THREE-LEVELS OF PREVENTION (Leavell and Clark)

1. Primary Prevention
-to encourage optimal health and to increase the person’s resistance to illness.
-seeks to prevent a disease or condition at a pre pathologic state, to stop
something from ever happening.
Examples: Health promotion, Specific protection
2. Secondary Prevention
-also known as health maintenance.
-seeks to identify specific illnesses or conditions at an early stage with prompt
intervention to prevent or limit disability, to prevent catastrophic effects that could
occur if proper attention and treatment are not provided.
Examples: Early diagnosis, detection, screening
Prompt treatment to limit disability
3. Tertiary Prevention
-to support the client’s achievement of successful adaptation to known risks,
optimal reconstitution and or/establishment of high-level wellness.
-occurs after a disease or disability has occurred and the recovery process has
begun.
-intent is to stop the disease or injury process snd assist the person in obtaining
optimal health status.
Example:Rehabilitation

PRESENT EPIDEMIOLOGICAL DATA USING TABLES AND GRAPHS

 TABLES- Any quantitative information can be organized into tables

-A table is a set of data arranged in rows and columns

Types of Chart/graph:

 Bar Graph-Used to show the frequency distribution of a variable with discrete,

noncontinuous categories (i.e., sex, rate)

-Can be either horizontal or vertical

-Used for comparing the contribution of different components to each of

the categories of the main variable
 BAR GRAPH

 Pie Chart- a pie graph for population composition or distribution

-Size of slices show proportional contribution of each component part Useful

for showing component parts of a single group or variable

PIE CHART

 Line graph- for trends over time or age

 LINE GRAPH

 Scatter Diagram for correlation of two variables

SCATTER DIAGRAM

DEPARTMENT OF HEALTH
Vision: Health for all Filipinos
 DOH is the leader, staunch advocate and model in promoting Health for All in the
Philippines

MISSION: Ensure accessibility and quality health care to improve the quality of life of
Filipinos, especially the poor
 DOH shall guarantee equitable, sustainable, and quality health for all Filipinos,
especially the poor, and shall lead the quest in excellence for health
 LEVELS OF PRIMARY HEALTH FACILITY:
 PRIMARY-client in fair health and with early symptoms of illness, usually renders
services on an outpatient basis
Examples: Barangay Health center, City Health Office, Municipal Health Office,
Lying-In clinics, Puericulture Center
 SECONDARY – patient in symptomatic stage of an illness and requires
moderately specialized knowledge/facilities.
Examples: Provincial Hospitals, Municipal Hospitals, Emergency Hospitals
 TERTIARY-patients seriously threaten and requires highly technical facilities and
knowledge
 Examples: National Hospital, Teaching an d training hospitals, regional hospitals

PARTS OF A STETHOSCOPE

PARTS OF A SPHYGMOMANOMETER
ADDITIONAL TERMS ON VITAL SIGNS:

 EUPNEA- Normal respiration that is quiet, rhythmic and effortless

 TACHYPNEA- rapid respirations, above 20 breaths per minute in and adult
 BRADYPNEA- slow breathing ,less than 12 breaths per minute in an adult
 HYPERVENTILATION- deep rapid respirations
 HYPOVENTIlATION- slow, shallow respirations
 DYSPNEA- difficult and labored breathing
 ORTHOPNEA- ability to breathe only in upright position
 APNEA- absence of respirations

ORTHOPNEA

ASSESSING BLOOD PRESSURE

1. Ensure that the client is rested.

2. Allow 30 mins to pass if the client had engaged in exercise or has smoked or
ingested caffeine before taking BP. These factors tend to increase BP.
3. Use appropriate size of BP cuff. Too narrow cuff causes FALSE HIGH reading.
Too wide cuff causes FALSE LOW reading.
4. Position the client in a sitting or supine position.
5. Position the arm at the heart level, with the palm of the hand facing up. The left
arm is preferably used because it is closer to the heart.
6. Apply BP cuff snugly, 1 in above antecubital space.
7. Inflate and deflate BP cuff slowly, 2-3 mmHg per second.
8. The sound during BP taking is Korotkoff sound
9. Read the lower meniscus of the mercury level of the sphygmomanometer at eye
level
 10. The systolic pressure in the popliteal artery is usually 10-40 mmHg higher than
that in the brachial artery. The diastolic pressure is usually the same.

