NUR 1:Engage Fundamentals RN: infection control and isolation

acute illness stage/invasive stage

3rd stage Manifestations of a specific infectious disease process become obvious the infection is considered severe

prodromal stage

2nd stage Client begins having initial manifestations as the infectious agent replicates Symp are nonspecific such as fever, aches, poor appetite and malaise

Airborne precautions

Tier 2 •Protect infections smaller than 5mcg •N95 •Private Room- negative pressure •Patient transport- patient wears mask •Gloves and gown

Place the steps in the correct order for removing nonsterile gloves

Use fingers of opposite hand to grasp the outside of the glove at the cuff. Peel glove away from body turning it inside-out and hold in other hand. Use bare fingers to slide under cuff of the glove. Peel the glove inside-out, leaving the first glove inside the second glove. Dispose of gloves in trash receptable inside the client's room Perform hand hygiene

Proper hand washing

Wet hands w/ water Apply enough soap to cover all hadn surfaces rub hands palm to palm Top of each hand fingers interlaced Remove dirt under fingernails Rinse hands w/ water Dry thoroughly w/ single towel use towel to turn off faucet

Infectious Agent or Causative Agent

a pathogen, such as a bacterium or virus that can cause a disease Example: Clostridium difficile, Staphylococcus Aureus

sterile field

an area that is set up for certain procedures and is free from all organisms

susceptible host

an uninfected person who could become a reservoir for infection; not everyone exposed will become ill

ALcohol-based Hand sanitzer

apply rub all over hands: inbtwn fingers and all around fingers and thumbs, rub until dry approx 15-30 seconds

Multidrug- Resistant Infections

are caused by multidrug-resistant organism (MDROs). if a bacterium is resistant to one or more classes of existing antimicrobials, typically responds to only one or two meds and is challenging to treat.

Health care-associated infections (HAIs)

are infections that are acquired in a health care facility

Portal of Entry

can be any body orifice; provides a place for infectious agents to enter the individual; IV and devices provide port of entry also

How to break the chain of infection at the portal of exit

careful containment of body fluids through usage of drains or dressings, methods to decrease body secretions

medical asepsis

clean technique; involves procedures and practices that reduce the number and transfer of pathogens example: isolation

examples of direct contact of transmission

client's blood coming in contact w/ open abrasion on nurse or touching a client w/ scabies w/o gloves

Types of precautions

droplet airborne contact standard or universal

Indwelling devices that make host more susceptible to infections

endotracheal tubes urinary catheters central venous catheters arterial catheters implants such as pacemakers and artificial joints

How to break the chain of infection

hand hygiene, cough etiquette, clean surfaces, habits for good health

Medication that makes a host more susceptible to an infection

immunosuppressants antirejection meds antineoplastics antimicrobials corticosteroids gastric suppressant (proton pump inhibitors)

Closed glove technique

initial technique, performed once the nurse is already wearing a sterile gown. Keep both hand within the cuffs of the gown, keeping hand inside the cuff edges grasp the gloves with hand still inside the gown, pulls the gloves over the cuff, and positions the hands inside the gloves.

nonspecific immunity

maintained by neutrophlis and macrophages-both WBCs and they work as phagocytes (eat and destroy micro-organisms) both are released during the inflammatory response

Period of decline

manifestations begin to subside as the number of infectious agents in the body decrease Client begins feeling better and regain strength and function

Low-level disinfection

most vegetative bacteria are destroyed but some spores, fungi and viruses may still remain; achieved by using hospital-grade disinfectants on surfaces. Cleaning bedrails, tables, computer equipment, BP cuffs, pulse ox

How to break the chain of infection by disrupting reservoirs

nurses should use proper hand hygiene when caring for clients; preop skin prep prior to surgery; clean facility

airborne transmission

occurs through contact with contaminated respiratory droplets spread by a cough or sneeze small particles less than 5mcg;travel long distance

Droplet precautions

pathogens transmitted by large particle droplets expelled during coughing, sneezing, talking, or laughing. cough or sneeze in a tissue and dispose immediately •Infections larger than 5mcg and travel 3-6 ft •Private room or similar infectious disease •Masks for providers and visitors •Patient wear mask outside room

specific immunity

refers to the work of antibodies(immunoglobulins) and lymphocytes Bind to infectious agents and activiate the WBCs and complement to destory the infectious agent

portal of exit

route by which an infectious pathogen can leave the reservoir; any body orifice-ears, nose, mouth, skin; blood or body fluids that leave the GI tract, resp tract,

surgical asepsis

techniques used to Prevent transmission of pathogenic organisms to the client, also called sterile technique no micro-organisms present on them

