FOUNDATIONS Exam 1 - Chapter 23: Asepsis and Infection Control

List the stages of an infection

1. Incubation Period: interval between pathogen's invasion of the body and the appearance of symptoms 2. Prodromal Stage: where person is most infectious; early S&S of disease are present but are often vague/nonspecific (malaise/low fever) 3. Full stage of illness: presence of S&S indicates the full stage of illness 4. Convalescent period: recovery period from an infection - vary according to severity of infection

Identify multidrug-resistant organisms that are prevalent in hospitalized patients and community settings

1. MRSA - methicillin resistant staphylococcus aureus: normally found in nasal mucosa, on skin, in respiratory and GI tracts - methicillin was used so frequently to treat staph it developed a tolerance to the drug >Now use Vancomycin to treat MRSA TWO KINDS: a. Community-associated MRSA is a common cause of skin and soft tissue infections >At risk: young children, older adults, people in close proximity, esp athletes/military b. Healthcare-associated MRSA - much more serious >At risk: pts who have surgery or other invasive procedures, have invasive devices, or are immunocompromised >Main mode of transmission is through contact with the contaminated hands of healthcare or contact with equiptment

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 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.

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 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 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 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 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. 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 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. 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 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. 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 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 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 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 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. 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 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. 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.

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. 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.

Identify multidrug-resistant organisms that are prevalent in hospitalized patients and community settings

C. diff Clostridium difficile Passed through feces >At risk? older adults who are receiving medical care and taking antibiotics >S&S: watery diarrhea, fever, and mild abdominal cramping are common

Identify multidrug-resistant organisms that are prevalent in hospitalized patients and community settings

CRE Carbapenem-resistant Enterobacteriaceae Normally found in the human intestine >At risk? People with bladder or venous catheters in place, require ventilator assistance, lengthy antibiotic use, or frequent hospitalizations/long-term care patients

Explain the infection cycle

Consists of six components: infectious agent (bacteria, viruses, and fungi), reservoir (for growth and multiplication of mo's), portal of exit (point of escape for the organism from the reservoir), means of transmission (means or routes of transportation), portals of entry (the point at which organisms enter a new host), susceptible host (susceptibility of a person depends if microorganism can continue to exist and thrive off of host)

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. 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 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. 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.

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. 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 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. 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).

Standard Precautions

Follow hand hygiene techniques. Wear clean nonsterile gloves when touching blood, body fluids, excretions or secretions, contaminated items, mucous membranes, and nonintact skin. Change gloves between tasks on the same patient as necessary and remove gloves promptly after use. Wear personal protective equipment such as mask, eye protection, face shield, or fluid-repellent gown during procedures and care activities that are likely to generate splashes or sprays of blood or body fluids. Use gown to protect skin and prevent soiling of clothing. Follow respiratory hygiene/cough etiquette. Any patients, family members, and visitors with undiagnosed, transmissible respiratory infections require education to cover their mouth and nose with a tissue when coughing and promptly dispose of the tissue. During periods of increased occurrence of respiratory infections, offer a surgical mask to coughing patients and other symptomatic people upon entry to the health care facility or office. Encourage the coughing patient to maintain more than a 3-foot separation from other people in the health care facility or office. Avoid recapping used needles. If you must recap, never use two hands. Use a needle-recapping device or the one-handed scoop technique. Place needles, sharps, and scalpels in appropriate puncture-resistant containers after use. Use safe injection practices including single-dose vials when possible; use disposable needles and syringes for each injection, and prevent contamination of injection equipment and medication. Wear face mask if placing a catheter or injecting material into the spinal or epidural space. Handle used patient care equipment that is soiled with blood or identified body fluids, secretions, and excretions carefully to prevent transfer of microorganisms. Clean and reprocess items appropriately if used for

Healthcare-associated infections

Healthcare-associated infections (HAI's): UTI's, surgical site infections, bloodstream infections, & pneumonia Most HAIs are caused by bacteria such as E. coli, Staphylococcus aureus, Streptococcus faecalis, Pseudomonas aeruginosa, and Klebsiella.

