Aspepsis & Infection Control
Active Immunity
Host produces antibodies in response to natural antigens (infectious microorganisms or vaccines) - Active Natural Immunity - Active Artificial Immunity * the way your body reacts
What is the #1 way to prevent the spread of infections?
HANDWASHING - Hands of healthcare workers are common vehicle for spread of microorganisms
Are all microorgansisms harmful?
No most are not harmful, because depends where in the body. Some are good. (table 31.1)
Acute
appear suddenly; last a short time
Cell Mediated Defenses
- Also called cellular immunity - Occurs through T-cell system - Cell mediated immunity is lost with diseases such as HIV - Individual is defenseless against most infections - viral, bacterial and fungal **Whenever our cells lose immunity, we are more susceptible. (HIV patients- their T cells become infected or ineffective and the patients can catch anything)
Indirect Transmission: Vector borne
- Animals - animal or insect that serves as an intermediate means of transporting the infectious agent
Resident Organism: OROPHARYNX
(Oropharynx is different from nasal because it is the connection between mouth and nasal • Streptococcus pneumoniae
Resident flora
(collective vegetation in a given area) harmless in one part of the body, but can cause illness in other body parts
Specific
(immune)- are directed against identifiable bacteria, viruses, fungi or other infectious agents
Resident Organism: VAGINA
*Clean area well before inserting catheter because risk of infection • Lactobacillus • Bacteriodes • Clostridium • Candida Albicans
Resident Organism: Urethra
*Important to teach when using bathroom is wipe from front to back because cause UTI's • Staphylococcus epidermidis • Proteus
What are the statistics on nosocomial infections?
- 2 million patients/year (10% of all); 20,000 deaths year; 7X more likely to die if nosocomial present
Examples of surgical asepsis?
- Abdominal wound that opens: surgical asepsis (want to make sure nothing dirty on that patient)
Pathogenicity
- Ability to produce a disease - "true" pathogen causes disease/infection in a healthy person
Mode of Transmission
- After leaving reservoir, requires a means of transmission to reach another person or host through a receptive portal of entry.
Active Natural Immunity
- Antibodies are formed in presence of active infection in the body - Duration lifelong (you naturally produce the infection yourself, you are building up antibodies) Ex. Getting the actual flu would be active/natural
Passive Natural Immunity
- Antibodies transferred naturally from an immune mother to baby through the placenta or in colostrum - Lasts 6 months to 1 year Ex. the antibodies that are passed from mother to baby in placenta, or breastfeeding
Active Artificial Immunity
- Antigens administered to stimulate antibody formation - Lasts for many years - Reinforced by booster Ex. Getting flu vaccination is active/artificial
BREAKING THE CHAIN of Portal of Exit
- Avoiding talking, coughing, or sneezing over open - wounds or sterile fields - Covering the mouth and nose when coughing or sneezing (isolation, PPE)
Disposal of Soiled Equipment and Supplies
- Bag all items that have been contaminated, likely to have been contaminated with pus, blood, body fluids, feces or respiratory secretions. - Use special bags and follow agency procedure - May need to double bag
Portal of Entry
- Before person can become infected, microorganisms must enter the body - Skin is a barrier to infectious agents; however any break in skin can = portal of entry - Often times the microorganism enters the body via the same route it left the source (Where it will enter other person, Skin is the first line of defense so when there is a break in skin we are at risk for infection)
Universal Precautions
- CDC 1988 - Techniques to be used with all clients to decrease risk of transmitting unidentified pathogens - Universal Precautions interfere with spread of blood borne pathogens (Hep B, Hep C, HIV) Ex. Washing hands, cover cuts, don't know what type of infection so doing whatever to protect.
How can people get nosocomial infections?
- Can develop during or after patient stay - Can also be acquired by healthcare workers
Examples of medical asepsis?
- Cdiff- medical asepsis because wearing gloves
BREAKING THE CHAIN of the Reservoir
- Changing dressings and bandages when soiled or wet - Appropriate skin and oral hygiene - Disposing of damp, soiled linens appropriately - Disposing of feces and urine in appropriate receptacles - Ensuring that all fluid containers are covered or capped - Emptying suction and drainage bottles at end of each shift or before full or according to agency policy
Gowns
- Clean or disposable impervious - When clothing of nurse susceptible to contamination - Sterile gowns for specific procedures
How do you transport a patient on precautions? (contact, airborne, droplet)
- Contact precautions - depends. You would gown yourself - Airborne precautions - mask (n95 for TB) - Droplet precautions - regular mask
BREAKING THE CHAIN of the etiologic agent
- Correctly cleaning, disinfecting or sterilizing articles before use - Educating clients and support persons about appropriate methods to clean, disinfect, and sterilize article
Effects of Nosocomial Infections
- Cost of nosocomial infections is tremendous! ( $4.5 Billion/annually) - ↑ LOS (Length of Stay) - ↑ time lost from work - Results in disability, discomfort and even death - Majority are preventable!!!!!!!!!
