RESPIRATORY DISTRESS SYNDROME

What is RDS?
Respiratory Distress Syndrome occurs most commonly in premature neonates weighing between 1000-1500 gms and between 28-27 weeks of gestation.



Definition:
“RDS formerly known as Hyaline membrane disease is a syndrome of premature neonates that is characterized by progressive & usually fatal respiratory failure resulting from atelectasis & immaturity of lungs”.

Pathophysiology:
Deficiency of surfactant leads to lung incompetence causing decrease alveolar function  resulting in reduced lung volume may result in atelectasis.

Etiology & Risk factors:

• Decreased pulmonary surface
• Hypoxia
• Intrapartum stress
• Maternal hypertension
• Sepsis
• Apnic episodes 
• Acidosis
• Hypothermia
• Intracranial hemorrhage
• Cardiac defects

Sign & Symptoms:
Primary symptoms:

• Nasal flaring
• Tachypnea > 60bpm
• Hypothermia
• Cyanosis
• Apnea
• Bradycardia
• Expiratory grunting
• Pulmonary edema

Secondary Symptoms:

• Hypotension
• Peripheral edema
• Decrease urine output
• Absent bowel sound

Medical & Nursing Management:

• Maintain suitable environment to keep normal body temperature.
• Oxygen administration by O2 hood or nasal prongs.
• SPO2 should be maintained at 90-93% for neonates & 88-92% for preterm neonates.
• Iv fluids.
• Antibiotics.
• NG tube.
• Infection control measures
• Intubation with PEEP mode ventilation.
• Surgical interventions may be planned as per situations.
• Drugs such as Aminophylline to treat apnea.
• Surfactant Replacement therapy.

Distinctive facts:

• Ix: Silverman Anderson score, Downes score, CXR, PFT
• ABG Analysis might show following results:

paco2 =increase
Pao2  = decrease
ph = decrease
Calcium = decrease
Glucose = decrease

• Adapt InSurE technique:

Intubate
Surfactant
Extubation to CPAP mode

• Complications include: Pneumothorax, Emphysema, Heart failure, Retrosternal fibroplasia, Tracheal stenosis.

 

Prognosis :
Prognosis depends on severity of symptoms.
Prevention can be done by early identification of cause.
Antenatal corticosteroid therapy should be given in preterm labor before 34 weeks of pregnancy.

COVID PNEUMONIA

                              COVID PNEUMONIA

What is the relationship between COVID & Pneumonia?

Infection of COVID begins with respiratory tract & damages the alveoli making it swell & inflammed leading to pus formation causing pneumonia.

How does COVID Pneumonia develop?

COVID patients may develop severe pneumonia by accumulation of fluid in lungs making fluid leak out of blood vessels in lungs leading to deprivation of oxygen carrying capacities of the lungs resulting in shortness of breath.

Who is at risk of developing COVID Pneumonia?

People with conditions that weaken the lungs or immune system may be more vulnerable to COVID Pneumonia. Besides older adults over 65 years of age & those living in long term health care facility are also put at high risk.

This include:

• Cancer
• Diabetes
• High blood pressure
• Severe heart disease
• Kidney or liver disease
• Asthma and other breathing disorders
• Obesity
• Having HIV
• Having bone marrow transplant

Incubation Period for COVID Pneumonia?

Approximately 14 days incubation period is suspected. 4-5 days after onset of symptoms is considered to be highly infectious & chances of transmission of infection is more. 

What are the symptoms of COVID Pneumonia?

• Cough may or may not be productive
• Fever
• Fatigue
• Chest pain

CDC guidelines for emergency signs of COVID Pneumonia:

• Difficulty breathing
• Rapid, shallow breathing
• Persistent feelings of pressure or pain in the chest
• Rapid heartbeat
• Confusion
• Bluish color of the lips, face, or fingernails
• Trouble staying awake or difficulty waking

How can COVID Pneumonia be diagnosed?

CT scans and laboratory tests found that people with COVID Pneumonia were more likely to have:

• Pneumonia that affects both lungs as opposed to just one.
• Lungs that had a characteristic “ground-glass” appearance via CT scan.
• Abnormalities in some laboratory tests, particularly those assessing liver function.
• Lab tests such as CBC, CXR, Nose swab is need.

How can COVID Pneumonia be treated?

• Treatment of COVID Pneumonia focuses on supportive care. 
• Patient with ARDS require mechanical ventilation.
• Systemic Antibiotic can be provided.
• Oxygen therapy needs to be provided.
• Severe cases require intubation.
• Isolation is must.

