Chapter 5

Infection Control

Chain of Infection

Nurses use infection control practices to break an element of the infection chain so infection will not be transmitted.

Patient-Centered Care

• Minimize the onset and spread of infection to the patient through:– Medical asepsis: Procedures used to reduce the

number of and prevent the spread of microorganisms.

– Surgical asepsis: Procedures used to eliminate all microorganisms from an area.

Safety

• Standard precautions:– Any patient may be a source for infection.– Body substances contain potentially infectious

organisms.– Fundamental to standard precautions is the use of

barrier protection (use of personal protective equipment [PPE]).

Medical Asepsis Principles

• Practice hand hygiene consistently.• Know a patient’s susceptibility to infection.• Recognize the elements of the chain of infection.• Use the basic principles of asepsis.• Protect against exposure to infectious agents through

proper use and disposal of equipment.• Be aware of sites where health care–associated infections

are most likely to develop.

Surgical Asepsis Principles • All items used within a sterile field must be sterile.• A sterile barrier compromised by punctures, tears, or

moisture is considered contaminated.• Once a sterile package is opened, a 2.5-cm (1-inch) border

around the edges is considered unsterile.• Tables draped as part of a sterile field are considered sterile

only at table level.• If there is any doubt about the sterility of an item, the item is

considered unsterile.

Surgical Asepsis Principles (cont’d)

• Sterile persons or items contact only sterile items; unsterile persons or items contact only unsterile items.

• Movement around and in the sterile field must not compromise or contaminate it.

• A sterile object or field out of the range of vision or an object held below a person’s waist is contaminated.

• A sterile object or field becomes contaminated by prolonged exposure to air.– Stay organized and complete any procedure as soon as possible.

Skill 5.1 Hand Hygiene

• Perform handwashing with either plain soap and water or an antimicrobial soap and water.– When hands are visibly dirty or soiled with

blood or other body fluids, before eating, and after using the toilet

– If hands are exposed to spore-forming organisms such as Clostridium difficile or Bacillus anthracis

Skill 5.1 Hand Hygiene (cont’d)

• If hands are not visibly soiled, use an alcohol-based hand rub:– Before and after direct contact with patients– Before touching an invasive device– After contact with body fluids or excretions, mucous

membranes, or nonintact skin– When moving from a contaminated to a clean body

site during patient care– After contact with inanimate objects such as medical

equipment near the patient– After removing gloves

Skill 5.2 Applying Personal Protective Equipment

• Cap: – Prevents hair from contaminating sterile field.

• Gloves:– Prevent contact with mucous membranes, nonintact skin, blood, body

fluids, or other infectious material.• Mask:

– Prevents inhalation/exhalation of microorganisms.• Eyewear:

– Protects eyes against splashing of body fluids.• Gown:

– Prevents transmission of and exposure to body fluids.

Skill 5.3 Caring for Patients Under Isolation Precautions

• Follow specific infection prevention and control practices to reduce cross-contamination risk.– Tier 1—Standard precautions

• Use with all patients.– Tier 2—Transmission-based precautions

• Use with patients known to have an easily transmitted serious illness.– Airborne precautions– Droplet precautions– Contact precautions– Protective environment

Procedural Guideline 5.1 Special Tuberculosis Precautions

• Prevention of TB transmission focuses on early detection, protecting close contacts of patients with active disease, and applying effective infection control measures.

• Equipment– TB isolation room with negative airflow.– N95 or P100 respirator.– Other personal protective equipment (PPE) based on patient’s clinical

condition.• Instruct patient to cover mouth with tissue when coughing

and to wear disposable surgical mask when leaving the room.

Skill 5.4 Preparing a Sterile Field

• A sterile field is an area free of microorganisms and may include a sterile kit or sterile drapes.– Instruct patient not to move or touch sterile area.– Check sterile package for integrity or compromise.– Keep sterile field and items above waist level.– Do not reach over a sterile field.– If a sterile object touches an nonsterile object, it

becomes contaminated.– Prevent splashing of poured liquids resulting in

contamination of field.

Skill 5.5 Sterile Gloving

• Sterile gloves act as a barrier against transmission of microorganisms.– Select correct glove size and type (latex or nonlatex).– Perform hand hygiene.– Open sterile glove package above waist level.– Identify right and left glove.

• Glove dominant hand first.• Glove nondominant hand; do not contaminate dominant hand.• Interlock fingers and keep hands above waist and below

shoulder level until procedure begins

Applying sterile gloves.

A B

C D