Evaluatin r/t infection
- Determine whether outcomes have been achieved - If outcomes were not achieved, nurse must reassess and make alterations
What is the Nursing Process and who developed it?
- Developed by Lydia Hall in 1955 - Universal language/theory of nursing care - Defined steps (5-6) ADPIE - JCAHO requires care documented according to the NP - Required learning by NLN (national league of nursing) - Heavily tested on NCLEX
Surgical Asepsis is used in:
- Dressing changes - Catheterizations - Surgical procedures
Surgical Asepsis
- Eliminates all pathogens - Can be referred as sterile technique - Practices that keep an area or object free of all microorganisms (sterile) - Includes practices that destroy all microorganisms & spores - Surgical asepsis is used for ALL procedures involving sterile areas of the body - Sepsis: is the state of infection
What do you do when there is a laceration or puncture to the skin?
- Encourage bleeding - Wash/clean the area with soap and water - Initiate first aid and seek treatment if indicated - Mucous membrane exposure (eyes, nose, mouth) - Flush with saline or water flush for 5 to 10 minutes
Where do microorganisms exist and where do they exist on the body?
- Exist everywhere: water, soil, body surfaces - Skin, Intestinal tract, mouth, upper/lower respiratory tract, vagina, lower urinary tract
Etiologic agent (microorganism)
- Extent of microorganism ability to produce infectious process depends on: o Number present o Virulence and potency (pathogenicity) o Ability to enter the body o Susceptibility of the host o Ability to live in host's body
Basic Principles of Nurses & HCP (healthcare personal)
- Hand hygiene - Soiled items away from your clothes - No soiled items on floor - Minimize patient airborne droplets - Avoid raising dust - Clean least soiled area first - Dispose soiled items directly into container - Pour liquids to minimize splashing - Good grooming - Follow hospital/agency policy
Surgical Asepsis is used during:
- surgical procedures - all procedures that invade bloodstream - procedures that cause break in skin - dressing changes & wound care - insertion of catheters into body cavities - care for high-risk groups
A young woman has just begun nursing school and her first clinical experience involves caring for a 79 year old patient with dehydration. Patient has a recent history of shingles and is at the convalescent stage of illness. Her skin is dry, oral Temp is 100.4F, urine is dark amber and WBC is 13,000/mm Identify the factors that make this patient susceptible for getting an infection?
- High level of white blood cells (4,000-10,000 is norm) - High temperature - Dehydration - History of shingles (viral) - Could have open sores from shingles - Dry skin - nutrition. - Age - Hospitalized - so at risk for nosocomial infection
Direct Transmission
- Immediate and direct transfer from person to person through biting, kissing, touching or sexual intercourse. - Droplet is also a form of direct transmission (must be within 3 feet). Ex. Sneezing, coughing, spitting, talking, singing can spread organisms via droplets
Diagnosis r/t Infection
- Inadequate primary defenses - Inadequate secondary defenses - Risk for infection - Potential Complications of Infection - Impaired physical mobility - Imbalanced nutrition - Acute pain - Impaired social interaction - Situational low self esteem
Age Related Urinary Tract Changes (5)
- Incomplete emptying of bladder - Decrease sphincter control - Enlarged prostate - Pelvic floor relaxation - Reduced renal blood flow - Encourage voiding at regular intervals - Force fluids - Meds for prostate - Change incontinence pads frequently/good peri-care - Assess for UTI (confusion, pain, odor, color) - Void after sex
Nosocomial Infections
- Infections that originate in the hospital - Are a subgroup of HAIs (health care-associated infections) --> Associated with the delivery of healthcare services in healthcare facilities
Specific Defenses
- Involves the immune system - Antigen: protein that induces a state of sensitivity or immunity. - Auto-antigen: antigen originates in person's own body - Immune system has two components: 1. Antibody mediated defenses 2. Cell mediated defenses
Signs and Symptoms of LOCAL infection
- Localized swelling - Localized redness - Pain or tenderness with palpation or movement - Palpable heat in the infected area - Loss of function of the body part affected, depending on the site and extent of involvement
Age Related Skin Changes
- Loss of elasticity - Increased dryness - Thinning of epidermis (takes longer to heal) - Slowing of cell replacement - Decreased vascular supply - Force Fluids - Good daily hygiene - Apply lotion to skin as needed - Assess for breaks in skin integrity, rashes or changes in the skin
Age Related Pulmonary (lungs) Changes (5)
- Loss of elasticity (lungs) - Increased dryness - Thinning of epidermis - Slowing of cell replacement - Decreased vascular supply - Place patient in sitting position to eat and drink - Encourage fluid intake - Encourage C, T, DB (spirometer) C= coughing, DB= deep breathing
Planning (Goals) r/t Infection
- Maintain or restore defenses - Avoid the spread of microorganisms - Reduce or alleviate problems associated with the infection
BREAKING THE CHAIN of Susceptible Host
- Maintaining the integrity of the client's skin and mucous membranes - Ensuring that the client receives a balanced diet - Educating the public about the importance of immunizations
Isolation procedures
- Many supplied for single use only - Disposed of after use - Agencies have specific policies and procedures for handling soiled reusable equipment - Nurses need to become familiar with these practices
1. Vascular and cellular responses
- Marked increase in blood supply called hyperemia. - Leukocytes (WBC) into interstitial space - Normal WBC 4500-11,000
Airborne Transmission
- May involve droplets or dust. - Droplet nuclei, residue of evaporated droplets emitted by and infected host (TB) can remain in the air for long period of time - Dust particles containing infectious agents (Clostridium difficile) can become airborne - Material is transmitted by air to suitable portal of entry, usually respiratory tract
Airborne Diseases
- Measles - Varicella - TB
Medical Asepsis is used in the administration of:
- Medications - Enemas - Tube feedings - Daily hygiene
Lifespan Considerations ( pay close attention!)
