Ch. 7) Infection Control

Antiseptic

"bacteriostatic" substance that prevents infection

Sterile technique (steps)

- Step 1: Sterile touching sterile = sterile; Ex: sterile gloves touching sterile scissors - Step 2: Sterile objects only stays in sterile field/area - Step 3: Sterile field/area out of range in vision or below the waist = contaminated - Never leave sterile area unattended = possible contamination - Step 4: Sterile object/area becomes contaminated due to prolonged exposure to air - Ex: Microorganisms - Step 5: When Sterile surface/area becomes wet = contamination —> sterile supply/equipments = contaminated - Step 6: Fluids flow in directions of gravity - Ex: refer to hand washing - Step 7: Edges of sterile field/area or containers = contaminated

Centers for Disease Control and Prevention (CDC)

- part of US Department of Health and Human Services - provides facilities and services for investigation, prevention, and control of disease. - Previously 2 types of precautions (universal blood and body fluid precautions and body substance isolation) now known as

Health care-associated infections (HAIs)

-1/20 patients develops HAI -To be classified as HAI, infection must develop 48 hours after hospitalization or health care facility. -Hospital harbor microorganisms are highly virulent (exceedingly pathogenic)

What is the proper method for disposable of sharps?

-Everyone (including health care providers) is responsible for disposing of sharps immediatlly after using them. -Sharps should be disposed of in a puncture-proof container in the patient area. Drop sharps into box; never push items into the box or overfill it. -Avoid leaving sharps on procedure trays or among bed linens.

Gowning

-Provides protection against unknown infectious microorganisms -Discard gown when leaving the patient's room -Protects patient whose immune system is inadequate

Rocky Mountain Spotted Fever

-Rickettsia rickettsii, vector is tick. -Rash (common) typically starts at wrists (see picture) and ankles and then spreads to trunk, palms, and soles. -Classic triad—headache, fever, rash (vasculitis).

pulmonary tuberculosis precaution

-Some strains of these bacteria are multi-drug resistant making treatment of infection very difficult -The best way to prevent transmission of pulmonary TB is to quickly identify, isolate, & treat patients with TB -The nurse should suspect a patient has pulmonary TB if the patient has respiratory symptoms that last longer than 2 weeks

virus

-composed of dna/rna - enter through broken skin, gastrointestinal tract, and respiratory tract -infect a host through mosquito bites

contact precautions

-gloves: don gloves before entering the room -hand hygiene -gowns -patient transport: limit transport, ensure infected or colonized area are covered -patient-care equipment: use disposable equipments

latex allergy

-milky fluid derived from the rubber tree found in Africa and Southeast Asia -latex proteins are able to enter the body through skin and mucous membranes, intravascularly and by inhalation

fungi

-mycotic infection found in human -"planet kingdom" -caused by yeast or mold -infections in external layers

the nurse should follow some basic principles regardless of which technique used:

-nurse should perform hand hygiene before and after patient -have an understanding of the disease process and the method of transmission to help determine a protective barrier to use -dispose contaminated equipments to prevent transmission of pathogens -infected patient taken into isolation accordance with hospital protocol

Airborne precautions

-patient placement: place in AIIR(Airborne Infection Isolation Room); keep door closed -patient transport: limit transport to medically necessary purposes only -hand hygiene -PPE; use n95 masks

protozoa

-single celled animals -found in intestinal tract -responsible for malaria, amebic dysentery, and African sleeping sickness

bacteria

-transmitted by: person-person direct contact, airborne, indirect contacts with bacteria contaminated objects -Spore forming bacteria causes acute diseases -forms capsules around the cell wall as a defense mechanism to help with protection

gloving

-wear gloves only once -if you have not completes patient's care but contact with infectious material, change the gloves -perform hand hygiene after removing the gloves

CDC guidelines apply to

1) Blood. 2) All body fluids, secretions, and exretions except sweat regardless if there is blood or not. 3) Non Intact skin. 4) mucous membranes

6 elements for the chain of infection

1) Infectious agent: pathogen 2) Reservoir: where the pathogen can grow 3) Portal of exit: exit route from the reservoir 4) Mode of transmission: method of vehicle or transportation 5) Portal of entry: entrance through skin, mucous, etc. 6) Host: another person or animal susceptible to the pathogen

procedure of opening a wrap sterile packaging

1. Perform hand hygiene. 2. Place the wrapped sterile package in the center of the work surface. 3. Remove the tape or seal indicating the sterilization date. 4. Grasp the outer surface of the tip of the outermost flap; open the outer flap away from your body. 5. Grasp the outside surface of the first side flap; open the side flap, allow it to lie flat on the table surface. 6. Grasp the outside surface of the second side flap and allow it to lie flat on the table surface. 7. Grasp the outer surface of the last and in- nermost flap; pull the flap back, allowing it to fall flat.

