Infection Control (chapter 31) outcomes

_______ is the freedom from disease-causing microorganisms.

asepsis

Cytotoxic T cells

attack and kill microorganisms and sometimes the body's own cells

Differentiate active from passive immunity

*Active immunity*: host produces antibodies in response to natural antigens *Passive immunity*: host receives natural or artificial antibodies from another source

Identify factors that increase susceptibility to infection

*Age*: newborns have immature immunes systems; immune responses weaken with advanced age *Heredity*: genetic susceptibility to some infections *Level of stress*: stressors elevate cortisol, leading to decreased anti inflammatory response, exhaustion and decreased resistance to infection *Nutritional status*: antibodies are PROTEINS *Current medical therapies*: radiation kills normal cells, diagnostic procedures that break skin, certain meds that depress bone marrow function (reduced WBCs), kill flora in large intestine *Preexisting diseases*: i.e., chronic pulmonary disease that impairs ciliary action and weakens mucous barrier, peripheral vascular disease which reduces blood flow, diabetes

Types of nosocomial infections

*Iatrogenic*- diagnostic or therapeutic procedure-IV line *Exogenous*-facility environment or personnel-URI (upper respiratory infection) *Endogenous*-from the client-reactivation dormant organism (TB)

Lab tests

*WBCs*- 4500 - 11, 000 *ESR* (erythrocyte sedimentation rate)-increased rate of RBCs settling in presence of inflammatory process *C&S*-culture & sensitivity: determines organism and effective medication; includes urine, blood, sputum, drainage

Course of infection

*incubation period*: time between initial contact and appearance of symptoms *prodromal stage*: time form onset of nonspecific symptoms to more specific symptoms; transmission is possible *full/illness stage*: time that specific symptoms are present; acute; transmission is possible *convalescence stage*: time when symptoms resolve and host returns to pre-illness state

Identify measures that break each link in chain of infection: Portal of exit from reservoir

-avoid talking, coughing, sneezing over opened wounds or sterile fields and cover mouth and nose

Identify measures that break each link in chain of infection: Etiologic agent

- correctly disinfect and sterilize articles before use -educate client/support persons about appropriate methods to sterilize and disinfect

Anatomic and physiologic barriers that defend body against microorganisms

-Intact skin/mucous membranes -dry skin deters microorganisms -resident bacteria on skin prevent other bacteria from multiplying (they use up available nourishment) -acidic skin secretions -moist mucous membranes and cilia of nasal passages -alveolar macrophages in lungs -mouth: sheds regularly to rid mouth of colonizers saliva contains microbial inhibitors -eyes protected by tears -stomach protected by acidic environment -resident flora in large intestine (peristalsis also helps move bacteria out) -low pH in vagina -urine flow keeps bacteria from ascending the urethra

Identify measures that break each link in chain of infection: Portal of entry to susceptible host

-Use sterile technique for invasive procedures -use sterile technique when exposing open wounds or handling dressings -place used disposable needles and syringes in puncture resistant containers for disposal -provide clients with own personal care items

Susceptible host

-any person at risk for infection -many factors affect susceptibility -compromised host (one at increased risk) -very young or very old in age -clients receiving immunosuppressive treatment -chronic illness -those with immune deficiency conditions

Portal of exit from reservoir

-before infection can establish itself in host, it must leave reservoir: *Respiratory tract* -nose/mouth through sneezing, coughing, breathing, talking *GI tract* mouth: saliva, vomitus; anus: feces; ostomies: feces *urinary tract* -urethral meatus and urinary diversion *reproductive tract* -vagina: discharge; urinary meatus: semen, urine *blood* -open wound, needle puncture site, any disruption of intact skin or mucous membrane surfaces *tissue* -drainage from cut or wound

Vascular response (1st stage)

-blood vessels constrict -tissue releases histamine -small blood vessels at site of injury dilate, thus increasing blood flow to injury -responsible for signs of redness and heat -vascular permeability increases; fluid and WBCs leaks into interstitial spaces

