1 nur 104 asepsis infection control. 2 standard precautions good health depends in part on a safe...
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NUR 104
Asepsis
Infection Control
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Standard Precautions
Good health depends in part on a safe environment.
Practice or techniques that control or prevent transmission of infection help to protect clients and health care workers from disease
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Standard Precautions
Employees are to follow precautions to prevent contact with blood or other infectious materials during the routine care of clients
Personal protective equipment (PPE) must be provided at no cost to the employees who are at risk for exposure and must be used by the employee
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.Standard Precautions
Principles/procedures to prevent and control infection and its spread.
Break the chain of infectionApplies to all blood and body fluid except
sweatNonintact skin and mucous membranesProtect patient and healthcare worked
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Asepsis
Asepsis—absence of pathogenic microorganisms
The nurse’s efforts to minimize the onset and spread of infection based on principles of aseptic technique
Aseptic technique refers to practices that keep a client as free from microorganisms as possible
Two types: medical and surgical
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Surgical Asepsis
Sterile techniqueTo eliminate all microorganisms,
including pathogens and spores from an object or area
If an area or object is touched by any object that is not sterile it is considered contaminated
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Medical AsepsisClean techniqueReduce number of organisms present
and prevent the transfer of organismsHand HygieneClean Gloves
Contaminated objectsBedpans/UrinalsOverbed tablesDirty Dressings
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Infection
Entry and multiplication of an infectious agent in the tissues of a host.
Infectious agent—pathogen
asymptomatic
symptomatic
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Health-Care Associated Infection
HAI result from delivery of health services in a health care facilityHigh population of virulent strains of
microorganisms that may be resistant to antibiotics
Increased hospital staysSurgical or traumatic woundsUrinary and Respiratory tractsBloodstream
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Healthcare Acquired Infection
Clients in hospital are at risk for acquiringLow resistance to infectious
microorganismsIncreased exposure to the number and
types of disease causing microorganisms
Invasive procedures
NON PAYMENT ISSUES
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Infection
IatrogenicHAI from a diagnostic or therapeutic
procedure
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Infection
Exogenous infection—from organisms external to the person that do not exist as normal flora
Endogenous infection—when person’s flora becomes altered and an overgrowth results—yeasts, streptococci
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Risk factors
Inadequate secondary defensesReduced hemoglobin levelSuppression of WBCsSuppressed inflammatory
responseLow WBC count (leukopenia)
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Patient Susceptibility
Age—infant, child, older adults Nutritional status—protein, carbohydrates,
fats Stress Heredity Disease process—immune system,
chronic diseases, burn patients Medical therapy—some drug and medical
therapies compromise immunity to infection
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Patients at Risk
Inadequate primary defensesBroken skin or mucosaTraumatized tissueDecreased ciliary actionObstructed urine outflowAltered peristalsisChange in pH of secretionsDecreased mobility
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Chain of Infection
CAUSATIVE AGENT
Reservoir
PORTAL OF EXIT
MODE OF TRANSMISSION
PORTAL OFENTRY
SUSCEPTIBLEHOST
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Chain of Infection
Infection occurs in a cycle
that depends on the presence
of all of the following:An infectious agent or pathogen
Bacteria, fungi, virus, parasiteDose, Virulence, Enter/ survive,
Host resistance
CAUSATIVE AGENT
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Chain of infection
A reservoir or source for pathogen growth Human beings,
animals, inanimate objects
Reservoir
Portal of exit from the reservoir Sputum, emesis,
stool, blood Sneeze/Cough UTI Drainage Saliva Exchange
PORTAL OF EXIT
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Chain of Infection
Mode of transmission Contact Airborne Vectorborne Vehicle
Portal of entry to a host Mucous
membranes Nonintact skin GI tract GU tract Respiratory tract
MODE OF TRANSMISSION
PORTAL OFENTRY
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Chain of Infection
Susceptible HostImmunosuppressedElderlyChronically illTraumaSurgery
SUSCEPTIBLEHOST
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Infectious Process
Severity of illness depends on:Extent of infectionPathogenicity of microorganismSusceptibility of host
LocalizedSystemic—affects entire body
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Sepsis
The spread of an infection from its initial site to the blood stream, initiating a systemic response that adversely affects blood flow to vital organs
Bacterial infections are the most common source of initial infection
When organisms overwhelm local defenses and enters the bloodstream the resulting condition is called septicemia
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Inflammatory responseBody’s cellular response to injury or
infection = inflammationInflammation = (1) protective vascular
and cellular reaction thatDelivers fluid, blood products, and nutrients
to interstitial tissues in the area of injuryNeutralizes and eliminates pathogens or
dead (necrotic tissues)Establishes means of repairing body cells
and tissues
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Signs of inflammation
LocalizedSwellingRednessHeatPain or tendernessLoss of function