Reservoir

the habitat of the infectious agent-where it lives, grows, reproduces; can inanimate or animate

Examples of airborne diseases

tuberculosis TB Rubeola(measles) Varicella (chickenpox)

antiseptic

used for cleansing the skin

Which of the following factors are examples of reservoirs in the chain of infection?( select all that apply) A. Health care workers B. Clients C. Bacteria D. Furniture E. Equipment F. Viruses

A,B,D and E

Sort the following clients into the type of isolation that should be utilized. A. Client who is sneezing, and is suspected to having seasonal influenza B. Client suspected of having TB C. Client diagnosed with adenovirus D. Client who need to have vital signs taken. E. Client who had a hematopoietic stem cell transplant this week F. Client diagnosed with a broken bone G. Client with frequent, large diarrheal stools and who is incontinent H. Client with a draining wound infected w/ MRSA.

A. Droplet B. Airborne C. Droplet D. Standard E. Protective F. Standard G. Contact H. Contact

Sort the following nursing actions according to whether or not they require nonsterile gloves to be worn A. Changing a diaper on an infant who has a heart defect. B. Reviewing discharge instructions w/ a client who had a heart attack. C. Emptying a client's bedpan. D. Administering an oral medication to a client who has na MDRO in their urine. E. Assisting a client who has a seizure disorder to a bedside chair.

A. Requires gloves- direct contact w/ body fluids B. Does not require C. Requires-direct contact w/ body fluids D. Requires- Should be on contact precautions E. Does not require

Infection Control Bundles

AKA Care bundles are guidelines for practice that are bundled together in an effort to prevent HAIs

Factors that increase host susceptibility

Age underlying disease HIV/AIDS Malignancy Transplants surgical procedures radiation therapy indwelling devices and meds

Type of Transmission? A nurse who enters a room where a client who has a Respiratory infection was present for several hours. The nurse inhales small particles that remain in the air and develops an infection.

Airborne Transmission

Types of antiseptic agents

Alcohols chlorhexidine chlorine chloroxylenol (parachlorometaxylenol(PCMX)) Hexachlorophene Iodine/Iodophors Quaternary ammonium compunds Triclosan

Medication that can block mast cell swelling response

Antihistamines: block histamine and help prevent swelling Anti-inflammatory's NSAIDs, ibuprofen

A nurse is caring for a client w/ a large draining foot wound. Which of following PPE equipment should the nurse don prior to entering the clients room? A. Sterile gloves and mask B. Non-Sterile gloves and gown C. Mask and face shield D. Gown and face shield

B. Non-sterile gloves and gown Contact precautions to prevent transmission of the pathogens contained in the drainage to other clients or the nurse,

Inflammatory Response Phase

Bacteria invade an open wound Histamine, Kinins and Prostaglandins arrive at the site Plasma form the blood enters the site Phagocytosis occurs Pus develops

Factors increasing client risk of Infection

Being in the health care environment Clients who has any type of medical device, IV catheter, tube, line, drain or wound of any type Proximity to other clients w/ infections Nursing home, care facilities or prisons

4 major HAIs

Central line-associated bloodstream infections(CLABSIs) Catheter-associated urinary tract infections (CAUTIs) Surgical-site infections(SSIs) Ventilator-assisted pneumonias(VAPs)

hand hyigene

Cleansing of hands with antibacterial soap and water, alcohol-based gel or foam or surgical scrub

Period of concalescence

Client returns to previous or new, balanced state of health

Local infections

Confined to one area of the body treated w/ topical antibiotics and oral antibiotics

3 main modes of transmission

Contact (w/ an object or person) Droplet ( through coughing, sneezing, singing) Airborne (through the air)

A home health nurse is caring for a client who had a left knee replacement 5 days ago. Which of following findings should the nurse report to the provider? A. the client can walk with a walker 40 ft B. The client elevates the L leg when sitting and sleeping C. The client's temperature is 98.6 F(37C) D. The client's L knee is warm to touch and erythematous

D. The client has 2 of the manifestations of inflammation and this could develop an infection at the surgical site

Examples of how skin integrity can become disrupted

Detergents adhesive tape some chemicals unintentional inj. breaks(incisions) or insect bites drying of mucous membranes lead to cracking

2 type of contact transmission

Direct contact (move directly from the infected host to another uninfected host) Indirect contact (from an infected person to another via a contaminated object or person)

Type of Transmission? A client has a draining, infected wound. The drainage touches a cut on a nurse's skin, leading to an infection.

Direct contact transmission

Type of Transmission? A client who has a respiratory infection sneezes without covering the mouth and nose. A person a few feet away becomes infected when large mucus particles land in their mouth.

