Chapter 28 - Infection Prevention & Control

Immunocompromised

Having an impaired immune system

Acute inflammation is an immediate response to cellular injury. Tissue repair

Healing involves the defensive, reconstructive, and maturative stages.

Communicable disease

An infectious disease that is transmitted directly from one person to another

Explain the following methods of controlling or eliminating infectious agents. Sterilization

Sterilization is the complete elimination or destruction of all microorganisms, including spores

Pathogen

Infectious agent

Identify some common waste materials that are considered infectious. (4)

a. Wounds b. Blood c. Stool d. Urine

The following factors influence a patient's susceptibility to infection. Nutritional status

A reduction in the intake of protein, carbohydrates, and afars reduces the body's defenses and impairs wound healing

Anaerobic bacteria

Bacteria that thrive with little or no free oxygen

The following factors influence a patient's susceptibility to infection. Stress

Basal metabolic rate increases; increase serum glucose levels and decrease anti-inflammatory responses with elevated cortisone levels

Explain the following methods of controlling or eliminating infectious agents. Disinfection

Disinfection is a process that eliminates many or all microorganisms with the exception of bacterial spores from inanimate objects

Effective prevention and control of infection requires the nurse to be aware of the following modes of transmission: Bottled solutions

Do not leave bottle solutions open; date and discard them in 24 hours

Explain the mode of transmission: Airborne

Droplets that suspend in the air

Explain the following methods of controlling or eliminating infectious agents. Hand hygiene

Hand hygiene includes washing hands with soap and water followed by a stream of water for 15 seconds

Effective prevention and control of infection requires the nurse to be aware of the following modes of transmission: Surgical wounds

Keep drainage tubes and collection bags patent

Effective prevention and control of infection requires the nurse to be aware of the following modes of transmission: Bedside unit

Keep surfaces clean and dry

Explain the mode of transmission: Droplet

Large particles that travel up to 3ft and come in contact with the host

Colonization

Organism that multiplies within a host but does not cause an infection

The isolation guidelines of the Centers for Disease Control and Prevention contain a two-tiered approach. Explain each one. Standard precautions Tier 1

Standard precautions are designed for all patients in all settings regardless of the diagnosis; they apply to contact with blood, body fluid, non intact skin, and mucous membranes

The nurse follows certain principles and procedures to prevent infection and to control its spread. Concept of asepsis

The absence of pathogenic microorganisms; the technique refers to the practices or procedures that assist in reducing the risk for infection

Describe the type of infection: Systemic

An infection that affects the entire body instead of just a single organ

List four common goals for a patient with an actual or potential risk for infection. (4)

a. Preventing exposure to infectious organisms b. Controlling or reducing the extent of infection c. Maintaining resistance to infection d. Verbalizing understanding of infection prevention and control techniques

List the nine responsibilities of infection control professionals. (9)

a. Provide staff and patient education b. Develop and review infection prevention and control policies and procedures c. Recommend appropriate isolation procedures d. Screen patient records e. Consult with health departments f. Gather statistics regarding the epidemiology g. Notify the public health department of incidences of communicable diseases h. Consult with all departments to investigate unusual events or clusters i. Monitor antibiotic-resistant organisms

Identify some common nursing diagnoses that apply to patients at risk or who have an actual infection. (6)

a. Risk for infection b. Imbalanced Nutrition c. Impaired Oral Mucous Membrane d. Impaired Skin Integrity e. Social Isolation f. Impaired Tissue Integrity

Identify the sites and causes of health care-associated infections. (4)

a. Urinary tract b. Surgical or traumatic wounds c. Respiratory tract d. Bloodstream

Explain the mode of transmission: Indirect

Personal contact of a susceptible host with a contaminated inanimate object

Carriers

Persons who show no symptoms of illness but who have the pathogens that are transferred to others

Aerobic bacteria

Bacteria that require oxygen for survival

Explain the mode of transmission: Vehicles

Contaminated items

Bactericidal

A temperature or chemical that destroys bacteria

pH

Acidity of the environment

The nurse sets up a nonbarrier sterile field on the patient's over-bed table. In which of the following instances is the field contaminated? 1. Sterile saline solution is spilled on the field 2. The nurse, who has a cold, wears a double mask 3. Sterile objects are kept within a 1-inch border of the field 4. The nurse keeps the top of the table above his or her waist

