NURA 1110 Exam: 2 Chapter 23: Asepsis and Infection Control and Chapter 31 Wound Care Sterile Dressing

sterilization

(1) the process by which all microorganisms, including spores, are destroyed (2) surgical procedure performed to render a person infertile

Contact Precautions: Equipment

* At least 3 ft spatial separation * Gown * Gloves

FYI - MICROORGANISMS

* DANGER OF SPREADING FROM PERSON TO PERSON OR PLACE TO PLACE * ARE NATURALLY PRESENT IN ALMOST ALL ENVIRONMENTS * SOME ARE BENEFICIAL - SOME ARE NOT * SOME ARE HARMLESS TO MOST PEOPLE - OTHERS ARE HARMFUL TO MANY PEOPLE * STILL OTHERS ARE HARMLESS, EXCEPT IN CERTAIN CIRCUMSTANCES

PPE - PERSONAL PROTECTIVE EQUIPMENT AND SUPPLIES

* Gloves * Gown * Mask * Protective Eyewear

Stages of Infection

* Incubation Period * Prodromal Stage * Full Stage of Illness * Convalescent Period

COMPONENTS OF THE INFECTION CYCLE

* Infectious Agent * Reservoir * Portal of Exit * Means of Transmission * Portal of entry * Susceptible host

FACTORS AFFECTING HOST SUSCEPTIBILITY (in older adults)

* Pulmonary infections * Urinary tract infections * Skin infections - Pulmonary infections Decreased cough reflex Decreased elastic recoil of lungs Decreased activity of cilia Abnormal swallowing reflexes - Urinary tract infections Incomplete emptying of bladder Decreased sphincter control Bladder-outlet obstruction due to enlarged prostate gland Pelvic floor relaxation due estrogen depletion Reduced renal blood flow - Skin infections Loss of elasticity Increased dryness Thinning of epidermis Slowing of cell replacement Decreased vascular supply

CDC- Center for Disease Control

* RESPONSIBLE FOR INVESTIGATING, PREVENTING, & CONTROLLING DISEASE * EFFORTS INCLUDE IMMUNIZATION PROGRAMS, LAWS GOVERNING SAFE SEWAGE DISPOSAL, REGULATIONS FOR CONTROLLING COMMUNICABLE DISEASES, & HOSPITAL INFECTION-SURVEILLANCE PROGRAMS

Airborne Precautions: Contamination

* Rubeola virus (measles) * Varicella virus (chicken pox) * M. tuberculosis * SARS-CoV

OSHA Guideline for Healthcare Providers

* Standard precautions shall be observed (every patient, every time) by wearing gloves = bodily fluids * Work practice control to eliminate employee exposure (Hep C transmitted easier than HIV 90% - No vaccine) * Hand hygiene practices (20 seconds) * No food kept where blood products are present

Contact Precautions

*direct contact is with the patient *indirect contact is with the patient environment Problems that can occur: - excessive wound drainage - fecal incontinence - other bodily discharge - extensive environmental contamination lead to risk of transmission Place the patient in a private room, if available. Wear PPE whenever you enter the room for all interactions that may involve contact with the patient and potentially contaminated areas in the patient's environment. Change gloves after having contact with a infected material. Remove PPE before leaving the patient environment, and wash hands with an antimicrobial or water-less antiseptic agent. * Limit movement of the patient out of the room. * Avoid sharing patient-care equipment.

7 PRINCIPLES OF SURGICAL ASEPSIS

1. Touching one sterile item with another sterile item 2. Touching one sterile item with a non-sterile item yields it contaminated 3. Partially unwrapped sterile package is contaminated 4. If a questions arises about sterility it is contaminated 5. A commercially packaged sterile item is not considered sterile past its recommended expiration date 6. Once a sterile item is opened it is only a matter of time before it becomes contaminated - set up immediately before using 7. A sterile wrapper, if it becomes wet, wicks microorganisms from its supporting surfaces, causing contamination

PRINCIPLE #4 - SURGICAL ASEPSIS

A STERILE OBJECT OR STERILE FIELD BECOMES CONTAMINATED BY PROLONGED EXPOSURE TO AIR.

PRINCIPLE #1 - SURGICAL ASEPSIS

A STERILE OBJECT REMAINS STERILE ONLY WHEN TOUCHED BY ANOTHER STERILE OBJECT.

d. The priority diagnosis in this situation is the possibility of an infection developing in the open skin area. The others may be potential or probable diagnoses for this patient and may also require nursing interventions after the first diagnosis is addressed.

