Fundamentals of Nursing Ch. 29: Infection Prevention & Control

Identify a cause for the following risk for infections - *Hereditary*

Sickle cell disease, diabetes

Portal of exit

Sites such as blood, mucus membranes, respiratory tract, genitourinary tract, and gastrointestinal tract.

The isolation guidelines of the Centers for Disease Control and Prevention contain two-tiered approach. Explain each one.

Standard precautions (tier 1): are designed for all patients in all settings regardless of the diagnosis; they apply to contact with blood, bodily fluid, nonintact skin, and mucus membranes. Isolation precautions (tier 2): Isolation precautions are based on the mode of transmission of disease. They are termed airborne; droplet; contact; and a new category protective environment.

Isolation

the separation and restriction of movement of ill persons with contagious diseases. - Barrier precautions - Standard precautions

__________________ is a type of HAI that results from a diagnostic or therapeutic procedure. - For example, procedures such as bronchoscopy and treatment with broad-spectrum antibiotics have been shown to increase the risk for certain infections.

Iatrogenic infection

Infectious disease

Illnesses such as viral meningitis or pneumonia

Explain the most common modes of transmission - Droplet

Large particles that travel up to 3 feet during coughing/sneezing/talking and come in contact with the susceptible host.

Explain the most common modes of transmission - Direct

Person-to-person (fecal/oral)physical contact between source and susceptible host (touching patient feces and then touching your inner mouth or consuming contaminated food)

Explain the most common modes of transmission - Indirect

Personal contact of a susceptible host with a contaminated inanimate object (needles or sharp objects, dressings, environment)

Carriers

Persons who show no symptoms of illness but who have the pathogens that are transferred to others.

Bacteriostasis

Prevention of the growth and reproduction of bacteria by cold temperatures.

Major route of transmission

Unwashed hands of a health care worker.

Identify a cause for the following risk for infections - *Travel history*

West Nile virus, SARS, avian flu

Patient Safety:

- Separate personal care items - Handling exudate - Wound cleaning - Cough etiquette - Dirty linen - Maintain skin integrity - Perineal care after toiling - Urinary catheters and drainage sets - Wound cleaning

Sterile Field

an area free of microorganisms and prepared to receive sterile items

Communicable disease

An infectious disease that is transmitted directly from one person to another.

The severity of a patient's illness depends on all of the following except: 1. Incubation period 2. Extent of the infection 3. Susceptibility of the host 4. Pathogenicity of the microorganism

Answer: 1. Incubation period Rationale: The incubation period is the interval between the entrance of the pathogen into the body and appearance of first symptoms.

Surgical Asepsis:

- Includes procedures used to eliminate all microorganisms, including pathogens and spores, from an object or area.

Psychological Implications of Isolation

- Isolation environment - Personal protective equipment - Specimen collection - Bagging of trash or linen - Patient transport

Patients at greater risk for Health Care-Associated Infections (HAIs)

- Multiple illnesses - Older adults - Poorly nourished - Compromised immune system

HAIs significantly increase costs of health care.

- Older adults have increased susceptibility to these infections because of their affinity to chronic disease and the aging process itself. - Extended stays in health care institutions, increased disability, increased costs of antibiotics, and prolonged recovery times add to the expenses both of the patient and the health care institution and funding bodies.

Masks are used for three primary purposes in health care settings:

(1) placed on health care personnel to protect them from contact with infectious material from patients (e.g., respiratory secretions); (2) placed on health care personnel when engaged in procedures requiring sterile technique to protect patients from exposure to infectious agents carried in a health care worker's mouth or nose; and (3) placed on coughing patients to limit potential dissemination of infectious respiratory secretions from the patient to others.

The following factors influence a patient's susceptibility to infection, briefly explain them, giving an example of each. (4) ANSD

*Age*: Infants have immature defenses, breastfed babies have greater immunity, viruses common in middle-aged adults, older adult cell-mediated immunity declines. *Nutritional status*: A reduction in the intake of protein, carbohydrates, and fats reduces the body's defenses and impairs wound healing. *Stress*: Basal metabolic rate increases; increase serum glucose levels and decrease anti-inflammatory responses with elevated cortisone levels. *Disease process*: People with diseases of the immune system (leukemia, AIDS) and chronic diseases (AODM) have weakened defenses against infection.