1. If moisture leaks through a sterile package's protective covering, organisms can travel to the sterile object

When a patient on respiratory isolation must be transported to another part of the hospital, the nurse: 1. Places a mask on the patient before leaving the room 2. Obtains health care provider's order to prohibit the patient from being transported 3. Instructs the patient to cover his or her mouth and nose with a tissue when coughing or sneezing 4. Advises other health team members to wear masks and gowns when coming in contact with the patient

1. Patients who are transported outside of their rooms need to wear surgical masks to protect other patients and personnel

The severity of a patient's illness depends on all of the following except: 1. Incubation period 2. Extent of infection 3. Susceptibility of the host 4. Pathogenicity of the microorganism

1. The incubation period is the interval between the entrance of the pathogen into the body and appearance of the first symptoms

Which of the following is not an element in the development or chain of infection? 1. Means of transmission 2. Infectious agent or pathogen 3. Formation of immunoglobulin 4. Reservoir for pathogen growth

3. Infection occurs in a cycle that depends on the presence of certain elements

Which of the following best describes an iatrogenic infection? 1. It results from a diagnostic or therapeutic procedure 2. It results from an extended infection of the urinary tract 3. It involves an incubation period of 3 to 4 weeks before it can be detected 4. It occurs when patients are infected with their own organisms as a result of immunodeficiency

4. An iatrogenic infection occurs when part of the patient's flora becomes altered and an overgrowth results

Identify the rationale for the following personal protective equipment. Masks

A mask should be worn when you anticipate splashing or spraying of blood or bloody fluid in your face and to satisfy droplet or airborne precautions

Reservoir

A place where a pathogen survives

Virulence

Ability to survive in the host or outside the body

Acute inflammation is an immediate response to cellular injury. Vascular and cellular responses

Acute Inflammation: rapid vasodilation that causes redness at the site and localized warmth, allowing phagocytosis to occur

Explain the following methods of controlling or eliminating infectious agents. Alcohol-based hand rubs

Alcohol-based hand rubs are recommended by Centers for Disease Control and Prevention to improve hand hygiene practices, protect health care worker's hands, and reduce pathogens to patients

Effective prevention and control of infection requires the nurse to be aware of the following modes of transmission: Dressing changes

Change dressings when they are wet or soiled

The nurse follows certain principles and procedures to prevent infection and to control its spread. Medical asepsis

Clean technique: hand hygiene, using clean gloves, cleaning the environment routinely

(health-care-associated infections - nosocomial). Exogenous

Exogenous infection comes from microorganisms outside the individual that do not exist in normal flora

(health-care-associated infections- nosocomial). Endogenous

Endogenous infection occurs when part of the patient's flora becomes altered and an overgrowth results

Identify the rationale for the following personal protective equipment. Gloves

Gloves prevent the transmission of pathogens by direct and indirect contact

Identify the rationale for the following personal protective equipment. Gowns

Gowns prevent soiling clothing during contact with patients

Infectious disease

Illnesses such as viral meningitis and pneumonia

Susceptibility

Individual's degree of resistance to pathogens

The following factors influence a patient's susceptibility to infection. Age

Infants have immature defenses, breastfed babies have greater immunity, viruses are common in middle-aged adults, older adult cell-mediated immunity declines

normal body defenses against infection: Inflammation

Inflammation is the body's response to injury, infection, or irritation. It is the protective vascular reaction that delivers fluid, blood products, and nutrients to an area of injury

Acute inflammation is an immediate response to cellular injury. Inflammatory exudate

Inflammatory exudate is the accumulation of fluid and dead tissue cells; WBCs form at the site. Exudate may be serous, sanguineous, or purulent.