A nurse is caring for an obese 62-year-old patient with arthritis who has developed an open reddened area over his sacrum. What is a priority nursing diagnosis for this patient? a. Imbalanced Nutrition: More Than Body Requirements related to immobility b. Impaired Physical Mobility related to pain and discomfort c. Chronic Pain related to immobility d. Risk for Infection related to altered skin integrity

a, c, d, f. It is recommended to use an alcohol-based handrub in the following situations: before direct contact with patients; after direct contact with patient skin; after contact with body fluids if hands are not visibly soiled; after removing gloves; before inserting urinary catheters, peripheral vascular catheters, or invasive devices that do not require surgical placement; before donning sterile gloves prior to an invasive procedure; if moving from a contaminated body site to a clean body site; and after contact with objects contaminated by the patient.

A nurse is caring for patients in an isolation ward. In which situations would the nurse appropriately use an alcohol-based handrub to decontaminate the hands? Select all that apply. a. The nurse is providing a bed bath for a patient. b. The nurse has visibly soiled hands after changing the bedding of a patient. c. The nurse removes gloves when patient care is completed. d. The nurse is inserting a urinary catheter for a female patient. e. The nurse is assisting with a surgical placement of a cardiac stent. f. The nurse removes old magazines from a patient's table.

c. If an impervious gown has been tied in front of the body at the waist, the nurse should untie the waist strings before removing gloves. Gloves are always removed first because they are most likely to be contaminated, followed by the goggles, gown, and mask, and hands should be washed thoroughly after the equipment has been removed and before leaving the room.

A nurse is finished with patient care. How would the nurse remove PPE when leaving the room? a. Remove gown, goggles, mask, gloves, and exit the room. b. Remove gloves, perform hand hygiene, then remove gown, mask, and goggles. c. Untie gown waiststrings, remove gloves, goggles, gown, mask; perform hand hygiene. d. Remove goggles, mask, gloves, gown, and perform hand hygiene.

c. According to the principles of medical asepsis, the nurse should move equipment away from the body when brushing, scrubbing, or dusting articles to prevent contaminated particles from settling on the hair, face, or uniform. The nurse should carry soiled items away from the body to prevent them from touching the clothing. The nurse should not put soiled items on the floor, as it is highly contaminated. The nurse should also clean the least soiled areas first and then move to the more soiled ones to prevent having the cleaner areas soiled by the dirtier areas.

A nurse is following the principles of medical asepsis when performing patient care in a hospital setting. Which nursing action performed by the nurse follows these recommended guidelines? a. The nurse carries the patients' soiled bed linens close to the body to prevent spreading microorganisms into the air. b. The nurse places soiled bed linens and hospital gowns on the floor when making the bed. c. The nurse moves the patient table away from the nurse's body when wiping it off after a meal. d. The nurse cleans the most soiled items in the patient's bathroom first and follows with the cleaner items.

b, e, f. Proper hand hygiene includes removing jewelry with the exception of a plain wedding band, wetting the hands and wrist area with the hands lower than the elbows, using about one teaspoon of liquid soap, using friction motion for at least 15 seconds, washing to one inch above the wrists with a friction motion for at least 15 seconds, and rinsing thoroughly with water flowing toward fingertips.

A nurse is performing hand hygiene after providing patient care. The nurse's hands are not visibly soiled. Which steps in this procedure are performed correctly? Select all that apply. a. The nurse removes all jewelry including a platinum wedding band. b. The nurse washes hands to one inch above the wrists. c. The nurse uses approximately two teaspoons of liquid soap. d. The nurse keeps hands higher than elbows when placing under faucet. e. The nurse uses friction motion when washing for at least 15 seconds. f. The nurse rinses thoroughly with water flowing toward fingertips.

c. If the patient touches a sterile field, the nurse should discard the supplies and prepare a new sterile field. If the patient is confused, the nurse should have someone assist by holding the patient's hand and reinforcing what is happening.

A nurse is preparing a sterile field using a packaged sterile drape for a confused patient who is scheduled for a surgical procedure. When setting up the field, the patient accidentally touches an instrument in the sterile field. What is the appropriate nursing action in this situation? a. Ask another nurse to hold the hand of the patient and continue setting up the field. b. Remove the instrument that was touched by the patient and continue setting up the sterile field. c. Discard the supplies and prepare a new sterile field with another person holding the patient's hand. d. No action is necessary since the patient has touched his or her own sterile field.

b. When using PPE, the nurse should work from "clean" areas to "dirty" ones, put on PPE before entering the patient room, always use goggles instead of personal glasses, and remove PPE in the doorway or anteroom.

