Chapter 26: Asepsis and Infection Control

During normal patient care that does not soil hands, effective hand hygiene between patients requires a. at least a 20-second soap and water scrub. b. at least a 23-minute scrub with antimicrobial soap. c. use of an alcohol-based antiseptic handrub. d. a mask must be worn while scrubbing is occurring.

ANS: C Hands that are not visibly soiled can be cleaned with an alcohol-based handrub. A mask or antiseptic soap is not necessary in this situation.

When caring for a patient with rubella, in addition to standard precautions, which precautions would be used? a. Droplet precautions b. Airborne precautions c. Contact precautions d. Universal precautions

ANS: A An illness transmitted by large-particle droplets, like rubella, requires droplet precautions in addition to standard precautions. Airborne precautions are used for illness transmitted via small particles, such as tuberculosis, varicella, and rubeola. Universal precautions are a part of standard precautions.

An infection occurs as a result of a cyclical process. The six components of an infection are a. infectious agent, source of infection, portal of exit, mode of transmission, portal of entry, and susceptible host. b. infectious agent, reservoir, portal of exit, vehicle of movement, portal of entry, and susceptible host. c. infectious agent, reservoir, portal of exit, vehicle of transmission, portal of entry, and unsusceptible host. d. invading agent, reservoir, portal of exit, vehicle of transmission, portal of entry, and susceptible host.

ANS: A The six components of an infection are the infectious agent, the source of infection, the portal of exit, the mode of transmission, the portal of entry, and the susceptible host.

The nurse is caring for a patient that has a diagnosis of methicillin-resistant Staphylococcus aureus (MRSA). Which of the following infection-control practices should the nurse implement? (Select all that apply.) a. Wear a protective gown when entering the patient's room. b. Don a particulate respirator mask when administering medication to the patient. c. Ensure that all staff serving the patient's meal trays don gloves prior to delivering of tray. d. Instruct all visitors to wear a surgical mask when entering the patient's room. e. Use sterile gloves when performing dressing changes. f. Use a face shield before irrigating the patient's wounds.

ANS: A, C, F Wearing a gown, wearing gloves when delivering trays, and using a face mask will ensure staff, patient, and visitor safety and will protect the individual from transmitting the infection from the patient to him or herself or others. Use of a particulate respirator mask is necessary when encountering someone on airborne precautions, and this organism is not transmitted via air. The use of sterile gloves is not necessary with this type of infection.

You are making a home visit to a family of 5 children. The youngest, aged 5, has a temperature of 101.1°F, is lethargic, and has a poor appetite. This assessment leads you to the diagnosis of influenza. Based on your knowledge that influenza is an airborne communicable disease, all of the following patient teachings regarding infection are appropriate for the mother and family except a. keep children home from day care and school while symptoms are present. b. remind family that they only need to wash their hands if they are visibly dirty. c. do not share tissues, dishes, or personal care items to reduce the risk of transmission. d. encourage the family to receive their annual influenza vaccine.

ANS: B The family needs to wash their hands frequently, especially after eating, coughing, sneezing, or touching contaminated material such as a tissue. Keeping the children home from day care and school while symptoms are present and not sharing personal items, such as towels and toothbrushes, as well as dishes, are good rules of thumb for individuals with an airborne infection. The family should be encouraged to receive annual influenza vaccines.

Of the following patients, which patient is at a higher risk of infection? a. 27-year-old female who is an athlete b. 60-year-old male with arthritis c. 12-year-old female with a broken leg d. 36-year-old female with HIV

ANS: D The patient with HIV has an incompetent immune system, which makes her at risk for infection. The other patients are all healthy.

A nurse is caring for an overweight 60-year old woman with a reddened area over her coccyx. The priority nursing diagnosis for this patient is a. Imbalanced Nutrition: More Than Body Requirements related to immobility. b. Impaired Physical Mobility related to pain and discomfort. c. Chronic Pain related to overweight. d. Risk for Infection related to altered skin integrity.

ANS: D The priority diagnosis is focused on the risk of developing an infection due to altered skin integrity. Imbalanced nutrition, impaired physical mobility, and chronic pain, all related to overweight, are potential or problem diagnoses that require the attention of the nurse after implementing care for the initial diagnosis.

The nurse is caring for a patient who has been diagnosed with methicillin-resistant Staphylococcus aureus located in her incision. What transmission-based precautions will the nurse implement for the patient? a. Private room b. Private, negative-airflow room c. Mask worn by the staff when entering the room d. Mask worn by the staff and the patient when leaving the patient's room

Answer: a A private room decreases the chance of another patient contracting the infection. The other precautions (i.e., private room with negative airflow, mask worn by staff when entering the room, and mask worn by staff and patient when leaving the patient's room) are airborne precautions, which are not necessary in managing this patient.