Effective prevention and control of infection requires the nurse to be aware of the following modes of transmission. (8)

*Bathing*: When bathing, use soap and water to remove drainage, dried secretions, and excess perspiration. *Bedside unit*: Keep surfaces clean and dry. *Bottled solutions*: Do not leave bottle solutions open; date and discard them in 24 hours. *Contaminated articles*: Place tissues, soiled dressings, or soiled linen in fluid-resistant bags. *Contaminated sharps*: Place all needles, safety needles, and needless systems into a puncture-proof container. *Drainage bottles and bags*: Wear gloves and protective eyewear and empty all drainage systems at the end of the shift. *Dressing changes*: Change dressings when they are wet or soiled. *Surgical wounds*: Keep drainage tubes and collection bags patent.

List the ways a nurse can teach patients and their families to prevent an infection from developing or spreading (community and health care settings).

*Community settings:* a. Nutrition b. Rest c. Maintenance of physiological protective mechanisms d. Recommended immunizations *Health care settings:* e. Eliminate reservoirs of infection f. Controlling ports of exit and entry g. Methods to control the spread of microorganisms: Proper use of sterile supplies, barrier precautions, standard precautions, transmission-based precautions, and hand hygiene.

The nurse follows certain principles and procedures to prevent infection and to control its spread. Briefly explain each one:

*Concept of asepsis*: The absence of pathogenic microorganisms; the technique refers to the practices or procedures that assist in reducing the risk for infection. *Medical asepsis*: Clean technique: Hand hygiene, using clean gloves, cleaning the environment routinely.

Define the following types of health care-associated infections (nosocomial)

*Exogenous*: infection comes from microorganisms outside the individual that do not exist in normal floras. *Endogenous*: infection occurs when part of the patient's flora becomes altered and an overgrowth results.

Explain the following methods of controlling or eliminating infectious agents: HADS

*Hand hygiene:* includes washing hands with soap and water followed by a stream of water. *Alcohol based hand antiseptics*: are recommended by CDC to improve hand hygiene practices, protect health care workers' hands, and reduce pathogens to patients. *Disinfection*: is a process that eliminates many or all microorganisms with the exception of bacterial spores from inanimate objects. *Sterilization*: is the complete elimination or destruction of all microorganisms, including spores.

Describe the two types of infection:

*Localized*: Patient experiences localized symptoms such as pain, tenderness, warmth, and redness at the wound site. *Systemic*: An infection that affects the *entire body* instead of just a single organ and can become fatal if undetected.

*Acute inflammation* is an immediate response to cellular injury. Explain each briefly:

*Vascular and cellular responses*: Rapid vasoconstriction that causes redness at the site and localized warmth, allowing phagocytosis to occur. *Inflammatory exudate*: is the accumulation of fluid and dead tissue cells; WBC's form at the site. Exudate may be serous, sanguineous, or purulent. *Tissue repair*: Healing involves the defensive, reconstructive, and maturative stages.

Explain the most common modes of transmission - Vector

- *External mechanical* transfer (flies) - *Internal transmission* such as parasitic conditions between vector and host (mosquito/louse/flea/tick)

Explain the most common modes of transmission - Vehicles

- Contaminated items - Water - Drugs, solutions - Blood - Food

Infections follow a progressive course by four stages. List and explain each stage: IPEC

1. *Incubation period*: Interval between entrance of the pathogen into the body and appearance of the first symptoms. 2. *Prodromal stage*: Onset of nonspecific signs and symptoms to more specific symptoms. 3. *Illness stage*: Manifests signs and symptoms to type of infection. 4. *Convalescence*: Acute symptoms of infection disappear.

Preparing for entrance into isolation room:

1. Apply cover gown 2. Apply either surgical mask or fitted respirator around mouth and nose 3. If needed, apply eyewear or goggles snugly around face and eyes. 4. Apply clean gloves.

Leaving the isolation room:

1. Remove gloves 2. Remove eyewear/face shelf or goggles 3. Untie waist and neck strings of gown 4. Remove mask 5. Perform Hand Hygiene

Reservoir

A place where a pathogen survives

Bactericidal

A temperature or chemical that destroys bacteria.

Virulence

Ability to survive in the host or outside the body.

pH

Acidity of environment

Which of the following best describes an iatrogenic infection? 1. It results from a diagnostic or therapeutic procedure. 2. It results from an extended infection of the urinary tract. 3. It involves an incubation period of 3 to 4 weeks before it can be detected. 4. It occurs when patients are infected with their own organisms as a result of immunodeficiency.