A nurse is using personal protective equipment (PPE) when bathing a patient diagnosed with C. difficile infection. Which nursing action related to this activity promotes safe, effective patient care? a. The nurse puts on PPE after entering the patient room. b. The nurse works from "clean" areas to "dirty" areas during bath. c. The nurse personalizes the care by substituting glasses for goggles. d. The nurse removes PPE prior to leaving the patient room.

b. In the home setting, where the patient's environment is more controlled, medical asepsis is usually recommended, with the exception of self-injection. This is the appropriate procedure for the home and is neither unethical nor grossly negligent.

A nurse teaches a patient at home to use clean technique when changing a wound dressing. This practice is considered: a. The nurse's preference b. Safe for the home setting c. Unethical behavior d. Grossly negligent

d. To add a sterile solution to a sterile field, the nurse would open the solution container according to directions and place the cap on the table away from the field with the edges up. The nurse would then hold the bottle outside the edge of the sterile field with the label side facing the palm of the hand and prepare to pour from a height of 4 to 6 inches (10 to 15 cm).

A nurse who created a sterile field for a patient is adding a sterile solution to the field. What is an appropriate action when performing this task? a. Place the bottle cap on the table with the edges down. b. Hold the bottle inside the edge of the sterile field. c. Hold the bottle with the label side opposite the palm of the hand. d. Pour the solution from a height of 4 to 6 inches (10 to 15 cm).

b. When a needlestick injury occurs, the nurse should wash the exposed area immediately with warm water and soap, report the incident to the appropriate person and complete an incident injury report, consent to and await the results of blood tests, consent to postexposure prophylaxis, and attend counseling sessions regarding safe practice to protect self and others

A nurse who is caring for a patient diagnosed with HIV/AIDS incurs a needlestick injury when administering the patient's medications. What would be the priority action of the nurse following the exposure? a. Report the incident to the appropriate person and file an incident report. b. Wash the exposed area with warm water and soap. c. Consent to postexposure prophylaxis at appropriate time. d. Set up counseling sessions regarding safe practice to protect self.

b. During the prodromal stage, the person has vague signs and symptoms, such as fatigue and a low-grade fever. There are no obvious symptoms of infection during the incubation period, and they are more specific during the full stage of illness, before disappearing by the convalescent period.

A school nurse is performing an assessment of a student who states: "I'm too tired to keep my head up in class." The student has a low-grade fever. The nurse would interpret these findings as indicating which stage of infection? a. Incubation period b. Prodromal stage c. Full stage of illness d. Convalescent period

COMPONENTS OF THE INFECTION CYCLE INFECTIOUS AGENT:

BACTERIA, VIRUSES, FUNGI, PARASITES

transmission-based precautions

CDC precautions used in patients known or suspected to be infected with pathogens that can be transmitted by airborne, droplet, or contact routes; used in addition to standard precautions

standard precautions

CDC precautions used in the care of all patients regardless of their diagnosis or possible infection status; this category combines universal and body substance precautions

COMPONENTS OF THE INFECTION CYCLE MEANS OF TRANSMISSION:

DIRECT CONTACT or INDIRECT CONTACT, AIRBORNE,ROUTE

PRINCIPLE #6 - SURGICAL ASEPSIS

FLUIDS FLOW IN THE DIRECTION OF GRAVITY. * dry hands from fingers to elbow in this order.

a, b, f. Rubella, diphtheria, and adenovirus infection are illnesses transmitted by large-particle droplets and require droplet precautions in addition to standard precautions. Airborne precautions are used for patients who have infections spread through the air with small particles, for example, tuberculosis, varicella, and rubeola. Contact precautions are used for patients who are infected or colonized by a multidrug-resistant organism (MDRO), such as MRSA.