Steps of Gowning for Isolation

1. Push up Long sleeves (if you have them) 2. Perform hand hygiene 3. Don gown and tie it securely at neck & waist 4. Remove gown after providing necessary patient care 5. Discard solid gown appropriately 6. Perform hand hygiene 7. Record use of gown in isolation procedure if required by the health care agency 8. Provide Patient Teaching 9. If contamination occurs, it is necessary to reassess

The nursing student has been diagnosed with "strep throat" Under what circumstances can the student go to the clinical unit and care for patient and complete the clinical objectives?

1. Has been taking prescribes antibiotics for at least 24 hours. (Answer 1: If the student has been taking anti- biotics for at least 24 hours, it would be okay for him/her to care for patients in the clinical area. The other options create opportunities to spread the infection.)

The new nurse observes a health care provider who routinely comes out of a patient's room, goes to the sink, quickly soaps her hands, so that it splashes on the floor, sink, and her uniform. What should the new nurse do?

1. contact infection-control nurse for advice (Answer 1: The health care provider demonstrates a bad habit that is placing all of her patients at risk. Consulting the infection-control nurse is a good strategy for a new nurse whomay be unsure how to approach the provider. (Remember, if you are unsure about how to do something, seek advice, especially when you are new on the job.) Doing nothing is in- correct. Health care providers are not directly accountable to nurses; however, nurses are directly responsible to safeguard the health of patients. Checking on the patient is okay, but the patient's status is unrelated to the provid- er's failure to correctly perform hand hygiene. Writing up an incident report could be an al- ternative if there is no other mechanism avail- able to deal with the problem at the systemic level. Offering a paper towel and assessing knowledge is a possibility, but the nurse must be prepared for the provider's response.z0

Which patient needs to be placed into contact with precautions?

1. has a draining would colonized with multidrug-resistant bacteria(Answer 1: Contact isolation is needed for infectious diseases that are passed by direct con- tact with an infected person or item. Draining wounds fall into this category. Leukopenic patients require isolation to protect them from exposure to pathogens. Neisseria meningitides meningitis and tuberculosis require droplet precautions.)

The nurse is observing the new staff member who is preparing to do a sterile dressing change. The nurse determines that the staff member require correction and additional instruction when he observes:

1. opening the closest flap of the sterile wrapped package first (Answer 1: If the closest flap is opened first, the nurse will have to cross the sterile field to open the rest of the kit. The other options are correct.)

Which patient is the most challenging regarding maintaining sterile technique throughout the procedure?

2. 30 year old woman who is obese and confuse needs a foley catheter inserted (Answer 2: All of these patients are going to take extra time and careful planning before starting the procedure; however, the patient who is confused and obese presents two chal- lenges. Inserting a urinary catheter into an obese female presents a challenge to visual- ize the meatus. If she is confused and moves at the wrong time, sterility will be broken. A 4-month-old is small enough that an expe- rienced nurse can give the injection without assistance; for those who need help, a parent or helper can stabilize the leg during the in- jection. The patient who is coughing can be medicated with a cough suppressant or given a cough lozenge. Also applying a mask to the patient is necessary. For the patient who is eager to help, give him a task that allows par- ticipation, but one that does not interfere with sterility. For example, he could hold the roll of tape and apply a piece of tape to the tubing after the IV is inserted.)

Immediately after donning a pair of gloves, a family member develops red, watery eyes, and contact dermatitis with itching on the hands. What should the nurse do first?

2. Instruct the person to remove the gloves and wash thoroughly with soap and water(Answer 2: Remove the gloves and flush the area freely with water to remove the allergens. After removing the immediate source, the other options would also apply.)

What is the best rationale for the consistent use of Standard Precaution?

2. It is difficult to accurately identify all patients infected with blood-borne pathogens. (Answer 2: All patients do not have infectious disease; however, use of Standard Precautions is based on the assumption that any of us could have an infectious disease and not nec- essarily be aware of it. "Universal blood and body fluid precautions" is a term that was used in the past. Studies do show higher in- fection rates if there are no precautions used. Hand hygiene is always appropriate, but use of gloves, masks, etc., should be based on as- sessment, protocols, and nursing judgment.)

