Repository STIKes Patria Husada Blitar

O'Horo, John C

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Siltuximab Solution for injection
U.S. Trade Names
Sylvant
The list of names may not include all products that are available on the market.
What is this medicine?
SILTUXIMAB is a monoclonal antibody. It is used to treat multicentric Castleman disease (MCD).
 
This medicine may be used for other purposes; ask your health care provider or pharmacist if you have
questions.
What should I tell my health care provider before I take this medicine?
They need to know if you have any of these conditions:
HIV or AIDS
infection (especially a virus infection such as chickenpox, cold sores, or herpes)
recently received or schedule to receive a vaccine
stomach or intestine problems
an unusual or allergic reaction to siltuximab, other medications, foods, dyes, or preservatives
pregnant or trying to become pregnant
breast-feeding
How should I use this medicine?
This medicine is for infusion into a vein. It is given by a health care professional in a hospital or clinical setting.
 
Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.
 
Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency
room at once. NOTE: This medicine is only for you. Do not share this medicine with others.
What if I miss a dose?
Keep appointments for follow-up doses as directed. It is important not to miss your dose. Call your doctor or
health care professional if you are unable to keep an appointment.
What may interact with this medicine?
This medicine may interact with the following medications:
atorvastatin
birth control pills
cyclosporine
live virus vaccines
lovastatin
theophylline
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warfarin
 
This list may not describe all possible interactions. Give your health care provider a list of all the medicines,
herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use
illegal drugs. Some items may interact with your medicine.
What side effects may I notice from receiving this medicine?
Side effects that you should report to your doctor or health care professional as soon as possible:
allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
back pain
breathing problems
chest pain or chest tightness
dizziness
facial flushing or redness
fast, irregular heart beat
feeling faint or lightheaded
headache
nausea, vomiting
signs of infection like fever or chills; cough; sore throat; pain or difficulty passing urine
stomach pain
Side effects that usually do not require medical attention (report to your doctor or health care professional if they
continue or are bothersome):
constipation
diarrhea
swelling of the legs or ankles
weight gain
 
This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You
may report side effects to FDA at 1-800-FDA-1088.
What should I watch for while using this medicine?
Tell your doctor or healthcare professional if your symptoms do not start to get better or if they get worse.
You may need blood work done while you are taking this medicine. Your condition will be monitored carefully
while you are receiving this medicine.
Call your doctor or health care professional for advice if you get a fever, chills or sore throat, or other symptoms
of a cold or flu. Do not treat yourself. This drug decreases your body's ability to fight infections. Try to avoid
being around people who are sick.
Birth control pills may not work properly while you are taking this medicine. Talk to your doctor about using an
extra method of birth control.
Do not become pregnant while taking this medicine or for 3 months after the last dose. Women should inform
their doctor if they wish to become pregnant or think they might be pregnant. There is a potential for serious side
effects to an unborn child. Talk to your health care professional or pharmacist for more information. Do not
breast-feed an infant while taking this medicine or for 3 months after the last dose.
Where should I keep my medicine?
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This drug is given in a hospital or clinic and will not be stored at home.
NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about
this medicine, talk to your doctor, pharmacist, or health care provider.
[Last revised: 04/10/2020]
Copyright © 2017 Elsevier Inc. All rights reserved.


English

Siltuximab Solution for Injection

Beck, Martha

   
 
Hand Hygiene (Ambulatory) – CE 
 
Copyright © 2020, Elsevier, Inc. All rights reserved. Page 1 of 6 
 
ALERT 
Hand hygiene is not optional. 
 
OVERVIEW 
Hand hygiene is the most important and most basic component in preventing and 
controlling the transmission of infection. Hand hygiene is the primary method used 
by health care team members to reduce the spread of germs or infection between 
the patient and the health care provider.3 Proper hand hygiene has been shown to 
significantly reduce infection and colonization rates for multidrug-resistant 
organisms 4
Hand hygiene is a general term that applies to handwashing, antiseptic handwash, 
antiseptic hand rub, and surgical hand antisepsis. Handwashing refers to washing 
hands with plain soap and water. An antiseptic handwash is defined as washing 
hands with soap and water or other detergents containing an antiseptic agent. An 
antiseptic hand rub is performed by applying an antiseptic hand rub product to all 
surfaces of the hands to reduce the number of microorganisms on the skin. Many 
antiseptic detergent preparations have persistent antimicrobial activity.5 
 
The most common mode of transmitting infection or organisms between patients is 
contact with a health care team member’s hands. For example, a health care team 
member assists a patient who has excessive pulmonary secretions to expectorate 
mucus. Then, the health care team member leaves that patient and cares for 
another patient. If the health care team member fails to perform hand hygiene, 
organisms from the first patient’s mucus are transmitted to other surfaces (e.g., 
door handle) and the second patient. 
 
Health care team members should not wear jewelry, including rings and watches, on 
the hands or wrists in patient care areas because of the increased risk of bacterial 
grown under it.1 If jewelry is worn, it must be removed before performing hand 
hygiene.5 The World Health Organization (WHO) strongly discourages wearing rings 
or other jewelry in the health care setting.5 
 
Long fingernails and artificial nails harbor bacteria, and artificial fingernails have 
been implicated in outbreaks of gram-negative bacteria and yeast infections.1
Therefore, neither artificial nails nor extenders should be worn, and natural 
fingernails should be kept at a length no longer than 2 mm.1 
 
Hand rubbing with an alcohol-based solution is the recommended action for health 
care team members when performing routine hand hygiene. Studies have shown 
that alcohol-based hand rubs are superior to antimicrobial detergents in their ability 
to reduce bacterial counts.5  
 
Hand hygiene guidelines recommend the use of alcohol-based products, unless the 
hands have been exposed to bodily fluids or are visibly soiled or when the patient 
has suspected or confirmed spore-forming pathogens (e.g., Clostridium difficile).2,5 
Spore-forming pathogens are known to be highly resistant to killing by alcohol. 
Mechanically handwashing with soap and water or antimicrobial soap and water may 
help physically remove spores from the surface of contaminated hands.2 
 
   
 
Hand Hygiene (Ambulatory) – CE 
 
Copyright © 2020, Elsevier, Inc. All rights reserved. Page 2 of 6 
Health care team members should wash their hands with antimicrobial soap and 
water in these situations:5 
• When hands are visibly dirty 
• When hands are visibly soiled with blood or other bodily fluids 
• When hands are contaminated with proteinaceous material 
• After using the bathroom 
• After exposure or suspected exposure to spore-forming pathogens (e.g., C. 
difficile) 
 