In addition to standard precautions, the nurse would initiate droplet precautions for which patients? Select all that apply. a. A patient diagnosed with rubella b. A patient diagnosed with diptheria c. A patient diagnosed with varicella d. A patient diagnosed with tuberculosis e. A patient diagnosed with MRSA f. An infant diagnosed with adenovirus infection

COMPONENTS OF THE INFECTION CYCLE SUSCEPTIBLE HOST:

MUST OVERCOME RESISTANCE MOUNTED BY HOST'S DEFENSES

Five Moments for Hand Hygiene (WHO+ Wash Hands Often)

Moment 1 - Before touching a patient Moment 2 - Before a clean or aseptic procedure Moment 3 - After a body fluid exposure risk Moment 4 - After touching a patient Moment 5 - After touching patient surroundings

aerobic

Most bacteria require oxygen to live and grow and are, therefore, referred to as aerobic

COMPONENTS OF THE INFECTION CYCLE RESERVOIR:

NATURAL HABITAT OF THE ORGANISM

PRINCIPLE #2 - SURGICAL ASEPSIS

ONLY STERILE OBJECTS CAN BE PLACED ON A STERILE FIELD

STAGES OF INFECTION INCUBATION PERIOD:

ORGANISMS GROWING AND MULTIPLYING

STAGES OF INFECTION PRODROMAL STAGE:

PERSON IS MOST INFECTIOUS, VAGUE AND NONSPECIFIC SIGNS OF DISEASE

COMPONENTS OF THE INFECTION CYCLE PORTAL OF ENTRY:

POINT AT WHICH ORGANISMS ENTER A NEW HOST

COMPONENTS OF THE INFECTION CYCLE PORTAL OF EXIT:

POINT OF ESCAPE FOR THE ORGANISM

STAGES OF INFECTION FULL STAGE OF ILLNESS:

PRESENCE OF SPECIFIC SIGNS AND SYMPTOMS OF DISEASE

COMMON PORTALS OF EXIT

Pathogens must leave the infected patient in order to infect other host via bodily secretions and excretions. Contact and be DIRECT ( by: sexual intercourse, kissing, and touching) or INDIRECT (by: touching items in a pt's room that has infection on it, ex: C Diff) • RESPIRATORY • GASTROINTESTINAL • GENITOURINARY TRACTS • BREAKS IN SKIN • BLOOD AND TISSUE

nurses

Prevention of infections are a major focus,_______ are involved in identifying, preventing, controlling and teaching their clients about infections.

STAGES OF INFECTION CONVALESCENT PERIOD:

RECOVERY FROM THE INFECTION

PRINCIPLE #3 - SURGICAL ASEPSIS

STERILE ITEMS OUT OF FIELD OF VISION, ABOVE THE SHOULDERS, OR BELOW THE WAIST ARE CONSIDERED UN-STERILE.

PRINCIPLE #7 - SURGICAL ASEPSIS

THE EDGES OF A STERILE FIELD OR STERILE CONTAINER ARE CONSIDERED TO BE CONTAMINATED. 1 inch from the edges

c. Indwelling urinary catheters have been implicated in most health care-associated infections. Cigarette smoking, a normal white blood cell count, and a vegetarian diet have not been implicated as risk factors for HAIs.

The nurse assesses patients to determine their risk for health care-associated infections. Which hospitalized patient is most at risk for developing this type of infection? a. A 60-year-old patient who smokes two packs of cigarettes daily b. A 40-year-old patient who has a white blood cell count of 6,000/mm3 c. A 65-year-old patient who has an indwelling urinary catheter in place d. A 60-year-old patient who is a vegetarian and slightly underweight

d. Standard precautions apply to all patients receiving care in hospitals, regardless of their diagnosis or possible infection status. These recommendations include blood; all body fluids, secretions, and excretions except sweat; nonintact skin; and mucous membranes.

The nurse caring for patients in a hospital setting institutes CDC standard precaution recommendations for which category of patients? a. Only patients with diagnosed infections b. Only patients with visible blood, body fluids, or sweat c. Only patients with nonintact skin d. All patients receiving care in hospitals

d. Considering the outer inch of a sterile field as contaminated is a principle of surgical asepsis. Moisture such as from splashes contaminates the sterile field, and sneezing would contaminate the sterile gloves. Forceps soaked in disinfectant are not considered sterile.

The nurse has opened the sterile supplies and put on two sterile gloves to complete a sterile dressing change, a procedure that requires surgical asepsis. The nurse must: a. Keep splashes on the sterile field to a minimum. b. Cover the nose and mouth with gloved hands if a sneeze is imminent. c. Use forceps soaked in a disinfectant. d. Consider the outer 1 inch of the sterile field as contaminated.