The nurse is assisting a health care provider by setting up a sterile tray for a procedure at the bedside. When the nurse opens the tray, there is moisture on a piece of equipment. What should the nurse do?

2. Return the entire tray to the supply area for resterilization and obtain a new tray. (Answer 2: Even though the tray was steril- ized, if moisture is present it should not be used. The other options are incorrect.)

a patient who is HIV-positive and ready for discharge expresses fears about exposure of other family members, particularly young children, to the disease. What is the best response to help decrease the patient's fears and concerns?`

2. Review principles of mode of transmission for HIV. (Answer 2: All of these strategies are likely to help the patient gain control over fears and concerns associated with being HIV positive; however, the mode of transmission for HIV is well-documented and reviewing this informa- tion will help the patient recognize that family members are unlikely to contract HIV during casual contact. The patient and sexual part- ners can be referred for additional counseling about how to manage intimate contact.)

The nurse is aware that the body has normal defenses against infection. Which medication can affect the acidic environment, which is one defense mechanism?

2. aluminum/magnesium antacid (mylanta) (Answer 2: Antacids can alter the acidity of gastric secretions which offers some defense against microorganisms that are ingested. Cipro and Vibramycin are antibiotics that fight infectious organisms. Hibiclens is an antiseptic solution for cleaning the skin.)

The nurse is supervising a nursing student. Which action by the student requires correction because it contributes to the potential transmission of pathogens?

2. shakes linen to remove debris and then places them in laundry bag (Answer 2: Shaking linens stirs up air currents that encourage transfer of microorganisms. The other actions are all useful to control infection.)

which patient is most likely to be susceptible to infection because of factors affecting immunologic defense mechanism?

3. A 73 year old man who recently had chemotherapy and radiation treatments (Answer 3: Advanced age, disease, chemo- therapy, and radiation all affect the immune system; thus the 73-year-old man has the most factors. The child needs to have immu- nizations prior to entering school. Traveling to Japan presents less risk than traveling to other countries where water, sanitation, food handling, and exposure to tropical diseases would create greater risk. Stress and over- weight increase likelihood for conditions such as diabetes or heart disease.)

The nurse sees the UAP trying to take an overly full laundry bag from the patient's room to the dirty utility room. The UAP is struggling to manage the bag and is partially dragging it on the floor. What should the nurse do?

3. Assisting the UAP to carry the bag and then find out how it got so overfilled (Answer 3: If coworkers are in the middle of a task, help them finish unless there is an im- mediate patient safety issue and then try to problem-solve to prevent future occurrences. The nurse could allow the UAP to continue to drag the bag, but the UAP is at risk for injury. The UAP may or may not be responsible for overfilling the bag; therefore, reporting or reminding are not fair until responsibility is established.)

A patient comes into the clinic and tells the nurse that he has a sore throat and would like to see a doctor. For which task(s) does the nurse need to wear gloves? (select all that apply)

3. Measuring an oral temperature 4. taking a throat swab for culture 5. reviewing the patient's home medications (Answer 3, 4, 6: Exposure to oral secretions would be reason to wear gloves. Taking a his- tory and reviewing medications should not require gloves (if bottles appear soiled, the nurse may opt to wear gloves). Taking blood pressure should not expose the nurse to any body fluids. (Note to student: Some nursing programs will require students to use gloves for a full set of vital signs. Following program and facility procedures is always recommended.)

For what circumstances would it be appropriate to contact the infection-control nurse for assistance?

3. an unusual cluster of infection is seen in emergency department (Answer 3: An unusual cluster of infection noted in the emergency department must be investigated because of the epidemiologic implications for the community (e.g., bioter- rorism or epidemic). The laboratory should be contacted for results of cultures. The nurse should follow protocols for disposal of con- taminated waste and putting patients into isolation.)

The nurse is preparing a room for a patient with herpes simplex virus. in particular, this type of precaution means that the care should include:

3. use of gloves and gown upon entering room (Answer 3: Herpes simplex virus is transmitted by contact; thus gloves and gowns are needed, but masks and negative airflow are not necessary.)

The patient has been receiving antibiotic therapy. Which laboratory result indicates a need to contact the health care provider for a reevaluation of prescribed therapy?