If hands are not visibly soiled or do not meet any of the above criteria, health care 
team members should use an alcohol-based hand rub for routinely decontaminating 
hands in these situations: 
• Before and after direct contact with patients 
• Before and after donning clean or sterile gloves5 
• Before performing a clean or sterile task (e.g., inserting a peripheral vascular 
catheter, administering or preparing medication, accessing a vascular access 
device)1 
• After contact with a patient’s intact skin (e.g., taking a pulse or blood pressure, 
lifting a patient) 
• After contact with bodily fluids or excretions, mucous membranes, nonintact skin, 
and wound dressings 
• When moving from a contaminated body site to a clean body site on the same 
patient1 
• After contact with inanimate objects (including medical equipment) in a patient’s 
immediate vicinity1 
 
If an alcohol-based hand rub is not available, health care team members should 
wash hands with an antimicrobial soap and water. Health care team members should 
avoid washing hands with soap and water in addition to using an alcohol-based hand 
rub because it is unnecessary and may lead to dermatitis.  
 
EDUCATION 
• Instruct the patient about proper hand hygiene techniques. 
• Provide developmentally and culturally appropriate education based on the desire 
for knowledge, readiness to learn, and overall neurologic and psychosocial state. 
• Educate the patient about situations in which hand hygiene is required. 
• Educate the patient about the risks for infection in health care facilities. 
• Educate the patient that he or she can play an important role in improving hand 
hygiene compliance by reminding health care team members to perform hand 
hygiene. 
• Encourage questions and answer them as they arise. 
 
PROCEDURE 
1. Inspect the surface of the hands for dermatitis or breaks or cuts in the skin or 
cuticles.  
2. Inspect the hands for visible soiling. 
3. Inspect the condition of the nails. Be sure that fingernails are short, filed, and 
smooth. Remove artificial nails, if worn. 
4. Cover any skin lesions before providing patient care. 
5. Push long uniform sleeves above the wrists. If jewelry is worn on the hands or 
arms (e.g., ring, watch), remove it during hand hygiene. 
   
 
Hand Hygiene (Ambulatory) – CE 
 
Copyright © 2020, Elsevier, Inc. All rights reserved. Page 3 of 6 
 
Rationale: Pushing the sleeves up and removing jewelry provides 
complete access to the fingers, hands, and wrists. WHO strongly 
discourages wearing rings or other jewelry in the health care setting.5 
Wearing rings contributes to the contamination of the hands, and 
wearing watches may decrease implementation of hygiene of the 
wrists.1 
 
Hand Antisepsis Using an Instant Alcohol Waterless Antiseptic Rub 
1. Dispense the recommended amount of product per the manufacturer’s instructions 
into the palm of one hand. 
 
Rationale: Many microorganisms on hands come from the subungual 
region (beneath the fingernails). Enough product is needed to 
thoroughly cover the hands. 
 
2. Rub the hands together, covering all surfaces of the hands and fingers with 
antiseptic rub. 
3. Rub the hands together until the alcohol is dry. Allow the hands to completely dry 
before donning gloves. 
 
Rationale: The alcohol must dry to ensure complete antimicrobial 
action and to decrease the incidence of skin irritation.5 
 
Perform hand hygiene with an instant alcohol waterless 
antiseptic rub, from start to dry, for 20 to 30 seconds.5 
 
Do not use an alcohol waterless antiseptic rub for hand hygiene 
when spore-producing pathogens are suspected or confirmed, 
such as from acute food poisoning. 
 
Handwashing Using Plain or Antimicrobial Soap and Water 
1. Stand in front of a sink, keeping the hands and uniform away from the sink 
surface. 
 
Rationale: The inside of the sink is a contaminated area. Reaching over 
the sink increases the risk of touching the edge, which is 
contaminated. 
 
If the hands touch the sink during handwashing, repeat 
handwashing. 
 
2. Turn on the water. Turn on the faucet, press the knee or foot pedals, if available, 
to regulate the flow and temperature. 
3. Avoid splashing water on the uniform. 
 
Rationale: Microorganisms travel and grow in moist environments. 
 
4. Regulate the temperature to ensure that the water is warm. 
 
   
 
Hand Hygiene (Ambulatory) – CE 
 
Copyright © 2020, Elsevier, Inc. All rights reserved. Page 4 of 6 
Rationale: Warm water removes less of the protective oils on hands 
than hot water. 
 
5. Wet the hands and wrists thoroughly under the running water. Keep the hands 
and forearms lower than the elbows during washing. 
 
Rationale: The hands are the most contaminated parts to wash. Water 
should flow from the least to most contaminated area, rinsing 
microorganisms into the sink. 
 
6. Apply the recommended amount of soap or antiseptic to the hands according to 
the manufacturer’s instructions for use. Soap granules and leaflet preparations are 
also an option. 
 
Rationale: Using antiseptic exclusively can be drying to the hands and 
may cause skin irritations. 
 
7. Lather hands thoroughly. 
8. Apply friction and perform handwashing for at least 15 seconds2 or for the length 
of time stated in the manufacturer’s instructions. Interlace the fingers and rub the 
palms and back of the hands together using a circular motion for at least five cycles.2 
Keep the fingertips down to facilitate removal of microorganisms. 
 
Rationale: Soap cleanses by emulsifying fat and oil and lowering 
surface tension. Friction and rubbing mechanically loosen and remove 
dirt and transient bacteria. Interlacing the fingers ensures that all 
surfaces are thoroughly cleansed. 
 
9. Clean the areas under the fingernails with the fingernails of the other hand and 
additional soap or clean them with a disposable nail cleaner. 
 
Rationale: The area under the nails may be highly contaminated, 
increasing the risk for transmission of infection from the health care 
team member to the patient. 
 
10. Rinse the hands and wrists thoroughly, keeping the hands down and the elbows 
up. 
 
Rationale: Rinsing mechanically washes away dirt and microorganisms. 
 
11. Dry the hands thoroughly from the fingers to the wrists with a paper towel, 
single-use cloth, or warm air dryer. 
 
Rationale: Drying from the cleanest (fingertips) to least clean (wrist) 
avoids contamination. Drying the hands prevents chapping and 
roughened skin. 
 
12. To turn off the hand faucet, use a clean, dry paper towel to avoid touching the 
handles with the hands. Turn off the water with the foot or knee pedals, if applicable. 
 