Droplet Transmission

how to prepare for a sterile field

Flat work surface close to the client but 12-18 in from walls or potential contaminating objects Check all packages to ensure no damage was done Remember that the outer 1 in border of the field is considered contaminated

What PPE should the nurse put on prior to performing care for a client who requires contact precautions?

Gown and gloves at minimum prior to entering the room if the nurse expects to come in contact w/ the client or any contaminated items in the room.

How to break the chain of infection at transmisson

Hand hygiene; use of proper barrier devices (PPE) by eliminating various modes of transmission

Antimicrobial soap

Handwashing to remove dirt and debris from surfaces; use warm water and sing Happy Birthday 2 times

Manifestations of inflammation at tissue level

Heat Redness (erythema) Swelling (edema) pain loss of function in that area

2 levels of disinfection

High level and low level

Examples of indirect contact of transmission

Hospital setting: Staphylococcus aureus Drainage from a client's wound might get on bed rail/side table, then someone else touches it. improper removal of PPE between clients Doesn't preform proper hand hygiene

how to break the chain of infection at Susceptible host

Increase host's line of defense; immunization, proper nutrition, dietary supplements. proper hygiene , control of blood sugar can decrease host susceptibility

5 stages of infection

Incubation period Prodromal stage Acute illness Period of decline Convalescent period

Type of transmission? A client who coughed on their hand touches a door handle. Another person touches the same door handle and becomes infected with the same pathogen as the client.

Indirect Contact

Virulent

Infectious agent that is very efficient at making people ill; more potent

processes that can trigger the inflammatory response

Infectious triggers: viruses, bacteria, fungi Noninfectious triggers: physical such as burns, frostbite, foreign bodies, trauma, inj, radiation Chemical noninfectious: irritants(fluoride, nickel) fatty acids, alcohol, toxins and glucose Biological: damaged cells Psychological: excitement

examples of droplet diseases

Influenza virus, Bordetella pertussis norovirus rhinovirus coronavirus Pneumonia Streptococcal pharyngitis (strep throat) Haemophilus influenzae type B Scarlet Fever Mumps Mycoplasma pneumonia Meningococcal pneumonia Sepsis Pneumonic plague

Ways to keep body defending itself

Moisturize and use cleanser that is gentle on the skin keep abrasive substance and chemicals away from client's skin moist mucous membranes (nares-moist humidification can be added to client's O2) coughing helps remove materials

Things that prevent proper hand hygiene

Nail polish, gel nails, artificial nails, jewelry-rings

A nurse needs to assign rooms for two new clients needing contact isolation, but only one semi-private room is currently available. One client is being admitted due to diarrhea from C.diff. The other client has a large draining abd wound, but the pathogen has not yet been ID from the culture. Can theses two clients be placed in the same room? why or why not?

No. These two clients both require contact isolation, but for different reasons(pathogens). It is preferable to isolate separately but as a last resort if they would have the same pathogen they may cohort.

droplet transmission

Occurs when the infectious droplets travel through the air and come in contact with the mucosa of a host.

High-level disinfection

Only some spores remain; process involves pasteurization or chemicals and is applied to procedural instruments: endoscopies and respiratory therapy equipment

Steps in preparing a sterile field

1. Peel back the first flap furthest from the nurse 2. peel the sides back one at a time 3.Peel the flap closest to the nurse's body 4.Never turn your back on the sterile field. 5. when waiting nurse should clasps head in front of them above waist line

Basic steps of inflammation

1. Recognition of harmful stimuli by pattern receptors(located on the surface of cells) (bacteria, viruses, micro-organisms, trauma or toxins) 2. Activation of the inflammatory pathway 3. Release of inflammatory markers ( CRP) 4. Recruitment of inflammatory cells ( 1st leukocytes, then monocytes and lymphocytes)

A nurse is washing the hands with antimicrobial soap and water. How long should the nurse rub hands together?

15-30 seconds; happy birthday 2 times

incubation period

1st stage Client may not feel ill or have visible manifestations, but changes in pathology occur that might be detectable through labs or diagnostic testing Last from the time the client is exposed to the infectious agent until 1st symp appears Can last seconds, min, hours, days or weeks

Chain of Infection (6)

A chain of necessary pieces needed for an infection to occur Infectious agent, reservoir, portal of exit, means of transmission, portal of entry and susceptible host.