3. white blood cell count is elevated (Answer 3: If the white blood cell count con- tinues to be elevated after antibiotic therapy, then the health care provider may have to change antibiotics or do additional diagnostic testing. Positive sensitivity results indicate that the antibiotic should be effective killing the organism. A positive blood titer for anti- bodies indicates possible previous exposure to disease or vaccination. Negative growth on blood cultures either means that insufficient time has passed for bacterial growth to occur or there are no pathogens in the sample.)

The patient has tuberculosis and has been placed in a negative-pressure isolation room with airborne precautions. Despite repeated attempts to educate the patient, he keeps sneaking out of his room and going outside to smoke cigarettes. What should the nurse do first?

4. Discuss the behavior with the patient (Answer 4: First talk to the patient about why he feels the need to sneak out and smoke. Smoking and/or getting out appear to have a very high value for him. Educating the pa- tient is often a one-way information flow from nurse to patient; thus education does not al- ways take the patient's feelings or needs into account. The other options might be used, based on assessment findings.)

A patient with rubella needs to be transported to the x-ray department. What should the nurse do to prepare the patient for transport?

4. Instruct the patient to wear a mask and follow cough etiquette (Answer 4: Rubella requires droplet precau- tions; thus mask and cough etiquette are appropriate. Washing hands before the proce- dure would be more useful to prevent spread of rubella to others. Calling x-ray is okay, but advise that patient should continuously wear mask; mask should be changed if it becomes wet. An isolation gown is not necessary in this case.)

The nurse assigned to care for patients who are in isolation and patients who are not in isolation. What should the nurse do to try to meet the needs of all the patients?

4. Organize and cluster care of isolation patients to minimize downing and ungowning. (Answer 4: Isolation of patients is increasingly more common, so learning to organize and cluster care is the best strategy. If all patients are stable, then caring for nonisolation pa- tients first is a good idea; however, prioritize according to patients' needs, not nurse's con- venience. If similar cases can be housed in the same room, this might help, but remember that all PPE still has to be changed and hand hygiene performed when moving from one patient to the next. If a nurse is repeatedly given all of the isolation cases day after day, talking to the charge nurse would be an op- tion. Caring for isolation patients is more time-consuming.)

The patient has a large midline abdomen; incision. With the specific purpose of reducing a possible reservoir of infection, the nurse:

4. changes the dressing when it becomes soiled (Answer 4: A soiled dressing is an environ- ment that is suitable for growth of micro- organisms. Wearing gloves and masks and isolating personal items interrupts mode of transmission. Having the patient cover mouth and nose interrupts the portal of exit.)

When caring for a patient with Tuberculosis who is on airborne precaution, the nurse should routinely use:

4. particular respiratory mask (Answer 4: It is mandatory that health care workers wear an N-95 or higher particulate respirator mask when caring for patients with active tuberculosis.)

the nurse is supervising a nursing student who is setting up a sterile tray to suction a patient. The nurse would intervene if the student:

4. puts on sterile gloves, open the bottle, and set the cap on the sterile field (Answer 4: There is no point in putting on sterile gloves to open the bottle, because the gloves are immediately contaminated by the outer surface of the bottle. In addition, the cap would never be placed on the sterile field be- cause the cap is contaminated; thus the entire field would be considered contaminated. The other actions are correct.)

bacteria found in

Agricultural regions of South & Central America, South & Eastern Europe, Asia, Africa, Caribbean, and Middle East

2nd Tier - Transmission Precautions

Airborne precautions Droplet precautions Tuberculosis isolation Contact precautions Patients with immunocompromised Monitoring of isolation

Disinfectants

Bactericidal solutions (-cidal "to kill") are used to destroy microorganisms, but they DON'T destroy pores. These solutions are strong and should not come in contact with human tissue. Use gloves when dealing with strong chemicals

valley fever

Coccidioidomycosis; mycotic fungi (systemic)

1st Tier - Standard Precautions

Contains precautions designed for health care workers to use when caring for all patients in health care facilities

Discuss disinfection and nursing implications for using disinfectants

Disinfection is used to destroy microorgan- isms; however, it does not destroy spores. Disinfectant solutions are too strong to use on human skin, but are appropriate to use on inanimate objects. If a disinfectant solution comes in contact with human tissue, the tissue may feel "slippery." This is the first step of tissue breakdown. Use clean gloves to protect the skin.

Prodromal Stage

Second Step: Interval from onset of nonspecific signs and symptoms (low- grade fever or feeling fatigue) to a more specific symptom. At this time, microorganisms grow and multiply so patient is more capable of spreading the disease. (ex: Herpes, starts off being itchy and tingly before lesions appear.)

