Transcript Promoting Asepsis and the Prevention of Infection

Promoting Asepsis
and Infection
Control
Teresa V. Hurley, MSN, RN
Nosocomial Infections
Worldwide Problem
 Acquired in health care facilities
 USA: Cost is in the billions for extended
care and treatment
 A Leading cause of death
 Spread by health care workers who fail to
wash hands or change gloves
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Asepsis
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The absence of contamination by disease
causing microorganisms
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Needed to prevent nosocomial infections,
limit transmission of infection and to
protect clients and healthcare workers
from infection
Infection
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Pathogen is an organism capable of
causing disease
 Bacteria
 Viruses
 Fungi
includes yeast and molds
 Helminths (worms)
Current Research Studies
Intensive Investigations into the:
 Role of bacteria in producing heart
disease
 Role of viruses in the development of
cancer
 Mutation of microorganisms and their
ability to resist antimicrobial drugs
Center of Disease Control and
Prevention Reports
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HIV
 Global
HIV AIDS Pandemic 2006
 Since 1981 65 million infections and 25 million
deaths
 Identified at risk populations in the USA
High school students engaged in unprotected sex
 High school students using injectable drugs
(CDC, 8/11/2006)
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CDC Reports
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HIV testing, counseling and treatment
recommendations for all people accessing
health care: adolescents, adults and
pregnant women as part of routine health
care in order to prevent spread (CDC,
9/22/06)
Antibiotic Resistance is WORLD’S MOST
PRESSING PROBLEM (CDC, 4/21/06)
CDC Reports
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MRSA Resistance to methicillin, oxacillin,
amoxicillin
 Surgical
wounds
-Bacteremia
 Catheters
-UTI
 Hospitals
-Pneumonia
 Nursing Homes
 Dialysis Units where there exits clients with
weakened immune systems
CDC Reports
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Emergence of CA-MRSA
 Community Associated
MRSA now occurring
in people who have not been hospitalized
within 1 year or even had a medical
procedure (dialysis, catheter or surgery)
 s/s skin infections, pimples, boils,
 Clusters: crowded living conditions and poor
hygiene practices
CDC Reports
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Athletes
Military Recruits
Children
Male to male sexual contact
Prisoners
Pacific Islanders
Alaskan Natives
Native Americans
Spread skin to skin, cuts, abrasions, contaminated items
and surfaces (CDC, 2/3/2005)
CDC Reports
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CA-MRSA Tattoo recipients (6/22/06)
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Streptococcus Pneumoniae Disease
 Leading
cause of morbidity and mortality in
the USA
 Emergence and widespread Drug Resistant
Strains (penicillin and multi-drug resistance)
(CDC, 1/26/2001)
CDC Reports
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Streptococcus Pneumoniae
 Transmission
person to person
Otitis media
 Pneumonia
 Bacteremia
 Sinusistis
 Peritonitis
 Arthritis
Populations at risk: HIV infected, Sickle Cell Disease,
Elderly, Children under 2 y/o and children attending group day
care centers (CDC, 10/24/2005)
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CDC Reports
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Drug Resistant Tuberculois Emergence
 TB
resistant to a least one MDRTB (multi-drug
resistant TB) INH and Rifampin (CDC, 10/6/2004)
June 2006 hc/Pro Briefings on Infection Control
HIPPA regulations and infection control practices must
protect privacy of patients. Door signs on patient
doors with TB could lead to potential legal problems
due to posting of a sign linked to patient
CDC Reports
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VRE Vancomycin Resistant Enterocci
-SPREAD BY DIRECT CONTACT, stool, urine
and hands of health care workers
-Normally present in intestines and female
genital tract
 UTI
 Wound Infections
 Bacteremia
Risk: long term antibiotic treatment; previous treatment
with vancomycin and gentamycin; ICU, CA and
Transplant Units; abdominal and chest surgeries;
catheters (IV or urinary) (CDC, 11/2005)
CDC Reports
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Clostridium Difficile
Increased reports of outbreaks in USA
 Emergence of new and more virulent strains
 Resistant to antibiotic group: floroquinolones
(CDC, July 2005)
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Acinertobacter Normally present in soil and water and skin of
people---especially in health care workers
Outbreaks reported in ICUs and in settings where very ill are
housed
Risk: people with weakenedd immune systems;chronic lung
disease, ventilator patients, diabetics, open wounds and
prolonged hospital stays (CDC, 9/24/2004)
Airborne Transmission
Agent Transferred by droplet nuclei
(moisture) or dust particles
 coughing , talking, sneezing
Vehicle Transmission
Agent transferred to host by contaminated
inanimate objects
 Food, milk, water, drugs, blood, urine
 Cholera by water
 Salmonellosis by meat
 E-coli by spinach
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Vectorborne
Agent transferred to host by animate
means
 Mosquitoes, fleas, ticks, lice, and other
animals
 Lyme Disease, malaria, West Nile virus
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Chain of Infection
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Agent, Host and Environmental Interaction
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The links symbolize essential elements
needed by microorganisms to invade and
cause cellular injury
Portal of Entry
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Agent enters the Host by:
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Integumentary system (skin breaks, mucous membranes as in surgical wounds)
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Respiratory tract (inhale droplets as colds, measles, influenza)
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Genitourinary (infected vaginal secretions, semen, as in STDs)
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Gastrointestinal (ingestion food, water contaminates, as typhoid and Hepatitis A)
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Circulatory (insect bites as malaria from mosquito bite
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Transplacental (mother to fetus as HIV and Hepatitis B)
Host
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Human being is a susceptible host that
can be affected by an agent
If you have not received measles vaccine
more likely to get it because you lack
immunity.