Describe nursing interventions used to break the chain of infection

Nurses play a critical role in preventing and controlling infection - beginning with early detection and surveillance techniques ASSESSMENT >look for signs and symptoms of a local or systemic infection The focus of nursing care depends on a nursing DIAGNOSIS that accurately reflects the pt's condition >ex: risk for imbalanced body temp related to infectious process; dehydration The nurse then develops an appropriate patient outcome after reviewing the assessment data OUTCOME IDENTIFICATION AND PLANNING >ex: Pt will demonstrate effective hand hygiene and good personal hygiene practices The practice of asepsis includes all activities to prevent infection/break the chain of infection by using aseptic techniques (medical "clean" & surgical "sterile" asepsis) IMPLEMENTING

Implement recommended techniques for medical asepsis

Performing hand hygiene and wearing gloves Practicing Basic Principles of Medical Asepsis: Practice good hand hygiene. Keep soiled items and equipment from touching the clothing. Carry soiled linens or other used articles so that they do not touch your clothing. Do not place soiled bed linen or any other items on the floor, which is grossly contaminated. It increases contamination of both surfaces. Avoid allowing patients to cough, sneeze, or breathe directly on others. Provide them with disposable tissues, and instruct them, as indicated, to cover their mouth and nose to prevent spread by airborne droplets. Move equipment away from you when brushing, dusting, or scrubbing articles. This helps prevent contaminated particles from settling on the hair, face, and clothing. Avoid raising dust. Use a specially treated cloth or a dampened cloth. Do not shake linens. Dust and lint particles constitute a vehicle by which organisms may be transported from one area to another. Clean the least soiled areas first and then the more soiled ones. This helps prevent having the cleaner areas soiled by the dirtier areas. Dispose of soiled or used items directly into appropriate containers. Wrap items that are moist from body discharge or drainage in waterproof containers, such as plastic bags, before discarding into the refuse holder so that handlers will not come in contact with them. Pour liquids that are to be discarded, such as bath water, mouth rinse, and the like, directly into the drain to avoid splattering in the sink and onto you. Sterilize items that are suspected of containing pathogens. After sterilization, they can be managed as clean items, if appropriate. Use practices of personal grooming that help prevent spreading microorganisms. Examples include shampooing the hair regularly, keeping it short or pinned up to limit th

List nursing diagnoses for a patient who has or is at risk for 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) Impaired Oral Mucous Membrane related to ineffective dental hygiene; trauma; side effect of medication; presence of invasive medical device 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

Describe strategies for implementing CDC guidelines for standard and transmission-based precautions when caring for patients

Standard precautions: precautions used in the care of all hospitalized patients regardless of their diagnosis or possible infection status. Apply to blood, body fluids, secretions, nonintact skin, mucous membranes, and excretions (except sweat) Transmission based precautions: precautions used in addition to standard precautions for patients in hospitals w suspected infection w pathogens that can be transmitted airborne, droplet, or contact routes Three types of transmission-based precautions (airborne, droplet, or contact) may be used alone or in combination

Implement recommended techniques for medical asepsis

Surgical Asepsis: urinary catheter, sterile dressing changes, preparing an injectable medication >Object is considered sterile when all microorganisms (pathogens/spores) have been destroyed Practicing Basic Principles of Surgical Asepsis: Allow only a sterile object to touch another sterile object. Unsterile touching sterile means contamination has occurred. Open sterile packages so that the first edge of the wrapper is directed away from the worker to avoid the possibility of a sterile surface touching unsterile clothing. The outside of the sterile package is considered contaminated. Opening a sterile package is shown and described in Skill 23-3. Avoid spilling any solution on a cloth or paper used as a field for a sterile setup. The moisture penetrates through the sterile cloth or paper and carries organisms by capillary action to contaminate the field. A wet field is considered contaminated if the surface immediately below it is not sterile. Hold sterile objects above the level of the waist. This will ensure keeping the object within sight and preventing accidental contamination. Avoid talking, coughing, sneezing, or reaching over a sterile field or object. This helps to prevent contamination by droplets from the nose and the mouth or by particles dropping from the worker's arm. Never walk away from or turn your back on a sterile field. This prevents possible contamination while the field is out of the worker's view. Keep all items sterile that are brought into contact with broken skin, or used to penetrate the skin to inject substances into the body, or to enter normally sterile body cavities. These items include dressings used to cover wounds and incisions, needles for injection, and tubes (catheters) used to drain urine from the bladder. Use dry, sterile forceps when necessary. Forceps soaked in disinfectant are

