Page 147 Complete Your CE Test Online - Click Here ○ ○ Before donning gloves for peripheral catheter placement, urinary catheter placement, or placing other invasive devices that do not require surgery. ○ ○ After contact with a patient’s skin (taking a patient’s vital signs, lifting the patient). ○ ○ After contact with body fluids or excretions, nonintact skin, wound dressings, mucous membranes if hands are not visibly soiled. ○ ○ Before moving to a clean body site after touching a contaminated body site during care of the patient. ○ ○ After contact with inanimate objects in the same general area as the patient (tables, chairs, IV poles, computer keyboards). ○ ○ After removing gloves. For hands that are not visibly soiled, alcohol rubs are more effective than washing with antimicrobial soap (CDC, 2002). Use an alcohol- based hand sanitizer unless hands are visibly dirty, if C. difficile exposure or Bacillus anthracis is known or suspected, after contact with a patient with infectious diarrhea, before eating, and after using the restroom (Figure 1). For hands that are visibly soiled, it is recommended to wash with antimicrobial soap and water. When using an alcohol rub, thoroughly rub product into hands, and rub until product is dry. When using soap and water, wash hands thoroughly for a minimum of 15 seconds. Nursing consideration: Nurses should remember to wash their hands frequently during, before, and after patient care to reduce the spread of nosocomial infections. Wearing gloves does not replace the need to wash hands! Educating patients and families One very important role that nurses perform in and out of the health care setting is patient and family education. General awareness and spreading the word about sepsis and sepsis symptoms provides critical information for the public so that early symptoms are not ignored or minimalized and care can be started earlier, allowing for a better outcome. The Global Sepsis Alliance has started an initiative known as World Sepsis Day to increase general awareness of sepsis. Nurses can relay important educational information to patients and their families to prevent, recognize, and report symptoms of infection promptly. In the hospital setting, for example, a medical surgical nurse might educate the patient during his stay as to signs and symptoms of infection of a surgical wound, or the importance of preventing pneumonia with the use of incentive spirometry postoperatively. In the outpatient setting, a nurse can educate patients as to the importance of vaccines to prevent such infections as pneumonia, meningococcus, and influenza vaccines, especially in those patients at high risk for infection. Nurses should encourage patients to quit smoking; smokers are at risk for pneumonia. Nurses can also take opportunities in everyday life to spread the word to the community and family and friends about signs and symptoms of worsening infection and who is at risk for sepsis because of comorbidities. Nurses can use the mnemonic SEPSIS to remember what to tell those they come in contact with (UK Sepsis Trust, 2016): S: Slurred speech. E: Extreme shivering or muscle pain. P: Passing no urine in a day. S: Severe breathlessness. I: “I feel like I might die.” S: Skin that is mottled or discolored. Another simple mnemonic, TPR (temperature, pulse, respirations), can be a useful tool to teach the lay population regarding when to call the doctor. If a person has an infection or flu and at least two of the three following symptoms, she should notify her doctor and tell him that she is concerned about sepsis (Sepsis Watch, n.d.): ● ● Temperature > 38.3˚C (101˚F) or < 36.1˚C (97˚F). ● ● Heart rate > 90 bpm. ● ● Respiratory rate > 20 to 22 rpm. Educating coworkers It is part of the nurse’s responsibility to ensure that other health care workers who come in contact with their patients follow proper techniques for infection control. The nurse should relay to others any contact precautions or neutropenic precautions that may be in place for a particular patient. If a nurse should see another health care worker not following proper protocol, she should educate the health care worker as to proper hand hygiene to protect not only other patients but also themselves. Sepsis protocols and sepsis rapid response teams Nurses are at the forefront of medical care. As such, continuing education for nurses is imperative to keep nurses up-to-date regarding evolving research on the pathology of sepsis and new evidence related to the care of patients with sepsis. Nurses can advocate for enactment and enforcement of sepsis protocols and the formation of sepsis response teams in their facility. They should always communicate with other members of the health care team to ensure timely response to an insidious process. Evidence-based practice guidelines should be part of the hospital policies on every unit, and nurses are responsible for setting the example in implementing these guidelines. The use of sepsis screening tools, sepsis protocols, and sepsis rapid response teams can help improve treatment and outcomes in patients identified early. An example of a sepsis rapid response team might include members of the hospital staff who have been thoroughly educated on sepsis and who can effectively communicate and work together to achieve a quick response and subsequent treatment of the patient suspected of having sepsis. A trained response team might include as members a physician, an ICU nurse, and a respiratory therapist. The Surviving Sepsis Campaign (SSC) gives the following example for an effective core leadership interdisciplinary team: ● ● Administrator over emergency department and critical care medicine. ● ● Critical care medicine (CCM) physician. ● ● ED physician. ● ● CCM nurse manager. ● ● ED nurse manager. ● ● ED charge/triage nurse. ● ● CCM charge nurse. Additional team members could include these health care professionals: ● ● Pharmacist. ● ● Respiratory therapy supervisor. ● ● Process improvement facilitator. ● ● Laboratory supervisor. ● ● Technicians from ED. An example of an effective sepsis work team includes the following (Surviving Sepsis Campaign, n.d.): ● ● ED physician.