Host Characteristics
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Age (immunity declines as age increases)
Illness and Injury
Stress (decreases immune response)
Immunization/Vaccination Status
Lifestyle (sharing needles, multiple sex partners,
smoking, alcohol and drug abuse)
Occupation (chemical agents,needle sticks
Skin breaks which is the first line of defense
(surgical, pressure ulcer, IV)
Host Characteristics
Nutritional Status (overweight,
underweight)
 Heredity
 Medications (steroids, non-steroidal antiinflammatory agents NSAIDs (ibuprofen,
aspirin), chemotherapy, antibiotics lead to
vaginal yeast infections
 Nursing and Medical Procedures (urinary
catheters, IV’s)
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Breaking Chain of Infection
Infection Control is the First Line of
Defense
 HAND HYGIENE IS THE SINGLE MOST
PRACTICE IN PREVENTING THE
SPREAD OF INFECTION
 JCAHO June 2006: Hand washing is the
top priority
 National Patient Safety Goal (USA
Government)
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Breaking the Chain of Infection
Wear gloves, masks, gowns and goggles
 Client Hygiene
 Dressing Changes using aseptic technique
 Clean linens
 Clean Equipment
 Educate on covering mouth and nose
when coughing and sneezing; throwing
tissues into garbage bag
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Breaking Chain of Infection
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Nutrition (protein needed to maintain and repair
tissues, production of antibodies, and acid-base
balance
Exercise
Immunizations (measles, mumps, rubella,
tetanus every 10 years and flu every year
MUMPS reported by CDC (8/6/2006) as being
beyond historical limits. Cummulative for 2006
in selected states 5,482
Body Defenses
Immune system recognizes its self
 Antigen is non-self “pathogen” and the
immune system will attack it
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Non-Specific Immune Responses are
 Skin
and its normal flora
 Mucous membranes (as cilia in respiratory
tract keep from entering lungs)
Non-Specific Immune Responses
Coughing, sneezing, tearing reflexes
 Elimination and acid environment
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 Flora
in the large intestine prevent growth of
pathogens and peristalsis removes them with
feces
 Natural urine acidity prevents growth and
urination rids bladder neck and urethra of
microorganisms
Non-Specific Immune Responses
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Vaginal Flora is acidic; puberty lactobacilli ferment and
produce sugars lowering the pH preventing growth of
microorganisms
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Inflammation is cellular response to tissue injury by
bacteria, trauma, chemicals, heat etc….
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Erythema (redness) increased blood flow to area
Heat (increased blood flow and metabolism)
Pain (pressure on pain receptors)
Edema (swelling) fluid and leukocytes
Function Loss (pain, swelling)
Purulent Exudate (WBCs, dead cells, bacteria, debris)
Specific Immune Response
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Response to invading antigen
 Phagocytes
do not destroy antigen completely
 T-cells (T lymphocytes) produce and release
lymphokines thus attracting phagocytes and
lymphocytes to destroy the antigens;
 T-cells stimulate B-cell production which leads
to antibody production against antigen
Medical Asepesis
Medical Asepsis is used to prevent the spread of
microorganisms. Hand washing is the most
effective means to prevent the spread of
infection.
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It is critical that Healthcare workers CLEAN
HANDS with alcohol based solution or wash with
soap and water as recommended by CDC 2002
Basic Principles of Medical Asepsis
Clean Technique used to prevent the
spread of microorganisms
 Hand washing AGAIN
 Carry soiled items away from body
 Do not place soiled items on floor
 Client instructed not to cough, sneeze,
breathe on anyone; expectorate into
tissues; cover mouth and nose when
coughing and sneezing; (Airborne)
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Medical Aseptic Principles
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Do not shake linens.
Clean from least soiled to most soiled.
Dispose of soiled or used items directly into
receptacles. Place bodily discharge and
drainage into plastic bags or containers (e.g.
briefs, diapers; linens; specimens).
Pour bath water, mouth wash directly into sink
drain.
