Asepsis and Infection Control

transmission precaution

- contact precaution - droplet precaution - airborne precaution - protective environment

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

b. Bacterium Rational: 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.

If an infectious disease can be transmitted from one person to another it is a a. Susceptible host b. Communicable disease c. Port of entry to a host d. Port of exit from the reservoir

b. Communicable disease

Which link in the chain of infection would be affected by teaching a patient to cover mouth when coughing? a. Susceptible host b. Mode of transmission c. Infectious agent d. Reservoir

b. Mode of transmission

You are caring for a patient diagnosed with mycoplasmal pneumonia. Droplet precautions have been instituted, so you must a. Wear a respirator b. Protect your eyes c. Use an air filter d. Wear shoe covers

b. Protect your eyes Rational: Droplet transmission involves contact of infectious, large particle droplets with the conjunctivae or the mucous membranes of the nose or mouth of a susceptible person. Droplets are generated by the patient during coughing, sneezing, or talking, and during procedures such as suctioning and bronchoscopy.

1. 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.

b. remind family that they only need to wash their hands if they are visibly dirty. Rational: 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.

A nurse needs to make rounds on 4 clients who are stable. Using the principle of medical sepsis, which client should be seen first? a. A postsurgical cardiac client who has pneumonia b. A client who has a draining wound c. A client who is severely neutropenic d. A child who has chicken pox

c. A client who is severely neutropenic

droplet precaution

Safeguards designed to reduce the risk of droplet transmission of infectious agents. Droplet transmission involves contact of the conjunctivae or the mucous membranes of the nose or mouth of a susceptible person with large-particle droplets (larger than 5 μm in size) containing microorganisms generated from a person who has a clinical disease or is a carrier of the disease. Droplets are generated from the source person primarily during coughing, sneezing, talking, and performance of certain procedures such as suctioning and bronchoscopy. Large-particle droplet transmission requires close contact between source and recipient persons because droplets do not remain suspended in the air and generally travel only short distances (usually 3 feet or less).

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

c. Vehicle Rational: 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.

When do you need to wash your hands with soap and water instead of using an alcohol rub? a. Working with a patient with MRSA b. After removing gloves c. When hands are visibly soiled d. After touching a patient

c. When hands are visibly soiled

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.

c. use of an alcohol-based antiseptic handrub. Rational: 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.

You are caring for a patient with pneumonia with a productive cough? What type of protection would you use when doing you AM assessment? a. gloves b. gown c. mask d. goggles e. all of the above

e. all of the above

Explain the principles and practices of surgical asepsis

- "Sterile technique" - Technique to eliminate micro-organisms from an object or area. --- The Operating Room --- Labor & Delivery-need wear caps and shoe covers --- Diagnostic Areas --- The bedside - Sterile Gloving

sterilization

- A process or act that renders a person unable to produce children. - A technique for destroying microorganisms or inanimate objects, using heat, water, chemicals, or gases.

immune (lymphoreticular) system

- A system of tissues, organs, and cells that protects the body against pathogenic organisms and other foreign bodies. - The principal components of the immune system include the bone marrow, the thymus, and the lymphoid tissues. - The system also uses peripheral organs, such as the lymph nodes, the spleen, and the lymphatic vessels.

Communicable disease

- Any disease transmitted from one person or animal to another directly, by contact with excreta or other discharges from the body; indirectly, by means of substances or inanimate objects such as contaminated drinking glasses, toys, or water; or by means of vectors such as flies, mosquitoes, ticks, or other insects. - Many communicable diseases, by law, must be reported to the local health department.

Describe hand hygiene impacts the health of the nurse and the patient

- Cleansing of the hands with soap and water, antiseptic hand wash, alcohol-based hand rub, or surgical hand antisepsis. - before and after a procedure; - before applying and after removing gloves. - When hands are visibly soiled, they must be washed, whereas alcohol-based hand sanitizer may be used. - Use soap and water to disinfect hands when contact with C. Diff.

Standard precautions

- Guidelines recommended by the Centers for Disease Control and Prevention for reducing the risk of transmission of blood-borne and other pathogens in hospitals. - The standard precautions synthesize the major features of universal precautions (designed to reduce the risk of transmission of blood-borne pathogens) and body substance isolation (designed to reduce the risk of pathogens from moist body substances) and apply them to all patients receiving care in hospitals, regardless of their diagnosis or presumed infection status. - Standard Precautions apply to (1) blood; (2) all body fluids, secretions, and excretions, excluding sweat, regardless of whether they contain blood; (3) nonintact skin; and (4) mucous membranes. - The precautions are designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection in hospitals.

HAI

- Hospital-acquired infections - patients come to hospital for a reason, they come here to surgical intervention, and they leave the infection after surgical. - Patients also got infection after surgery.