Precautions to be taken to prevent COVID Pneumonia:

• Avoid contact as much as possible. When contact is unavoidable, maintain a safe 6-foot distance from other people. Avoid physical contact with others, including shaking hands.
• Wash hands frequently by using soap and warm water.
• Not go outside remain at home and do not go out into public places if sick.
• Wear a face covering when around other people.
• Isolate in a single room and when using the bathroom to avoid spreading germs.
• Do not share personal care products.
• Practice good self-care by getting plenty of rest, eating regularly, and drinking lots of fluids.

Is Pneumococcal vaccine effective for COVID pneumonia?

According to the WHO, the pneumonia vaccine does not protect against the new COVID Pneumonia.

Vaccines for pneumonia only prevent certain types of pneumonia, such as pneumococcal pneumonia. However, these immunizations may help prevent other serious illnesses, including infections a person may contract while in hospital. 

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ABRUPTIO PLACENTAE

                              ABRUPTIO PLACENTAE

What is placental abruptio?

It is a type of APH where there is premature separation of normally situated placenta in upper part of uterus before delivery of baby, or sometimes even before labour begins.

Definition:

“It is defined as a condition where bleeding occurs due to premature separation of normally situated placenta.”

Etiology & risk factors:

•         Advanced age of mother
•         Grand multipara
•         Poor socioeconomic status
•         Smoking  
•         Malnutrition
•         Premature Rupture of membranes
•         Toxemia of pregnancy
•         Traumatic
•         Idiopathic
•        Short umbilical cord
•        Previous third trimester bleeding

TyTypes of placental abruptio:

REVEALED TYPE : In this type, the bleeding that occurs behind placenta trickles down between the membranes & the uterine wall to be revealed at vaginal opening. There is no collection of blood behind the placenta. Hence separation of placenta from uterus is less likely to occur.

CONCEALED TYPE : The blood fails to trickle down & collects between the placenta & uterine wall. The enlarging blood clot further dissects out the placenta from its bed & placental separation  can occur over a large area.

MIXED TYPE : In this type some part of blood collects inside & a part is expelled out.

Degrees of placental abruptio:

MARGINAL/LOW SEPARATION : This occurs when the separation is low & bleeding is evident.

MODERATE/HIGH SEPARATION : This occurs when separation is high in uterine segment, causing fundus of uterus to rise. The fetus is in grave danger because of lack of oxygen. External bleeding will probably not be present where as amniotic fluid will be a port white color.

SEVERE/COMPLETE SEPARATION : This occurs when fetus head is present in cervical os that prevents external bleeding. An immediate cessarean section will probably be needed in order to save the baby’s & mother’s lives.

Sign & Symptoms:

•         Sharp abdominal pain
•        Backache
•        Uterine tenderness
•        Vaginal bleeding
•        Signs of Maternal shock

Grade for clinical classification:

Grade 0: Absent clinical features.

Grade 1: 

•        slight vaginal bleeding
•        Tender uterus
•        Maternal BP & Fibrinogen unaffected
•        FHS is good

Grade 2:

•        Vaginal bleeding mild to moderate
•         Maternal tachychardia
•         Fibrinogen Elevated
•         Fetal distress or fetal death
•         Shock is absent

Grade 3: 

•        Bleeding is moderate to severe
•        Shock is seen
•        Fetal death is a rule
•        Coagulation defect or anuria

Medical & Nursing Management:

REVEALED TYPE:

If bleeding is slight:

•      If patient is stable & USG shows minimal retro-placental bleeding with a healthy immature fetus- conservative treatment to be given
•      A cessarean section must be done once the fetus reaches maturity
•      If the patient has come in labour intensive monitoring to be done
•      If the fetus is mature term fetus, cessarean section is done as early as possible to minimize blood loss

If bleeding is considerable:

If the bleeding is enough to compromise mother’s life, immediate cessarean section is done regardless of age of fetus.

CONCEALED TYPE :

•        If the patient has come in shock , she is promptly resuscitated with IV fluids , blood transfusion etc.
•        An emergency caesarean section is to be done to cut down blood loss.
•        In most of patients, the fetus is dead at the time of treatment.

CAESAREAN HYSTERECTOMY : in some patients with concealed type, the retroplacental clot may be very large. There may be even bleeding into muscles & blood vessels of uterus causing injury.