- Normal aging predisposes to infection - Nutrition is poor/ protein inadequate (antigens) - Diabetes increases risk of infection and delays healing - Immune system reacts slower - Normal inflammatory response is delayed - Normal symptoms not always seen; confusion and disorientation may be first symptom - Other symptoms may include lethargy, incontinence, falls, general fatigue
Passive Artificial Immunity
- Occurs when immune serum (antibody) from an animal or another human is injected - Lasts 2 to 3 weeks Ex. when baby is born and injected with antibodies
Elderly & Illness - what percent of hospital patients? - what percent of homecare patients - what percent of nursing home patients?
- Over 48% of hospital patients - 80% of homecare patients - 85% of all nursing home patients are elderly
BREAKING THE CHAIN of Mode of Transmission
- Proper hand hygiene - Instructing clients and support persons to perform hand hygiene before handling food, eating, after eliminating and after touching infectious material - Wearing gloves when handling secretions and excretions - Wearing gowns if there is danger of soiling clothing with body substances - Placing discarded soiled materials in moisture-proof refuse bags - Holding used bedpans steadily to prevent spillage - Disposing of urine and feces in appropriate receptacles - Initiating and implementing aseptic precautions for all clients - Wearing masks and eye protection when in close contact with clients who have infections transmitted by droplets from the respiratory tract - Wearing masks and eye protection when sprays of body fluid are possible
Gloves
- Protect hands of the nurse - Protect patient from nurse's microorganisms - Reduce chance of nurse spreading organisms from one patient to another - Why wash hands after gloves are removed?
Eyeware
- Protective eyewear - goggles, glasses, or face shields and masks - may be indicated where body secretions may splatter the face
Medical Asepsis
- Reduces number of pathogens "clean technique" - Includes all practices to confine a specific organism to a specific area, limiting number, growth, and transmission - Objects can be: - clean: absence of almost all microorganisms - dirty: soiled, contaminated, likely to have microorganisms that can cause infection
3. Reparative phase
- Regeneration - Scar tissue (cicatrix) - Granulation tissue
What do you do when there is a Bloodborne Pathogen Exposure?
- Report the incident immediately - Complete injury report - Seek appropriate evaluation and follow-up
Infectious Diseases in the world
- Represent the major cause of world wide death - Leading cause of death in USA
Addressing the Psychosocial Needs of Patients on Precautions
- Sensory deprivation - Feelings of inferiority - Risk for low self esteem - Assess individuals need for stimulation - Communicate regularly - Explain the infection and PPE needed - Warm, accepting behavior - Use the least restrictive precaution indicated by the dx or pt condition
2. Exudate production (pus)
- Serous (clear drainage), purulent (pusy drainage), sanguineous (blood drainage)
Reservoir
- Sources of the microorganisms o Own o Others o Plants o Animals o General environment - Carrier is person/animal reservoir who may or may not have symptoms of illness/disease Ex. Patient is AIDS positive, also cancer patient but is asymptomatic. She is considered a carrier because she has it but not showing signs.
Full stage of illness
- Specific signs and symptoms - Symptoms may be localized or systemic
HICPAC Isolation Precautions 1996
- Standard precautions- used in care of all hospitalized patients regardless of diagnosis or possible infection status (ex: AIDS) - Apply to all bodily fluids, blood, secretions, and excretions (except sweat), non-intact skin and mucous membranes - Includes: proper technique for coughing, sneezing, etc - Body substances: o Blood o Urine o Feces o Wound drainage o Oral secretions o Any other body product or tissue
Transmission Based Precautions: Tier 2
- These are used in addition to standard precautions - Used to prevent spread of infection by airborne, droplet, or contact
BREAKING THE CHAIN of Portal of Entry
- Using sterile technique for invasive procedures, when exposing open wounds or handling dressings (Use surgical aseptic technique) - Placing used disposable needles and syringes in puncture-resistant containers for disposal - Providing all clients with own personal care items
3 Important Organizations with Infectious diseases
- WHO- World Health Organization (Ebola) - CDC- Center for Disease Control & Prevention (something in the US) - DPH- Department of Public health (people overdosing from heroin in Worcester (traveling to different parts of the state and DPH takes care of state level issues)
Standard Precaution: Tier 1
- Wash hands after handling bodily secretions, gloves or not - Clean gloves, not sterile - Mask, face shield with risk of splashing of bodily fluids - Respiratory hygiene/cough etiquette - Wear non-sterile gown to protect clothing against bodily fluids - Handle equipment appropriately; dispose of it appropriately - Handle linen appropriately - Guard against sharps
When do infections occur?
