Transcript Asepsis - fog.ccsf.edu - City College of San Francisco

PERSEPHONE GEE, RN, MSN
CITY COLLEGE OF SAN FRANCISCO
INSTRUCTOR
Asepsis and Infection Control
introduction
• The nurse’s major focus is wellness. In the hospital
setting, prevention of infection is primary.
• The nurse identifies, prevents, control infection, and
teach the patient and other healthcare providers asepsis
and infection control.
• Prevent spread of microorganism from person to person
and from place to place.
Start with definition of terms
• Asepsis-a condition free from germs,
infection, and any form of life
• Sterile-free from living
microorganisms, i.e. bacteria, fungi,
protozoa, viruses, spores, or other
living organisms
If sterile means:
•-free from living
microorganisms, i.e. bacteria,
fungi, protozoa, viruses,
spores, or other living
organisms-
•What is sterility?
It is a state-of freedom from
contamination or colonization by
living microorganisms.
activity
• Student draws from the box, a term written on a piece of
paper to define (instructor explains the rules)
• Student draws a term to define. After giving his
comments, takes the term to another student or has the
other student choose another term to define.
DEFINE THE TERM DRAWN FROM BOX
DEFINE THE TERM DRAWN FROM BOX
• HANDWASHING AND FRICTION
• (HOW DO THE TERMS RELATE?)
• ISOLATION TECHNIQUES: RESPIRATORY, CONTACT
AND REVERSE ISOLATION
Next terms to define
• Nosocomial infection- an infection acquired
from a healthcare setting e.g. hospital, nursing home,
SNF
• Standard precaution- guidelines
recommended by the Centers for Disease Control
and Prevention to reduce the risk of spread of
infection in the hospitals.
• What are the precautions? Handwashing and use
of personal protective equipment such as gloves,
mask, gown, and eye protection.
Current CDC Guidelines
• Standard precautions—used in care of all hospitalized
patients
– Apply to blood, body fluids, secretions, excretions,
non-intact skin, mucous membranes
• Transmission-based precautions—used in addition to
standard precautions for patients with suspected
infection
– Include airborne, droplet, or contact precautions
Targeted body fluids in standard
precaution:
• Blood
• All body fluids: BLOOD, URINE, SPUTUM, EMESIS,
VAGINAL SECRETIONS, AMNIOTIC FLUID, PERITONEAL
FLUID, THORACENTESIS FLUID, SPINAL FLUID
• Secretions
• Excretions (except sweat)
• Non-intact skin
• Non-intact mucous membranes
Personal Protective Equipment
and Supplies
• Gloves
• Gowns
• Masks
• Protective eye gear
Components of the Infection Cycle
• Infectious agent—bacteria, viruses, fungi
• Reservoir—natural habitat of the organism
• Portal of exit—point of escape for the organism
• Means of transmission—direct contact, indirect contact,
airborne route
• Portal of entry—point at which organisms enter a new
host
• Susceptible host—must overcome resistance mounted by
host’s defenses
The Infection Cycle
Infectious Agents
• Bacteria—most significant and most prevalent in hospital
settings
• Virus—smallest of all microorganisms
• Fungi—plantlike organisms present in air, soil, and water
Bacterial Flora
• Transient—attached loosely on skin, removed with
relative ease
• Resident—found in creases in skin, requires friction with
brush to remove
Classification of Bacteria
• Spherical (cocci), rod shaped (bacilli), corkscrew shaped
(spirochetes)
• Gram positive or gram negative—based on reaction to
Gram stain
• Aerobic or anaerobic—based on need for oxygen
Factors Affecting an Organism’s
Potential to Produce Disease
• Number of organisms
• Virulence (ability to cause disease)
• Competence of person’s immune system
• Length and intimacy of contact between person and
microorganism
Possible Reservoirs for Microorganisms
• Other humans
• Animals
• Soil
• Food, water, milk
• Inanimate objects
Common Portals of Exit
• Respiratory
• Gastrointestinal
• Genitourinary tracts
• Breaks in skin
• Blood and tissue
METHODS OF TRANSMISSION
• INFECTED WATER
• RAW VEGETABLES
• VECTORS
• DIRECT CONTACT
• SEXUAL CONTACT
• AIRBORNE
• DROPLET SPREAD
Play-acting instruction
• Trace the path of the Hepatitis B virus
• Prevent the infection. Break the chain of infection
Play-acting:
• The chain of infection: Hepatitis B pathogen (blood and
body fluid transmission
• Actors: host, what will make you susceptible?