• Obtain blood samples for CBC, blood type & cross matching.
• Institute complete bed rest.
• If the patient is having active bleeding, continously monitor her blood pressure, pulse, respiration, CVP, I/O, amount of vaginal bleeding & FHR.
• If patient is rhesus negative & not sensitized, administer anti D immune globulin after bleeding episode.
• Administer prescribed IV fluids & blood products.
• Prepare patient & her family for possible caesarian delivery & birth process.
• If continuation of pregnancy is deemed safe for patient & fetus , administer prescribed magnesium sulphate for preterm labour.
• Assist with application of CTG.
• Encourage patient & her family to verbalize their feelings & help them to develop effective coping strategies or refer them to counselor if necessary.
• Assure patient that frequent monitoring & prompt management greatly reduce death risk of neonate.

Distinctive Facts:

•        Ix: Usg
•        Couvelaire Uterus: also called as uteroplacental apoplexy is a pathological condition characterized by massive intravasation of blood into uterine muscle.
•        Dark white color patchy uterus may be seen.
•        Partial thromboplastin time may be increased in concealed type.
•        Fetus may die & disproportionately large uterus may be seen in concealed type.

Prognosis:

MMR varies from 2-8%. Perinatal mortality is 15-20%.

Contributes 30%  of APH. Some cases who manage to survive

may develop Sheehan's syndrome later.

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DEPRESSION

                                     DEPRESSION

What is depression?

It is an affective disorder characterized by pathological changes in mood.

Definition:

WHO defines Depression as common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self worth, disturbed sleep or appetite, low energy & poor concentration .

Etiology or Risk factors:

• Fertile Ground Theory : It states that depression must have hereditary or physical vulnerability to the changes that causes mood regulating system to fail when life stresses exceed the person's ability to cope with them.
• Biochemical Theory : It postulates deficiency of neurotransmitters (noradrenaline, serotonin & dopamine) in certain areas of brain.
• Dopaminergic activity : Reduced in case of depression & increased in case of mania
• Genetic causes
• Environmemtal factors
• Endocrine pathology : Hypothyroidism, cushing syndrome
• Hormonal changes 
• Abuse of drugs or Alcohol
• Physical illness: Viral illness, Neurological disorders, Multiple sclerosis, Diabetes, Addison's disease etc

Theories for depression:

Biogenic Amine Hypothesis: deficiency of monamines particularly noradrenaline, serotonin.

Receptor sensitivity Hypothesis: Depression is caused by pathological alterations in receptor site.

The Serotonine only hypothesis: Alteration or decrease in levels of serotonine leads to depression.

The Permissive Hypothesis: Fall in levels of serotonine & noradrenaline causes depression. the emotional behaviour is controlled by these two neurotrasmiters. If the level of serotonin falls & noradrenaline remains same or abnormally high the patient becomes manic.

The Electrolyte Membrane Hypothesis: Hypercalcemia is associated with depression.

The Neuroendocrine Hypothesis: Altered endocrine levels lead to pathological mood changes

Psychopathology:

precipitating & predisposing factors causes cognitive appraisal leading to threat to loss of self esteem causing weakening of ego & inability of patient to use coping & defense mechanisms leads to maladaptive response causing exaggerated grief & clinical depression.

If the response of patient is adaptive it causes uncomplicated bereavement & denial of loss.

Types:

• Atypical depression
• Post partum depression
• Catatonic depression
• Melancholic depression
• Bipolar disorder
• Dysthymic depression
• Situational depression
• Psychotic depression

Severity of depression:

Mild episode: Lasts for 2 weeks with atleast 1 usual symptoms of depressive episodes

Moderate episode: Lasts for 2 weeks with atleast  2 usual depressive episodes & atleast 3-4 common symptoms

Severe episode: lasts for more than 2 weeks with all usual depressive symptoms & 3-4 common symptoms.

Sign & Symptoms:

Physical state:

• Altered sleep
• Low energy
• Agitation
• Fatigue
• Changes in brain chemistry

Emotional state:

• Discouragement
• Sadness
• Irritability 
• Hallucination
• Numbness
• Anger 
• Anxiety

Thoughts:

• Negative thinking habits
• Harsh self criticism
• Unrealistic thoughts

Situation:

• Isolation
• Conflicts
• Stress

Actions:

• Social Withdrawl
• Poor self care
• Reduced activity
• Suicidal tendency

Intellectual & Cognitive symptoms:

• Decreased ability to concentrate
• Slow thinking
• Poor memory

Medical & Nursing Management :

Pharmac measures:

