Transcript Medical Asepsis

Definition
 An infection is the result of an
interaction between a susceptible hose
and an infectious agent (bacteria,
viruses, fungi, parasites) a clinical
syndrome caused by the invasion and
multiplication of a pathogen in the
body.
Localized
Systemic
 The
course of an infection can be
divided into four major phases:
1. Incubation
2. Prodromal
2. Period of Clinical illness
3. Convalescence
 Health
Care institutions can present a danger
in infectious disease transmission
‣ Nosocomial infection infection
a hospital-acquired
‣ Iatrogenic infection – a direct result of treatments
 Goal
4 of the National Patient Safety Goals
(NPSG’s) is directed toward infection related
sentinel events: “Preventing health-care
associated infections”.
 Health
care-associated infections are a
serious problem and health care workers
need to strive toward preventing the
occurrence.
1. Skin and mucous membrane
2. Respiratory system
3. Gastrointestinal system
4. Circulatory system
1.
Inflammatory response
 Local reaction to an infectious agent
 Serves to localize, destroy, dilute,
neutralize, remove a pathogen
 Signs – redness, heat, swelling and pain
2. Immune response
Immunity is a measure of a person’ s ability to
fight disease by forming immunoglobulins (
antibodies formed against invading antigens),
or producing interferon.
Host
Susceptibility
Source of infection
Pathogenic
microorganism
Portal of Entry to
susceptible host
Mode of
transmission
Reservior
Portal of exit
from Reservior
http://www.d.umn.edu/ehso/training/idp1.html
 What
is the type of organism – virus, bacteria,
fungi, parasites, etc.
 Level
of virulence
 Number
of organisms
 Eyes
 Mucous
membranes
 Respiratory
tract
 Placenta
 Breaks
in the host barriers
 Humans
 Animals
 Environmental
surfaces
 Respiratory
tract
 Genitourinary tract
 Gastrointestinal tract
 Skin / mucous membrane
 Placenta
 Blood and body fluids
 Direct
contact
 Droplets
 Vectors
 Airborne
 Lack
of effective resistance
 Changes
 Tissue
in host defense
destruction
Risk for Infection RT:
The patient will:
1.
2.
3.
 Although
it is impossible to ensure
that the patient’s environment is
free of microorganisms, there are
many steps that a nurse can take
to reduce the spread of
microorganisms and thus promote
safety for both the patient and the
healthcare personnel.
 Goal
4
‣ Reduce the risk of health care–associated
infections.
 According to the Centers for Disease Control and
Prevention, each year, millions of people acquire an
infection while receiving care, treatment, and
services in a health care organization.
 Consequently,
health care-associated infections
(HAIs) are a patient safety issue affecting all types
of health care organizations.
 The
goal of QSEN is to address the challenge
of preparing future nurses with the
knowledge, skills and attitudes (KSA)
necessary to continuously improve the quality
and safety of the healthcare systems in which
they work.
 They
have 6 competencies and Safety is one
of the main competencies.
Infection
control measures used in the
hospital include:
‣ Medical Asepsis
‣ Standard Precautions
‣ Isolation Precautions
Definition:
 Practices
designed to reduce
the numbers of pathogenic
microorganisms and limit
their growth and
transmission in the patient’s
environment
1.
Helps the patient fight a current infection
and prevent its spread.
2.
Prevents the patient from being re-infected
by the same pathogen.
3.
Prevents the patient from being infected
with a new pathogen.
4. Prevents health care professionals and
visitors who come in contact with the
patient from being infected.
5.
Helps decrease the chance of the patient acquiring a
nosocomial infection.
◦ The infections can be simple and uncomplicated,
or major and life threatening. Patients are at
risk for nosocomial infection because they often
have weakened immune systems and because
the health care facility contains patients and
equipment that harbor infection.