Medical Aseptic Principles
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Personal Grooming
 Shampoo
hair
 Fingernails short, free of broken cuticles,
ragged edges
 Do not wear false nails
 Do not wear rings with grooves and stones
 Keep hair off shoulder
Handwashing
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Five Key Factors
 Time:
15 seconds
 Water: warm
 Soap: 1 teaspoon liquid
 Friction: rub in circular motions from fingers to 1
inch above wrist if not visibly soiled (moving from
dirtiest to cleanest) and 1 inch above area of
contamination
 Drying: begin with fingers and move upward
DRY HANDS FIRST THAN TURN OFF FAUCET WITH
PAPER TOWEL
Personnel Protective Equipment
(PPE)
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Purpose is to lessen or prevent exposure
to infectious material
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OSHA (1992) mandated that health care
agencies must provide its employees with
equipment to protect against infection
Gloves
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Wear once
Do not wear outside client’s room which includes and is not
limited to:
 Charting
 Telephoning
 Using the computer
 Cell phones, pagers, blackberries
Double gloving is acceptable practice when working with
blood and bodily fluids.
Latex Allergies
Is a critical concern in health care facilities
Clients and health care workers have
developed latex allergies.
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Handwashing
CDC (2002) recommendations for hand
hygiene
 Use
soap and water if visibly soiled
 Alcohol based hand rub if not visibly soiled
PPE
Personal Protective Equipment (PPE) is
any equipment or supplies used to protect
clients and healthcare workers.
 Clean and sterile gloves
 Impervious gowns
 Surgical and high-efficiency particulate air
(HEPA) masks,
 Face shields
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PPE
Protective eye wear
 Surgical caps
 Shoe covers
 Splash guards
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Nursing Diagnosis : Risk for Infection
 Goal: Transmission of microorganisms
will be contained
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Risk for Infection
Assessment: determine need for use
 Diagnosed infection, communicable
disease
 Likelihood of contact with bodily fluids or
blood
 Check infection control manual
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Risk for Infection
Use of PPE interrupts chain of infection
and protects client and nurse.
 Implementation
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 Wash
Hands
 Don gown, gloves, mask, and eyewear
 Remove gloves, mask, gown, protective
eyewear and discard
 Wash hands
Risk for Infection
Outcomes:
 Transmission of microorganisms contained
 Client free of exposure to potentially
infectious microorganisms
 Client verbalizes rationale for use of PPE
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Surgical Asepsis
Sterile means without life
 Nurse creates an environment free from
microorganisms
 Sterile Technique is used to perform a
variety of procedures as giving an
injection, starting and IV, sterile dressing
change, insertion of urinary catheter,
suctioning)
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Basic Principles of Surgical Asepsis
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Sterile Technique
Sterile objects can only touch sterile objects
If Un-sterile touches sterile = contaminated
Outside of sterile package is contaminated
Inside of sterile package is sterile
Open sterile package by making sure the first
edge is away from you.
Sterile Principles
Spilling solution on paper or cloth used for
a sterile field = contaminated
 Sterile objects are held above waist level
to keep object in sight
 Limit talking, coughing, sneezing, or
reaching over a sterile field or object.
 Never turn your back or walk away from a
sterile field.
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Sterile Principles
The outer 1 inch edge of the sterile filed is
contaminated.
 Use dry sterile forceps to place sterile
items on the sterile field.
 Every item that comes in contact with
broken skin, to penetrate skin, inject into
body, or enter sterile body cavities is to be
sterile ( e.g. dressings, needles, tubes).
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Sterile Technique
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Wash your hands
Check expiration date on package labels
Check to make sure package is intact
Check for signs of wetness
Horizontal plane on a field is considered
sterile
Anything dropping over the edges
contaminated
One inch border around the sterile plane is
considered not sterile
Preparing a Sterile Field
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Purpose: Maintain sterile asepsis
Explain procedure to client
Gather equipment
Perform hand hygiene
Work area flat and waist high
Prepare sterile field with drape
Place sterile objects on field
Check solution three times
Place cap on table with edges up
Pour with label facing palm from height 4-6 inches into sterile
basin
Unexpected Outcomes
What would you do if:
 part of the sterile field becomes
contaminated?
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forgot something?
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client touches your hand or sterile field?
Donning and Removing Sterile
Gloves
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Purpose: provide barrier against infection spread
Wash hands
Obtain correct size glove and bring to work area
Surface is clean and dry
Open outside package
Open inside package
Don gloves using non-dominant hand to put on dominant hand glove
than later for non-dominant
Remove using dominant first
Discard gloves in hazardous waste container
Wash hands
Be careful that you do not touch your face when you have gloves on.
If you sneeze or cough and cover your nose or mouth you must re-glove.
Risk for Latex Allergy Response
Assess for Latex Allergy
 Hx allergies etc.
 Use latex-free gloves
 Goal: Client will not exhibit signs and
symptoms of latex allergy response
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