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Chapter 27:Asepsis

Professional Nursing

Role of nurses in infection control: Prevention of infection Awareness of infection cycle Compliance with infection control measures
Infectious Agent: bacteria, viruses, fungi. (Pathogens & Normal flora that become pathogenic)
Reservoir: natural habitat of the organism (Where pathogens live and multiply (H2O – E coli) May be living Humans, animals, insects May be nonliving Food, floors, equipment, contaminated water)
Portal of Exit: point of escape for the organism (Bodily fluids Coughing, sneezing, diarrhea Seeping wounds Tubes, IV lines)
Means of Transmission: direct contact, indirect contact, airborne route (Direct – touching, kissing, sexual contact Indirect – contact with a fomite Droplet: Cough, sneeze Airborne: Via air conditioning, sweeping)
Portal of Entry: point at which organisms enter a new host (Eye, nares, mouth, vagina, cuts, scrapes Wounds, surgical sites, IV or drainage tube sites) Bite from a vector
Susceptible Host: must overcome resistance mounted by host’s defenses (Person with inadequate defense Three determining factors: Virulence Number of organisms Host’s defenses)
Bacteria: Most commonly observed infection causing agent in healthcare organizations.
Aerobic: stain violet. requires O2 to grow
Anaerobic do not stain. are bacteria that do not need oxygen to live.
Antibiotics: are classified as treating gram negative, gram positive or broad spectrum.
Virus: Smallest of microorganisms. Common cold, Influenza, HIV, Herpes are caused by viruses.Antivirals given in the prodromal period are effective on some viral infections *Antibiotics may work on viral.
Fungi: Plant like organisms – mold & yeast Present in the soil, air and water. Antifungal medications are available.
Examples of Fungi: ringworm, athletes foot, candidas albicans, vaginal yeast infections, and candidal diaper rash.
The most significant and commonly found infection-causing agent in healthcare institutions: Bacteria
Fungi (molds and yeasts): can cause infection and are present in the air, soil, and water.
Viruses: cause infections including the common cold and do not respond to antibiotics.
Possible Reservoirs for Microorganisms: Other humans Animals Soil Food, water, milk Inanimate objects
Food poisoning: mad cow, lysteria (canteloupe)
Inanimate object: floors, equipment
Common Portals of Exit: Respiratory Gastrointestinal Genitourinary tracts Breaks in skin Blood and tissue
Respiratory: cough or sneeze
Gastrointestinal: Diarrhea
GU (genitourinary): catheter (UTI)
Skin: seeping wounds
Means/Methods of Transmission: Direct Indirect Vehicle-borne Vector borne Airborne
Direct: touching, kissing, biting, sneezing, sexual intercourse, coughing, spitting – droplet spread.
Indirect: (vehicle borne) inanimate object/material – handkerchief, toys, soiled clothes, cooking utensils, surgical instruments, dressings, water, food, blood, serum, (Hepatitis A food)
Vector borne: an animal insect – salivary fluid during biting, Depositing feces.
Airborne: dust or droplet nuclei.
The entry route into the new host often is the same as the exit route from the prior reservoir: Urinary Respiratory Gastrointestinal Tracts Skins microorganisms must enter the body to cause infection (Mouth, nose, cuts, scrapes, vagina)
Susceptible Host: Any person at risk for infection Compromised host – increased risk Immune deficiency conditions
Any person at risk for infection: Compromised host – increased risk, young – infant/newborn, elderly, immune suppression treatment for CA/HIV, chronic illness, immune deficiency conditions.
Hand hygiene: is the single most effective method of preventing the spread of infection.
There are four stages of infection: 1.Incubation 2.Prodromal 3.Full stages of the illness 4.Convalescent period
There are four stages of infection: 1.Incubation 2.Prodromal 3.Full stage of the illness 4.Convalescent period
Incubation: Interval between invasion and the appearance of symptoms. Organisms are growing and multiplying. Length – varies ( 1-2 days to longer). Tetnus – 2-21 days. Influenza – 1-4 days.