TRANSMISSION-BASED PRECAUTIONS

1. Air-borne precautions
 These are used for microorganisms transmitted by small-particle
droplets that can remain suspended and become widely dispersed
by air currents. Examples: TB, varicella and measles.
 The client should be cared for in a private, negative air-flow room to
contain the air within the client’s unit.
 Caregivers are to wear masks, the client should wear mask when
transported out of the room.
2. Droplet Precautions
  These are used for microorganisms transmitted by larger-particle
droplets (through coughing, sneezing or talking) which dispense into
air currents. Examples: Haemophilus Influenzae, Diphtheria, Rubella/
German Measles , Mycoplasma Pneumoniae.
 The client should be in private room.
 Caregivers are to wear masks when working within 3 feet of the client.
 Client should wear mask outside the room.
3. Contact Precautions
 Used for microorganisms that can be transmitted by hand or skin to
skin contact such as during client care activities or when touching
the client’s environmental surfaces or care items.Example:
Clostridium deficile, Shigella, Impetigo
 Personnel gloves before entering the room and change gloves when
exposed to potentially infected material during care delivery.
 Remove gloves before leaving client’s room.
 Gowns and other protective barriers are to be used when contamination is
likely either from the client, the environmental surfaces or client’s room.

Protective Isolation
 -implemented to prevent infection for people whose resistance to
infection or body defense s are lowered or compromised.
 Examples: clients with low WBC count (leukopenia), or
immunosuppressive medications like those undergoing chemotherapy
or extensive burns.
 The client must be placed on a private room.
 Meticulous handwashing is strictly practiced by the client, his family and
caregivers.
 Restrict visitors.
 Persons with signs and symptoms of infection are not allowed to visit the
client, Examples: those with cough and colds, diarrhea and skin infections
 No fresh fruits or vegetables, raw foods, fresh flowers, potted plants are
allowed.
 Only cooked or canned fruits are allowed.

SURGICAL HAND SCRUB

Steps:
1. Be sure fingernails are short, clean and healthy. Nail polish must be
removed.
 Rationale: long nails and polish increase number of bacteria residing on
the nails.
2. Remove rings. Apply surgical shoe covers, cap, face mask and
protective eyewear.
Rationale: Rings can harbor microorganisms. Applying attire after
handwashing would contaminate hands.
3. Wash and rinse hands for initial wash.
Rationale: To remove gross contamination and transient
mircoorganisms.
4. Open disposable brush impregnated with antimicrobial soap, adjust
water temperature to warm using knee or foot control lever.
Rationale: Antimicrobial soap reduces microorganisms. Warm water
decreases drying of hands.
5. Wet hands and arms. KEEP HANDS ABOVE ELBOWS.
Rationale: Movement of water and dirt will flow from hands to less clean
areas, thus preventing contamination of the hands during the scrub.
6. Use nail stick or cleaner to clean under nails of both hands.
Rationale: the nails can harbor significant bacteria and need to be
cleaned thoroughly.
7. Wet scrub brush or apply antibacterial soap if not already impregnated in
the brush.
Rationale: Antibacterial soap assists in removing transient and resident
microorganisms.
8. Anatomic Time Scrub. Starting with fingertips, scrub each anatomic area
(nails, fingers each side, palmar surface, dorsal surface and forearm) for
around 5 minutes. Scrub vigorously using vertical strokes. Repeat with
the other hand.
Rationale: Ensures that all surfaces will be systematically scrubbed to
remove transient and resident microorganisms.
9. Counted Brush Stroke Method: Starting with fingertips, scrub each
anatomic area (same as in step 8) for the designated number of strokes
according to hospital policy. Scrub vigorously using vertical strokes.
10. Rinse hands thoroughly under warm running water, holding hands
UPWARD. This is to allow water to drain towards flexed elbows.
Rationale: Prevents contamination of the hands from dirtier areas.

***Do not touch anything before and after rinsing the hands. Touching
nonsterile objects would mean the surgical scrub would need to be
repeated.
11. Keep hands help upward to allow water to drip from the hands to the
elbow. Dry hands with sterile towel.
Rationale: Prevents contamination before gloving/

Note: Please watch the video on how to do surgical scrubbing for better
visualization.