• Monamine Oxidase Inhibitors: Isocarboxazid, Clorgyline
• TriCyclic Acid Inhibitors: Imipramine, Clomipramine
• Selective Serotonine Reuptake Inhibitors: Fluxetine, Sertaline
• Atypical Antidepressants: Bupropion, Trazodone

Non Pharmac Therapy :

Life style changes:

• Stress reduction measures
• Social support 
• Adequate sleep

Psychotherapy :

• Cognitive behavioural therapy
• Interpersonal therapy
• Psychodynamic therapy
• Electroconvulsive therapy

Talk with patient 

Remove all harmful articles away from patient

Provide positive reinforcement to the patient

Allow patient to achieve small tasks for increasing self esteem

Ask patient about episodes of hallucinations

Keep patient NBO status before ECT

Distinctive Facts:

• Ix : MSE, ICD 10 Classification
• Thinking is often pessimistic
• Hypersomnia & libido may be seen
• Ideas of suicide is very common
• Smiling depression is most common Type of depression
• Usual symptoms: Depressed mood, Loss of interest & enjoyment, reduced energy leading to fatiguability & diminished activity.

  

Prognosis:

Up to 60% of people who die of suicide have a mood disorder such as major depression, and the risk is especially high if a person has a marked sense of hopelessness.Around 90% of those with severe or psychotic depression, experience recurrence. Continuing antidepressant medications after recovery can reduce the chance of relapse by 70%.

Universal Infection Control Precautions

    

Introduction:

Universal Infection Control Precautions are the adoption of routine safe infection control practices to protect patients, self & colleagues from infection.

Universal Infection Control Precautions Include:

HAND WASHING:

Proper hand washing is the single most important aspect to prevent & reduce infections.

Methods of hand washing:

• Alcohol Hand rub 30 seconds
• Routine hand washing 10-15 seconds
• Before Aseptic procedure 1 minute
• Surgical wash- 3-5 minutes

Moments of hand washing:

• Before & after duty
• Before & after touching the patient
• Before & after eating
• After toileting
• Before & after any aseptic or invasive  procedure 

PPE:

• Articles designed to safeguard self & patient from infection by breaking chain of infection.

Sequence of donning PPE:

• Gown
• Mask or respirator
• Goggles or face shield
• Gloves

MANAGING SHARPS:

• Never recap needles.
• Dispose of used needles & small sharps immediately in puncture resistant boxes.
• Reusable sharps must be handled with care avoiding direct handling during processing.
• Separate sharps from other waste so laundry workers or waste disposable staff do not get needle stick injury.
• In case of injury report to staff & take hepatitis B vaccine.
• Wash wounds & do not suck.
• Check record for HIV, Hepatitis B & C periodically.

ASEPTIC TECHNIQUE:

• Minimizing risk of introducing pathogenic micro organisms into susceptible sites.
• Prevent transfer of potential pathogens from contaminated site to other sites, patients or staff.

ISOLATION:

• Mostly performed to reduce droplet & airborne infection.
• Limiting the number of visitors & safe handling of patient using barrier method can reduce spread of infection.

STAFF HEALTH:

• Appropriate immunization & initial & periodical health check up of staff.
• Report accidents or incidents.
• Cover lesions with dressing & restrict pregnant staff in departments prone to infection.

LINEN HANDLING & DISPOSAL:

• Appropriate handling of linen needs to be made.
• Gloves need to be donned & any spillage must not be touched bare handed.
• Disposable linen needs to be disposed as per biomedical waste protocols.

WASTE DISPOSAL:

• Yellow bin or plastic sack for high risk waste including contaminated waste of body fluids & human tissue.
• Red bin or sack for plastic wasted including catheter, plastic syringes, gloves etc.
• Blue bin or sac for glass materials.
• White bin for handling sharps.

SPILLAGE OF BODY FLUIDS:

• Don PPE.
• Soak with paper towels & cover the area with hypochlorite solution.
• Clean area with warm water and detergent & then dry.
• Report the incident & follow local policy.

ENVIRONMENTAL CLEANING:

• Proper air ventilation
• Water pipes examination
• Cleaning & dis-infection of equipment.
• Physical facility plans must meet quality & infection control measures.

RISK ASSESSMENT:

• Identify education needs.
• Evaluate new products.
• Periodic assessment of staff.
• Periodic assessing of protocols.

PLACENTA PREVIA

                                          

    

What is Placenta Previa ?

The term previa means in front of.
It denotes the position of placenta in relation to presenting part.

Definition :
“It is defined as the condition in which the placenta is implanted partially or completely over the lower uterine segment [over & adjacent to internal os].”