- When open wound - Anytime there is a break in the body (can be as little as getting an IV) - Chance of infection is much greater with foley catheter as opposed to IV
Iatrogenic infections
- direct result of a diagnostic or therapeutic procedure - Ex. urinary catheterization, IV's, etc
Indirect Transmission: Vehicle borne
- inanimate objects/non-living things - any substance that serves as intermediate means to transport and introduce infectious agent to susceptible host through suitable portal of entry. - Fomites (inanimate objects) handkerchiefs, toys, soiled clothing, cooking or eating utensils, surgical instruments, dressings, water, food, blood, serum and plasma - Stethoscopes=STAPHOSCOPE, using tissues, utensils, doorknobs, phones, elevator buttons
Non-specific
- protect individual against all microorganisms regardless of prior exposure (anything natural in the body) o Intact, dry, acidic skin o Resident bacteria of skin o Mucous membranes, saliva o Cilia o Lung macrophages o Shedding oral epithelium o Tears o Acidity of stomach o Urine o Low vaginal pH
A compromised host is a person at increased risk, those include
- very young; very old - receiving chemotherapy - chronic illness - receiving anti-rejection medications - immune deficiency - At risk to own microorganisms, from unwashed hands of others, nonsterile items - Have diseases such as leukemia, that depress patient's resistance to infectious organisms - Have extensive skin impairments such as severe dermatitis or major burns
Signs and Symptoms of SYSTEMIC infection
-Fever - Increased pulse (tachycardia) and respiratory rate (dyspnea) if the fever high - Malaise and loss of energy - Anorexia and, in some situations, nausea and vomiting - Enlargement and tenderness of lymph nodes that drain the area of infection
Medical diagnosis vs. nursing diagnosis:
-Medical: Right total hip replacement secondary to osteoporosis -Nursing: immobility related to right hip replacement. (looking at actions)
Types of Immunity
1. Active 2. Passive
4 classes of organisms that can cause infection?
1. Bacteria 2. Viruses 3. Fungi 4. Parasites
There are 3 mechanisms for Mode of Transmission
1. Direct Transmission 2. Indirect Transmission - Vehicle-borne transmission - Vector-borne transmission 3. Airborne Transmission
In what order do we remove PPE?
1. Gloves 2. Eyeware 3. Gown 4. Mask
In what order do we put on PPE?
1. Gown 2. Mask 3. Eyewear 4. Gloves
4 Stages of infection
1. Incubation Period 2. Prodromal stage 3. Full stage of illness 4. Convalescent period
4 Types of Infections
1. Local 2. Systemic 3. Acute 4. Chronic
2 kinds of asepsis?
1. Medical Asepsis 2. Surgical Asepsis
*5 CARDINAL signs:* of infection
1. Pain 2. Swelling 3. Redness 4. Heat 5. Impaired function of the body part
Examples of resident organisms:
1. Skin 2. Nasal passages 3. Oropharynx 4. Mouth 5. Intestines 6. Urethra 7. Vagina
Body Defenses Against Infection are what 2 things?
1. Specific 2. Nonspecific
INDIRECT Transmission: (2 types)
1. Vehicle borne 2. Vector borne
For droplet, how far away do you have to stand?
3 feet
Which of the following is a transmission based precaution? A. Droplet B. Respiratory C. Blood D. Body fluids
A. Droplet Answer (A) Droplet is a type of transmission based precaution. The other two types are airborne and contact. The remaining answers are not considered types of precautions
Define disease
A detectable alteration in normal tissue is called disease
What is a Resident Organism?
A resident organism can live on any part of the body.
Immunity that is obtained as a result of experiencing and illness is known as: A. Active natural immunity B. Passive natural immunity C. Active acquired immunity D. Passive acquired immunity
A. Active natural immunity A is the correct answer. Active Natural immunity results from the development of antibodies in response to an antigen, as from exposure to an infectious disease or through vaccination
After evaluating the client's chart, the nurse concludes a 65-year-old client's immunizations are current. What evidence supports this conclusion? (Select all that apply.) A. Last tetanus booster was at age 50 B. Receives a flu shot every year C. Has not received the hepatitis B vaccine D. Has not received the hepatitis A vaccine
A. All adults should receive a tetanus booster every 10 years (or sooner if injured). B. Correct. Flu shots are recommended for all adults over age 50. C. Correct. Only persons at risk need to receive hepatitis B vaccine. D. Correct. Only persons at risk need to receive hepatitis A vaccine
Which is the most effective nursing action for controlling the spread of infection? A .Thorough hand hygiene B. Wearing gloves and masks when providing direct client care C. Implementing appropriate isolation precautions D. Administering broad-spectrum prophylactic antibiotics
A. Correct. Since the hands are frequently in contact with clients and equipment, they are the most obvious source of transmission. Regular and routine hand hygiene is the most effective way to prevent movement of potentially infective materials. B. PPE (gloves and masks) is indicated for situations requiring Standard Precautions. C. Isolation precautions are used for clients with known communicable diseases. D. Routine use of antibiotics is not effective and can be harmful due to the incidence of superinfection and development of resistant organisms
The client is a chronic carrier of infection. To prevent the spread of the infection to other clients or health care providers, the nurse emphasizes interventions that do which of the following? A. Eliminate the reservoir. B. Block the portal of exit from the reservoir. C. Block the portal of entry into the host. D. Decrease the susceptibility of the host.