   
 
Hand Hygiene (Ambulatory) – CE 
 
Copyright © 2020, Elsevier, Inc. All rights reserved. Page 5 of 6 
Rationale: Wet towels and hands allow the transfer of pathogens from 
the faucet by capillary action. 
 
13. Discard the paper towel or single-use cloth, if used, in the proper trash 
receptacle. 
14. Apply an organization-approved lotion or barrier cream to hands. Avoid 
petroleum-based lotions. 
 
Rationale: Lotion helps minimize skin dryness. The organization-
approved lotion or barrier cream will be compatible with antimicrobial 
soaps and latex. 
 
15. Reinspect the surface of hands for obvious signs of dirt or other contaminants. 
 
EXPECTED OUTCOMES 
• Hands and areas under fingernails are clean and free of debris. 
• Health care team member remains free from health-care associated infection. 
• Patient remains free from health care–associated infection. 
 
UNEXPECTED OUTCOMES 
• Hands or areas under fingernails remain soiled. 
• Repeated use of soaps or antiseptic cause dermatitis or cracked skin. 
• Health care team member contracts a health care-associated infection. 
• Patient contracts a health care–associated infection. 
 
REFERENCES 
1. Association of PeriOperative Registered Nurses (AORN). (2020). Hand hygiene. In 
Guidelines for perioperative practice (pp. 273-298). Denver: AORN. (Level VII) 
2. Boyce, J.M. and others. (2002). Guideline for hand hygiene in health-care 
settings: Recommendations of the healthcare infection control practices advisory 
committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force: Society for 
Healthcare Epidemiology of America/Association for Professionals in Infection 
Control/Infectious Diseases Society of America. Morbidity and Mortality Weekly 
Report, 51(RR-16), 1-45. (classic reference)* (Level VII) 
3. Centers for Disease Control and Prevention (CDC). (2020). Hand hygiene in 
healthcare settings. Retrieved on March 12, 2020 from 
https://www.cdc.gov/handhygiene/providers/index.html 
4. World Health Organization (WHO). (n.d.). Evidence of hand hygiene to reduce 
transmissions and infections by multi-drug resistant organisms in health-care 
settings. Retrieved March 12, 2020, from 
http://www.who.int/gpsc/5may/MDRO_literature-review.pdf?ua=1 (Level I)  
5. World Health Organization (WHO). (2009). WHO guidelines on hand hygiene in 
health care: First global patient safety challenge: Clean care is safer care. Retrieved 
March 12, 2020, from 
http://apps.who.int/iris/bitstream/10665/44102/1/9789241597906_eng.pdf 
(classic reference)* (Level VII)  
 
ADDITIONAL READINGS 
 
   
 
Hand Hygiene (Ambulatory) – CE 
 
Copyright © 2020, Elsevier, Inc. All rights reserved. Page 6 of 6 
Centers for Disease Control and Prevention (CDC). (2016). Handwashing: Clean 
hands save lives: When and how to wash your hands. Retrieved March 12, 2020, 
from https://www.cdc.gov/handwashing/when-how-handwashing.html  
 
*In these skills, a “classic” reference is a widely cited, standard work of established 
excellence that significantly affects current practice and may also represent the 
foundational research for practice. 
 
Elsevier Skills Levels of Evidence 
• Level I - Systematic review of all relevant randomized controlled trials 
• Level II - At least one well-designed randomized controlled trial 
• Level III - Well-designed controlled trials without randomization 
• Level IV - Well-designed case-controlled or cohort studies 
• Level V - Descriptive or qualitative studies 
• Level VI - Single descriptive or qualitative study 
• Level VII - Authority opinion or expert committee reports 
 
 
Supplies  
• Alcohol-based waterless antiseptic containing emollients 
• Easy-to-reach sink with warm running water 
• Antimicrobial or regular soap 
• Organization-approved lotion or barrier cream 
• Paper towels or air dryer 
• Disposable nail cleaner (optional) 
 
 
Author: Martha Beck, MA, BSN, RN, CNOR 
Published: March 2020 
 
 


Hand Hygiene (Ambulatory)

Chambers, Kerrie L

Isolation Precautions: Droplet (Ambulatory)

Fleming, Loraine

Adolescent Suicide Risk Assessment and

Precautions

  
 
Staff Stress and Resilience - CE 
 
Copyright © 2020, Elsevier, Inc. All rights reserved.               1 of 5 
ALERT 
If a health care team member’s resilience is tested by extremely stressful working 
conditions, a challenging patient, or other difficult situation, ensure that there is a 
reproducible process in place that evaluates the concern and identifies and 
implements solutions. 
 
OVERVIEW 
Caring for patients during a disaster or pandemic exposes health care team members to the 
entire spectrum of human emotion, sometimes during a single day. Caring for ill or injured 
patients can result in repetitive stress that can reach acute levels of stress.6 Maintaining 
equilibrium, professionally and personally, in the face of fear, the unknown, anger, grief, 
and perceived hopelessness, can be challenging. Frequent exposure to high levels of 
suffering and distress can lead to compassion fatigue.4  
 
Compassion fatigue is the result of exposure to prolonged, multiple stressors while providing 
care that exceeds one’s ability to successfully cope with those stressors.14 Compassion 
fatigue leads to physical, emotional, and spiritual distress.14 Some of the symptoms of 
compassion fatigue include sleep disturbance, irritability, anxiety, and loss of hope.8 For 
many health care team members, the negative effects of providing care are offset by the 
reward of work that they find meaningful. However, for some, the fatigue can lead to 
burnout, which involves a diminished sense of professional satisfaction and 
accomplishment.8 The negative effects of compassion fatigue do not only impact the health 
care team member providing care; they can also have a negative effect on patient 
outcomes.14 
 
Health care team members should take steps to maintain their emotional wellness, with 
continued support from the organization, which plays an essential role in the maintenance 
of individual and team wellness.  
 
When balance is lost in the workplace, health care team members begin to suffer the 
consequences of burnout and move from personal fulfillment and job satisfaction to 
emotional exhaustion and stress.9 The stressors of compassion fatigue and the cumulative 
effects of burnout can cause team members to leave the health care profession. A healthy 
balance is achieved through a person’s resilience, or the ability to respond and adapt well to 
the stressors of the job. The ability to be resilient typically determines how an individual 
gauges personal success and how that individual determines positive approaches to the next 
task. Occupational stressors that overwhelm a team member’s resilience can lead to 
decreased quality of care, damaged team morale, and staff turnover. 
 
