This book presents novel design principles and technologies for dynamic isolation based on experimental studies. These approaches have now become the. Request PDF on ResearchGate | On Dec 1, , Zhonglin Xu and others published Dynamic Isolation Technologies in Negative Pressure Isolation Wards.
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You can remove the unavailable item s now or we'll automatically remove it at Checkout. Remove FREE. Unavailable for purchase. Continue shopping Checkout Continue shopping. Chi ama i libri sceglie Kobo e inMondadori. Choose Store. Or, get it for Kobo Super Points! Learn how to more effectively run your immediate care or walk-in center as well as start incorporating urgent care services into your existing primary care practice. Standards of cleanliness in the NHS: a framework in which to measure performance outcomes. Leeds: NHS Estates; Available at:. Exposure prone procedures EPPs are invasive procedures where there is potential for direct contact between the skin, usually finger or thumb of the healthcare worker, and sharp surgical instruments, needles, or sharp tissues e.
During EPPs, there is an increased risk of transmitting bloodborne viruses between healthcare workers and patients. The nature of the EPP performed by the healthcare worker can be categorised according to level of risk of transmission, in increasing order of magnitude.
London; AandE staff members who are restricted from performing EPPs should not provide pre-hospital trauma care. These staff should not physically examine or otherwise handle acute trauma patients with open tissues because of the unpredictable risk of injury from sharp tissues. Cover from colleagues who are allowed to perform EPPs would be needed at all times to avoid this eventuality.
Endotracheal intubation, use of a laryngeal mask and procedures performed purely percutaneously are not exposure prone. The only procedures currently performed by anaesthetists which would constitute EPPs are:. The insertion of a chest drain may or may not be considered to be exposure prone depending on how it is performed. Procedures where, following a small initial incision, the chest drain with its internal trochar is passed directly through the chest wall as may happen e.
However, where a larger incision is made, and a finger is inserted into the chest cavity e. Modern techniques for skin tunnelling involve wire guided techniques and putting steel or plastic trochars from the entry site to the exit site where they are retrieved in full vision. Although the use of more percutaneous techniques has made arterial or venous cutdown to obtain access to blood vessels an unusual procedure, it may still be used in rare cases.
Staff working in areas where there is a significant risk of being bitten should not be considered to be performing EPPs. Implantation of permanent pacemakers for which a skin tunnelling technique is used to site the pacemaker device subcutaneously may or may not be exposure prone. The definition for exposure-prone procedures for dentistry is currently under review.
The guideline will be updated once this issue is resolved.
Simple endoscopic procedures e. In general there is a risk that surgical endoscopic procedures e. Open surgical procedures are exposure prone. Cone biopsies performed with a loop or laser would not in themselves be classified as exposure prone, but if local anaesthetic was administered to the cervix other than under direct vision i. Exceptions are: if main trochar inserted using an open procedure, as for example in a patient who has had previous abdominal surgery. Also exposure prone if rectus sheath closed at port sites using J-needle, and fingers rather than needle holders and forceps are used.
In general there is a risk that a therapeutic, rather than a diagnostic, laparoscopy may escalate due to complications, which may not have been foreseen necessitating an open EPP. Simple vaginal delivery, amniotomy using a plastic device, attachment of foetal scalp electrodes, infiltration of local anaesthetic prior to an episiotomy and the use of scissors to make an episiotomy cut are not exposure prone. The only EPPs routinely undertaken by midwives are repairs following episiotomies and perineal tears: category 1 in the case of first-degree lacerations; category 2 in the case of second, third and fourth degree lacerations.
Repairs of third and fourth degree tears are normally undertaken by medical staff members who may include general practitioners assisting at births in a community setting.
In the context of general practice, minor surgical procedures such as excision of sebaceous cysts, skin lesions, cauterisation of skin warts, aspiration of bursae, cortisone injections into joints and vasectomies do not usually constitute EPPs. Healthcare workers need not refrain from performing EPPs pending follow up of occupational exposure to a BBV infected source. The combined risks of contracting a BBV from the source patient and then transmitting this to another patient during an EPP is so low as to be considered negligible.
However in the event of the worker being diagnosed with a BBV, such procedures should cease in accordance with this guidance. General nursing procedures do not include EPPs.
The duties of operating room nurses should be considered individually. Instrument nurses do not generally undertake EPPs. Obstetricians perform surgical procedures, many of which will be exposure prone according to the criteria. Exceptions may occur in some acute trauma cases, which should be avoided by EPP restricted surgeons. Paramedics do not normally perform EPPs. However, paramedics who would be restricted from performing EPPs should not provide pre-hospital trauma care. In the event of injury to an EPP restricted pathologist performing a post mortem examination, the risk to other workers handling the same body subsequently is so remote that no restriction is recommended.
Routine procedures undertaken by podiatrists who are not trained in and do not perform surgical techniques are not exposure prone. Procedures undertaken by podiatric surgeons include surgery on nails, bones and soft tissue of the foot and lower leg, and joint replacements. These procedures are not exposure prone and neither haemofiltration nor haemodialysis constitute EPPs. The working practices of those staff members who supervise haemofiltration and haemodialysis circuits do not include EPPs.
London: UK Dept Health. Typically, IV maintenance procedures will be assessed as requiring Standard ANTT with the employment of a main general aseptic field and critical micro aseptic fields. Such a tray provides a sufficiently large, robust and controlled working area. Reprocess re-usable trays according to local policy. Hands are contaminated when gathering equipment from storage cupboards etc. Gathering equipment at this point also allows the tray to dry properly and saves a little time. This occurs immediately before assembly of equipment and the preparation of drugs.
This way, hands are optimally clean prior to glove application and non-touch technique key part manipulation. Primarily, gloves are worn to protect the user from drug exposure and blood products. All peripheral and central access IV procedures should be performed without touching key parts. Therefore, non-sterile gloves will nearly always be the logical and efficient glove choice.
In the event the healthcare worker unknowingly touches a key part, non-sterile gloves also act as a safety net as they are typically cleaner than skin. Assemble equipment and prepare medications — protect key parts using non-touch-technique. A non-touch technique is the most important component of aseptic practice because a key part cannot be contaminated directly if it is not touched. Key parts should be protected throughout the procedure when they are not in use.
This can be achieved by using sterilised IV bungs or the inside of syringe packets.