Of the following hospitalized patients, who is most at risk for acquiring a health-care-associated infection? a. 60-year-old who smokes two packs of cigarettes per day b. 40-year-old who has an indwelling urinary catheter in place c. 65-year-old who is a vegetarian and slightly underweight d. 60-year-old who has a white blood cell count of 6000

Answer: b Hospital-acquired infections are associated with indwelling urinary catheters. A normal white blood cell count, smoking cigarettes, or being a vegetarian has not been associated with hospital-acquired infections.

The nurse is caring for a patient who had abdominal surgery and has developed an infection in the wound while hospitalized. Which agent is most likely the cause of the infection? a. Virus b. Bacterium c. Fungus d. Spore

Answer: b The cause of an infection in the surgical wound in a hospitalized patient who has had abdominal surgery is most likely bacteria because it is present on the skin as normal flora. Fungi and spores are the focus of removal during the surgical preparation. Viruses are target specific and do not usually live on the skin.

The nurse is providing patient education on infection prevention. Which definition of an infection does the nurse use as a teaching point? a. An illness resulting from living in an unclean environment b. A result of lack of knowledge about food preparation c. A disease resulting from pathogens in or on the body d. An acute or chronic illness resulting from traumatic injury

Answer: c A disease resulting from pathogens in or on the body is the definition of an infection. An illness resulting from living in an unclean environment, from lack of knowledge about food preparation, or from trauma can lead to an infection but does not define an infection.

A new patient is admitted to a medical unit with Clostridium difficile. Which type of precautions or isolation does the nurse know is appropriate for this patient? a. Airborne precautions b. Droplet precautions c. Contact precautions d. Protective isolation

Answer: c Contact precautions are used with C. difficile because transmission of a contagious disease is possible through contact with the patient or with the equipment or items in the patient's room. Airborne precautions are used when a contagious disease is spread by small droplets that remain suspended in the air for a long period of time. Droplet precautions are used when a disease is spread by large droplets in the air. Protective isolation is used for patients who are immunosuppressed.

A patient develops food poisoning from contaminated food. What is the means of transmission for the infectious organism? a. Direct contact b. Vector c. Vehicle d. Airborne

Answer: c Contaminated food is a vehicle for transmitting an infection. Direct contact requires close proximity between the susceptible host and an infected person. A vector is a nonhuman carrier. In airborne transmission, the organism is carried in droplet or dust particles.

What is the proper order of removal of soiled personal protective equipment when the nurse leaves the patient's room? a. Gown, goggles, mask, gloves, and exit the room b. Gloves, wash hands, remove gown, mask, and wash hands c. Gloves, goggles, gown, mask, and wash hands d. Goggles, mask, gloves, gown, and wash hands

Answer: c Gloves are removed before the rest of personal protective equipment because they usually are the most contaminated. Protective eyewear or goggles are removed next by grasping them by the earpieces. Gowns are removed by untying the waist and then the neck and grasping inside the neck. The mask is removed last because it prevents the spread of respiratory microorganisms. Hands should be washed thoroughly after the equipment has been removed and before leaving the room.

A nurse is preparing to change a sterile dressing and has donned two sterile gloves. To maintain surgical asepsis, what else must the nurse do? a. Keep the amount of splashes on the sterile field to a minimum. b. If a sneeze is imminent, cover the nose and mouth with a gloved hand. c. With a moist saline sponge, use the dominant hand to clean the wound and then apply a dry dressing. d. Regard the outer 1 inch of the sterile field as contaminated.

Answer: d Considering the outer 1 inch of the sterile field as contaminated is a principle of sterile technique. Moisture contaminates the sterile field. Sneezing or coughing would contaminate the sterile glove and would necessitate replacing the contaminated glove with a new sterile one. The hand used to clean the wound would never be used to apply a dry dressing. The hand would have to be re-gloved.

Of the following assessment findings, which signs indicate to a nurse that a patient has a surgical site infection? (Select all that apply.) a. Thick, white drainage in the Jackson-Pratt tubing b. Redness or warmth at the affected site c. Purulent drainage at the incision site d. Temperature 100.4 F (38 C) e. Tenderness and localized pain f. Wound with well-approximated edges g. Purulent drainage at the incision site

Answers: a, b, c, d, e, g Purulent drainage at the site and thick, white drainage in the Jackson-Pratt tubing indicate the presence of white blood cells and microorganisms at the site of infection. Fever, localized pain, and redness are results of the inflammatory response to an infection. Well-approximated edges are a desired outcome of wound healing.

In which situations does the nurse wear clean gloves as part of standard precautions? (Select all that apply.) a. In the care of a patient diagnosed with an infectious process b. When the patient is diaphoretic c. During care of each individual under treatment in the facility d. In the presence of urine or stool e. When taking the patient's blood pressure

Answers: a, c, d The nurse uses standard precautions for situations in which an infectious disease is known or when there is a possibility of contact with blood or body fluids (except perspiration). Gloves are not necessary when taking the blood pressure of a patient who is not in isolation and who does not have any other risk factors.