Prodromal: Most infectious period. Not aware contagious ---spread. Early signs and symptoms (Fever, Malaise, Vague) Length- several hours to several days
Full Stage of the Illness: Presence of signs and symptoms of disease indicates entry into this period Severity of manifestations and length of illness are dependent on type of infection (Localized vs. systemic)
Convalescent Period: Recovery Period. Convalescence will vary: Severity of the illness. Patient’s general condition. Signs and symptoms disappear Return to healthy state. Possible temporary or permanent changes to health state even after this period.
Localized: illnesses limited or localized to one body area.
Systemic: symptoms manifested through out the entire body.
Portal of Entry: is the point in the chain of infection in which the organism enters a new host.
Bacteria: are the smallest of all microorganisms.
During the prodromal stage of illness: A person is most infectious. Person is not aware contagious, symptoms are vague, therefore spreads.
Hand Hygiene: is the most effective way to prevent the spread of organisms.
The reservoir of a microorganism: is the natural habitat of the organism where growth and multiplication occur.
Vectors: (mosquitoes, ticks, and lice) are carriers that transmit organisms from one host to another.
The Inflammatory Response: helps the body to neutralize, control, or eliminate an offending agent and to prepare the site for repair.
Transmission-based precautions: are used for patients in hospitals with suspected infection with pathogens that can be transmitted by airborne, droplet, or contact routes.
The Infection Control Process of Sterilization: destroys all pathogenic organisms, including spores.
Types of Infection: Colonization, Local infection, Systemic infection - (Bacteremia, Septicemia) Acute, Chronic
Colonization: Strains of microorganisms become resident flora. Infection occurs when newly introduced microorganisms invade a part of the body where the host’s defense mechanisms are ineffective and the pathogen causes tissue damage.
Local Infection: limited to part of the body.
Systemic Infection: (bacteremia & septicemia) spread and damage.
Bacteremia: culture of blood reveals microorganisms.
Septicemia: bacteremia results in systemic infection.
Acute Infection: appear suddenly and last a short time.
Chronic Infection: occur slowly over a long period of time and lasts for month or years.
(Reason for why some people get sick and others don't) Potential for an organism to cause infection in a particular individual depends on: Number of organisms Virulence of organism Immune status Length & intimacy of contact with organism
All of the factors in the infection cycle: must be present for illness to occur. “Perfect storm”
Organisms: can establish as normal flora and are part of the body’s natural defense system.
Opportunist Infection: other factors align in such a way that this usually harmless organism generate infection. Ex: Ecoli stain found in GI tract is benign, if travels to urinary tract ----UTI
Endemic: infections may occur with predictability in one specific region or geographical areas. Example: (Such as Denge fever, which is Southeast Asia, but can pose a significant health risk if emerges in US).
Factors Affecting the Risk for Infection: Integrity of skin and mucous membranes, pH levels of the GI and GU tracts, Integrity and number of the body’s WBC & Age, sex, race, and hereditary factors.
Factors Affecting the Risk for Infection: (cont) Immunizations, natural or acquired, Level of fatigue, nutritional and general health status, Stress level, Use of invasive or indwelling medical devices.
Classification of Infections: Through Location & Duration.
Local: Occurs in a limited region in the body (urinary tract infection, & pneumonia).
Systemic: Spread via blood or lymph, Affects many regions - septicemia
Duration: acute, chronic, latent
Acute: Rapid onset of short duration Example: Common cold
Chronic: Slow development, long duration Example: Hypertension, diabetes mellitus, osteomyelitis.
Latent: Infection present with no discernible symptoms Example: HIV/AIDS
Nosocomial Infection: An infection acquired in a health-care facility (hospital acquired infection). Cost to the health-care system = $4.5 billion/year, Reportable, Leading cause of death, Preventable with use of aseptic principles/ techniques.
Exogenous Nosocomial Infection: Pathogen acquired from health-care environment
Endogenous Nosocomial Infection: Normal flora multiply and cause infection as a result of treatment
Nosocomial Infections: Can develop during a patient’s hospitalization or after discharge. Hospital surgical or medical intensive care units are the most common.
Healthcare Acquired Infections: Surgical Sight Infection (SSI), Catheter Associated Infections (CA-UTI), Central Line Associated Blood Stream Infections (CLABSI)
Any tubes: potential infection.