The desired result is:
◦
to reduce the transmission of the
microorganisms from one person to another.
◦
Or from one person to an object
The
first line of defense in
medical asepsis is hand-washing.
Proper
hand-washing is considered
the single most effective way to
stop the spread of microorganisms
and preventing infection.
Reduction
in the
number of
pathogens on the
hands
 Assess
that the fingernails are short
Highest concentration of organisms on the
hands are found UNDER THE NAILS.
 Jewelry
should be removed, especially
rings with stones. Wedding bands may be
worn sometimes.
 Skin
is free of lesions
‣ If the skin should have a small lesion, bandage
the area then double glove.
 At
the start of each shift
 After
sneezing or coughing
 After
using the bathroom
 After
handling contaminated items
 Before
and after giving patient care and between
patients.
 After
on
handling body excretions- even with gloves
Before
and after performing any
treatments
After
At
removing gloves
the end of each shift before
leaving the health facility
WASH
YOUR
HANDS !
1. Hand-washing is one of the most effective
methods of preventing the spread of
bacteria.
2. Usually 15 seconds should be allowed to
wash the hands
3. Clean from the cleanest
area to the dirtiest area
wrist
Finger
tips
1. Friction
3. Cleansing
Agent
2. Running Water
4. These 3 are necessary to remove
microorganisms
5. Do not touch the sink when washing hands –
stand away
6. Keep clean items separate from dirty ones.
7. Turn off water with a dry paper
towel – wet acts as a wick.
8. Jewelry makes it difficult to adequately
cleanse the hands. It is best to not wear
jewelry in the clinical setting. Wedding
bands are acceptable sometimes.
9. If using hand lotion—allow hands to dry
about 30 minutes before applying. Do NOT
apply hand lotion immediately after washing
hands.
 Alcohol-based
hand rubs (foam or gel) kill
more effectively and more quickly than
handwashing with soap and water.
 They are less damaging to skin than soap and
water, resulting in less dryness and irritation.
 They require less time than handwashing with
soap and water.
 Bottles/dispensers can be placed at the point
of care so they are more accessible.
 HAND
RUB (foam and gel)
‣ Apply to palm of one hand (the amount used
depends on specific hand rub product).
‣ Rub hands together, covering all surfaces,
focusing in particular on the fingertips and
fingernails, until dry. Use enough rub to require
at least 15 seconds to dry.
ALCOHOL-BASED HAND RUBS ARE MORE
EFFECTIVE IN KILLING BACTERIA THAN
SOAP AND WATER.
 Bring
bacterial soap and paper
towels with you to the patient’s
home
 If
no running water is available in
the home, use disposable wipes or
alcohol-based rubs.
Standard
Precautions are:
‣ Those precautions designed
for the care of all patients
in hospitals regardless of
their diagnosis or
presumed infection status.
Standard Precautions
 Set
of guidelines developed by the
Centers for Disease Control and
Prevention (CDC) for preventing
contact with potentially infectious
blood or body fluids that may
harbor diseases regardless of
whether or not they contain visible
blood
 All
body fluids, secretions and excretions
regardless of whether or not they contain visible
blood







 All
Sputum, saliva
Urine
Feces
Nasal secretions, tears
Vomitus
Spinal fluid/ cerebrospinal fluid
Synovial, pleural, peritoneal , pericardial,
amniotic fluid
moist body surfaces, mucus membranes
 Blood
Used
for all patient’s, not just those
with known infections
These
precautions should be
implemented whenever contact with
potentially infectious material is
anticipated.
Used
to protect the caregiver.
1. Hand-Washing
2. Personal Protective Devices


3.
4.
5.
6.
Gloves
Mask, Eye Protection, Face Shield, Gown
Patient-care equipment
Environment
Linen
Sharp Objects
 Hands
must be washed after
patient contact regardless of the
use of gloves. Even if you wear
gloves, wash your hands
 Gloved
hands cannot be effectively
washed.
 Gloves
can be used to avoid direct contact
with infectious material
 Wear
gloves to handle:
‣ Blood
‣ Body fluids
‣ Secretions, Excretions
‣ Contaminated items
 Change
gloves before preceding to the next
task, or touching non-contaminated items
even on the same patient.
 Made