• the organism, where do you go? Portals?
• Susceptible individual, how can you diminish your risk
Transmission barriers
• Hand washing
• Barrier techniques (sterilization, decontamination,
dispose waste properly)
• Personal protective equipment (gloves, mask, gown,
protective eye gear)
The Infection Cycle
Laboratory Data Indicating Infection
• Elevated white blood cell count—normal is 5000 to
10,000/mm3
• Increase in specific types of white blood cells
(neutrophils-bacterial, eosinophils-allergic, parasitic,
basophils-parasitic, allergic, lymphocytes-viral (measles,
rubella,chicken pox, infectious mono), monocytes-severe
infection by phagocytosis
• Elevated erythrocyte sedimentation rate
• Presence of pathogen in urine, blood, sputum, or
draining cultures
Questions/comments
• What are Nursing interventions used to break the chain
of infection?
• Let’s have a look---
Aseptic Technique
• Includes all activities to prevent or break the chain of
infection
• Two categories
– Medical asepsis—clean technique
– Surgical asepsis—sterile technique
USE OF GLOVES, EYE PROTECTORS &
APRONS
• SURGICAL PROCEDURES
• GENERATION OF DROPLETS
• SPLASHING BLOOD, AND/OR BODY FLUIDS
SITUATIONS REQUIRING GLOVES
• ADMINISTRATION OF INJECTIONS
• APPLICATION OF TOPICAL PREPARATIONS
• EMPTYING DRAINAGE BAGS (BILE, URINE, ETC.)
• PERINEAL CARE
• HANDLING SOILED LNEN
Proper handling of linen & soiled articles
• Keep soiled linen from touching clothing
• Do not put soiled linen on the floor
• Avoid raising dust
• Place soiled linen in plastic bag, dispose in appropriate
containers
Practice good hygiene and grooming
• Shampoo hair regularly
• Pin hair up or have it cut short
• Keep fingernails short and free of broken cuticles and
ragged nails
• Avoid artificial nails
• Avoid wearing rings with grooves
• Follow institutional guidelines re infection control
Any questions or comment?
Measures to Reduce Incidence
of Nosocomial Infections
• Constant surveillance by infection-control committees
and nurse epidemiologists
• Written infection-prevention practices for all agency
personnel
• Hand hygiene recommendations
• Infection control precaution techniques
• Keeping patient in best possible physical condition
Stages of Infection
• Incubation period—organisms growing and multiplying
• Prodromal stage—person is most infectious, vague and
nonspecific signs of disease
• Full stage of illness—presence of specific signs and
symptoms of disease
• Convalescent period—recovery from the infection
Body’s Defense Against Infection
• Body’s normal flora
• Inflammatory response
• Immune response
Factors Affecting Host Susceptibility
• Intact skin and mucous membranes
• Normal pH levels
• Body’s white blood cells
• Age, sex, race, hereditary factors
• Immunization, natural or acquired
• Fatigue, climate, nutritional and general health status
• Stress
• Use of invasive or indwelling medical devises
Ball toss
• Toss the ball to a student, the class will listen to
student’s statement about who is at risk, your rationale.
Evolution of Specialized Infection
Control Precautions
• Early CDC guidelines
• Specific isolation techniques
• Disease-specific isolation
• Universal precautions
• OSHA regulations for universal precautions
• Body substance precautions
• Current CDC guidelines
Type N95 Particulate Respirator
REVIEW
Infection Control Measures
• Identifying the infection
• Preventing infection
– Breaking the chain of infection
• Controlling infection
– Minimizing complications
– Reducing adverse outcomes
• Teaching patient about infection
Aseptic Technique
• Includes all activities to prevent or break the chain of
infection
• Two categories
– Medical asepsis—clean technique
– Surgical asepsis—sterile technique
Practice of Asepsis
• Medical asepsis (clean technique)
– Involves procedures and practices that reduce the
number and transfer of pathogens
• Surgical asepsis (sterile technique)
– Includes practices used to render and keep objects
and areas free from microorganisms
Basic Principles of Medical Asepsis
• Practicing good hand hygiene
• Carrying soiled items away from body
• Keeping soiled items off the floor
• Avoiding having patients cough, sneeze, or breeze on
others
• Moving equipment away when cleaning articles
• Avoiding raising dust
• Cleaning least soiled areas first
Basic Principles of Medical Asepsis (cont.)