Identify patients at risk for developing an infection

The body has natural defenses against infection including: body's normal flora, inflammatory response, & immune response *If any of these are compromised, risk for infection is increased* >Integrity of skin and mucous membranes, which protect the body against microbial invasion >pH levels of the gastrointestinal and genitourinary tracts, as well as the skin, which help to ward off microbial invasion >Integrity and number of the body's white blood cells, which provide resistance to certain pathogens >Age, sex, race, and hereditary, which influence susceptibility. >Neonates and older adults appear to be more vulnerable to infection. >Immunizations, natural or acquired, which act to resist infection >Level of fatigue, nutritional and general health status, the presence of preexisting illnesses, previous or current treatments, and certain medications, which play a part in the susceptibility of a potential host >Stress level, which if increased, may adversely affect the body's normal defense mechanisms >Use of invasive or indwelling medical devices, which provide exposure to and entry for more potential sources of disease-producing organisms, particularly in a patient whose defenses are already weakened by disease Examples: Pulmonary infections with decreased: cough reflex, elastic recoil of lungs, activity of cilia, and abnormal swallowing reflexes UTI's with incomplete emptying of bladder, decreased sphincter control, bladder-outlet obstruction, reduced renal BF Skin Infections with: loss of elasticity, increased dryness, thinning of epidermis, slowing of cell replacement, decreased vascular supply

Contact Precautions

Use these for patients who are infected or colonized by a multidrug-resistant organism (MDRO). 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 infective material. Remove PPE before leaving the patient environment, and wash hands with an antimicrobial or waterless antiseptic agent. Limit movement of the patient out of the room. Avoid sharing patient-care equipment.

Airborne Precautions

Used for infections that spread through the air: tuberculosis, varicella (chicken pox), rubeola (measles), and possibly SARS (severe acute respiratory syndrome). Place patient in a private room that has monitored negative air pressure in relation to surrounding areas, 6 to 12 air changes per hour, and appropriate discharge of air outside or monitored filtration if air is recirculated. Keep door closed and patient in room. Wear a mask or respirator when entering room of patient with known or suspected tuberculosis. If patient has known or suspected rubeola (measles) or varicella (chicken pox), respiratory protection should be worn unless the person entering room is immune to these diseases. Transport patient out of room only when necessary and place a surgical mask on the patient if possible. Consult CDC Guidelines for additional prevention strategies for tuberculosis.

Droplet Precautions

Used for patients with an infection that is spread by large-particle droplets: rubella, mumps, diphtheria, and the adenovirus infection in infants and young children. Use a private room, if available. Door may remain open. Wear PPE upon entry into the room for all interactions that may involve contact with the patient and potentially contaminated areas in the patient's environment. Transport patient out of room only when necessary and place a surgical mask on the patient if possible. Keep visitors 3 feet from the infected person.

Identify multidrug-resistant organisms that are prevalent in hospitalized patients and community settings

VISA Vancomycin intermediate-resistant Staphylococcus aureus VRSA vancomycin-resistant staphylococcus aureas VRE Vancomycin-resistant enterococci: found in normal male/female genital tracts can cause HAIs with high mortality >Has become resistant to penicillin, ampicillin, gentamicin, and vancomycin >At risk? immunocompromised patients, recent abdominal/chest surgery, presence of urinary or central IV catheter, prolonged antibiotic use, lengthy stay in hospitals >VRE is spread via feces, urine, blood, or by person

Identify situations in which hand hygiene is indicated

WHO's Five Moments for Hand Hygiene: 1. Before touching the patient 2. Before a clean/aseptic procedure: urinary catheters, peripheral vascular catheters, or invasive devices 3. After a body fluid exposure risk: mucous membranes, nonintact skin, wound dressings - *if hands are not visibly soiled* 4. After touching a patient 5. After touching patient surroundings >also after removing gloves, before donning sterile gloves, if moving from a contaminated body site to a clean body site