Infection Control

Handling Equipment Discard [blank_start]Disposables[blank_end] Nondisposable mouthpieces should be washed, disinfected and dried after each use. External spirometry tubing should be replaced or [blank_start]disinfected[blank_end] Wipe equipment parts with [blank_start]alcohol[blank_end] that patient touches Noseclips thrown away or wiped Change water in water seal spirometer Change filters after [blank_start]each use[blank_end]

Pt Scheduling Schedule pt with possible or confirmed infection at the [blank_start]end[blank_end] of the day

Routes of transmission Contact Respiratory [blank_start]Droplets[blank_end] Airborne [blank_start]Droplet[blank_end] Nuclei

Standard Precautions Handwash Gloves Mask/eye/face [blank_start]shields[blank_end] Gowns Pt Care equipment Occupational Health and bloodborne [blank_start]pathogens[blank_end] Pt Placement Expanded Precautions [blank_start]Contact[blank_end] precautions Droplet Precautions Airborne Infection isolation (Niosh [blank_start]Respirator[blank_end]) Protective Equipment

PPE [blank_start]Gloves[blank_end] – secretions or blood [blank_start]Gowns[blank_end] – strict or reverse isolation [blank_start]Goggles[blank_end] – contact with secretions or blood [blank_start]Masks[blank_end] – airborne

Preventing Nosocomial Infections Wright Respirometer should have 1 way [blank_start]valve[blank_end] or personal sampling chambers [blank_start]Double bag[blank_end] HIV/Aids before gas sterilization Avoid cross contamination with aerosolized meds by using [blank_start]MDI[blank_end]

Biohazardous Materials [blank_start]Bio[blank_end] Waste – Lab Waste, specimen cultures, vaccines, culture dishes. Human Blood, things contaminated with blood or other body fluids [blank_start]Medical[blank_end] Waste – Waste that is generated pertaining to diagnosis, treatment, immunization or testing. Sharps must be placed in a puncture proof container

[blank_start]Sterilization[blank_end] – Complete destruction of ALL microorganisms. [blank_start]Disinfection[blank_end] – Destroying vegetative pathogenic microorganisms 6 Chemical Methods of disinfection/Sterilization 1. Ethylene Oxide – ETO alkalization of enzymes 2. Alkaline glutaraldehyde – [blank_start]Cidex[blank_end] 3. [blank_start]Acid[blank_end] Glutaraldehyde – Sonacide 4. Alcohol 5. Soaps/Detergents 6. [blank_start]Bleach[blank_end] (for blood) 4 Physical Methods of Disinfection / Sterilization 1. Steam under pressure ([blank_start]autoclave[blank_end]) 2. Pasteurization – moderate temps 3. Incineration – best method for [blank_start]contaminated[blank_end] disposable items 4. [blank_start]Irradiation[blank_end] – Gamma Rays to sterilize prepackaged equipment

Volume Measuring Spirometers [blank_start]Wedge[blank_end] Bellows Collapsable bellows that folds and unfolds as patient breathes Will [blank_start]lose[blank_end] volume if [blank_start]cracks[blank_end] or holes in bellows Dry Rolling Seal Spirometer Volume Displacement Consists of a [blank_start]piston[blank_end] within a cylinder supported by a [blank_start]rod[blank_end] resting on a frictionless bearings Rod can be attached directly to a potentiometer or recording pen on paper Can be used to assess pre/post bronchodilator changes Water Seal Spirometer Volume Displacement AKA [blank_start]Collins[blank_end] or [blank_start]Steadwell[blank_end] Large bell [blank_start]7[blank_end]-[blank_start]14[blank_end] L, submerged in a column of H2O As pt breathes, bell moves an equally [blank_start]proportional[blank_end] distance Recorded with chain/pulley device connected to kymograph For [blank_start]rebreathing[blank_end] studies: separate hoses and CO2 scrubber are needed Calibration: Using 3L syringer, must be accurate - range +- [blank_start]3.5[blank_end]% Leak Test: Filling spirometer to [blank_start]1/2[blank_end] volume then applying a weight Flow Cal: using [blank_start]rotameter[blank_end] 2-12 L/sec

Peak flow meter Measure peak expiratory flow at [blank_start]bedside[blank_end] Pt inhales maximally then exhales hard and fast through deice [blank_start]PEFR is[blank_end] read directly from scale Factors that affect accuracy - Pt effort, Moisture, Debris Turbine Device Wright Respirometer Rotating [blank_start]Vane[blank_end] with [blank_start]gears[blank_end], flow causes vanes to [blank_start]spin[blank_end] and displays volume Accurate from 3-[blank_start]300[blank_end] lpm Assure linearity by checking [blank_start]flows[blank_end] with 3L syringe Can become alinear from vane [blank_start]deformation[blank_end], contamination or debris

Pneumotach - measures flow and converts to volume display [blank_start]Ultrasonic[blank_end] Pneumotach AKA Vortex Shedding or [blank_start]Transit[blank_end] Time Consists of an [blank_start]emitting[blank_end] and [blank_start]recieving[blank_end] crystal and a lflow tube with struts Number of pulses is [blank_start]proportional[blank_end] to flow Pitot Tube Flow measured by placing a series of small tubes in a [blank_start]flow[blank_end] sensor and connecting to a [blank_start]pressure[blank_end] transducer Condensation and [blank_start]secretions[blank_end] do not affect measurements [blank_start]Thermal[blank_end] Element Contains heated platinum wire or small metal bead that cools as gas [blank_start]flows[blank_end] across. [blank_start]Amount[blank_end] of current needed to maintain tem is proportional to [blank_start]flow[blank_end] Accuracy is affected by gas composition Pressure Differential AKA Fleisch Pneumotach Contains [blank_start]resistive[blank_end] element that causes pressure to drop as gas flows across. Difference in [blank_start]pressure[blank_end] is proportional to flow Commonly used in Body Box Heat is incorporated to reduce condensation

Calibration 3L syringe to check for [blank_start]leaks[blank_end] Volume should be checked at low, med and high [blank_start]flows[blank_end] to assure linerity Rotameter is a good device for reproducible low flows Sine-Wave pump: [blank_start]Biphasic[blank_end], simulates flows and volumes Automatic Syringe - Computer Controlled motor [blank_start]syringe[blank_end] Explosive decompression device - simulates [blank_start]FVC[blank_end] Alinearity can happen: Contamination, bent [blank_start]vanes[blank_end], moisture, debris Once volume displacement spirometer is caled it will retain linearity until it develops a [blank_start]leak[blank_end]