Ch 23: Asepsis

The nurse conducting an in-service on hand hygiene determines that additional education is needed when a participant states which of the following?

"I do not need to wash my hands if I am using gloves."

stages of infection

1. incubation period 2. prodromal stage 3. full stage of illness 4. convalescent period

infection cycle

1. infectious agent 2. reservoir 3. portal of exit from reservoir 4. mode of transportation 5. portal of entry 6. susceptible host

normal white blood cell count

5,000-10,000 per microliter

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

A, B, F

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.

A, C, D, F It is recommended to use an alcohol-based handrub before inserting urinary catheters, peripheral vascular catheters, or invasive devices that do not require surgical placement

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

B

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

B

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 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 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 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 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.

B, E, F use about one teaspoon of liquid soap

The nurse is preparing to don a gown to care for a client requiring contact precautions. When should the nurse don the gown?

Before entering the client's 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

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.

C

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.

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 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

C that is a normal white blood cell count

how are antibiotic resistant microorganisms spread?

CONTACT!!!!!

antibiotic resistant microorganisms

Clostridium difficult (C. diff) Methicillin-resistent S. aureus (MRSA) Vancomycin-intermediate S aureus (VISA) Vancomycin-resistant S aureus (VRSA) Vancomycin-resistant enterococci (VRE)

sterilization

Complete destruction of all forms of microbial life

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

D

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).

D

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

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.

D

Which piece of personal protective equipment (PPE) should be removed first?

Gloves

Iatrogenic infection

HAI; Results from a diagnostic or therapeutic procedure

Which statement best explains the rationale for bringing an extra pair of sterile gloves into an adult client's room before preparing for a sterile procedure?

If the first pair is contaminated and needs to be replaced, the nurse does not need to leave the room for a new pair.

To eliminate needlesticks as potential hazards to nurses, the nurse should:

Immediately deposit uncapped needles into puncture-proof plastic container.

The nurse is disposing of an old dressing that is saturated with a client's blood. How should the nurse dispose of the dressing?

In a bag marked "biohazards"

normal erythrocyte sedimentation rate

M: 0-15 micrometers/hr F: 0-20 micrometers/hr

When preparing to use a bottle of sterile saline for a dressing change, the nurse notes that the date it was opened was two days previous. What should the nurse do?

Obtain a new bottle of sterile saline

After changing the bed linens for a client, the nurse uses an alcohol-based handrub to perform hand antisepsis. What is the proper way to use an alcohol-based handrub?

Rub the product between the hands until they are dry.

A nurse prefers to use an alcohol-based hand rub when providing care for patients. In which case is this practice contraindicated?

The nurse is caring for a client with a C. difficile infection.

A nurse who has finished cleansing and dressing the wound of a young client now needs to change the dressings of a client in the burn unit. Which action should the nurse perform, keeping in mind the importance of asepsis and client comfort?

Wash hands thoroughly and then wear sterile gloves.

Surgical asepsis is defined as:

absence of all microorganisms.

Which client would require a negative flow room?

an 81-year-old man with active tuberculosis and a productive cough

For which client would the use of standard precautions alone be appropriate?

an incontinent client in a nursing home who has diarrhea

nosocomial infection

any HAI, broad

transient bacteria flora

attached loosely on skin, removed with ease

what is the most significant and commonly found infection causing agent in healthcare institutions

bacteria

The nurse is caring for a client with human immunodeficiency virus (HIV). The client currently has no signs or symptoms of the disease, but the nurse teaches the client that she may transmit this disease to another person. What term is used to describe an individual who is asymptomatic but can transmit the disease?

carrier

direct transmission

contact, airborne, droplets airborne: less than 5 micrometers droplet: moe than 5 micrometers

laboratory data indicating infection

elevated white blood cell count, increase in specific types of WBC (neutrophil, eosinophil, monocyte, lymphocyte), elevated erythrocyte sedimentation rate, presence of pathogen in urine blood sputum or draining cultures

PPE removal

gloves, goggles, gown, mask

PPE

gloves, gown, mask, N95 respirator, protective eye gear

infection control technique

includes all activities to prevent/break the chain of infection medical asepsis (clean technique), surgical asepsis (aseptic technique)

means of transmission

indirect and direct

factors affecting host susceptibility

intact skin and mucous membranes, normal blood pH (7.4), white blood cells, immunization (natural or acquired), stress, age sex race heredity factors, fatigue climate national and general health, use of invasive or indwelling medical devices

infections associated with contact precautions

multi-drug resistant organisms

infections associated with droplet precautions

mumps, rubella, diphtheria, adenovirus

medical asepsis

no bad or harmful microorganisms

surgical asepsis

no microorganisms at all

body defense against infections

normal flora, inflammatory response, immune response

The nurse is completing a sterile dressing change on a confused client. During the procedure, the client reaches down and touches the contents of the open dressing kit. What should the nurse do?

open a new sterile dressing kit

incubation period

organisms growing and multiplying

prodromal stage

person is most infectious, vague and nonspecific signs of disease

full stage of illness

presence of specific signs and symptoms of disease

contact precautions

private room, PPE

droplet precautions

private room, PPE

airborne precautions

private room, PPE, negative air pressure, N95

in what stage of infection is the patient most contagious?

prodromal stage

convalescent period

recovery from the infection

disinfection

removing pathogens

resident bacteria flora

requires friction to remove; found in crevices

common portals of exit

respiratory, gastrointestinal, genitourinary, breaks in skin, blood, tissue

medical asepsis (clean technique)

routine hand washing, using non-sterile gloves when touching intact skin, feeding, simple procedures

surgical asepsis (aseptic technique)

sterile gloves, used for invasive procedures, antiseptic on patients skin, clean and dedicated area, use when inserting IV ad catheter

The nurse begins a task and then realizes that personal protective equipment (PPE) is needed. What is the correct action by the nurse?

stop and obtain appropriate PPE

Standard precautions apply to blood; all body fluids, secretions, and excretions; intact and nonintact skin and mucous membranes.

true

infections associated with airborne precautions

tuberculosis, varicella, measles, SARS

Which is not appropriate regarding the use of gowns as PPE?

use of one gown per person per shift

transmission based precautions

used in addition to standard for patients with suspected infection; contact, droplet, airborne

standard precautions

used in care of ALL hospitalized patients includes: hand hygiene, PPE, cough etiquette, safe injection practices (single dose vials), avoid recapping needles, clean non sterile gloves when touching blood body fluids or non intact skin

indirect transmission

vehicles and vectors vehicles: inanimate object vectors: nonhuman organisms

When caring for a client with a respiratory infection, the nurse washes her hands frequently and thoroughly. What are the other precautionary steps the nurse should take in order to prevent infection?

wear a mask when talking to the client

When is hand hygiene with an alcohol-based rub appropriate, as opposed to using handwashing?

when hands are not visibly soiled