A. Since the carrier person is the reservoir and the condition is chronic, it is not possible to eliminate the reservoir. B. Correct. Blocking the movement of the organism from the reservoir will succeed in preventing the infection of any other persons. C. Blocking the entry into a host will be effective for only that one single individual and, thus, is not as effective as blocking exit from the reservoir. D. Decreasing the susceptibility of the host will be effective for only that one single individual and, thus, is not as effective as blocking exit from the reservoir.
The most effective nursing action for controlling the spread of infection includes which of the following? A. Thorough hand cleansing B. Wearing gloves and masks when providing direct client care C. Implementing appropriate isolation precautions D. Administering broad-spectrum prophylactic antibiotics
A. Thorough hand cleansing Correct. Since the hands are frequently in contact with clients and equipment, they are the most obvious source of transmission. Regular and routine hand cleansing is the most effective way to prevent movement of potentially infective materials. PPE (gloves and masks) is indicated for situations requiring Standard Precautions. Isolation precautions are used for clients with known communicable diseases. Routine use of antibiotics is not effective and can be harmful due to the incidence of superinfection and development of resistant organisms.
A client with a wound infection is placed on contact precaution based on a wound culture. When should the nurse caring for this patient don gloves? A. Upon entering the clients room B. When anticipating contact with drainage form the wound C. When determining a potential for contamination with blood or body fluids of the client D. When providing care within 3 feet of the client
A. Upon entering the clients room A is the answer. Gloves should be worn upon entry into the room of a client requiring contact precautions. Gloves are also worn in the other actions described in the other options
What is the miroorganism of an infection called?
An infectious agent
Signs of infection would include all of the following except: A. Swelling B. Redness C. Elevated RBC's D. Purulent drainage
C. Elevated RBC's WBC's would be elevated if the client has an infection.
A nurse enters a patients room at the beginning of the shift. The nurse looks around the room for potential sources for infection. Which of the following options pose a potential risk for infection for this client? Select all that apply A. A bottle of saline irrigation solution which is tightly closed and a label identifying that it was opened 10 hrs earlier. B. The clients abdominal dressing has 3 different areas of moist drainage saturating the dressing and soiling the clients gown. C. An opened package of gauze sponges in present on the window sill. D. The tubing of the clients IV fluids is not labeled with the date of the last tubing change.
Answers B, C, D The saturated dressing represents a risk for contamination since microorganisms can move through the moist environment through the dressing to the wound and back. An opened package of dressing supplies is considered contaminated and should not be used for dressing changes. Recommendations for IV tubing changes is every 72-96 hrs. unlabeled IV tubing represents a potential risk for infection
How would you treat these infections?
Antibiotics
Susceptible Host
Any person who is at risk for infection is susceptible host
• Student in clinical having issues with faculty. Inserting Foley catheter, become distracted and contaminate the tip. No one else present in the room; you are concerned at requesting another catheter because of cost and fear of the instructor. Rest of students are waiting for post conference to begin. • What will you do, why?
Ask for new catheter
Which of the client statements indicates a client who is at risk for infection? A. " I am just about five pounds overweight according to those insurance charts" B. "I had my last dose of chemotherapy two weeks ago and I'm glad that's over" C. "My life is pretty uneven now: I'm really busy." D. "I haven't had anything more serious that a cold in the past two years."
B. "I had my last dose of chemotherapy two weeks ago and I'm glad that's over" B is the correct answer. This patient's immune system is compromised related to the chemotherapy. Therefore he needs to be cautioned about his risk for infection.
Infection Control Precautions
Gloves, gowns, masks, keeping stuff in one room and not using them as vehicles
The client is a chronic carrier of infection. To prevent the spread of the infection to other clients or health care providers, the nurse emphasizes interventions that do which of the following? A. Eliminate the reservoir B. Block the portal of exit from the reservoir C. Block the portal of entry into the host D. Decrease the susceptibility of the host
B. Block the portal of exit from the reservoir Since the carrier person is the reservoir and the condition is chronic, it is not possible to eliminate the reservoir. Correct. Blocking the movement of the organism from the reservoir will succeed in preventing the infection of any other persons. Blocking the entry into a host will be effective for only that one single individual and, thus, is not as effective as blocking exit from the reservoir. Decreasing the susceptibility of the host will be effective for only that one single individual and, thus, is not as effective as blocking exit from the reservoir.