Resilience can be learned, and it can be regained. It grows with experience and closely 
follows self-confidence. To cultivate and nurture resilience, individual, group, and 
organizational efforts should be made to protect health care team members from being 
overwhelmed. Confronting suffering, while also being open to and present in that suffering, 
should be the goal of these efforts.12 Self-care and stress management is vital in decreasing 
compassion fatigue and the risk for burnout.12 Focused awareness of the challenges at work 
and of the team member’s own emotional responses to those challenges is integral to 
effective self-care.10,12 Meditation practices, such as mindfulness, as well as individual rituals 
(e.g., memory sharing), can greatly enhance resilience and awareness.9,10   
 
Self-care on the individual level is the practice of taking actions to preserve one’s well-
being, including a cultivation of self-awareness, resilience, and mindful vulnerability. 
  
 
Staff Stress and Resilience - CE 
 
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Protective team factors provide democratic conflict management, a safe environment for 
candid discussion, and commitment of the group to work together on difficult cases. 
Organization practices should raise awareness about services, increase health care team 
members’ use of services available, and protect the autonomy of service. 
 
ASSESSMENT AND PREPARATION 
Assessment 
1. Assess the health care team member for suicidal or homicidal ideation or thoughts of 
self-harm. Use an organization-approved standardized tool for suicide assessment.7 
2. Identify the root of the health care team member’s concern. Is it clinical, social, 
emotional, or spiritual? 
3. Help the health care team member reflect on the source of his or her negative emotional 
response.  
4. Assess the health care team member’s situation.  
 
a. Does the team member require the assistance of another discipline or mentor?  
b. Does the team member have the appropriate skill set to care for an assigned patient, 
family, or situation effectively?  
c. Does the team member recognize a limitation within himself or herself, in the 
environment, or in the system, that is hindering intervention? 
 
5. Evaluate the urgency of the health care team member’s concern. 
6. Determine which self-care tools have been used with success and which may be 
introduced or considered.  
7. Help the health care team member reflect on the source of his or her negative emotional 
response.  
 
Preparation 
1. Consider the health care team member’s values and goals. These may differ depending 
on experience, education, practice setting, age, and other personal and professional 
factors. 
2. Understand that health care team members are often exposed to acute suffering. Create 
a space that allows for candid discussion of difficult and challenging cases. Ideally, 
discussions should be interdisciplinary to take advantage of multiple perspectives. 
3. Recognize that health care team member care should be a holistic interdisciplinary 
approach with consideration for the health care team and individual and is achieved 
through effective communication and teamwork.12 
4. Define self-care as it applies to work and life outside work.  
5. Create an environment of trust and safety. 
6. Create an environment that advocates for health care team member needs.  
 
STRATEGIES 
Self-Care Practices 
1. Implement informal practices to promote mindfulness and reflection.5  
 
a. Walking meditation 
b. Mindful pauses before patient interaction 
c. Focused breathing 
d. Therapeutic listening 
e. Mindful pauses after patient interaction 
f. Journaling, while maintaining patient privacy 
  
 
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2. Use debriefing as a method for sharing insight and receiving guidance.  
3. Implement informal mindful practices outside of work (e.g., meditation, yoga, martial 
arts, reflective journaling, art, exercise).  
 
Rationale: Finding meaningful outlets for dealing with stress and negative 
energy assists health care team members with creating a healthy separation 
between work and private life. 
 
4. Engage in rituals (e.g., grounding prayer, reading a meaningful poem, bereavement 
calls).3 
 
Rationale: Rituals are familiar, reproducible processes that can return the 
health care team member to focus or calm the mind amid sensory overload.  
 
5. Engage in activities that promote the development of personal resilience such as 
exemplifying a positive attitude, practicing self-reflection, and seeking mentorship from 
others.11 
6. Take actions that nurture the mind, body, and spirit and engage in self-care. Understand 
that at times, self-care may require that one needs to say no to a request.1 
 
Team Practices 
1. Promote open and honest communication within the interdisciplinary team.  
2. Encourage burden sharing among health care team members to identify unique 
differences and skill sets to meet the challenges of a difficult case.  
3. Create some time and space for breaks to support health care team members where the 
focus is discussing the emotional impact of difficult patients or situations.  
4. Encourage mentorship, if possible, to facilitate open communication.  
5. Recognize successes and celebrate milestones. 
6. Schedule debriefing sessions, as appropriate, to discuss difficult cases and situations. 
Discuss what may be needed and available for team member support. 
 
Organization Practices 
1. Maintain clear and consistent messages highlighting the importance of self-care.  
 
a. Posters encouraging resilience through mindful self-care 
b. Organization wide programs that identify team members at risk (e.g., Schwartz Rounds® 
[a regularly scheduled forum that brings team members together with the goal of 
processing difficult emotional and social issues faced in caring for patients and 
families])2 
 
2. Provide education about resources and specifically about updates on disasters or 
pandemics. 
3. Provide information on the status of a crisis. 
 
Keeping the health care team informed and providing accurate 
information is essential to minimizing stress. 
 
Rationale: Unreliable or inaccurate information can increase stress.13 
 
  
 
Staff Stress and Resilience - CE 
 
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4. Assess the need for an employee assistance program (EAP) consult and seek a consult 
as appropriate. 
 
REASSESSMENT 
1. Continue to monitor health care team members for stress and burnout. 
2. Monitor the effectiveness of support measures offered to health care team members. 
 
EXPECTED OUTCOMES 
• Improved staff resilience 
• Use of resources for self-care 
• Open discussion among health care team members about challenges 
• Improved interaction among health care team members  
• Improved interaction between health care team members, patients, families, and 
caregivers 
• Reduced turnover 
 
UNEXPECTED OUTCOMES 
• Unmanaged stress 
• Refusal to use self-care resources 
• Ineffective discussion 
• Increased turnover 
• Loss of team morale 
• Decrease of productivity 
• Patient care negatively affected 
 
DOCUMENTATION 
• Usage of available resources 
• Notes from debriefing or discussions 
• Unexpected outcomes and related interventions 
 
