Download - Airborne Case Study Presentation-NEW
![Page 1: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/1.jpg)
Case Study Presentation
Airborne Isolation Management
![Page 2: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/2.jpg)
Patient’s History
• Madam A- 55yrs old, Female. • Admitted for right eye ECCE + IOL insertion
surgery, under Dr.Mohammed.
• No drug/food allergy.
• Patient has HTN, DM, dyslipidemia and active PTB- on medication.
![Page 3: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/3.jpg)
Medications patient is on:
Amlodipine , Omeprazole, Metformin, Glibenclamide, Insulin, Cozar, Rifadin, Pyrazinamide, Citalopram, Ethambutol.
![Page 4: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/4.jpg)
Background of patient :
• PTB since year 2011, after 3 sputum smear positive.
• Started on Isoniazid & Rifampicin for 6 months and 2 additional antibiotics- Pyrazinamide & Ethambutol everyday for 1st 2 months.
• Patient stopped taking meds in year 2012 for 8 months and defaulted follow ups, due to personal reasons.
• Started back on TB meds in year 2013.• Last follow up with Dr.Thamer was on
12/1/14.• Chest x-ray last done on 26/2/14.• Still active PTB.
![Page 5: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/5.jpg)
What is PTB?
• Pulmonary tuberculosis (PTB) is an infectious disease caused by slow- growing bacteria that resembles a fungus, Myobacterium tuberculosis, which is usually spread from person to person by droplet nuclei through the air.
• The lung is the usual infection site but the disease can occur elsewhere in the body, such as at the cervical lymph glands, bone, the renal system.
![Page 6: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/6.jpg)
![Page 7: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/7.jpg)
Incidence and Prevalence
of Tuberculosis in KSA
![Page 8: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/8.jpg)
Table 1: Annual TB patient numbers and incidence rate/100,000 in Saudi Arabia
(1991-2010)
![Page 9: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/9.jpg)
Epidemiology for more Incidence of TB occurrence in Saudi Arabia
According to WHO statistics review:
Huge number of expatriate worker force who are residents of this country,came from countries with a high burden of TB such as India, Pakistan, Bangladesh, Indonesia, and Yemen.
This probably has adversely affected TB control in the Kingdom.Relapse and default patients to moderate likelihood of MDR
![Page 10: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/10.jpg)
Late diagnosis
• Pulmonary TB patients are often diagnosed many weeks after the onset of symptoms.
• This diagnostic delay allows for transmission of the disease to many contacts.
• Emphasis on timely contact tracing and treatment of those with active or latent disease is one of the most important aspects of TB control.
• Clinicians caring for TB patients need to be more vigilant in this particular area.
![Page 11: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/11.jpg)
Pilgrims from various part of the world coming into KSA with background of unknown medical conditions.
• TB incidence for Saudis showed a clear variation in different regions. Makkah and Gizan regions showed the highest incidence rate that reached up to 29.5/100,000.
• The trend was rising significantly in Makkah over the last 20 years. The Central region had a significant rise in incidence climbing from 6.4 to 14.2/100,000.
• Other regions showed a much lower and stable incidence of 4-9/100,000.
![Page 12: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/12.jpg)
Drug resistance
• One of the most dangerous forms of TB is multidrug-resistant TB (MDR-TB), defined as resistance to, at least, Isoniazid and Rifampin, the two most potent first-line anti-TB drugs.
• Arises due to improper use of antibiotics in chemotherapy of drug-susceptible TB patients.
![Page 13: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/13.jpg)
![Page 14: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/14.jpg)
![Page 15: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/15.jpg)
AIRBORNE ISOLATION PRECAUTIONS
![Page 16: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/16.jpg)
• Airborne infection isolation is based on the following hierarchy of control measures:
a) Administrative (work practice) controls
b) Environmental controls
c) Personal protective equipments (PPE)
Principles of Airborne Infectious Disease Management
![Page 17: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/17.jpg)
a) Administrative (work practice) controls
Work practice controls include using infection control precautions while performing aerosol-generating procedures, closing doors to AIIRs, hand hygiene, and signage.
Written policies and protocols to ensure the rapid identification, Isolation, diagnostic evaluation, and treatment of persons likely to have an airborne infectious disease.