POSSIBLE RESERVOIRS FOR MICROORGANISMS

Think about (Bacteria and their Environment) Reservoir --> <-- Human host animanls Vectors Water/ Milk Soil Food • OTHER PEOPLE • ANIMALS • SOIL • FOOD, WATER, MILK • INANIMATE OBJECTS

anaerobic

Those that can live without oxygen are anaerobic bacteria.

STANDARD PRECAUTIONS

USED IN THE CARE OF ALL HOSPITALIZED PATIENTS REGARDLESS OF THEIR DIAGNOSIS OR POSSIBLE INFECTION STATUS • APPLY TO BLOOD, ALL BODY FLUIDS, SECRETIONS, AND EXCRETIONS EXCEPT SWEAT (WHETHER OR NOT BLOOD IS PRESENT OR VISIBLE), NON-INTACT SKIN, AND MUCOUS MEMBRANES • NEW ADDITIONS ARE RESPIRATORY HYGIENE/COUGH ETIQUETTE, SAFE INJECTION PRACTICES, AND DIRECTIONS TO USE A MASK WHEN PERFORMING HIGH-RISK PROLONGED PROCEDURES INVOLVING SPINAL CANAL PUNCTURES * PPE * Safe injection practices * Safe handling of equipment/surfaces * Respiratory/cough hygiene

PRINCIPLE #5 - SURGICAL ASEPSIS

WHEN A STERILE SURFACE COMES IN CONTACT WITH A WET, CONTAMINATED SURFACE THE STERILE OBJECT OR STERILE SURFACE BECOMES CONTAMINATED BY CAPILLARY ACTION. *Solution that is opened is only good for 24 hrs after opening

biofilm:

a thick grouping of microorganisms

virulence

ability to produce disease

asepsis

absence of disease-producing microorganisms; using methods to prevent infection includes all activities to prevent infection or break the chain of infection

health care-associated infection (HAI)

an infection that was not present on admission to a health care institution and develops during the course of treatment for other conditions (nosocomial)

host

animal or person on or within which microorganisms live

antimicrobial

antibacterial agent that kills bacteria or suppresses their growth

débridement:

cleaning away devitalized tissue and foreign matter from a wound

infection

disease state resulting from pathogens in or on the body

pathogens

disease-producing microorganism

bundles

evidence-based best practices that have proven positive outcomes when implemented together to prevent infection

antigen

foreign material capable of inducing a specific immune response

personal protective equipment (PPE)

gloves, gowns, masks, and protective eye gear designed to minimize or prevent the health care worker's exposure to infectious material

antibody

immunoglobin produced by the body in response to a specific antigen

endogenous

infection in which the causative organism comes from microbial life harbored within the person

exogenous

infection in which the causative organism is acquired from outside the host

iatrogenic

infection that occurs as a result of a treatment or diagnostic procedure

reservoir

natural habitat for the growth and multiplication of microorganisms

vector

nonhuman carriers—such as mosquitoes, ticks, and lice—that transmit organisms from one host to another

parasites

organism that lives on or in a host and relies on it for nourishment

bandage:

piece of gauze or other material used to cover a wound

fungi

plant-like organisms (molds and yeasts) that can cause infection

medical asepsis

practices designed to reduce the number and transfer of pathogens; synonym for clean technique clean technique, involves procedures and practices that reduce the number and transfer of pathogens. Procedures include performing hand hygiene and wearing gloves.

surgical asepsis

practices that render and keep objects and areas free from microorganisms; synonym for sterile technique sterile technique, includes practices used to render and keep objects and areas free from microorganisms. Procedures include inserting an indwelling urinary catheter or inserting an IV catheter.

colonization

presence of an organism residing in an individual's body but with no clinical signs of infection

disinfection

process used to destroy microorganisms; destroys all pathogenic organisms except spores

isolation

protective procedure designed to prevent the transmission of specific microorganisms; also called protective aseptic techniques and barrier techniques

virus

smallest of all microorganisms; can be seen only by using an electron microscope

nosocomial

something originating or taking place in the hospital (i.e., infection)

endemic

something that occurs with predictability in one specific region or population and can appear in a different geographical location

bacteria

the most significant and most commonly observed infection-causing agents

ASSESSMENT for infections

• ASSESS IMMUNIZATION STATUS; ASSESS PREVIOUS OR RECURRING INFECTIONS • MONITOR S/S OF LOCAL OR SYSTEMIC INFECTION • LOCALIZED - REDNESS, SWELLING, WARMTH IN THE INVOLVED AREA, PAIN OR TENDERNESS, AND LOSS OF FUNCTION OF THE AFFECTED PART • SYSTEMIC - FEVER, OFTEN ACCOMPANIED BY AN INCREASE IN PULSE AND RESPIRATORY RATE, LETHARGY, ANOREXIA, AND TENDERNESS AND ENLARGEMENT OF LYMPH NODES THAT DRAIN THE AREA WHEN AN INFECTION IS PRESENT.