REFERENCES 
1. American Psychiatric Nurses Association. (n.d.). Self care tip sheet for nurses. Retrieved 
April 6, 2020, from https://www.apna.org/files/public/APNASelfCareTipSheet.pdf (Level VII)  
2. Barker, R., Cornwell, J., Gishen, F. (2016). Introducing compassion into the education of 
health care professionals; Can Schwartz Rounds help? Journal of Compassionate Health 
Care, 3, 3. doi:10.1186/s40639-016-0020-0 
3. Buzzanell, P.M. (2018). Organizing resilience as adaptive-transformational 
tensions. Journal of Applied Communication Research, 46(1), 14-18. 
doi:10.1080/00909882.2018.1426711 
4. Chung, J.W., Davies, N. (2016). A review of compassion fatigue of nurses during and 
after the Canterbury earthquakes. Australasian Journal of Disaster & Trauma Studies, 20(2), 
69. 
5. Donald, J.N. and others. (2016). Daily stress and the benefits of mindfulness: Examining 
the daily and longitudinal relations between present-moment awareness and stress 
responses. Journal of Research in Personality, 65, 30-37. doi:10.1016/j.jrp.2016.09.002 
(Level VI) 
6. Frey, R. and others. (2018). Burnout, compassion fatigue and psychological capital: 
Findings from a survey of nurses delivering palliative care. Applied Nursing Research, 43, 1-
9. doi:10.1016/j.apnr.2018.06.003 (Level VI) 
  
 
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7. Joint Commission, The. (2020). National patient safety goals. Hospital accreditation 
program. Retrieved April 6, 2020, from https://www.jointcommission.org/-
/media/tjc/documents/standards/national-patient-safety-
goals/npsg_chapter_hap_jan2020.pdf (Level VII)  
8. Klappa, S.G. and others. (2016). Compassion fatigue: A conceptual model for re-entry 
after disaster relief work in Haiti. HPA The Catalyst, 15(4), 1-18. (Level VI) 
9. Montross-Thomas, L.P. and others. (2016). Personally meaningful rituals: A way to 
increase compassion and decrease burnout among hospice staff and volunteers. Journal of 
Palliative Medicine, 19(10), 1043-1050. doi:10.1089/jpm.2015.0294 
10. Orellana-Rios, C.L. and others. (2017). Mindfulness and compassion-oriented practices 
at work reduce distress and enhance self-care of palliative care teams: A mixed-method 
evaluation of an “on the job” program. BMC Palliative Care, 17(1), 3. doi:10.1186/s12904-
017-0219-7 
11. Prosser, S.J., Metzger, M., Gulbransen, K. (2017). Don't just survive, thrive: 
Understanding how acute psychiatric nurses develop resilience. Archives of Psychiatric 
Nursing, 31(2), 171-176. doi:10.1016/j.apnu.2016.09.010 (Level VI) 
12. Mota Vargas, R. and others. (2016). The transformation process for palliative care 
professionals: The metamorphosis, a qualitative research study. Palliative Medicine, 30(2), 
161-170. doi:10.1177/0269216315583434 (Level VI) 
13. Yumiya, Y. and others. (2019). Unreliable information as a risk factor for worse mental 
fatigue among residents in Fukushima after the nuclear power station accident. Tohoku 
Journal of Experimental Medicine, 248(4), 261. doi:10.1620/tjem.248.261 (Level VI) 
14. Zhang, Y.Y. and others. (2018). Determinants of compassion satisfaction, compassion 
fatigue and burn out in nursing: A correlative meta-analysis. Medicine, 97(26), e11086. 
doi:10.1097/MD.0000000000011086 (Level I) 
 
 
Elsevier Skills Levels of Evidence 
• Level I - Systematic review of all relevant randomized controlled trials 
• Level II - At least one well-designed randomized controlled trial 
• Level III - Well-designed controlled trials without randomization 
• Level IV - Well-designed case-controlled or cohort studies 
• Level V - Descriptive or qualitative studies 
• Level VI - Single descriptive or qualitative study 
• Level VII - Authority opinion or expert committee reports 
 