POURING SOLUTIONS TO A STERILE FIELD

1. Check the label and expiration date of the solution . Note any signs of
contamination.
 Rationale: Ensures that the correct solution is used and that it is
sterile.
2. Remove cap and place it with the inside facing up on a flat surface.
Do not touch inside of cap or rim of bottle.
 Rationale: Maintains sterility of the solution and the field.
3. Pour a small amount of solution into a sink or waste container to
rinse the rim of the container. (This is done when pouring weak
solutions like sterile normal saline solutions, distilled water).
 Rationale: This ensures sterility of the solution .
4. Hold bottle 6 inches above receptacle on the sterile field and pour
slowly to avoid spills.
 Rationale: Spilling fluid on the sterile field results in contamination
because a wet surface allows microorganisms to transfer from the
flat surface which is not sterile.
5. Recap the solution bottle, place it outside the sterile field and label it
which date and time of opening if the solution is to be reused.
 Discard excess solution and do not return from sterile receptacle to
the bottle
 Rationale: Keep solutions in the bottle sterile and avoids use of
solution that has passed expiration date.

REMOVAL OF SURGICAL GLOVES

 Wash gloved hands first (Rationale: To reduce the number of
microorganisms that could contaminate the hands)
 With dominant hand, grasp the outer surface of the non-dominant
glove. Peel off glove inside out, without touching the exposed
wrist. (rationale: After use, the outer surface of loves is
contaminated and could transfer microorganisms to the wrist.)
 Place ungloved hand under the second cuff and peel off toward
the fingers holding first glove inside second glove. Discard to
appropriate receptacle.
 Use “glove-to-glove”, “skin-to-skin” technique when removing
gloves.
 Wash hands.
***Wash hands before and after removing gloves to prevent
contamination of hands

Removing PPE
1. For sterile surgical procedures, apply a clean cap that covers all
of the hair then the surgical mask, eye wear and shoe cover
2. A mask must fit snugly around the face and nose to prevent
contamination by droplet nuclei.
3. To remove PPE: remove gloves first, then the mask, the gown,
the eyewear or goggles, cap and shoe cover. Removing the
gloves first prevents contamination of the hair, neck and facial
area.
For removing protective wear:
Glove Mask Gown other PPE

DISPOSAL OF SHARPS
 Syringes, needles, or other similar equipment should NEVER be reused
 Do not recap used needles by two hand capping . If recapping is allowed, use
one-hand scooping technique.
 Never direct the point of a used needle towards any part of the body •
  Do not remove used needles from disposable syringes by hand
 Do not bend, break, or otherwise manipulate used needles by hand •
 Dispose of syringes, needles, scalpel blades, or other sharp objects in
appropriate, puncture-resistant containers

Unexpected Death

In the case of an unexpected death, a medical practitioner must be called immediately

to attend and verify death. Consideration should be given to the need for referral to the
Coroner and police if:

 The cause of the death is unknown ƒ

 The deceased was not seen by a certifying doctor either after death or within 14
days before death ƒ
 The death was violent, unnatural or was suspicious ƒ
 The death is of a child ƒ
 The death may be due to an industrial disease or related to the deceased
employment ƒ
 The death may be due to an abortion ƒ
 The death may be suicide ƒ
 The death occurred during or shortly after detention in police or prison custody ƒ
 Death is of an unidentified person
 Death has occurred within 24
 hours of onset of illness or where no firm clinical diagnosis has been made ƒ
Death is 24 hours post-operative or post invasive procedures ƒ
 Death is following an untoward incident, fall or drug error ƒ
 Death has occurred as a result of negligence or malpractice ƒ
 Death is unclear or remotely suspicious

Details of death must be recorded in the patient’s record/clinical pathway before the
deceased’s body can be removed by the funeral directors. In the event of an
unexpected death within an Inpatient area the room should be left untouched and, if in a
bay, then the curtains should remain around the patient and the following procedure
undertaken: ƒ

 A member of staff is to remain with the patient. ƒ

 The police and On-Call-Manager/head of service is informed. ƒ
 A Serious Incident Requiring Investigation process is commenced. ƒ
 The patient will be collected by the Coroner. ƒ
  When the patient has left the room the room should be locked as this is a crime
scene. ƒ
 Records to be photocopied. ƒ
 Police will visit the Ward..

Terms:

 Pathologist- A doctor trained in the detection and diagnosis of disease

 Post-mortem-Involves the examination of the brain and other internal organs by a
pathologist, usually undertaken when the cause of death is uncertain or
suspicious
 Coroner-A person appointed by the Home Office who is required by law to
investigate deaths due to unnatural, suspicious or unknown causes
 Inquest-An investigation held by the Coroner when death is known or suspected
to be due to any other cause than natural death