Explain the mode of transmission: Vector

Internal and external transmissions

The isolation guidelines of the Centers for Disease Control and Prevention contain a two-tiered approach. Explain each one. Isolation precautions Tier 2

Isolation precautions are based on the mode of transmission of disease. They are termed airborne; droplet; contact; and a new category, protective environment

The following factors influence a patient's susceptibility to infection. Disease process

People with diseases of the immune system (leukemia, AIDS) and chronic diseases (AODM) have weakened defenses against infection

Explain the mode of transmission: Direct

Person-to-person or physical source and susceptible host

Effective prevention and control of infection requires the nurse to be aware of the following modes of transmission: Contaminated sharps

Place all needles, safety needles, and needleless systems into puncture-proof containers.

Effective prevention and control of infection requires the nurse to be aware of the following modes of transmission: Contaminated articles

Place tissues, soiled dressings, or soiled linen in fluid-resistant bags

Bacteriostasis

Prevention of the growth and reproduction of bacteria by cold temperatures

Identify the rationale for the following personal protective equipment. Protective eyewear

Protective eyewear should be worn for procedures that generate splashed or tsplatters

Portal of exit

Sites such as blood, mucus membranes, respiratory tract, genitourinary tract, gastrointestinal tract

normal body defenses against infection: Normal flora

The body contains microorganisms that reside on the surface and deep layers of the skin, in saliva and oral mucosa, and in the intestinal walls and genitourinary tract that maintain health

normal body defenses against infection: Body system defenses

The skin, mouth, eyes, respiratory tract, urinary tract, genitourinary tract and vagina have unique defenses against infection

Major route of transmission

Unwashed hands of a health care worker

Effective prevention and control of infection requires the nurse to be aware of the following modes of transmission: Drainage bottles and bags

Wear gloves and protective eyewear and empty all drainage systems at the end of the shift

Effective prevention and control of infection requires the nurse to be aware of the following modes of transmission: Bathing

When bathing, use soap and water to remove drainage, dried secretions, and excess perspiration

Describe the type of infection: Localized

Wound infection; patient experiences localized symptoms

List the seven principles of surgical asepsis. (7)

a. A sterile object remains sterile only when touched by another sterile object b. Place only sterile objects on a sterile field c. A sterile object or field out of the range of vision or an object held below a person's waist is contaminated d. A sterile object or field becomes contaminated by prolonged exposure to air e. When a sterile surface comes in contact with a wet, contaminated surface, the sterile object or field becomes contaminated by capillary action f. Because fluid flows in the direction of gravity, a sterile object becomes contaminated if gravity causes a contaminated liquid to flow over the object's surface g. The edges of a sterile field or container are considered to be contaminated

Development of an infection occurs in a cycle that depends on the following elements. (6)

a. An infectious agent or pathogen b. A reservoir or source c. A portal of exit from the reservoir d. A mode of transmission e. A portal of entry to the host f. A susceptible host

List in order the steps for performing a sterile procedure. (10)

a. Assemble all equipment b. Don caps, masks and eyewear c. Open sterile packages d. Open sterile items on a flat surface e. Open a sterile item while holding it f. Prepare a sterile field g. Pour sterile solutions h. Surgical crub i. Apply sterile gloves j. Don a sterile gown

Identify clinical situations in which a nurse would use surgical asepsis. (3)

a. During procedures that require intentional perforation of the patient's skin b. When the skin's integrity is broken c. During procedures that involve insertion of catheters

The elements of a respiratory hygiene or cough etiquette are: (6)

a. Education of health care facility staff and visitor b. Posters and written material for agency and visitors c. Education on how to cover your nose and mouth when you cough, using a tissue, and the prompt disposal of contaminated tissue d. Placing a surgical mask on the patient of it will not compromise respiratory function or is applicable e. Hand hygiene after contact with contaminated respiratory secretions f. Spatial separation greater than 3 feet from persons with respiratory infections

The expected outcome is the absence of signs and symptoms of infection. List some ways the nurse can monitor the patient. (4)

a. Monitor patients postoperatively, including surgical sites, invasive sites, the respiratory tract, and the urinary tract b. Examine all invasive and surgical sites for swelling, erythema, or purulent drainage c. Monitor breath sounds d. Review laboratory results

List the ways a nurse can teach patients and their families to prevent an infection from developing or spreading. (6)

a. Nutrition b. Immunizations c. Personal hygiene d. Regular rest and exercise e. Eliminate reservoirs of infection f. Control portals of exit and entry