![Page 18: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/18.jpg)
Internal Policies and Procedures (IPP) in NGHA
Airborne Isolation Precautions – ICM-III-03 Management of Suspected/Confirmed Cases of
Infectious Tuberculosis – ICM-V-03 Standard Precautions – ICM-II-03 Transporting Patients in Isolation Precautions –
ICM-III-09 Isolation System: A Quick Reference Guide – ICM-
III-06
![Page 19: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/19.jpg)
b) Environmental controls
• Physical or mechanical measures (as opposed to administrative control measures) used to reduce the risk for transmission of airborne infectious diseases. Example :
• ventilation• filtration• AIIRs (Airborne Infection Isolation Rooms)• local exhaust• UVGI (Ultra-violet Germicidal Irradiation)
![Page 20: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/20.jpg)
c) Personal Protective Equipment (PPE)
• Equipment worn by health care workers and others to reduce exposure to communicable diseases.
EXAMPLES:
Gowns Gloves Masks (N95) Respirators Eye protection
![Page 21: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/21.jpg)
NURSING ASPECTS FOR PTB PATIENTS
![Page 22: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/22.jpg)
Risk for Infection
• The goal is to reduce the risk of spreading tuberculosis and making sure the patient's tuberculosis is effectively treated.
Teach the patient about the infectious nature of tuberculosis and the need to prevent its spread.
Place the patient in a negative pressure room (AIIRs) or in a private room.
All nurses and visitors entering the patient's room should wear a N-95 mask.
Put a surgical mask on the patient during transportation to other departments. Refer to
ICM-III-09 Transporting Patients in Isolation Precautions.
![Page 23: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/23.jpg)
Keep the door to the patient's room shut and place an isolation sign at a visible location near the door.
Use standard precautions when providing direct care to the patient. This includes wearing gloves, gowns, mask and effective hand washing.
Teach patient how to avoid spreading the disease by sneezing or coughing into doubly ply tissue instead of their bare hands, washing their hands after this and disposing of the tissue into a closed plastic bag.
![Page 24: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/24.jpg)
![Page 25: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/25.jpg)
• Airborne isolation precautions must be used together with standard precautions
–ICM-II-03
![Page 26: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/26.jpg)
Standard precautions
ICM-II-03
• Treating all patients in the health care facility with the same basic level of "standard" precautions.
• It involves work practices that are essential to provide a high level of protection to patients, health care workers and visitors.
![Page 27: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/27.jpg)
These include the following: • hand washing and antisepsis (hand hygiene); • use of personal protective equipment when
handling blood, body substances, excretions and secretions;
• appropriate handling of patient care equipment and soiled linen;
• prevention of needle stick/sharp injuries; • environmental cleaning and spills-
management; and appropriate handling of waste.
![Page 28: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/28.jpg)
TB Patient Transportation
• THE PATIENT SHOULD WEAR A SURGICAL MASK IF TRANSPORT OUTSIDE OF THE ROOM AND IT IS ESSENTIAL.
• Surgical masks are designed to reduce the number of droplets being exhaled into the air by persons with infectious TB disease when they breathe, talk, cough, or sneeze.
• Respirators/N95 are designed to protect HCWs and other individuals from inhaling those droplet nuclei.
![Page 29: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/29.jpg)
After discharge patient :
• KEEP DOORS CLOSED FOR AT LEAST 30 MINUTES AFTER AN AIRBORNE INFECTION ISOLATION PATIENT LEAVES THE ROOM.
• During that time the door should remain closed and respiratory protection is still required to enter the room.
• In a room with re-circulated air, if the patient has been in the room without a surgical mask on, the portable HEPA (High-efficiency Particulate Absorption) unit should be left running approximately 30 minutes after the patient leaves.
![Page 30: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/30.jpg)
Discontinuation :
• Airborne precautions in a health-care or congregate setting may be discontinued when a patient has been on adequate therapy for 2 weeks or longer, symptoms improved, and there have been three consecutive, negative AFB (Acid-Fast Bacilli) sputum smear results.
![Page 31: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/31.jpg)
References
• NGHA Infection Control Manual.
• Lippincott Manual of Nursing Practice"; Sandra M. Nettina ANP-BC.; 2013.
• World Health Organization:WHO Report 2013: Global Tuberculosis Control; 2013.
• "Nursing care Plans: Nursing Diagnosis and Intervention"; NANDA; Meg Gulanick, PhD, APRN, FAAN., et. al.; 2012.
![Page 32: Airborne Case Study Presentation-NEW](https://reader034.vdocuments.site/reader034/viewer/2022052603/563dbab4550346aa9aa75a46/html5/thumbnails/32.jpg)