INFECTIOUS AGENTS

• BACTERIA: MOST SIGNIFICANT AND MOST PREVALENT IN HOSPITAL SETTINGS • VIRUS: SMALLEST OF ALL MICROORGANISMS • FUNGI: PLANT-LIKE ORGANISMS PRESENT IN AIR, SOIL, AND WATER

MEASURES TO REDUCE INCIDENCE OF NOSOCOMIAL INFECTIONS

• CONSTANT SURVEILLANCE BY INFECTION-CONTROL COMMITTEES AND NURSE EPIDEMIOLOGISTS • WRITTEN INFECTION-PREVENTION PRACTICES FOR ALL AGENCY PERSONNEL • FOLLOW HAND HYGIENE RECOMMENDATIONS • INFECTION CONTROL PRECAUTION TECHNIQUES • KEEPING PATIENT IN BEST POSSIBLE PHYSICAL CONDITION

OUTCOME IDENTIFICATION AND PLANNING FOR INFECTION CONTROL (its up to the nurse to develop the appropriate outcome)

• DEMONSTRATE EFFECTIVE HAND HYGIENE AND GOOD PERSONAL HYGIENE PRACTICES. • IDENTIFY THE SIGNS OF AN INFECTION. • MAINTAIN ADEQUATE NUTRITIONAL INTAKE. • DEMONSTRATE PROPER DISPOSAL OF SOILED ARTICLES. • USE APPROPRIATE CLEANSING AND DISINFECTING TECHNIQUES. • DEMONSTRATE AN AWARENESS OF THE NECESSITY OF PROPER IMMUNIZATIONS. • DEMONSTRATE STRESS-REDUCTION TECHNIQUES.

LABORATORY DATA INDICATING INFECTION

• ELEVATED WHITE BLOOD CELL COUNT—NORMAL IS 5,000 TO 10,000/MM3 (anything ^ than 10,000 could be an infection) • INCREASE IN SPECIFIC TYPES OF WHITE BLOOD CELLS • ELEVATED ERYTHROCYTE SEDIMENTATION RATE (ESR) • PRESENCE OF PATHOGEN IN URINE, BLOOD, SPUTUM, OR DRAINING CULTURES

PRINCIPLES & PRACTICES OF SURGICAL ASEPSIS

• ESSENTIAL QUALITIES FOR MAINTAINING SURGICAL ASEPSIS: -CONSCIENTIOUSNESS -ALERTNESS -HONESTY

CARDINAL SIGNS OF INFLAMMATION

• HEAT • REDNESS • SWELLING • PAIN • LOSS OF FUNCTION

ASEPTIC TECHNIQUE

• INCLUDES ALL ACTIVITIES TO PREVENT OR BREAK THE CHAIN OF INFECTION • TWO CATEGORIES: - MEDICAL ASEPSIS: CLEAN TECHNIQUE - SURGICAL ASEPSIS: STERILE TECHNIQUE

FACTORS AFFECTING HOST SUSCEPTIBILITY

• INTACT SKIN AND MUCOUS MEMBRANES • NORMAL PH LEVELS • BODY'S WHITE BLOOD CELLS • AGE, SEX, RACE, HEREDITARY FACTORS • IMMUNIZATION, NATURAL OR ACQUIRED • FATIGUE, CLIMATE, NUTRITIONAL AND GENERAL HEALTH STATUS • STRESS • USE OF INVASIVE OR INDWELLING MEDICAL DEVICES

MEDICAL VS. SURGICAL ASEPSIS

• MEDICAL ASEPSIS - AREAS ARE CONSIDERED CONTAMINATED IF THE AREA BEARS PATHOGENS Way to prevent: -clean technique used -controls microorganisms -basic hand hygiene used -clean equipment and supplies -clean field • SURGICAL ASEPSIS - AREAS ARE CONSIDERED CONTAMINATED IF THEY ARE TOUCHED BY ANY OBJECT THAT IS NOT-ALSO-STERILE. Ways to prevent: -sterile technique used -absence of microorganisms -surgical scrub performed -sterile equipment and supplies -sterile field

