Transcript NUR 23 Week 3

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 infection
 Applies to all blood and body fluid except
sweat
 Nonintact skin and mucous membranes
 Protect 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 technique
 To 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 Asepsis
Clean technique
 Reduce number of organisms present
and prevent the transfer of organisms

Hand Hygiene
 Clean Gloves


Contaminated objects
Bedpans/Urinals
 Overbed tables
 Dirty 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 facility
 High
population of virulent strains
of microorganisms that may be
resistant to antibiotics
 Increased hospital stays
 Surgical or traumatic wounds
 Urinary and Respiratory tracts
 Bloodstream
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Healthcare Acquired Infection

Clients in hospital are at risk for acquiring
 Low
resistance to infectious
microorganisms
 Increased exposure to the number and
types of disease causing
microorganisms
 Invasive procedures
 NON
PAYMENT ISSUES
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Infection

Iatrogenic

HAI 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
defenses
 Reduced
hemoglobin level
 Suppression of WBCs
 Suppressed inflammatory
response
 Low WBC count (leukopenia)
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Patient Susceptibility



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

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 defenses
 Broken
skin or mucosa
 Traumatized tissue
 Decreased ciliary action
 Obstructed urine outflow
 Altered peristalsis
 Change in pH of secretions
 Decreased mobility
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Chain of Infection
CAUSATIVE
AGENT
SUSCEPTIBLE
HOST
Reservoir
PORTAL OF
ENTRY
PORTAL OF EXIT
MODE OF
TRANSMISSION
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Chain of Infection

CAUSATIVE
AGENT
Infection occurs in a cycle
that depends on the presence
of all of the following:

An infectious agent or pathogen


Bacteria, fungi, virus, parasite
Dose, Virulence, Enter/ survive,
Host resistance
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Chain of infection

A reservoir or
source for
pathogen growth

Human beings,
animals, inanimate
objects

PORTAL OF
EXIT
Portal of exit from
the reservoir



Reservoir


Sputum, emesis,
stool, blood
Sneeze/Cough
UTI
Drainage
Saliva Exchange
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Chain of Infection

MODE OF
TRANSMISSION

Mode of
transmission




Contact
Airborne
Vectorborne
Vehicle
Portal of entry to a
host





Mucous
membranes
Nonintact skin
GI tract
GU tract
Respiratory tract
PORTAL OF
ENTRY
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Chain of Infection
 Susceptible
Host
 Immunosuppressed
 Elderly
 Chronically
 Trauma
ill
SUSCEPTIBLE
HOST
 Surgery
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Infectious Process

Severity of illness depends on:
Extent of infection
 Pathogenicity of microorganism
 Susceptibility of host

Localized
 Systemic—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 response
Body’s cellular response to injury or
infection = inflammation
 Inflammation = (1) protective vascular
and cellular reaction that

Delivers fluid, blood products, and nutrients
to interstitial tissues in the area of injury
 Neutralizes and eliminates pathogens or
dead (necrotic tissues)
 Establishes means of repairing body cells
and tissues
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Signs of inflammation

Localized
Swelling
 Redness
 Heat
 Pain or tenderness
 Loss of function


Systemic:

Fever, leukocytosis, malaise, anorexia,
nausea, vomiting, lymph node
enlargement
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Vascular response

Injury/infection:


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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 site
 WBC pass thru blood vessels into the
tissues
 Phagocytosis—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 inflammation
Serous—clear, like plasma
 Sanguineous—containing RBCs
 Purulent—containing WBCs and
bacteria


Cleared away by the lymphatic
drainage
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3. Tissue Repair

Healing involves the defensive,
reconstructive, and maturative stages
Damaged cells replaced with healthy new
cells
 New 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 infection
 Risk for injury
 Imbalanced
nutrition
 Impaired skin
integrity
 Impaired oral
mucus membrane

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Plan
 Prevent
exposure to infectious
organisms
 Controlling or reducing the extent of
infection
 Maintain resistance to infection
 Education 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 B
 HIV

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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 precautions
 Protective environment
 PPE


Gloves, gowns, masks, eye protection
Specimen collection
 Bagging trash/linen
 Transporting 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 environments
 Client 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 room
 Gowns, 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 implications
 Environment
 Equipment
 Specimen collection
 Bagging of trash and linen
 Transporting 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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