 
Author: Loraine Fleming, DNP, APRN, PMHNP-BC, PMHCNS-BC 
 
Published: April 2020 


Staff Stress and Resilience





5/4/� Sechter D, et al. J Affect
Disord. 2004;83(2-3):233-
236 [50546] 
A 6-week double-blind, randomized, 
parallel group study compared milnacipran 
(100 mg/day) with paroxetine (20 mg/day)
in 300 outpatients with major depression. 
Efficacy (ITT-LOCF) was evaluated using 
HAMD17, MADRS, and CGI. Safety and 
tolerability were assessed in standard 
fashion 
Drug Interactions 
MAO inhibitors 
HAMD17, MADRS, and 
CGI: No significant 
differences were noted on 
any outcome measure 
between groups 
Safety/tolerability: No 
major safety issues were 
noted; tolerability was similar 
Both milnacipran and 
paroxetine were effective and 
well-tolerated by outpatients 
with major depression treated 
for 6 weeks. After treatment 
discontinuation milnacipran was 
associated with fewer emergent 
symptoms 
SNRls are contraindicated in patients receiving MAO inhibitors (MAOls) or within 2 weeks of their 
discontinuation due to the risk of serotonin syndrome. Medications with MAOI activity, such as linezolid 
or intravenous methylene blue, are also contraindicated for use with SNRls because of an increased 
risk of serotonin syndrome.[23430][23431 ][28275][29934][33715][34940][55469] 
SSRls, SNRls and other serotonergic drugs 
Any use of an SNRI with other serotonergic agents increases the likelihood of serotonergic adverse 
effects and should be monitored closely. Drugs that have serotonergic properties include opiates, 
triptans, most antidepressants, amphetamines, St. John's wort, tramadol, lithium, buspirone, and others. 
[23430][23431 ][28275][29934][33715][34940][55469] 
Antithrombotic drugs 
Anticoagulants, antiplatelet drugs (e.g., aspirin), and nonsteroidal anti-inflammatory drugs (NSAIDs) 
should be administered with caution to any patient taking an SNRI. Platelet aggregation may be 
impaired by SNRls due to platelet serotonin depletion, possibly increasing the risk of a bleeding 
complication. Patients should be instructed to monitor for signs and symptoms of bleeding while taking 
an SNRI with an anticoagulant medication and to promptly report any bleeding events to the practitioner. 
[23430][23431 ][28275][29934][33715][34940][55469] 
http� 
Drugs that inhibit CYP2D6 or CYP1A2 
Levomilnacipran and milnacipran are not metabolized to any significant extent by CYP450 isoenzymes 
and are not inducers or inhibitors of any of these isoenzymes. Venlafaxine is metabolized by CYP2D6, 
and CYP2D6 inhibitors may increase venlafaxine concentrations. A dose-related CYP2D6 inhibitory 
effect has been observed with desvenlafaxine; therefore, the dose of primary CYP2D6 substrates 
should be reduced by up to one-half if coadministered with desvenlafaxine 400 mg/day. Duloxetine is 
metabolized by CYP1A2 and CYP2D6; inhibitors of CYP1A2 and CYP2D6 may increase duloxetine 
concentrations. [23430][23431 ][28275][29934 ][33715][34940][55469] 
5/6 
Copyright© 2020 Elsevier Inc. All rights reserved. 
Appendix A 
Therapeutic Use Table 
Indications Desvenlafaxine 
Renal Impairment 
Yes 
Dosing Adjustment 
Hepatic 
Impairment Dosing Yes 
Adjustment 
depression Yes 
diabetic 
neuropathy 
fibromyalgia 
generalized anxiety 
disorder (GAD) 
hot flashes Yest 
menopause Yest 
musculoskeletal 
pain 
osteoarthritis 
panic disorder 
premenstrual 
dysphoric disorder 
(PMDD) 
social phobia 
(social anxiety 
disorder) 
urinary 
incontinence 
Yes - Labeled 
Yest - Off-label 
Desvenlafaxine 
Duloxetine Levomilnacipran Milnacipran HCI 
Venlafaxine 
Succinate Hydrochloride 
Yes Yes Yes Yes Yes 
Yes Yes Yes 
Yes Yes Yes Yest Yes 
Yes Yest 
Yes Yes Yest 
Yes Yes 
Yest Yest 
Yest Yest 
Yes 
Yes 
Yes 
Yest 
Yes 
Yest 
Appendix B 
Top 20 Adverse Reactions / Side Effects Table
Adverse Reaction 
/ Side Effect Desvenlafaxine 
Desvenlafaxine 
Succinate Duloxetine Levomilnacipran Milnacipran HCl 
Venlafaxine 
Hydrochloride 
anorexia 5 - 10% 5 - 10% 7 - 10% 3% Reported 8 - 18% 
constipation 9 - 14% 9 - 14% 9 - 11% 9% 15 - 16% 8 - 15% 
dizziness 10 - 16% 10 - 16% 8 - 10% Reported 10 - 11% 11 - 20% 
ejaculation 
dysfunction <7% <7% 2 - 3% 5% >2% 8 - 19% 
hyperhidrosis 10 - 21% 10 - 21% <6% 9% 8 - 9% 6.7 - 19.3% 
hypertension 0.7 - 2.3% 0.7 - 2.3% Reported 3% 4 - 7% 0.5 - 13% 
impotence 
(erectile 
dysfunction) 
3 - 11% 3 - 11% 4% 6% >2% 4 - 5% 
nausea 22 - 41% 22 - 41% 4 - 24% 17% 35 - 39% 21 - 58% 
withdrawal 22 - 27% 22 - 27% >1% Reported Reported 0.1 - 1% 
drowsiness 4 - 12% 4 - 12% 9 - 12% >1% 12 - 23% 
insomnia 9 - 15% 9 - 15% 7 - 11% 12% 18 - 23% 
orthostatic 
hypotension 
<8% <8% 0.1 - 1% 11.6% 0.1 - 1% 
weight loss Reported Reported 0.1 - 14% >1% 4 - 47% 
xerostomia 11 - 25% 11 - 25% 2 - 14% 5% 12 - 22% 
asthenia <2% <2% 10 - 11% 8 - 15% 
fatigue 7 - 11% 7 - 11% 7 - 11% >1%
abdominal pain 5 - 13% <2% 3% 
headache 13 - 18% 17 - 19% 25 - 38% 
hot flashes 0.1 - 1% 3% 11 - 12% 
weakness 8 - 19% 