Answer: 1. It results from a diagnostic or therapeutic procedure. Rationale: Iatrogenic infections are a type of health care associated infection (HAI) caused by an invasive diagnostic or therapeutic procedure.

When a patient on respiratory isolation must be transported to another part of the hospital, the nurse: 1. Places a mask on the patient before leaving the room. 2. Obtains a health care provider's order to prohibit the patient from being transported. 3. Instructs the patient to cover his or her mouth and nose with a tissue when coughing or sneezing. 4. Advises other health team members to wear masks and gowns when coming in contact with the patient.

Answer: 1. Places a mask on the patient before leaving the room. Rationale: Patient who are transported outside of their rooms need to wear surgical masks to protect other patients and personnel.

The nurse sets up a nonbarrier sterile field on the patient's overbed table. In which of the following instances is the field contaminated? 1. Sterile saline solution is spilled in the field. 2. The nurse, who has a cold, wears a double mask. 3. Sterile objects are kept within a 1-inch border of the field. 4. The nurse keeps the top of the table above his or her waist.

Answer: 1. sterile saline solution is spilled in the field. Rationale: If moisture leaks through a sterile package's protective covering, organisms can travel to the sterile object.

Which of the following is not an element in the development or chain of infection? 1. Means of transmission 2. Infectious agent or pathogen 3. Formation of immunoglobulin 4. Reservoir for pathogen growth

Answer: 3. Formation of immunoglobulin Rationale: Infection occurs in a cycle that depends on the presence of certain elements.

Aerobic bacteria

Bacteria that require oxygen for survival

Anaerobic bacteria

Bacteria that thrive with little or no free oxygen

Identify a cause for the following risk for infections - *Chronic disease*

COPD, heart failure, diabetes

Identify the rationale for the following personal protective equipment

Gowns: Prevent soiling clothing during contact with patients. Respiratory protection: A full-face protection when you anticipate splashing or spraying of blood of bodily fluid into your face and a mask to satisfy droplet or airborne precautions. Protective eyewear: should be worn for procedures that generate splashes or splatters. Gloves: prevent the transmission of pathogens by direct and indirect contact.

__________________ is the most effective way to break the chain of infection.

Hand Hygiene

Immunocompromised

Having an impaired immune system.

Identify a cause for the following risk for infections - *Occupation*

Health care worker; miner, unemployed, homeless

Explain the most common modes of transmission - Airborne

Droplets that suspend in the air via coughing/sneezing or carried on dust particles

Identify a cause for the following risk for infections - *Lifestyle behaviors*

Exposure to communicable/infectious diseases, use of IV drugs and other drugs/substances

Identify a cause for the following risk for infections - *Trauma*

Fractures, internal bleeding

Susceptibility

Individual's degree of resistance to pathogens.

Pathogen

Infectious agent

Identify a cause for the following risk for infections - *Diagnostic procedures*

Invasive radiology,transplant

Basophils

Normal adult values: 0.5% - 1.5% Indication of infection: Normal during infection

Eosinophils

Normal adult values: 1% - 4% Indication of infection: Increased in parasitic infection

Monocytes

Normal adult values: 2% - 8% Indication of infection: Increased in protozoan, rickettsial, and tuberculosis infections.

Lymphocytes

Normal adult values: 20% - 40% Indication of infection: Increased in chronic bacterial and viral infection, decreased in sepsis

WBC count

Normal adult values: 5,000 - 10,000 Indication of infection: Increased in acute infection, decreased in certain viral or overwhelming infections.

Neutrophils

Normal adult values: 55% - 70% Indication of infection: Increased in acute suppurative (pus-forming) infection, decreased in overwhelming bacterial infection (older adult)

Iron level

Normal adult values: 80 - 180 for men 60 - 160 for women Indication of infection: Decreased in chronic infection

Cultures and Gram stain of wound, sputum, and throat

Normal adult values: No WBC's on Gram stain, possible normal flora Indication of infection: Presence of infectious microorganism growth and WBC's on Gram stain.

Cultures of urine and blood

Normal adult values: Normally sterile, without microorganisms growth. Indication of infection: Presence of infectious microorganisms growth.

Erythrocyte sedimentation rate

Normal adult values: Up to 15 for men 20 for women Indication of infection: Elevated in presence of inflammatory process.