• Disposing of soiled or used items in appropriate
containers
• Pouring discarded liquids directly into the drain
• Sterilizing items suspected of containing pathogens
• Using personal grooming habits that prevent spread of
microorganisms
• Following guidelines for infection control or barrier
technique
Basic Principles of Surgical Asepsis
• Only a sterile object can touch another sterile object
• Follow guidelines for opening sterile packages
• Avoid spilling solution on a sterile setup
• Hold sterile objects above waist level
• Avoid talking, coughing, reaching over sterile field
• Never turn your back on a sterile field
Basic Principles of Surgical Asepsis
(cont.)
• Sterilize all items brought in contact with broken skin or
sterile body cavities
• Use dry, sterile forceps when necessary
• Consider outer 1 inch of sterile field to be contaminated
• When in doubt, consider all suspect items contaminated
Use of Surgical Asepsis
• Operating room, labor and delivery areas
• Certain diagnostic testing areas
• Patient bedside
– e.g., for procedures that involve insertion of urinary
catheter, sterile dressing changes, or preparing and
injecting medicine
HAND HYGIENE
• HANDWASHING
• TECHNIQUE
Criteria for Performing Hand Hygiene
• Before and after contact with each patient
• Before putting on sterile gloves
• Before performing invasive procedures
• After accidental contact with body fluids
• When moving from contaminated body site to clean one
• After contact with inanimate objects near the patient
• After removal of gloves
Lathering Hands With Soap and Rubbing
With Firm Circular Motion
Washing Areas Between Fingers
Washing to 1 inch Above the Wrist
Using Fingernails to Clean Under Nails of
Opposite Hand
Rinsing Hands Under Running Water With
Water Flowing Toward Fingertips
Standard Precautions
• Follow hand hygiene techniques
• Wear clean nonsterile gloves when touching body fluids
• Wear personal protective equipment during care
activities likely to generate splashes or sprays of blood
• Avoid recapping used needles
• Handle used patient care equipment appropriately
• Ensure routine care, cleaning, and disinfection
procedures are followed
• Review room assignments carefully
Mask and Goggles
Glove Cuffs Covering Wrists of Gown
Transmission-Based Precautions:
Airborne
• Use for patients who have infections spread through air
• Place patient in private room with monitored negative air
pressure
• Use respiratory protection when entering room of patient
• Transport patient out of room only when necessary;
place surgical mask on patient
• Consult CDC guidelines for prevention strategies for
tuberculosis
Transmission-Based Precautions: Droplet
• Use for patient with infection spread through droplets
• Use a private room (door may remain open)
• Wear a mask when working within 3 feet of patient
• Transport patient out of room only if necessary; place
surgical mask on patient
• Keep visitors 3 feet from patient
Transmission-Based Precautions: Contact
• Use for patients infected by a microorganism spread by
direct or indirect contact
• Place patient in private room if available
• Wear gloves when entering the room; change as
appropriate
• Wear a gown if contact with infection agent is likely
• Limit movement of patient out of room
• Avoid sharing patient care equipment
Guidelines for Effective Use of PPE
• Put on PPE before contact with patient
• Choose appropriate PPE based on type of exposure
• When wearing gloves work from clean to dirty areas
• Touch as few surfaces and items with PPE as possible
• Avoid touching or adjusting other PPE
• Keep gloved hands away from face
• Remove and replace torn or heavily soiled gloves
• Do not substitute goggles with personal glasses
Patient Teaching for Medical
Asepsis at Home
• Wash hands before preparing or eating food
• Prepare foods at high enough temperatures
• Use care with cutting boards and utensils
• Keep food refrigerated
• Wash raw fruits and vegetables
• Use pasteurized milk and fruit juices
• Wash hands after using bathroom
• Use individual care items
homework
• Describe strategies for implementing CDC guidelines for
standard and transmission-based precautions when
caring for patients.
• Submit typed, 2-3 pages, include rationale. Due at the
beginning of next class.