Serotonin Norepinephrine Reuptake Inhibitors

CARE PLANNING
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B. Patient, family or significant other will teach 
back or demonstrate education topics and points:
• Education: Overview
• Education: When to Seek Medical 
Attention
• Education: Self Management
A. The patient will demonstrate achievement
of the following goals:
• Anxiety Reduction or Resolution
Anxiety
Setting:  Population:  Keywords:     Inpatient Pediatric apprehension, dread, anxiety, uncertainty, uneasiness
Last Updated: 03/13/2020. Copyright Elsevier BV. All rights reserved.
Clinical Description
Care of the hospitalized child experiencing feelings of apprehension, uneasiness, uncertainty or dread about possible 
future events and the ability to deal with the events.
Key Information
• Anxiety is a subjective, individual experience ranging from vague discomfort to feelings of panic. It is a normal 
response to threatening situations.
• Increased parental anxiety and concern has been directly correlated to increased anxiety and concern in children.
• Studies show a decrease in a child’s anxiety when provided with coping strategies prior to a procedure or 
surgery.
• Anxiety can become excessive and difficult to control; negatively affecting day-to-day living, physical comfort 
and medical diagnosis symptoms.
 Clinical Goals
 By transition of care
Correlate Health Status
  CARE PLANNING  CPG IP Anxiety Peds Setting: Inpatient Population: Pediatric
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Copyright ©  Elsevier, except certain content provided by third party.2020
Correlate health status to:
• history, comorbidity, congenital anomaly
• age, developmental level
• sex, gender identity
• baseline assessment data
• physiologic status
• response to medication and interventions
• psychosocial status, social determinants of health
• barriers to accessing care and services
• child and family/caregiver:
• health literacy
• cultural and spiritual preferences
• safety risks
• family interaction
• plan for transition of care
Anxiety 
Signs/Symptoms/Presentation
• acting out
• agitation
• anger
• apprehension
• crying
• distress
• fear
• helplessness
• hypervigilance
• increased dependence
• irritability
• joking
• nervousness
  CARE PLANNING  CPG IP Anxiety Peds Setting: Inpatient Population: Pediatric
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• panic
• regressive behavior
• restlessness
• sense of impending doom
• social withdrawal
• worry
Physical symptoms
• dry mouth
• muscle tension
• shortness of breath
• skin flushed
• skin rash
• sleep disturbance
• urinary frequency
• urinary urgency
Vital Signs
• heart rate increased
Problem Intervention(s)
Promote Anxiety Reduction
• Maintain a calm and reassuring environment; minimize noise; provide familiar items; offer choices; follow 
home routine.
• Encourage parent/caregiver presence and participation to enhance ability to support the child.
• Support expression and identification of feelings and worries; compassionately acknowledge and validate 
concerns.
• Utilize existing coping strategies and assist in developing new strategies (e.g., music, deep breathing, relaxation 
techniques, massage, diversional activity, play, pet therapy).
• Identify thoughts and feelings that led to current anxiety onset to enhance understanding of triggers.
  CARE PLANNING  CPG IP Anxiety Peds Setting: Inpatient Population: Pediatric
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• Reframe anxiety-provoking situations; provide a new perspective; engage in problem-solving.
• Utilize anticipatory guidance to enhance sense of control.
• Consider referral for a comprehensive assessment if there are concerns about the number, severity and duration 
of symptoms; degree of distress; functional impairment or excessive substance use.
Associated Documentation
• Complementary Therapy
• Supportive Measures
• Family/Support System Care
General Education
• admission, transition of care
• orientation to care setting, routine
• advance care planning
• diagnostic tests/procedures
• opioid medication management
• oral health
• medication management
• pain assessment process
• safe medication disposal
• tobacco use, smoke exposure
• treatment plan
Safety Education
• call light use
• equipment/home supplies
• fall prevention
• harm prevention
• infection prevention
  CARE PLANNING  CPG IP Anxiety Peds Setting: Inpatient Population: Pediatric
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• MDRO (multidrug-resistant organism) care
• personal health information
• resources for support
Education: Overview
• risk factors
• signs/symptoms
Education: Self Management
• coping strategies
• resources for support
Education: When to Seek Medical Attention
• unresolved/worsening symptoms
References
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systematic review of benefits and risks. European Journal of Integrative Medicine. 2016;8(5), 695-706. doi:10.1016/
j.eujim.2016.05.005  [Metasynthesis, Meta-analysis, Systematic Review]Source
Capurso, M.; Ragni, B. Psycho-educational preparation of children for anaesthesia:  A review of intervention methods.
Patient Education and Counseling. 2016;99(2), 173-185. doi:10.1016/j.pec.2015.09.004  [Metasynthesis, Source
Meta-analysis, Systematic Review]
Chow, C. H.; Van Lieshout, R. J.; Schmidt, L. A.; Dobson, K. G.; Buckley, N. Systematic review:  Audiovisual 
interventions for reducing preoperative anxiety in children undergoing elective surgery. Journal of Pediatric 
Psychology. 2016;41(2), 182-203. doi:10.1093/jpepsy/jsv094 [Metasynthesis, Meta-analysis, Systematic Review]
Cincinnati Children's Hospital Medical Center. (2013, Aug 13). Best evidence statement (BESt).  Providing most 
 . (pp.5). Cincinnati, OH: Cincinnati Children's Hospital effective child life care for patients having general anesthesia
Medical Center. [Review Articles, Expert/Committee Opinion, Core Curriculum, Position Statements, Practice 
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Halter, M. J. (2018).  . St. Louis: Varcarolis' foundations of psychiatric-mental health nursing: A clinical approach.
Elsevier. [Review Articles, Expert/Committee Opinion, Core Curriculum, Position Statements, Practice Bulletins]
Hockenberry, M. J.; Wilson, D.; Rodgers, C. C. (2019).  . St. Louis: Wong's nursing care of infants and children
Mosby, Elsevier. [Review Articles, Expert/Committee Opinion, Core Curriculum, Position Statements, Practice 
Bulletins]
Koller, D.; Goldman, R. D. Distraction techniques for children undergoing procedures:  A critical review of pediatric 
research. Journal of Pediatric Nursing. 2012;27(6), 652-681. doi:10.1016/j.pedn.2011.08.001  [Review Articles,Source
Expert/Committee Opinion, Core Curriculum, Position Statements, Practice Bulletins]
Kuang, H. The efficacy of benzodiazepines as acute anxiolytics in children: A meta-analysis.. Depression & Anxiety. 
2017;34(10), 888-896. doi:10.1002/da.22643  [Metasynthesis, Meta-analysis, Systematic Review]Source
Locher, C.. Efficacy and Safety of Selective Serotonin Reuptake Inhibitors, Serotonin-Norepinephrine Reuptake 
Inhibitors, and Placebo for Common Psychiatric Disorders Among Children and Adolescents. JAMA Psychiatry. 2017
;74(10), 1011-1020. doi:10.1001/jamapsychiatry.2017.2432 [Metasynthesis, Meta-analysis, Systematic Review]
Munn, Z.; Jordan, Z. Interventions to reduce anxiety, distress, and the need for sedation in pediatric patients 
undergoing magnetic resonance imaging:  A systematic review. Journal of Radiology Nursing. 2013;32(2), 87-96. doi:
10.1016/j.jradnu.2012.08.003  [Metasynthesis, Meta-analysis, Systematic Review]Source
Norton-Westwood, D. The health-care environment through the eyes of a child?  Does it soothe or provoke anxiety?. 
International Journal of Nursing Practice. 2012;18(1), 43292. doi:10.1111/j.1440-172X.2011.01995.x [Review 
Articles, Expert/Committee Opinion, Core Curriculum, Position Statements, Practice Bulletins]
Robb, S. L.; Hanson-Abromeit, D. A review of supportive care interventions to manage distress in young children 
with cancer and parents. Cancer Nursing. 2014;37(4), E1-26. doi:10.1097/NCC.0000000000000095 [Metasynthesis, 
Meta-analysis, Systematic Review]
Runyon, K.. Screening for childhood anxiety: A meta-analysis of the screen for child anxiety related emotional 
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Meta-analysis, Systematic Review]
Sridharan, K.; Sivaramakrishnan, G. Therapeutic clowns in pediatrics:  A systematic review and meta-analysis of 
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, Systematic Review]
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Pediatric Inpatient Anxiety

