benzene or ether.

Procedure
 Explain procedure to the patient.
 Clean trolley or tray; assemble sterile equipment on one side, and clean
items on the other side. Make sure it is covered.
 Drape and put patient in comfortable position.
 Place rubber sheet and its cover under the affected side.
 Remove the outer layer of the dressing e.g. adhesive tape bandage.
63

Procedure…
 Remove the inner layer of the dressing using the first sterile
forceps and discard both the soiled dressing and the forceps.
 Take the second sterile forceps. Clean wound with cotton balls
soaked in antiseptic solution, starting from inside to the outside.
 Again use the second forceps to clean the skin around and remove
adhesive mark with benzene or ether.
 Apply medication if any and dress the wound with sterile gauze.
64

Procedure…
 Ointment must be smeared with spatula on gauze.
and then applied on the wound.
 Solutions or powder can be applied direct on the wound.
 Make sure that the wound is properly covered
 Fix dressing in place using adhesive tape or bandage
 Leave patient comfortable and tidy
 Record state of wound
 Clean and return equipment to proper place
65

Oxygen therapy
 Is the administration of oxygen at a concentration greater than that
found in the atmosphere (21%).
 The oxygen may be administered with or without humidity.
 Purpose
 To provide adequate O2concentration to the lung during hypoxemia,
severe respiratory distress, COPD and acute MI
 Used as a short term therapy such as post-anaesthesia recovery

Equipment
• Oxygen Cylinder with oxygen regulator or
flow meter, Oxygen Tubing
• Humidifier bottle, if humidification used
• 50ml distilled water
• Tissue paper or normal saline in galipot
• Nasal cannula, simple mask, nasal catheter
• Sign of ‘NO SMOKING’
• Clean glove, pen light
• Cotton tipped applicator
• Towel, receiver
• Safety Pin, plaster

Procedure…
 Explain procedure to the patient.
 Wash hands and bring equipment to the pt.’s bed side.
 Check the emptiness or fullness of cylinder by knocking and bring it to
the pt.’s bed side.
 Post ‘NO Smoking’ signs in the room and on the door.
 Place the patient on semi fowler’s position.
 Assess the nasal passages of the pt. with a pen light for obstruction.

Procedure…
 Apply clean glove, place towel over the chest & clean his nostril using
tissue paper or NS.
 If humidification is used, connect the humidifier bottle to the flow
meter.
 Attach oxygen tubing to the humidifier bottle
 Connect the nasal cannula to oxygen tubing.
 Turn on oxygen flow system by turning the knob to the left

Procedure…
 Adjust flow rate to the prescribed amount (usually 1-6 LPM).
 Insert nasal prongs into client’s nostrils.
 Wrap tubing over and behind the client’s ears.
 Adjust the tubing under the chin by sliding the adjuster upward.
 Secure the tubing to the bed linen by safety pin.
 Record pt. status, starting time, flow of O2, used method & your findings.
 Assess the pt.’s nares and ears Q 4 hr. for signs of skin breakdown and the
presence of nasal secretions.

Definition
• Tracheotomy: A surgical procedure in which
an opening (stoma) is made
• Tracheostomy: is an artificial airway (20
airways) through the anterior neck into the
windpipe (trachea).
• Tracheostomy tube (curved tube) is a
breathing tube that is used for an extended
period of time breathing.

Indication
 To supply adequate amount of O2 to the lungs
 To bypass upper respiratory tract obstruction
 To remove secretion from the tracheostomy tube
 To keep the airway open

Tracheostomy care
 Includes:
 Cleaning the inner cannula
 Cleansing the stoma and skin around the stoma
 Changing the tracheostomy tie and dressing

Equipment
 Sterile Set containing:
• Sterile gloves, H2O2, normal
saline
• 3 Sterile solution containers
(galipots)
• Cotton tip applicators
• Sterile 4x4 gauze sponge
• Test tube brush
Clean set containing:
• Exam gloves
• Stethoscope
• Clean scissors
• Tracheostomy Tie
• Waste receptacle

Procedure
 Explain the procedure to the patient.
 Wash hands and assemble and bring necessary equipment.
 If suctioning is required, perform that procedure prior to beginning
tracheostomy care.
 Position the patient in semi-Fowler's position and perform respiratory
assessment.
 Open the sterile set and pour

Procedure…
H2O2 in one basin and
sterile saline in the other two basins
Put on exam gloves to:
• remove soiled tracheostomy dressing
• unlock, remove & place the inner cannula in the H2O2 to soak for a
few minutes

Procedure…
 Remove exam gloves and put on sterile gloves to:
clean the inner cannula with the test tube brush
rinse the inner cannula in the sterile saline
remove and allow it to dry on a sterile gauze
 Reinsert the inner cannula and lock in place.
Cleanse the stoma and surrounding area with normal saline.
 If crusty mucus is not present:
 Dip cotton tipped in sterile saline.

Procedure …
 Roll the cotton tip swab b/n the trach tube and the skin in outward motion
then clean the neck plate of trach tube.
 Use each swab only one (1) time.
 Repeat this process until mucus is removed.
 Dry area with the regular 4x4 gauze.
 If crusty mucus is present:
 Dip cotton tipped in the mixture of 10ml of H2O2 and 10ml of sterile
saline.

Procedure …
 Roll the cotton tip swab between the trach tube and the skin in
outward motion.
 Use each swab only 1x.
 Repeat this process until mucus is removed.
 Rinse the area using a cotton tip swab with sterile saline only after
the crusts are removed.
 Dry area with the regular 4x4 gauze.

Procedure …
• Reapply ties by Cutting and removing soiled ties while the patient or an
assistant should hold the outer tube in place to prevent dislodgement of the
tube.
• Apply sterile tracheostomy dressing (pre-cut sterile 4x4 gauze) with the
split toward the chin, allowing the uncut portion to absorb secretions.
• Remove gloves and wash your hands.
• Returns all equipment to the appropriate location.
• Record procedure in Nursing Notes.

Jimma Nursing Art: Infection Control and Patient Safety Practices

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