Identify measures that break each link in chain of infection: Reservoir

-change dressings and bandages when soiled or wet -assist clients to carry out appropriate skin and oral hygiene -disposed of soiled linens appropriately -dispose of feces, urine in appropriate receptacles - ensure fluid containers are covered and capped -empty caution and drainage bottles before full or at end of shift (according to agency policy)

Identify measures that break each link in chain of infection: Method of transmission

-clean hands between clients, after touching body substances, and before performing invasive procedures or touching open wounds -Instruct clients and support to cleanse hands before handling food or eating, after eliminating, and after touching infectious material -wear gloves when handling secretions and excretions -wear gowns if danger of soiling clothing with body substances -place discarded soiled materials in moisture proof refuse bags -hold bedpans steadily to prevent spillage, dispose of urine/feces in appropriate receptacles. Initiate and implement aseptic precautions for all clients -wear masks and eye protection (droplets from respiratory tract/when sprays of body fluids are possible)

Exudate production (2nd stage)

-consists of fluid escaped from the blood vessels, death phagocytes, and dead tissue cells and products that they release -injurous agent is overcome; exudate is cleared away by lymphatic drainage Major types of exudate: -serous -purulent (pus) -sanguinous (hemmorrhagic)

C&S PEP

-culture & sensitivity (test to find out what kind of organism causes infection & checks to see what kind of medication will best treat the infection) -post exposure protocol

Signs/symptoms of systemic infection

-fever -leukocytosis (leukocytes enter interstitial tissue and bone marrow increase WBC production exponentially to replace in blood stream) -increased pulse and respiratory rate if fever is high -malaise and loss of energy -lymph node enlargement -anorexia and, in some situations, nausea and vomiting -enlargement and tenderness of lymph nodes that drain that area of infection

Cellular response (still 1st stage)

-fluid & WBCs in interstitial spaces -edema and pain appear -pain caused by pressure of accumulating fluid on nerve endings and irritating chemical mediators -WBCs exit into interstitial spaces, bone marrow makes large amounts of leukocytes to put in blood (leukocytosis)

Medical asepsis

-includes all practices intended to confine a specific microorganism to a specific area, limiting the number, growth, and transmission of microorganisms. -objects are referred to as "clean" and "dirty"

Signs/symptoms of localized infection

-localized swelling, redness, pain, heat -loss of function of body part affected (depending on extent of involvement) -vascular response -cellular response -exudate

Identify measures that break each link in chain of infection: Susceptible host

-maintain integrity of client's skin and mucous membranes -ensure client receives a balanced diet -educate public on importance of immunizations -encourage deep, slow, full breathing, ambulation, and movement -offer stress management strategies and encourage healthy relationships

Identify risks for nosocomial infection

-nosocomial infections: infections that originate in the hospital Risks -catheterization (urinary tract 33%) -surgical wounds (22%) -IVs (bloodstream 14%) -respiratory procedures (respiratory tract 15%) -compromised host **poor hand hygiene is common vehicle

Portal of entry to susceptible host

-place where infectious microorganism enters the body -breaks in skin can serve as portal of entry -microorganisms generally use same route to enter body as they used to leave the source

Risks for nosocomial infections

-poor hand washing -compromised host-surgery--illness -improper procedure technique--dressing , suctioning, catheterization -improper cleaning-maintenace of invasive devices--foley caths, IV lines -contamination of closed drainage system--chest tubes

Tissue repair (3rd stage)

-repair of injured tissues by regeneration or replacement with fibrous tissue scar formation -when regeneration is not possible, granulation tissue is formed (beginning of scar)

Describe steps to take in event of a blood-borne pathogen exposure

-report incident immediately -complete accident report and incident report -seek appropriate evaluation and follow up including: -identification and documentation of the source individual when feasible and legal -testing of source for Hep B, Hep C, and HIV when feasible and consent is given -postexposure prophylaxis if medically indicated -medical/psychological counseling *Puncture/Laceration* -allow some bleeding to drain the site but don't squeeze tissue -wash area with soap and water -initiate first aid and seek treatment if needed *Mucous membrane exposure* -saline or water flush for 5-10 minutes ***specific post exposure protocol for HIV, Hep B, and Hep C listed on page 711