Assessing: Patient history, observe, review data
Patient History: Vaccines Recurrent or recent infections Signs and symptoms, history of current illness
Observe: Nonverbal cues Sign & symptoms
Signs & Symptoms: localized & systemic.
Localized Infection: Redness, swelling, warmth Pain or tenderness Loss of function in body part
Systemic Infection: Fever Tachycardia and tachypnea Lethargy, anorexia Tenderness and enlargement of lymph nodes
Lab Data: Elevated WBC increased neutrophils in acute infections, increased lymphocytes in chronic infections or viral, increased monocytes- severe infections and function as, phagocytes/scavengers, Eosinophil- allergic reactions or parasites
Elevated erythrocyte sediment rate: rate that RBC settle to bottom of tube when inflammation is present settle more rapidly.
Body’s Defense Against Infection: Body’s normal flora, Inflammatory response, and Immune response
(Primary Defenses) Anatomical features, limit pathogen entry: Intact skin Mucous membranes Tears Normal flora in GI tract Normal flora in urinary tract
(Secondary Defenses) Biochemical processes activated by chemicals released by pathogens: Phagocytosis Complement cascade Inflammation Fever
Inflammation - Body’s defensive response to an infectious agent: Destroys or dilutes agent Prevents further spread of injury Promotes repair of damaged tissue
Inflammation - Characterized by 5 signs: Pain Swelling Redness Heat Impaired Function of the part
Exudate: drainage
Serous: clear
Sanguinous: contains blood
Purulent: contains pus
Neutrophils: through epitaxis , move to area of inflammation to rapidly phagocytize the organism and consume cell debris and foreign material.
Exudate: is composed of fluid, cells and inflammatory by products
phagocytize: phagocyte devour bacteria
Antigen –Antibody reaction (immune response): known as the humoral immunity Humoral Immunity Antigen Antibody
Antigen: foreign material (splinter)
Antibody: body produces in response to the antigen
Cell-mediated defense (immune defense): Cellular immunity Lymphocytic action
Cellular Immunity: increase in lymphocytes that destroy and react with cells the body recognizes as harmful, defend body against bacteria, viral, fungal as well as malignant cells.
Two Types of Immunity: Active & Passive
Active: actively exposed to the antigen in illness or vaccine *Natural- person is exposed to disease, contracts the disease, establishes immunity. *Artificial – induced by vaccine with antigen.
Passive: the antibody is passed to the patient, short term immunity *Artificial- short term immunity by vaccine with antibody, such as gamma globulin. *Natural – placenta transfer of antibody from mother to fetus.
Active: natural: chicken pox artificial: vaccinations (MMR, Hep B)
Diagnosis - Nursing: Anxiety related to high risk infection Anxiety related to social isolation Risk for imbalances body temperature related to infectious process
Anxiety can be due to: illness, fear, lack of knowledge, social isolation, high risk or susceptibility for infection
Risk for Imbalanced body temperature related to infectious process: Dehydration
Anxiety related to high risk infection: social isolation --- who might experience this? -> (example: TB w/ children – scary yellow gowns and masks)
Plan and Implementation - Nursing interventions will depend upon: Susceptibility of the host Virulence of organism Patient’s sign & symptoms Impact of the illness on patient as a holistic being
Virulence: ability of organism to invade
Virulent: Latin meaning “poisoned wound”
Expected Patient Outcomes: Demonstrate : Effective hand washing Personal hygiene Disposal of soiled articles Cough etiquette Awareness of appropriate vaccines Identify signs of infection Maintains adequate hydration and nutrition
Factors that Increase Infection Risk: Developmental stage Breaks in the skin Illness/injury, chronic disease Smoking, substance abuse Multiple sex partners Medications that inhibit/decrease immune response Nursing/medical procedures
Bacterial Flora: Transient and Resident
Transient: Attached loosely on skin, removed with relative ease. Transient are usually removed by hand washing, they have the ability to adjust the environment and become resident.
Transient: cont' If Pathogenic bacteria become resident bacteria on the skin, the hands become carriers of the particular organism. To prevent transient bacteria from becoming resident bacteria…important to cleanse the hands properly.