FACTORS AFFECTING AN ORGANISM'S POTENTIAL TO PRODUCE DISEASE

• NUMBER OF ORGANISMS • VIRULENCE (ability to cause disease) • COMPETENCE OF PERSON'S IMMUNE SYSTEM (amino compromised) • LENGTH AND INTIMACY OF CONTACT BETWEEN PERSON AND MICROORGANISM

USE OF SURGICAL ASEPSIS

• OPERATING ROOM, LABOR AND DELIVERY AREAS • CERTAIN DIAGNOSTIC TESTING AREAS • PATIENT BEDSIDE * EXAMPLES: -PROCEDURES THAT INVOLVE INSERTION OF URINARY CATHETER -STERILE DRESSING CHANGES -PREPARING AND INJECTING MEDICINE

IMPLEMENTING (techniques to prevent infections)

• PRACTICE OF ASEPSIS INCLUDES ALL ACTIVITIES TO PREVENT INFECTION OR TO BREAK THE CHAIN OF INFECTION • TWO ASEPSIS CATEGORIES: - MEDICAL ASEPSIS (CLEAN TECHNIQUE) - PROCEDURES AND PRACTICES THAT REDUCE THE NUMBER AND TRANSFER OF PATHOGENS (SEE BOX 23-2 ON PAGE 539) - SURGICAL ASEPSIS (STERILE TECHNIQUE) - PRACTICES USED TO RENDER AND KEEP OBJECTS AND AREAS FREE OF ALL MICROORGANISMS

Diagnosing (for or possible infection)

• RISK FOR INFECTION RELATED TO: PRESENCE OF CHRONIC DISEASE ALTERED IMMUNE RESPONSE EFFECTS OF MEDICATION ALTERED SKIN INTEGRITY MALNUTRITION PRESENCE OF INVASIVE OR INDWELLING MEDICAL DEVICE LACK OF PROPER IMMUNIZATION • SOCIAL ISOLATION RELATED TO PRESENCE OF COMMUNICABLE DISEASE (AIDS) • DEFICIENT DIVERSIONAL ACTIVITY RELATED TO LACK OF VISITORS; RESTRICTIONS IMPOSED BY AIRBORNE PRECAUTIONS • RISK FOR IMBALANCED BODY TEMPERATURE RELATED TO INFECTIOUS PROCESS; DEHYDRATION • ANXIETY RELATED TO HIGH RISK FOR INFECTION; SOCIAL ISOLATION

CLASSIFICATION OF BACTERIA

• SPHERICAL (COCCI), ROD SHAPED (BACILLI), CORKSCREW SHAPED (SPIROCHETES) - by shape • GRAM POSITIVE OR GRAM NEGATIVE—BASED ON REACTION TO GRAM STAIN • AEROBIC (o2) OR ANAEROBIC(non o2)—BASED ON NEED FOR OXYGEN

4 CATEGORIES RESPONSIBLE FOR MAJORITY OF HOSPITAL-ACQUIRED INFECTIONS (HAIS)

• URINARY TRACT INFECTIONS • SURGICAL SITE INFECTIONS • BLOODSTREAM INFECTIONS • PNEUMONIA

Transmission Based Precautions

• USED IN ADDITION TO STANDARD PRECAUTIONS FOR PATIENTS IN HOSPITALS WITH SUSPECTED INFECTION WITH PATHOGENS THAT CAN BE TRANSMITTED BY AIRBORNE, DROPLET, OR CONTACT ROUTES. • THE 2007 GUIDELINES INCLUDE A DIRECTIVE TO DON PERSONAL PROTECTIVE EQUIPMENT (PPE) WHEN ENTERING THE ROOM OF A PATIENT ON CONTACT OR DROPLET PRECAUTIONS. • PREVIOUSLY, PPE WAS ONLY REQUIRED WHEN THE NURSE WAS DELIVERING CARE WITHIN 3 FEET OF THE PATIENT. • THESE CATEGORIES RECOGNIZE THAT A DISEASE MAY HAVE MULTIPLE ROUTES OF TRANSMISSION: AIRBORNE, DROPLET, CONTACT). * Used in addition to Standard Precautions PATHOGENS CAN BE TRANSMITTED BY: Airborne Droplet Contact