Identify interventions to reduce risks for infection (pg 686-infection control)

-teach proper hand hygiene -before handling foods, before eating, after toiling, before and after home care treatment, after touching any body substances -promote nail care: keep fingernails short, clean ,well manicured to eliminate rough edges/hangnails that harbor microorganisms -instruct not to share personal care items and describe rationale of how infections can be transmitted from shared items -toothbrushes, washcloths, towels -discuss antimicrobial soaps and effective disinfectants -ensure access to and proper use of gloves and other barriers and indicated by the type of infection or risk -discuss the relationship between hygiene, rest, activity, and nutrition in the chain of infection -Instruct about proper administration of medication -Instruct about cleaning reusable equipment and supplies. Use soap, water, and disinfect with a chlorine bleach solution

Common sites for nosocomial infections

-wounds -urinary tract -respiratory tract -blood stream

Which is the most effective nursing action for controlling the spread of infection? 1. Thorough hand hygiene 2. Wearing gloves and masks when providing direct client care 3. Implementing appropriate isolation precautions 4. Administering broad-spectrum prophylactic antibiotics

1.

A client with poor nutrition enters the hospital for treatment of a puncture wound. What would be the most appropriate nursing diagnosis? 1. Risk for Infection 2. Acute Pain 3. Imbalanced Nutrition

1. (most immediate health risk)

The CDC recommends antimicrobial hand cleansing agents in all of the following situations EXCEPT: 1. where there are unknown multiple nonresistant bacteria 2. before invasive procedures 3. in special care units, such as nurseries and ICUs 4. before caring for severely immunocompromised clients.

1. (should be where there are KNOWN multiple nonresistant bacteria)

When caring for a single client during one shift, it is appropriate for the nurse to reuse only which of the following personal protective equipment? 1. goggles 2. gown 3. surgical mask 4. clean gloves

1. (unless goggles have been splashed on they can be worn repeatedly)

The nurse evaluates the chart of a 65 year old client with no apparent risk factors and concludes that which immunizations are current? Select all that apply: 1. last tetanus booster was at age 50 2. Receives a flu shot every year 3. Has not received the Hep B vaccine 4. Has not received the Hep A vaccine 5. Has not received the herpes zoster vaccine

2, 3, & 4: (flu shot recommended yearly, Hep B & A only recommended for at risk clients. Needs booster every 10 years, and over age 65 should receive herpes zoster vaccine.)

An antigen is a: 1. host that produces antibodies in response to natural antigens (e.g., infectious microorganisms) or artificial antigens (e.g., vaccines). 2. substance that induces a state of sensitivity or immune responsiveness (immunity). 3. host that receives natural (e.g., from a nursing mother) or artificial (e.g., from an injection or immune serum) antibodies produced by another source 4.part of the body's plasma proteins

2.

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? 1. Eliminate the reservoir 2. Block the portal of exit from the reservoir 3. Block the portal of entry into the host 4. Decrease the susceptibility of the host

2.

Which types of precautions are used for clients known or suspected to have serious illnesses transmitted by particle droplets larger than 5 microns? 1. Airborne 2. Droplet 3. Contact 4. Connection

2.

After teaching a client and family strategies to prevent infection, which statement by the client would indicate effective learning has occurred? 1. "We will use antimicrobial said and hot water to wash our hands at least 3x/day." 2. "We must wash or peel all raw fruits and vegetables before eating." 3. "A wound or sore is not infected unless we see it draining pus." 4. "We should not share toothbrushes but it's OK to share towels and washcloths."

2. (raw foods touched by human hands can carry microorganisms and should be washed or peeled)

A nurse is evaluating a nursing student's understanding of types of infections. Which of the following statements demonstrates a need for more teaching? 1. A local infection is limited to the specific part of the body where the microorganisms remain. 2. If the microorganisms spread and damage different parts of the body, it is a systemic infection. 3. Acute infections may occur slowly, over a very long period, and may last months or years. 4. Nosocomial infections are classified as infections that are associated with the delivery of health care services in a health care facility.