Anaphylaxis

Severe allergic reaction through latex

(T/F) HIV is the most commonly transmitted by infected needle

False. Hepatitis B, or serum hepatitis, is the most commonly transmitted infection by contaminated needles.

(T/F) Microorganism are present only in susceptible host

False. Microorganisms are present in all people, but infection will not develop unless the host is susceptible to the microorganism's strength and number

Incubation Period

First step: Interval between pathogen entering body and appearing of first symptom (ex: chickenpox 1-3 weeks). Host may be infectious during this time.

convalescence

Fourth Step: when acute symptoms of infections disappear; length of recover depends on severity of infection and how healthy a patient is. Recovery can take several days to months.

Varicella Zoster

HIV virus disease

HEPA respirators

OSHA & CDC guidelines require health care workers who suspect patients with known or suspected pulmonary TB to wear

Handling Linen

Place solid linen in a laundry bag in the patient's room Treat all linen as though it is infectious

identify at least 5 miscellaneous guidelines for standard precautions:

Standard precautions include techniques for hand hygiene, disposal of equipment/sharps; handling of specimens, supplies, and equipment; and use of private rooms for patients.

Acute Stage

Third Step: Interval when patient manifests signs and symptoms specific to type of infection (ex: Mumps manifested by earache, high fever, parotid and salivary gland swelling) THIS IS WHEN YOU ARE MOST CONTAGIOUS!!!

(T/F) HAIs are most commonly transmitted by direct contact between health care workers and patients from patient to patient

True

inflammation

a localized response to an injury or to the destruction of tissues; delivers bodily fluids, blood products, and nutrients to interstitial tissue -triggered by physical agents, chemical agents, and microorganisms

histoplasmosis

a systemic fungal disease caused by inhalation of dust contaminated by fungus

portal of entry (example)

accidental needle stick is an example of

three types of transmission

airborne, droplet, contact

4 pathogens

bacteria, virus, fungi, and protozoa

B.anthracis

can live in soil for many years. Number one potential agents that maybe used during a biological terrorism event. spread through airborne and skin contact with skin

common cold

caused by virus

bacillus anthracis

causes acute infections; 3 types of anthrax: cutaneous, inhalation, gastrointestinal; seen more in South and Central America, southern and Eastern Europe, Asia, Africa, the Caribbean, and the Middle East -live in soil and casual contact from person to person does not spread -detected in blood, skin lesions, or respiratory secretions

Treatments for bacteria

cipro or vibramycin as well as vaccines

Medical asepsis

clean technique; most effective for breaking the chain of infection

3 basic bacteria shapes

coccus(round), bacillus(oblong), spirilla(spiral)

Infection prevention and control

consists of the implementation of policies and procedures in hospitals and other health care facilities to minimize the spread of health care-associated or community-acquired infections to patients and other staff members

difference between airborne, droplet, and contact

contact precautions can be in a room with people with the SAME illness -airborne/droplet patients have to be isolated

3 forms of anthrax

cutaneous, inhalation, gastrointestinal

Doffing PPE

gloves, goggles, mask, gown

Donning PPE

gown, mask, goggles, gloves

Occupational Safety and Health Administration (OSHA)

hospital accrediting agencies and hospital administration place strong emphasis on infection control

N-95 masks (what it's for and when to use)

illborne diseases and respiratory infections

4 stages of infection:

incubation period, prodromal stage, acute stage, convalescence

environmental barriers

keep pathogens in confined area (ex: barriers are placing patient in a private or isolation room, closing the patient's door, and wearing PPE.

Sterilization

kills microorganisms and spores

which products can affect the glove's permeability

pertroleum

Two types of sterilization

physical and chemical

regular hand hygiene vs surgical hand hygiene

regular: circular motions surgical: scrubbing hands together with sponge

Streptococcus vs staphylococcus

responsible for diseases than any other organism but staphylococcus (MRSA) is more serious and can sometimes be a fatal infection

droplet precautions:

same as airborne but does not need the n95 masks

AIDS (acquired immune deficiency syndrome)

self limiting nature viral infection

types of precaution

standard vs transmission

Surgical asepsis

sterile technique; used mostly in surgical rooms

4 determination of ability to produce disease

strength of pathogens, numbers of pathogen presented, person's immune system, and length of exposure of pathogen

contaminated articles should be thrown away:

trash if disposable or a clear bio-hazard bins

hai infection

uti, pnuemonia, bloodstream infections