Disinfection

A process that eliminates almost all microorganisms, with the exception of bacteria spores, from inanimate objects 2 levels

Aspesis

Involves interventions to eliminiate or decrease the presence of micro-organisms that can cause infection

vehicle transmission

Involves transmission form contaminated objects to multiple persons: produce becomes infected w/ E.coli and consumed by many individuals who become ill

2 types of infections

Local and systemic infections

A nurse is caring for a client who has been diagnosed with a multidrug-resistant organism(MDRO) infection on the leg. Nurse: Hello, I've just spoken w/ your provider about the treatments we will be using for the infection in your leg. Clients: (sighs) I'm so frustrated that I have an infection. I forgot the name of it- something like vancomycin-resistance staff? Nurse: Yes, that's close; you have an infection with methicillin-resistant Staphylococcus aureus. It means that the bacterium S. aureus is not affected by the antibiotic methicillin. Nurse: in addition to you antibiotic regimen, we'll need to take some special precautions Client: (confused) Special precautions? What does that mean? Nurse: We will be implementing what we call contact precautions, which means anyone in your room should wear certain PPE Client: So, does this mean I can't leave my room? Nurse: No, you'll be able to leave your room for tests and as long as your wound is covered, you can go out and walk in the hallway Client: Okay, that makes me feel so much better. I don't want to be isolated all the time. The nurse continues to answer questions for client to promote understanding about the diagnosis. What additional info should the nurse teach the client about MDROs?

MDROs are bacteria that are resistant to at least one of the antimicrobials. Typically respond to only one or two of the med, making it challenging to treat. Nurses must take precautions when caring for these clients to avoid transmitting MDROs from one client to others.

Modes of tranmission

May be engaged to move bacteria, viruses, fungi, parasites and prions from place to place- contact, droplet, airborne, vehicle and vector-borne transmission; may be transmitted by one or more means

What term describes the clean technique used in health care?

Medical aspesis

3 types of body defenses

Physical and chemical barriers nonspecific immunity specific immunity

When to wear gloves?

Potential for direct contact w/ blood, body fluid, mucous membranes, nonintact skin, or potentially infectious material Direct contact w. clients colonized/infected w. pathogens listed under contact precautions

swelling

Protective mechanism that keeps other body tissues coming in contact w/ whatever foreign substance or infectious agent is in the body. Mast cells release histamine, bradykinin and prostaglandins which creates swelling causing the blood vessels to leak fluis into the tissues.

Skin 3 major functions

Reduce loss of water Protect against abrasion and micro-organism Provide a permeable barrier against the environment

A nurse is caring for a client whose family member asks why nurses cannot wear gel nail polish or have long fingernails. How should the nurse respond?

Short fingernails helps to protect clients by preventing growth of bacteria under the nail. Nail polish must not be chipped , also promotes bacteria growth. Gel nail polish is esp difficult to clean around and harbor bacteria.

Enhanced barrier precautions

Staff must wear gowns and gloves to prevent transfer or organisms to themselves or their clothing when engaging with the patient

systemic infection

Start as local infections and move into the bloodstream. Iv antibiotics and careful monitoring are both needed to treat systemic infections

infammatory response

The body's natural defense that is activated when the body is injured, foreign substances are present or when an infectious agent attacks

Sterilization

The process that completely destroys all microbial life, including spores.

physical and chemical barriers

The skin is the body's largest organ and the primary defense mechanism intact skin(lipid layer-stratum corneum) is one of the most important components in fighting infection

A client who has extremely dry, flaky skin asks why the nursing staff continually applies lotion. How should the nurse respond?

The skin is your body's primary physical defense. Keeping the skin moisturized helps to keep the skin intact, which reduces the risk of infection. The skin performs 2 major functions: 1 reducing loss of water 2 protecting against abrasion and micro-organism and 3 providing a permeable barrier against the environment

vector-borne transmission

The use of an animal to spread an organism from one person or place to another; Mosquitoes and rats not infected w. the pathogen but carry micro-organisms from one location or person to indiviuals

Airborne precautions

• tier 2 •Protect infections smaller than 5mcg •N95 •Private Room- negative pressure Or (AIIR) •Patient transport- patient wears mask •Gloves and gown TB

Standard or universal precautions

•Tier 1 •Hand hygiene- when should be done? •Applies to all body fluids, non-intact skin, mucous membranes •Considered potentially infectious •Used for all clients •Splashing- masks, eye protection, face shields •Clean gloves •Proper equipment cleaning •Dispose of all sharps

Protective isolation precautions

•Tier 2 Protects client •Private room •Positive airflow •Mask for client out of room •HEPA filtration •Immunocompromised patients, transplants, cancer patients

contact precautions

•Tier 2 •Worn if within 3 feet from patient •Private room •Gloves and gown examples: cdiff, RSV

droplet precations

•tier 2 •Infections larger than 5mcg and travel 3-6 ft •Private room or similar infectious disease •Masks for providers and visitors •Patient wear mask outside room •Flu, covid, pneumonia