The patient is positive for C- difficile. The nurse should institute the which of the following: A. Droplet B. Contact C. Reverse D. Airborne
B. Contact Contact precautions are transmitted by patient who have an illness transmitted by direct contact or items contaminated by the patient. C-difficile would be and example of an infection that would require that the patient be placed on contact precautions
After evaluating the client's chart, the nurse concludes a 65-year-old client's immunizations are current. What evidence supports this conclusion? (Select all that apply.) A. Last tetanus booster was at age 50 B. Receives a flu shot every year C. Has not received the hepatitis B vaccine D. Has not received the hepatitis A vaccine
B. Receives a flu shot every year C. Has not received the hepatitis B vaccine D. Has not received the hepatitis A vaccine
Portal of Exit
Before infection can establish itself, needs to leave the reservoir
The nurse is exiting an isolation room. Considering infection control protocols which would be the first action the nurse would take? A. Bag equipment and double bag it out at the door B. Remove protective gear C. Dispose of equipment inside of the room (then A, B, D) D. Wash hands
C. Dispose of equipment inside of the room (then A, B, D) The answers would be C,A,B,D in order of importance. The first action would be to dispose of dirty equipment into the garbage in the room then remove the protective gear beginning with the gown and place it in the garbage. Then the nurse would wash her hands and dispose of all double bagged items in the dirty utility room. Then she would wash her hands again.
When caring for a client with AIDS-related cancer the nurse should always use which of the following protective measures? A. Gloves, gown and mask B. Gloves C. Standard precaution D. No precautions
C. Standard precaution Using standard precaution minimizes the risk of cross-infection from HCW to patient, from patient to HCW, and from patient to patient, even in high-risk situations. They are recommended for the care and treatment of all patients, regardless of their perceived infectious status.
The patient's abdominal dressing is described as having a moderate amount of serosanguineous drainage and a very foul odor. In planning the dressing change, it is most important for the nurse to: A. Apply extra dressings to the wound B. Use sterile gloves to remove the dirty dressing C. Wash her hands before and after the dressing change D. Change the dressing more often
C. Wash her hands before and after the dressing change C is the answer. Handwashing is the single most effective method in preventing the spread of microorganisms A could be done, but not most important B clean gloves only D may be dependent nursing function
Handwashing: What are the rules?
CDC recommends anitmicrobial foam, hand gel, or vigorous hand washing under a stream of water for at least 10-20 seconds - Nails should be kept short (harvest bacteria) - No artificial nails or chipped nail polish - No jewelry except wedding band - Check hands for breaks in the skin - Compliance with handwashing and good hygiene is difficult to achieve amongst healthcare professionals
Role of a comprised host in nosocomial infections
Compromised host also contributes to development of nosocomial infections (surgery or illness)
For an infection to occur six links or steps must be present. Which of the following is not considered a link? A. Infectious agent B. Reservoir C. Portal of Entry D. Droplet transmission
D. Droplet transmission Answer (D) Droplet transmission is not considered a link in the 6 step process of infections. Droplet is one of the three types of precautions based on the route of transmission. The additional three links needed for an infection to occur are route of transmission, portal or exit and susceptible host
Which of the following groups of people are most at susceptible to infection? A. Middle aged adults B. Young adults C. Young children D. Newborn infants
D. Newborn infants D is correct. Age influences the risk of infection. Newborns and older adults have reduced defenses against infection. Infections are a major cause of death in newborns due to their immature immune systems.
An individual who is more likely to acquire an infection is: A. Etiologic agent B. Vehicle C. Reservoir D. Susceptible host
D. Susceptible host Susceptible people or immunocompromised people are most likely to develop infections
Droplet Diseases
Diphtheria, mycoplasma pneumonia, pertussis, mumps, strep pharyngitis, pneumonia, scarlet fever
Example of resident flora
E. Coli: normal in lg. intestine but common cause of infection in UTI's
You are caring for a pt who has a large open and draining ABD wound. You notice another HCW (health care worker) changing the dsg without wearing gloves or using sterile technique. When you question him, he replies that the "wound is already infected and the pt is on abx anyway"
Educate him and report him.
What is the chain of infection?
Etiologic agent (microorganism) --> Reservoir --> Portal of Exit --> Mode of Transmission --> Portal of Entry --> Susceptible Host
Passive (acquired) Immunity
Host receives natural (nursing mother) or artificial (from an injection of immune serum) antibodies produced from another source - Passive Natural Immunity - Passive Artificial Immunity
Most common nosocomial infecting microorganisms:
Iatrogenic infections E-Coli, Staph Aureus, and Enterococci
Airborne Precautions
In addition to Standard Precautions: - Private room with negative air pressure room - Wear respirator device (N95) when entering the room (known or suspected TB) - Susceptible people should not enter the room of a pt with rubeola or varicella - Limit movement of pt outside the room - *pt should wear a surgical mask during transport* Ex. TB
Contact Precautions (most common!)