3.

A nurse is planning a seminar on the chain of infection. Which of the following is NOT one of the six links? 1. Etiologic agent 2. Reservoir 3. Handwashing 4. Mode of transmission

3.

In caring for a client on contact precautions for a draining infected foot ulcer, which action should the nurse perform? 1. Wear a mask during dressing changes 2. Provide disposable meal trays and silverware 3. Follow standard precautions in all interactions with the client 4.Use surgical aseptic technique for all direct contact with the client.

3.

Which of the following consists primarily of nucleic acid and therefore must enter living cells in order to reproduce? 1. Fungi 2. Bacteria 3. Viruses 4. Parasites

3.

Which of the following statements about disinfectants is is INCORRECT? 1. A disinfectant is a chemical preparation, such as phenol or iodine compounds, used on inanimate objects. 2. Disinfectants are frequently caustic and toxic to tissues. 3. Disinfectants and antiseptics often have similar chemical components, but the disinfectant is a less concentrated solution. 4. A disinfectant is an agent that destroys pathogens other than spores.

3.

Assuming all articles were sterile when applied, what areas are considered sterile on a person in an operating room? 1. back of the surgical gown 2. front of a surgical mask 3. front of a surgical gown, chest level 4. upper arm of gown 5. scrubs underneath gown

3. (Sterile objects are considered unsterile if placed below the waist. Above the neck, higher than 2 inches above the elbow, below the waist/table, and back are all considered unsterile.)

The nurse determines that a field remains sterile if which of the following conditions exist? 1. tips of wet forceps are held upward when held in ungloved hands 2. the field was set up 1 hour before the procedure 3. sterile items are 2 inches from the edge of the field 4. the nurse reaches over the field rather than around the edges

3. (all items within 1 inch of edge of sterile field are considered contaminated because the edge of the field is in contact with unsterile areas. When hands are ungloved, forceps tips are to be held downward to prevent fluid from becoming contaminated by hands and then returned to sterile field. Fields should be established immediately before use to prevent accidental contamination. Reaching over sterile field increased chance of dropping unsterile item onto or touching sterile field.)

Inflammation is a local and nonspecific defensive response of the tissues to an injurious or infectious agent. Which of the following is NOT a sign of inflammation? 1. pain 2. swelling 3. redness 4. fatigue

4.

While applying sterile gloves (open method), the cuff of the first glove rolls under itself about 1/4 inch. What is the best action for the nurse to take? 1. Remove the gloves and start over with a new pair 2. Wait until the second glove is in place and then unroll the cuff with the other sterile hand 3. Ask a colleague to assist by unrolling the cuff 4. Leave the cuff rolled under

4. (It should not be necessary to unroll this small portion of the cuff. The concern is the hands and fingers of the glove that will be touching the client. Rolled under portion is now contaminated and should be left alone.)

Four commonly used methods of sterilization are moist heat, gas, boiling water, and radiation. Which of the following is the most practical and inexpensive method for sterilizing in the home? 1. gas 2. moist heat 3. radiation 4. boiling water

4. (moist heat needs an autoclave for steam under pressure, gas is toxic to humans, radiation does not penetrate deeply & equipment is expensive.)

Identify relevant nursing diagnoses and contributing factors for clients at risk for infection and who have infection

At risk: -Inadequate primary defenses r/t broken skin, traumatized tissue, decreased ciliary action, stasis of body fluids, etc -Inadequate secondary defenses r/t immunosuppression, decreased hemoglobin, suppressed inflammatory response Have infection: -Potential complication of Infection: Fever -Imbalanced nutrition: Less that body requirements (client too ill to eat properly) -acute pain (from tissue damage and discomfort) -Impaired social interaction or Social Isolation (if client is required to be separated during contagion) -Anxiety (client is apprehensive about life changes resulting from infection and treatment i.e., absence from work or inability to perform ADLs.)