Etiology & Risk factors:

• Age
• Multiparity
• Dropping down theory
• Multiple gestation
• Smoking or Alcoholism
• Defective decidua
• Scar on uterine wall

Degrees of Placenta Previa:
•First degree/type I [low lying placenta or placental lateralis]: Major part of placenta is attached at upper segment but lower placental edge does not reache the internal os besides being at lower uterine segment.

 
•Second degree/type II [placenta previa marginalis]: the placenta reaches the margin of internal os but does not cover it. 

•Third degree/type III [Incomplete centralis]:
The placenta covers the internal os when it is closed or partially dilated but not when it is fully dilated.

•Fourth degree/type IV [Complete centralis]: the placenta covers the internal os when the cervix is fully dilated.

Sign & symptoms :

• The only symptom of placenta previa is vaginal bleeding
• Secondary symptoms are due to bleeding :
• Hypotension
• Shock
• Hypovolemia
• Delirium
• Respiratory distress
• Asphyxia neonatrum to the fetus

Mechanism of bleeding:
Dilatation of lower uterine segment caused by retardation of placental growth in later months of gestation causing shearing of placenta from uterine wall leading to opening of uteroplacental blood vessels ending in episoded of bleeding

Medical & Nursing Management:
Immediate Mgt-

• Assessment of amount of blood loss
• IV infusion of NS or RL to be started
• Provision of blood transfusion to be made
• Resuscitation if needed

Conservative treatment:

• This is to be opted when the mother is not in labour
• Provison of contuinuing pregnancy until 36 weeks is to be made by 
• Complete bed rest following hospital admission
• Complete observation of patient until delivery
• Correct anemia & observe fetal well being
• Administer anti-D immunoglobulin for Rh negative mothers

If the mother is in labour:

• Assessment of the condition & selection of either NVD or LSCS

NVD:

• All possible steps to be taken to restore blood volume
• Oxytocin 10 units IV/IM ,methergin 0.2 mg should be given
• Proper examination of cervix should be done to detect evidence of tear
• Hemoglobin level of baby to be checked & if necessary arrangements of blood transfusion is made

LSCS:
It is to be performed if following conditions persist:

• Placenta previa centralis
• Placenta previa marginalis posterior
• Severe bleeding
• Presentation other than vertex
• Contracted pelvis
• Cord prolapse
• Vasa previa

Distinctive facts:

• Ix:  Visualization of bright red blood per vaginally, USG is the method of choice
• PV examination is to be avoided or to be done with all equipments ready for delivery
• Coitus needs to be avoided as it can provoke the placental separation
• NVD is usually done by Amniotomy+ Oxytocin.
• Placenta Previa Marginalis is also called as dangerous placenta previa
• Complications include :APH, PPH, Fetal asphyxia, IUD

Prognosis:

MMR is < 1% if appropriate & timely management is seeked.

Pv  

PREVENTION OF PATIENT FALL

Fall Prevention

Nurses play an integral role in keeping patients safe. Nearly every nurse can recall an incident in which a patient fell, and how devastating this was for the patient, family and for the nurse. A leading cause of injury during hospitalizations is patient falls.

Organization-wide approaches

There should be a Falls Prevention Committee that monitors fall data, call light data, viewing of falls prevention videos data, and uses storytelling about specific cases to engage staff and promote transparency.

Staff and patient education

• Extensive staff education for RNs and non-RN care providers.
• Education for patients and family, including a fall prevention video that is pushed to every patient  within four hours of admission.
• Use of visual tools to identify patients at risk: yellow bands, door magnets, and magnets on patient locater board.

Practice

• ·         Bedside report, engaging patients and families in safety discussions.
• ·         Keeping within arm's reach of fall risk patients while toileting.
• ·         Post fall huddles and completion of detailed Huddle Sheet.
• ·        Purposeful hourly rounding while closely monitoring patients voiding patterns and fluid intake.
• ·        Shortened pajama length to prevent tripping.

 

Unit-based/patient population specific strategies

·         Monthly meetings with high-fall units with Falls Prevention Committee Chair and Director of Research to:

• ·         Develop unit/population-based action plans.
• ·         Review every incident of a fall and discuss alternate prevention strategies.

Examples of unit-based strategies:

• ·      Developed extensive training materials for Traveller nurses.
• ·     Created EPIC reports for nursing assistance with fall risk score.
• ·     Early Mobility evidenced-based practice project.
• ·    Falls "reflection tool" completed by the nurse whose patient fell, who interviews two colleagues about their fall assessment, prevention strategies and documentation.
• ·   Call bell near patient to contact nurse
• ·     Various strategies to enhance teamwork.
• ·    Yellow bracelets for fall risk patients.