Systemic: Fever, leukocytosis, malaise, anorexia,
nausea, vomiting, lymph node enlargement
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Vascular response
Injury/infection: Arterioles supplying the area dilate, allowing more
blood into the local area. This causes redness, localized warmth is from greater blood volume. Vasodilation delivers blood and WBCs to injured tissues
Injury causes tissue necrosis. Fluid, protein, and cells enter interstitial spaces, accumulated fluid appears as localized swelling (edema)
Pain is caused by the swelling of inflamed tissues increasing pressure on nerve endings
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Cellular response
WBCs arrive at the siteWBC pass thru blood vessels into the
tissuesPhagocytosis—specialized WBCs called
neutrophils and monocytes ingest and destroy microorganisms or other small particles
Leukocytosis—increased # of circulating WBCs in response to WBCs leaving the blood vessels
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2. Inflammatory exudate
Accumulation of fluid and dead tissue cells and WBCs form an exudate at the site of inflammationSerous—clear, like plasmaSanguineous—containing RBCsPurulent—containing WBCs and
bacteria
Cleared away by the lymphatic drainage
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3. Tissue Repair
Healing involves the defensive, reconstructive, and maturative stagesDamaged cells replaced with healthy new
cellsNew cells undergo gradual maturation until
they have the same structural and appearance as previous cells
Chronic inflammation—tissue defects may fill with fragile granulation tissue—not as strong as tissue collagen--scar
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Nursing Assessment
Review of disease history, exposure to CD
Review of clinical condition—signs and symptoms of actual infection or risk for infection
Analysis of lab findings
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Nursing Diagnosis
Risk for infectionRisk for injuryImbalanced
nutritionImpaired skin
integrityImpaired oral
mucus membrane
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Plan
Prevent exposure to infectious organisms
Controlling or reducing the extent of infection
Maintain resistance to infectionEducation of client and family about
infection control techniques
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Management of Infection
Asepsis Handwashing is the MOST EFFECTIVE
means for preventing the spread of organisms Basic Practices:
- Wash hands before and after each patient- Cleans from clean to dirty- Do not hold soiled items close to body- Wear gloves when exposure is expected
UCSF dress code includes:- Clean uniforms- Short nails, non-acrylic- No rings with grooves or stones that may harbor organisms
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Blood Borne pathogens
Hepatitis BHIV
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Transmission of pathogens
Control or elimination of infectious agents Cleaning Disinfection and sterilization
Control or elimination of reservoirs Control of portal of exit Control of transmission
Handwashing, sharing of equipment, carrying dirty linen out from the body
Control of portals of entry
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Protection of susceptible hosts
Isolation precautionsProtective environmentPPE
Gloves, gowns, masks, eye protectionSpecimen collectionBagging trash/linenTransporting clients
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Isolation Precautions
Standard Precautions Universal precautions Neutropenia Respiratory Contact
Hand hygiene Most important and most basic in controlling
transmission of infection Use alcohol hand antiseptic before and after
providing care Handwashing is a vigorous, brief rubbing together of
the surface of the hands lather with soap, followed by rinsing under a stream of water
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Isolation Precautions
Standard Precautions (Tier One)- Assumes that all patients are potentially infectious- Sometimes referred to as Body Substance or Universal Precautions (body fluids, secretions, excretions, blood)
Transmission-Based (Tier Two)- Airborne - Droplet - Direct
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Isolation Precautions
Personal protective equipment Gloves Goggles Gown Mask Shoe covers
Isolation/protective environmentsClient and family education
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What’s Wrong With This Picture?
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Isolation Precautions (cont.)
Airborne (measles, varicella, TB)- Private, negative pressure room- Wear fit-tested (N 95 respirators) masks- Stop Sign at Door
Droplet (diphtheria, rubella, mumps, (p663) etc.)- Private room- Mask (regular) when within 3 feet of patient- Stop Sign at Door
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Isolation Precautions
Contact (C-diff, E-coli, hepatitis, HSV, VRE, MRSA, etc.)Private roomGowns, gloves, masks (regular)
- Stop Sign at Door
Protective (Reverse Isolation)
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Isolation Signage
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Respirator Equipment
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Isolation Precautions
Psychological implicationsEnvironmentEquipmentSpecimen collectionBagging of trash and linenTransporting clients
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Disposal Techniques
Bagging
- Contaminated materials (i.e. blood, feces etc.) in Biohazard Bag- Slightly soiled and disposable equipment go in regular trash
Soiled linen in linen hampers- Bring hamper to bedside, do not carry soiled linens down the hall
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Disposal Techniques
Sharps- Needles, syringes, scalpels etc. in puncture resistant Sharps containers- Do NOT recap used needles
Isolation Rooms- May require special disposable equipment (i.e. food trays, blood pressure cuffs, thermometers etc.) that remain in room until patient leaves
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Handwashing
Is important because
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