In addition to Standard Precautions: - Private room, if unavailable, place with pt who is infected with SAME microorganism - Hand hygiene before & after contact (C. diff- soap & H20) - Wear gloves & gown (as needed) - Put on before entering pts room - Remove before leaving pts room - Limit movement of pt outside the room - *dedicated equipment *
Droplet Precautions
In addition to Standard Precautions: - Private room, if unavailable, place with pt who is infected with SAME microorganism - Wear a mask within 3ft of the pt - Limit movement of pt outside the room - *pt should wear a surgical mask during transport*
Communicable Diseases:
Infectious agents transmitted by direct or indirect contact or as airborne infections Easily transferable (ex. Ebola, SARS, norovirus)
What represents the major cause of worldwide deaths?
Infectious diseases (worldwide, nation wide, state wide) In other countries, a lot of prevention starts with education. Poor nutrition. Sanitation. Lack of clean water.
Non-Specific Inflammatory Response (3 stages)
Inflammation is adaptive mechanism that destroys, dilutes and prevents spread and contributes to healing 1. Vascular and cellular responses 2. Exudate production (pus) 3. Reparative phase
Incubation Period
Interval between pathogen invasion and appearance of infection
What is an Infection?
Invasion of body tissues by microorganisms and their proliferation in that area
Sepsis
Is the state of infection
Where to look for areas where there is friction on skin?
Look for tears in skin where there is friction and not much meat on the bone: look on elbow, knees, heels, back of head,thighs, back, feet (think circulation when look at feet because theyw ill be cold)
MRSA represents what % of staph aureus infections?
MRSA represents 40% of staph aureus infections. These are resistant to penicillin. Vancomycin is the last line of defense to these organisms and increasingly strains are becoming resistant to the Vancomycin
Most common nosocomial infections in the ICU setting?
Most common ICU setting - #1 Urinary tract (33%) - Respiratory tract (15%) - Bloodstream (14%) - Surgical wounds (22%)
What is the nurses role when caring for patients who have infections or are at risk for infections?
Nurses provide biologically safe environments for patients which includes preventing infections Prevent spread of infections - Hand washing - Blocking portal of entry - Gloves and gowns - Patient education
Assessment r/t Infection
Nursing History: - Degree to which the client is at risk for developing an infection - Any patient complaints suggesting presence of infection Lab Data: - WBC 5,000-10,000 - ↑ ESR (erythrocyte sedimentation rate) - + cultures - Blood, sputum, urine, other drainage Physical Assessment: - Localized: 5 CARDINAL symptoms - Swelling - Redness - Pain/tenderness - Warm/heat - Loss of function Systemic: - Fever - ↑ pulse (tachycardia) & respiratory rate - Malaise; fatigue; loss of energy - Anorexia; n/v - Enlarged lymphnodes/involvement
Bloodstream infections (organisms and causes)
ORGANISM - Coagulase-negative staphylococci - Staphylococcus aureus - Enterococcus species CAUSES - Inadequate Handwashing - Improper IV fluid, tubing and site care technique
Urinary Tract Infections (organisms and causes)
ORGANISM - E-Coli - Enterococcus species - Psuedomonas aeruginosa CAUSES - Inadequate handwashing - Improper dressing change technique
Surgical Site Infections (organisms and causes)
ORGANISM - Staphylococcus aureus - Enterococcus species - Pseudomonas aeruginosa CAUSES - Inadequate handwashing - Improper dressing change technique
Pneumonia Infections (organisms and causes)
ORGANISM - Staphylococcus aureus - Pseudominas aeruginosa - Enterobacter species CAUSES - Inadequate handwashing - Improper Suctioning Technique
What is PPE and when is it used?
Personal protective equipment Used when in contact with bodily fluids
Ms. Niles is 85 and lives alone. She has difficulty walking and relies on the church to deliver lunches during the week. She has limited funds. Last week her 79 year old sister died and they had been very close. As a home healthcare nurse, explain the factors that might increase Ms. Niles risk for infection.
Poor nutrition, impaired mobility, emotional stress, poor hygiene, old age
Prominent health problems of older people are chronic or acute?
Prominent health problems of older people are chronic rather than acute and are exacerbated by the normal changes of aging and the increased risk of illness associated with old age.
Convalescent Period
Recovery from illness, depends on severity of illness and co-morbidities
Why is it important for nurses to know the different stages of infection?
So we known how to treat it, catch it early, prevent the spread, patient education
Surgical Asepsis
Sterile technique used to prevent introduction of microorganisms into the environment
What are the 5 steps of the Nursing Process?
Systematic approach between the patient and the nurse 1. ASSESSMENT: Systematically collect data 2. DIAGNOSIS: Identify actual and potential problems (NANDA) 3. PLANNING/GOALS: Develop plan of individualized care 4. IMPLEMENT: Execute the plan 5. EVALUATION: Evaluate the effectiveness
What is one of the most common airborne transmission?
TB
What is measurable in terms of infection?
Temperature
When do infections become diseases?
When the signs and symptoms can be differentiated from other conditions.
Implementing r/t infection
Whenever possible, the nurse implements strategies to prevent infection - Handwashing - Universal precautions - Infection control - Disinfectants/sterilizing
What is the major lab that will tell you if someone has an infection?