Adult Obstetrics Inpatient Perinatal Anxiety Symptoms

Infection Prevention in the Home 
If you have an infection, may have been exposed to an infection, or are taking care of someone who has 
an infection, it is important to know how to keep the infection from spreading. Follow your health care 
provider's instructions and use these guidelines to help stop the spread of infection. 
How infections are spread 
In order for an infection to spread, the following must be present:   
 A germ. This may be a virus, bacteria, fungus, or parasite. 
 A place for the germ to live. This may be: 
o On or in a person, animal, plant, or food. 
o In soil or water. 
o On surfaces, such as a door handle. 
 A person or animal who can develop a disease if the germ enters the body (host). The host does 
not have resistance to the germ. 
 A way for the germ to enter the host. This may occur by: 
o Direct contact with an infected person or animal. This can happen through shaking 
hands or hugging. Some germs can also travel through the air and spread to others. This 
can happen when an infected person coughs or sneezes on or near other people. 
o Indirect contact. This occurs when the germ enters the host through contact with an 
infected object. Examples include: 
 Eating or drinking food or water that has the germ (is contaminated). 
 Touching a contaminated surface with your hands, and then touching your face, 
eyes, nose, or mouth. 
Supplies needed: 
 Soap. 
 Alcohol-based hand sanitizer. 
 Standard cleaning products. 
 Disinfectants, such as bleach. 
 Reusable cleaning cloths, sponges, or paper towels. 
 Disposable or reusable utility gloves. 
How to prevent infection from spreading 
There are several things that you can do to help prevent infection from spreading. 
Take these general actions 
Everyone should take the following actions to prevent the spread of infection: 
 Wash your hands often with soap and water for at least 20 seconds. If 
soap and water are not available, use alcohol-based hand sanitizer. 
 Avoid touching your face, mouth, nose, or eyes. 
 Cough or sneeze into a tissue, sleeve, or elbow instead of into your hand 
or into the air. 
o If you cough or sneeze into a tissue, throw it away immediately 
and wash your hands. 
Keep your bathroom clean 
 Provide soap. 
 Change towels and washcloths frequently. 
 Change toothbrushes often and store them separately in a clean, dry place. 
 Clean and disinfect all surfaces, including the toilet, floor, tub, shower, and sink. 
 Do not share personal items, such as razors, toothbrushes, deodorant, combs, brushes, towels, 
and washcloths. 
Maintain hygiene in the kitchen 
 Wash your hands before and after preparing food and before 
you eat. 
 Clean the inside of your refrigerator each week. 
 Keep your refrigerator set at 40°F (4°C) or less, and set your 
freezer at 0°F (–18°C) or less. 
 Keep work surfaces clean. Disinfect them regularly. 
 Wash your dishes in hot, soapy water. Air-dry your dishes or 
use a dishwasher. 
 Do not share dishes or eating utensils. 
Handle food safely 
 Store food carefully. 
 Refrigerate leftovers promptly in covered containers. 
 Throw out stale or spoiled food. 
 Thaw foods in the refrigerator or microwave, not at room temperature. 
 Serve foods at the proper temperature. Do not eat raw meat. Make sure it is cooked to the 
appropriate temperature. Cook eggs until they are firm. 
 Wash fruits and vegetables under running water. 
 Use separate cutting boards, plates, and utensils for raw foods and cooked foods. 
 Use a clean spoon each time you sample food while cooking. 
Do laundry the right way 
 Wear gloves if laundry is visibly soiled. 
 Do not shake soiled laundry. Doing that may send germs into the air. 
 Wash laundry in hot water. 
 If you cannot wash the laundry right away, place it in a plastic bag and wash it as soon as 
possible. 
Be careful around animals and pets 
 Wash your hands before and after touching animals. 
 If you have a pet, ensure that your pet stays clean. Do not let people with weak immune 
systems touch bird droppings, fish tank water, or a litter box. 
o If you have a pet cage or litter box, be sure to clean it every day. 
 If you are sick, stay away from animals and have someone else care for them if possible. 
How to clean and disinfect objects and surfaces 
Precautions 
 Some disinfectants work for certain germs and not others. Read the manufacturer's instructions 
or read online resources to determine if the product you are using will work for the germ you 
are trying to remove. 
 If you choose to use bleach, use it safely. Never mix it with other cleaning products, especially 
those that contain ammonia. This mixture can create a dangerous gas that may be deadly. 
 Keep proper movement of fresh air in your home (ventilation). 
 Pour used mop water down the utility sink or toilet. Do not pour this water down the kitchen 
sink. 
Objects and surfaces 
 If surfaces are visibly soiled, clean them first with soap and 
water before disinfecting. 
 Disinfect surfaces that are frequently touched every day.  
This may include: 
o Counters. 
o Tables. 
o Doorknobs. 
o Sinks and faucets. 
o Electronics, such as: 
 Phones. 
 Remote controls. 
 Keyboards. 
 Computers and tablets. 
Cleaning supplies 
Some cleaning supplies can breed germs. Take good care of them to prevent germs from spreading. To 
do this: 
 Soak toilet brushes, mops, and sponges in bleach and water for 5 minutes after each use, or 
according to manufacturer's instructions. 
 Wash reusable cleaning cloths and sanitize sponges after each use. 
 Throw away disposable gloves after one use. 
 Replace reusable utility gloves if they are cracked or torn or if they start to peel. 
Additional actions if you are sick 
If you live with other people: 
 Avoid close contact with those around you. Stay at least  
3 ft (1 m) away from others, if possible. 
 Use a separate bathroom, if possible. 
 If possible, sleep in a separate bedroom or in a separate bed to 
prevent infecting other household members. 
o Change bedroom linens each week or whenever they are soiled. 
 Have everyone in the household wash hands often with soap and water. If soap and water are 
not available, use alcohol-based hand sanitizer. 
In general: 
 Stay home except to get medical care. Call ahead before visiting your health care provider. 
 Ask others to get groceries and household supplies and to refill prescriptions for you. 
 Avoid public areas. Try not to take public transportation. 
 If you can, wear a mask if you need to go out of the house, or if you are in close contact with 
someone who is not sick. 
 Avoid visitors until you have completely recovered, or until you have no signs and symptoms of 
infection. 
 Avoid preparing food or providing care for others. If you must prepare food or provide care for 
others, wear a mask and wash your hands before and after doing these things. 
Where to find more information 
 Centers for Disease Control and Prevention: 
www.cdc.gov/nonpharmaceutical-interventions/index.html  
 World Health Organization (WHO): www.who.int/infection-prevention/about/en/  
 Association for Professionals in Infection Control and Epidemiology: 
professionals.site.apic.org/settings-of-care/non-healthcare-setting/home/  
Summary 
 It is important to know how to keep the infection from spreading. 
 Make sure everyone in your household washes their hands often with soap and water. 
 Disinfect surfaces that are frequently touched every day. 
 If you are sick, stay home except to get medical care. 
This information is not intended to replace advice given to you by your health care provider. Make sure 
you discuss any questions you have with your health care provider. 
Document Released: 09/26/2009 Document Revised: 03/13/2020 Document Reviewed: 03/13/2020 
Elsevier Interactive Patient Education © 2020 Elsevier Inc. 


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