Transient: cont' **Most important step in preventing infection spread and breaking the cycle is effective hand hygiene
Resident: found in creases in skin, requires friction with brush to remove.
Aseptic Technique: Includes all activities to prevent or break the chain of infection.
Medical Asepsis: (clean technique) practices and procedures that reduce the number and transfer of pathogens (clean technique)– most common EXAMPLE: hand hygiene, wearing gloves
Surgical Asepsis: (Sterile technique) practice used to render and keep objects and areas free of microorganisms (sterile technique) EXAMPLE: Urinary catheter placement, inserting an IV catheter
Implementing Surgical Asepsis: Creation of a sterile environment Use of sterile equipment/supplies Sterilization of reusable supplies Surgical hand scrub Surgical attire Sterile gloves Sterile field Use of sterile technique
Implementing Surgical Asepsis: cont' Sterile on sterile only. 1 inch border around sterile drape is “ not sterile” , when sterile gloves are not worn a nurse can touch the outer 1 inch border.
Implementing Surgical Asepsis: cont' Do not shake products, or reach across a sterile field, sterile products above the waist above waist, do not turn back to a sterile field.
Implementing Surgical Asepsis: cont' “ when in doubt…throw it out” – consider everything contaminated unless can prove it is sterile. Disinfectant does not sterilize. If do not know it is sterile, discard.
Performing Hand Hygiene: Before and after direct contact with patients, Before and after using gloves, Before inserting urinary catheters, IV, or invasive devices.
Performing Hand Hygiene: cont' If moving from a contaminated body site to a clean body site, After contact with objects (including equipment) located in the patient’s environment.
Personal Protective Equipment and Supplies (PPE): Gloves Gowns Masks Protective eye gear
Blood Borne Pathogens: Hepatitis B, Hepatitis C, HIV
Needle sticks and transfer of blood borne pathogens: are true risk to health care providers.
Hepatitis B: Risk factor: contact with infected blood or OPIM (other potentially infections materials) – serum, saliva, CSF, all cultures, any fluid contaminated w/ blood
Hepatitis C: HCV causes liver inflammation Risk factor: Direct blood-to-blood contact
HIV: attacks the bodies immune system and causes AIDs Direct blood-to-blood contact and sexual contact May show no signs or symptoms for up to 10 years or longer
Blood borne pathogens is transferred: with contact of blood or other body fluids other potential means of infection (OPMI)Saliva Semen Cerebrospinal fluid Any body fluid visibly contaminated with blood Unfixed human tissue/organs All cultures/culture fluids of human bloodborne pathogens
Contact Precautions - pathogen is spread by direct contact: Sources of infection - draining wounds, secretions, supplies
Precautions include: Possible private room Clean gown and glove use Disposal of contaminated items in room Double-bag linen and mark
Droplet Precautions: coughing, sneezing, and touching contaminated objects
Precautions include: Same as those for contact Addition of mask and eye protection within 3 ft of client
Airborne Precautions: Transmission via ventilation systems, shaking sheets, sweeping
Precautions include: Same as those for contact, with addition of special mask Negative pressure room
Blood and semen: body substances that most easily transmits human immunodeficiency virus (HIV).
Safe injection practices: A nurse is caring for a patient who is on contact precautions. The nurse is to give an IM dose of Reocephin. This is the signle most important practice.
Neutropenic Precautions: Provide a healthy caregiver Restrict visits from friends and family members who have colds or contagious illnesses Avoid standing collection of water in the room (ie. With flowers or in humidifiers) to prevent bacteria typically found in this water
Neutropenic diet: No raw meats, veggies, fruits No deli foods No uncooked or partially cooked eggs
Healthcare-associated pathogens resistant to antibiotics: Methicillin & Vancomycin
Methicillin resistant S. aureus (MRSA)
Vancomycin: resistant enterococcus (VRE)
Strategies to Protect the Patient: Practice meticulous hand hygiene, Use indwelling and IV catheters only when essential and remove as soon as no longer needed, Implement and follow an antibiotic protocol that ensures prudent use of vanco and extended-spectrum cephalosporins
Strategies to Protect the Patient: cont' Place a patient with multidrug-resistant organisms in a private room, Disinfect high-touch surfaces in the patient’s room
Created by: mr209368
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