White blood cells!
Facemasks
Worn to reduce the risk of transmission of organisms by droplet contact, by airborne routes and by splattering of body substances
The patient has been diagnosed with a gastrointestinal bacteria obtained from drinking contaminated water. In the chain of infection, the water is the: a. Portal of entry b. Reservoir c. Portal of exit d. Infectious agent
b. Reservoir B is the answer. The water is the reservoir that provided the environment for the infectious agent to reproduce. Options a, c, and d are part of the chain of infection, but the water is the reservoir
Linens
bag all contaminated linen. Handle as little as possible. Follow agency policy
Which patient is at higher risk for infection? Stubbing toe or in a burning building with burns waist down?
burn patient
Opportunistic pathogen
cause disease only in a susceptible individual Ex. when stressed out you are the opportunistic pathogen because immune system is shutting down
Viruses
consist of nucleic acid and therefore must enter living thing to reproduce o rhinovirus, herpes, HIV - Require living host, if someone has weakened immune system they are more likely to get it
Contact Diseases
gastrointestinal, respiratory, skin or wound infection, C-Diff infections, E-Coli, Shigella, Hepatitis, VRE infections
Words ending in pnea
involves breathing
Local
limited to the specific part of the body where the microorganisms remain Ex. swollen nail from nail salon
Parasites
live on other organisms Ex. ticks, fleas, lime disease, bed bugs, ringworm
Systemic
microorganisms spread and damage different parts of the body o bacteremia, septicemia Ex. if that nail infection becomes a fever (MRSA) Local infections, if not treated, can lead to systemic
Bacteria
most common & likely to cause infection; can be transported thru air, water, food, soil, body tissue/fluids, and inanimate objects - some are harmful - want to keep patients clean after surgery because lots of bacteria in hospitals, most likely to cause infection of 4 types. - Can be transported to anything
For airborne, what specific type of mask do you have to wear?
n95 mask
BP equipment
no special precautions unless becomes contaminated, many facilities have disposable cuffs
Thermometers
no special precautions with disposable covers
Dishes
no special precautions; may use disposable
Which of the following require clean vs sterile gloves? o Changing a wound dressing: o Taking an oral temperature: o Obtaining a venous blood sample: o Providing hygienic care: o Inserting a Foley catheter: o Removing a Foley catheter: o Preparing an IM injection:
o Changing a wound dressing: (sterile) o Taking an oral temperature: (clean) o Obtaining a venous blood sample: (clean) (needle should be sterile)) o Providing hygienic care: (clean) o Inserting a Foley catheter: (sterile) o Removing a Foley catheter: (clean) o Preparing an IM injection: (clean)
Chronic
occur slowly; may last for months or years (ex. HIV)
Prodromal Stage
person most infectious! - signs and symptoms present, but vague (fatigue, malaise) - can last hours-days, might not know they're contagious
Resident Organism: Skin
skin is a way to transfer bacteria, skin is a resident organism and these are the types. • Staphylococcus epidermis • Propionibacterium acnes • Staphylococcus aureus • Corynebacterium xerosis • Pityrosporum oxale (yeast)
What is the most common risk for nosocomial infection?
urinary catheters (CAUTI) - catheter associated urinary tract infeciton
Sharps
use sharps containers
Lab specimens
use specimen bags; label appropriately
Asymptomatic or subclinical is what?
when microorganism produces no clinical evidence of disease
Septic patient
whole body becomes infected (surgical aspesis can lead to septicism)
What does Asepsis mean?
without contamination, freedom from disease causing microorganisms
Fungi
yeasts and molds o candida albicans, aspergilla - warm, moist dark locations (dry patient)
Resident Organism: INTESTINES
• Bacteriodes • Fusobacterium • Eubacterium • Lactobacillus • Streptococcus • Enterobacteriaceae • Shigella; E Coli
Sterile Gowns, Gloves, Fields
• Gloves mandatory for all procedure requiring surgical technique • Worn to prevent contamination of wounds, equipment, supplies, & sites • Proper donning & removal technique • Sterile Field is area free of microorganisms on which sterile objects can be placed • Provides work surface to facilitate sterility during a sterile procedure • Drapes or sterile wrappers can also be used • Transfer to the surface by peeling back packaging & dropping item onto the field without contact with anything non-sterile • Always use new, unopened dressing supply: WHEN IN DOUBT THROW IT OUT • Always place sterile objects on a dry surface • DO NOT splash liquids when pouring as moisture causes contamination • NEVER turn your back on a sterile field or leave it unattended • NEVER reach over a sterile field
Resident Organism: Nasal Passages
• Staphylococcus aureus • Staphylococcus epidermidis
Resident Organism: MOUTH (coughing)
• Streptococcus mutans • Lactobacillus • Bacteriodes • Actinomyces
Category-Specific Isolation Precautions
• Strict isolation • Contact isolation • Respiratory isolation • Tuberculosis isolation • Enteric precautions • Drainage/secretions precautions • Blood/body fluid precautions