Identify common signs and symptoms of local inflammation/infection

- Swelling - Redness - Increased warmth - Pain - Tenderness - Loss of function - drainage - numbness/tingling - loss of function to the affected area

asepsis

- The absence of germs. - refers to freedom from and prevention of disease-causing contamination.

inflammation

- The protective or destructive response of body tissues to irritation or injury. - Inflammation may be acute or chronic. - Its cardinal signs are redness (rubor), heat (calor), swelling (tumor), and pain (dolor), often accompanied by loss of function

surgical hand scrub

- a surgical hand scrub must be performed before all surgical procedures and before other procedures as necessary. - performed with an antiseptic agent - a disposable sponge is used to scrub the hands, fingers, and wrists to reduce the number of microorganisms on intact skin.

Identify common signs and symptoms of systemic inflammation/infection

- infections that infiltrate the bloodstream - Malaise不舒服，心神不安 - Anorexia - Nausea/Vomiting - Lymph node enlargement - fever >100° - increases in heart and respiratory rates - lethargy

Discuss the actions that patients can take to decrease risk for infections

- proper hand hygiene - not to share personal care items - antimicrobial soaps and effective disinfectants - cleaning reusable equipment and supplies: use soap and water, and disinfect with a chlorine bleach solution - avoid coughing, sneezing, or breathing directly on others and to cover the mouth and the nose. - immunizations - put used needles in a puncture-resistant container with a screw-top lid and to label the container so that it will not be discarded in the garbage

airborne precaution

Guidelines recommended by the Centers for Disease Control and Prevention for reducing the risk of airborne transmission of infectious agents. Airborne transmission occurs by dissemination of either airborne droplet nuclei or dust particles containing the infectious agent. Special air handling and ventilation are required to prevent airborne transmission. Airborne precautions apply to patients known or suspected to be infected with epidemiologically important pathogens that can be transmitted by the airborne route.

contact precaution

Guidelines recommended by the Centers for Disease Control and Prevention for reducing the risk of transmission of epidemiologically important microorganisms by direct or indirect contact. Direct-contact transmission involves skin-to-skin contact and physical transfer of microorganisms to a susceptible host from an infected or colonized person. Indirect-contact transmission involves contact of a susceptible host with a contaminated intermediate object, usually inanimate, in the patient's environment. Contact precautions apply to specified patients known or suspected to be infected or colonized with epidemiologically important microorganisms that can be transmitted by direct or indirect contact.

The nurse determines that a field remains sterile if which of the following conditions exist? a. Tips of wet forceps are held upward when held in ungloved hands b. The field was set up 1 hour before the procedure c. Sterile items are 2 inches from the edge of the field d. The nurse reaches over the field rather than around the edges.

c. Sterile items are 2 inches from the edge of the field

disinfections

The process of killing pathogenic organisms or rendering them inert.

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

a,c,d Rational: 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.

What are the manifestations of systemic infection? Choose all that apply a. Increased body temperature b. Redness c. Malaise d. Swelling e. WBC 14000

a,c,e

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

a,b,c,d,e Rational: 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.

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

b. 40-year-old who has an indwelling urinary catheter in place Rational: 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 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.

a,c,f Rational: 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.

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

a. Droplet precautions Rational: 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.

Which of the following is an advantage of using alcohol based gel? a. Its use takes less time than washing with soap and water does b. It removes gross contamination better than soap and water c. Its protective nature reduces the need for frequent hand washing d. It provides adequate protection before surgical applications

a. Its use takes less time than washing with soap and water does

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

a. Private room Rational: 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.

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.

a. infectious agent, source of infection, portal of exit, mode of transmission, portal of entry, and susceptible host.

A nurse is documenting data about a healing wound on a patient's lower leg. The predominant exudate in the wound is watery in consistency and light red in color. The nurse should document this exudate as: a. serosanguineous b. sanguineous c. serous d. purulent

a. serosanguineous

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

c. A disease resulting from pathogens in or on the body Rational: 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.

Nurse caring for a pt. who is heavily draining wound that continues to show evidence of bleeding which dressing should the nurse select to help promote hemostasis a. Transparent b. Hydrofiber c. Alginate d. Biologic

c. Alginate

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

c. Contact precautions Rational: 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.

Standard precautions mandate a. Rinsing gloves that become visibly soiled during use b. Using antimicrobial soap for routine handwashing c. Disinfecting hands immediately after removing gloves d. Keeping gloves on when touching environmental surfaces

c. Disinfecting hands immediately after removing gloves

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

c. Gloves, goggles, gown, mask, and wash hands Rational: 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.

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

d. 36-year-old female with HIV Rational: The patient with HIV has an incompetent immune system, which makes her at risk for infection. The other patients are all healthy.

Contact precautions would be mandated for a hospitalized adult patient diagnosed with a. Hepatitis B b. Measles c. Meningitis d. Infectious diarrhea

d. Infectious diarrhea Rational: Hepatitis B - standard Measles - airborne Meningitis - droplet

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.

d. Regard the outer 1 inch of the sterile field as contaminated. Rational: 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.

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.

d. Risk for Infection related to altered skin integrity. Rational: 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.

infection

is the establishment of a pathogen in a susceptible host; a disease state is caused by the infectious agent.

Surgical asepsis

procedures used to eliminate any microorganisms; sterile technique.

Medical asepsis

procedures used to reduce the number of microorganisms and prevent their spread.