Identify a cause for the following risk for infections - *Nutrition*

Obesity, anorexia

Colonization

Organism that multiplies within a host but does not cause an infection

Explain then normal body defenses against infection - Normal flora:

The body contains microorganisms that reside on the surface and deep layers of the *skin, in saliva and oral mucosa, and in the intestinal walls and genitourinary tract* that maintain health.

Explain then normal body defenses against infection - Body system defenses:

The skin, mouth, eyes, respiratory tract, urinary tract, genitourinary tract, and vagina have unique defenses against infection.

List the seven principles of surgical asepsis

a. A sterile object remains sterile only when touched by another sterile object. b. Place only sterile objects on a sterile field. c. A sterile object or field out of the range of vision or an object held below a person's waist is contaminated. d. A sterile object or field becomes contaminated by prolonged exposure to air. e. When a sterile surface comes in contact with a wet, contaminated surface, the sterile object or field becomes contaminated by capillary action. f. Because fluid flows in the direction of gravity, a sterile object becomes contaminated if gravity causes a contaminated liquid to flow over the object's surface. g. The edges of a sterile field or container are considered to be contaminated.

Development of an infection occurs in a cycle that depends on the following elements - Chain of Infection: PRXTEH (6)

a. An infectious agent or pathogen b. A reservoir or source for pathogen growth c. A portal of exit from the reservoir d. A mode of transmission e. A portal of entry to a host f. A susceptible host

List in order the steps for performing a sterile procedure:

a. Assemble all equipment b. Don caps, masks, and eyewear c. Open sterile packages d. Open sterile items on a flat surface e. Open a sterile item while holding it f. Prepare a sterile field g. Pour sterile solutions h. Surgical scrub i. Apply sterile gloves j. Don a sterile gown

Identify clinical situations in which a nurse would use surgical asepsis. (3)

a. During procedures that require intentional perforation of the patient's skin. b. When the skin's integrity is broken as a result of trauma, surgical incision, or burns c. During procedures that involve invasive procedures, such as insertion of catheters or surgical instruments.

The elements of respiratory hygiene or cough etiquette are:

a. Education of health care facility staff and visitors b. Posters and written material for agency and visitors c. Education on how to cover your nose and mouth when you cough, using a tissue, and the prompt disposal of the contaminated tissue. d. Placing a surgical mask on the patient if it will not compromise respiratory function or is applicable. e. Hand hygiene after contact with contaminated respiratory infections. f. Spatial separation greater than 3 feet from persons with respiratory infections.

The expected outcome is the absence of signs and symptoms of infection. List some ways the nurse can monitor the patient.

a. Monitor patients postoperatively, including surgical sites, invasive sites, the respiratory tract, and the urinary tract. b. Examine all invasive and surgical sites for swelling, erythema, or purulent drainage. c. Monitor breath sounds d. Review laboratory results.

List four common goals for a patient with an actual or potential risk for infection.

a. Preventing exposure to infectious organisms b. Controlling or reducing the extent of infection c. Maintaining resistance to infection d. Verbalizing understanding of infection prevention and control techniques.

List the nine responsibilities of infection control professionals

a. Provide staff and patient education b. Develop and review infection prevention and control policies and procedures. c. Recommend appropriate isolation procedures. d. Screen patient records. e. Consult with health departments f. Gather statistics regarding *epidemiology* g. Notify the public health department of incidences of communicable diseases. h. Consult with all departments to investigate unusual events or clusters. i. Monitor antibiotic-resistant organisms

Identify some common *Nursing Diagnoses* that apply to patients at risk or who have an actual infection.

a. Risk for infection b. Imbalanced nutrition c. Impaired oral mucous membrane d. Risk for impaired skin integrity e. Social isolation f. Impaired tissue integrity g. Readiness for Enhanced Immunization Status

Identify some common waste materials that are considered infectious

a. Wounds b. Blood c. Stool d. Urine

Isolation precautions:

airborne, droplet, contact, and protective environment

Identify the sites of health care-associated infections.

c. Respiratory tract a. Urinary tract d. Bloodstream b. Surgical or traumatic wounds

Explain then normal body defenses against infection - Inflammation:

the body's response to injury. infection, or irritation. It is a protective vascular reaction that delivers fluid, blood products, and nutrients to the area of injury.