NURSE’S ROLE IN PREVENTING HOSPITAL ACQUIRED INFECTIONS

                  

Introduction:

Healthcare-associated infections (HAI) are a threat to patient safety. A nosocomial infection is contracted because of an infection or toxin that exists in a certain location, such as a hospital. The term nosocomial infections is interchangeably used with the terms health-care associated infections (HAIs) and hospital-acquired infections. For a HAI, the infection must not be present before someone has been under medical care.

Areas prone for HAI:

One of the most common wards where HAIs occur is the intensive care unit (ICU), where doctors treat serious diseases. About 1 in 10 of the people admitted to a hospital will contract a HAI. They are also associated with significant morbidity, mortality, and hospital costs.

Types of HAIs:

• CAUTI : Catheter Associated Urinary Tract Infection
• CLABSI: Central Line Associated Blood Stream Infection
• SSIs: Surgical Site Infections
• MRSA : Methicillin Resistant Staphylococcus Aureus Infections
• VAE : Ventilator Associated Events

Role of a Nurse :

Nurses play a pivotal role in preventing hospital-acquired infections (HAI), not only by ensuring that all aspects of their nursing practice is evidence based, but also through nursing research and patient education.

• Nurse as an Advocate : The nurses need to adopt Universal precautions. Universal precautions are designed to prevent the transmission of blood borne pathogens when providing first aid or healthcare. Nurses came across in contact with various body fluids  including blood, cerebrospinal fluid, amniotic fluids, semen and vaginal secretions, nasal secretions, sputum, saliva, sweat, tears, urine, feces or vomit . Under the universal precautions rule, nurses must wear personal protective equipment when coming into contact with the specified body fluids. This is helpful to prevent transmission to other patients or to self.

• Nurse as a Clinician : . Avoidance of urinary catheterization is recommended whenever possible. For patients who require long-term catheterization, supra-pubic catheters should be considered. Scrupulous hand washing and aseptic technique is vitally important in the insertion and care of urinary catheters, as well as accurate and precise documentation.Irrigating cutaneous wounds thoroughly between dressing changes, debriding necrotic material effectively and dressing a wound appropriately to absorb exudates, are all ways in which nurses can protect patients from HAIs

.

• Nurse as a Care Provider : Neutropenic patients should receive frequent oral care, including teeth brushing and gentle flossing, or receive oral antimicrobial rinses when gingivitis or poor hygiene is noted. Intravenous therapy is a huge area of concern with HAIs. Nurses can make a huge contribution in this war against infection by using full barrier precautions (sterile field, caps, gowns, masks and gloves) when preparing for the insertion of central venous catheters. All catheters, regardless of site, should always be placed aseptically. A 2% chlorhexidine preparation is the preferred cleansing agent of catheter sites and injection ports and diaphragms of multidose vials should be cleansed with 70 percent alcohol prior to accessing . Catheters should be removed promptly when deemed unnecessary. Catheter dressings should be replaced immediately when damp, soiled or loosened. IV administration sets, extensions and secondary sets should be replaced every 72 hours, unless infection is suspected or documented.

• Nurse as Protector : Nurses can foster a safe environment for patients by creating an open, non-punitive environment where errors and near misses can be reported. This approach helps an organization determine how to improve the system and prevent future errors from occurring.Hand washing is another potent weapon in the nurse’s arsenal against infection, and is the single most important nursing intervention to prevent infection. Effective hand washing may be accomplished with antimicrobial soap and water, and specific guidelines for the use of alcohol-based hand rubs as acceptable substitutes.

General tips to be followed :

• ·   Adopt a safety-minded attitude. Safety is everybody’s job! Make prevention a part of your work habits. Focus on the task at hand.
• ·    When “noise” in your environment is distracting, you and others are at risk for accidents.
• ·   Noise” might include your own thoughts that are unrelated to the task at hand, an interesting conversation going on nearby, or anything that breaks your concentration.
• ·   Identify “noise” and take actions to limit the source.
• ·   Develop a personal list-making or note-taking system to keep your thoughts focused.

Conclusion :

Nurses in all roles and settings can demonstrate leadership in infection prevention and control by using their knowledge, skill and judgment to initiate appropriate and immediate infection control procedures. Practice diligently and keep your patient safe.