of vinyl or latex -- vinyl are used
if allergy to latex is present.
Masks provide barrier protection against
splashes and sprays, and airborne
droplets
Masks come in various types depending on
their permeability to airborne particles.
Eye goggles or glasses and face shields
provide barrier protection against
splashes and sprays.
Gown – should be water
impermeable to provide barrier
protection
 Handle
equipment in a manner that
prevents personal skin and mucous
membrane exposure and cross
contamination to other patient’s.
 Reusable
equipment must be cleaned/
disinfected and reprocessed before using
it in the care of another patient.
Each
hospital, clinic has procedures
for care, cleaning, and disinfection of
environmental surfaces.
Spills
of blood or body fluids need to
be handled with special procedures.
 Handled
in a way to prevent contamination of
skin, mucous membranes, and clothing.
 Fold
soiled linen with contaminated area to
the inside. Do not shake.
 Hold
away from body and place in
appropriate bag and dispose
of properly.
 Place
all sharp objects in a
puncture-proof container.
 Do
not re-cap needles
 Immediately
discard after use. Do not
attempt to bend or break a needle before
discarding. Throw away the whole thing.
Isolation precautions are utilized when:
‣ patients have a greater susceptibility to
infection than others
‣ A patient or patient’s body fluids are a carrier
of microorganisms that can easily be
transmitted to other patients, family
members, or health care workers.
In addition to standard precautions, the
CDC recommends three categories of
transmission-based precautions. They
include:
‣ 1.
‣ 2.
‣ 3.
Airborne precautions
Droplet precautions
Contact precautions
The fourth type of isolation is protective
isolation.
Used when the organism is capable of
remaining in the air for prolonged periods
of time and can be transported in the air
for distances greater than 3 feet.
Most common organisms are:
‣ Tuberculosis
‣ Chicken pox
‣ Measles
Must wear a special particulate filter mask
A
private negative air pressure room is
used for patients needing airborne
precautions.
‣ Negative air pressure rooms are used for
‣
‣
patients needing airborne precautions
Bring air into the room from the hallway and
have a separate exhaust system.
Outside the room is isolation cart that contains
supplies needed to care for the patient and
protects persons entering the room.
 Caring
for the patient in isolation
‣ Personal Care - **Remember it is the disease
that is being isolated, not the patient.
Place linens in proper contaminated –waste
container, and soiled paper towels in an
isolation waste container.
‣ Food Service – disposable paper trays and
disposable dishes that are discarded in proper
isolation waste container. Do not put tray
back on the food cart.
‣ Contaminated articles – according
to agency policy, usually double
bagged or color-coded waste
bags to indicate contaminated waste.
 All
patients on airborne precautions should
wear surgical
masks when leaving
the negative air
pressure room for
x-rays, tests, or
procedures.
 Organisms
that can be spread by large
airborne droplets through the air but are
unable to remain in the air further than 3
feet.
 Examples of organisms include:
‣ Influenza
‣ Cold
‣ Meningitis
‣ Mumps
‣ Pertussis
 Single
rooms are preferable
 Patients with same disease can share
the same room
 Standard surgical masks without a filter
must be worn for anyone coming
within 5 feet of the patient.
 Gowns should be worn if clothing or
uniforms are likely to become
contaminated with respiratory
secretions.
 Gloves should be worn anytime
handling tissues or items contaminated
with the respiratory secretions
 Purpose
is to prevent the transmission of
disease by direct or indirect contact
‣ Direct contact involves:
 Touching
 Bathing
 Skin-to-skin contact
‣ Indirect contact involves:
 Contact with inanimate objects – doorknobs, light
switches, tabletops, telephones
 Examples
of diseases are: staph, herpes,
diphtheria, and many others
 Contact
precautions include use of barrier
precautions such as gloves and
impermeable gowns to prevent direct
contact with infectious organism
 Used:
‣ For patient with diarrhea
‣ When coming into contact with draining wounds
‣ Patients with acquired antibiotic resistance
infections
 You
have gone in Mr. A.’s room to perform a
dressing change.
 What
 What
type of isolation is he in?
equipment would you use?
‣ A. Gloves only
‣ B. Gloves and gown
‣ C. Gloves, gown, and mask
 Used
with patients who are
immunocompromised such as:
‣ Chemotherapy
‣ AIDS
‣ Organ transplants
1.
2.
3.
4.
5.
6.
7.
__
__
__
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__
__
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Influenza
Diarrhea
Tuberculosis
AIDS
Chicken pox
Draining wound
Chemotherapy pt’s
 A.
Airborne
 B. Droplet
 C. Contact
 D. Protective / Strict
 Mrs.
B. is on airborne isolation.
 What
specific equipment is used in airborne
isolation that is not used in other types of
isolation?
 When
would the nurse apply goggles
or a face mask?