A nurse has prepared a sterile field for assisting a provider with a chest tube insertion. Which of the following events should the nurse recognize as contaminating the sterile field? Select all that apply. A. the provider drops a sterile instrument onto the near side of the sterile field B. The nurse moistens a cotton ball with sterile normal saline and places it on the sterile field C. The procedure is delayed 1 hour because the provider receives and emergency call D The nurse turns to speak to someone who enters through the door behind the nurse E. The client's hand brushes agains the end of the sterile field.

B, C, D (field remains sterile if you don't reach over, 1 inch border around sterile field is not sterile)

A nurse is reviewing hand hygiene techniques with a group of assistive personnel. Which of the following instructions should the nurse include when discussing hand washing? Select all that apply. A. Apply 3-5mL of liquid soap to dry hands B. Wash the hands with soap and water for at least 15 seconds C. rinse the hands with hot water D. Use a clean paper towel to turn off hand faucets E. Allow the hands to air dry after washing

B, D (dry hands get alcohol rubs, warm water not hot, dry with clean paper towel, not air.)

_______ are by far the most common infection-causing microorganisms.

Bacteria

A nurse is wearing sterile gloves in preparation for performing a sterile procedure. Which of the following object may the nurse touch without breaching the sterile technique? Select all that apply. A. A bottle containing sterile solution B. the edge of the sterile drape at the base of the field C. the inner wrapping of an item on the sterile field D. an irrigation syringe on the sterile field E. One gloved hand with the other gloved hand

C, D, E

When entering a client's room to change a surgical dressing, a nurse notes that the client is coughing and sneezing. When preparing the sterile field, it is important that the nurse A. keep the sterile field at least 6 feet away from client's bedside B. Instruct the client to refrain from coughing and sneezing during the dressing change C. place a mask on the client to limit the spread of microorganisms into the surgical wound d. keep a box of facial tissues nearby for the client to use during the dressing change

C.

_______ is the process by which strains of microorganisms become resident flora.

Colonization

A nurse has removed a sterile pack from its outside cover and placed it on a clean work surface in preparation for an invasive procedure. Which of the following clasp should the nurse unfold first? A. The flap closest to the body B. The right side flap C. The left side flap D. The flap farthest from the body

D. (priority goal is to maintain sterility. Unless nurse pulls top flap--the flap furthest from her body--away from her body first, she risks touching part of the inner surface of the wrap and thus contaminating it.)

6 links in the chain of infection

Etiologic Agent Reservoir Portal of exit from reservoir Method of transmission Portal of entry susceptible to host Susceptible host

A disease is an invasion of body tissue by microorganisms and their growth within that tissue. T/F

False

Surgical asepsis or sterile technique includes all practices intended to confine a specific microorganism to a specific area, limiting the number, growth, and transmission of microorganism. T/F

False

_______ include yeasts and molds.

Fungi

Infections that are the direct result of diagnostic or therapeutic procedures are called _______ ________.

Iatrogenic infections

Etiologic agent

Infectious process depends on: -number of microorganisms present -virulence and potency of microorganisms -ability of microorganisms to enter body -susceptibility of the host -ability of microorganism to live in hosts body

_______ infection is limited to the specific part of the body where the microorganisms remain.

Local

_______ defenses protect a person agains all microorganisms, regardless of prior exposure.

Nonspecific

_______ infections are classified as infections that are associated with the delivery of health care services in a health care facility.

Nosocomial

_______ live on other organisms.

Parasites

Describe tier 1 isolation procedures (pg 694)

Tier 1 = standard precautions -used in care of all hospitalized persons regardless of diagnosis or possible infection status -apply to blood, body fluids, excretions, secretions (except sweat), nonintact skin, mucous membranes -perform proper hygiene regardless of whether or not gloves were worn -wear clean gloves when touching contaminated items or body fluids -wear mask, eye protection, face shield if splash can be expected -wear clean, water resistant, non-sterile gown if splash is expected -handle client care equipment that is soiled carefully to avoid transfer of microorganism -handle soiled linens as little as possible. Do not shake. Bundle dirty side in and away from self -place sharps immediately in puncture proof containers

Describe tier 2 isolation procedures

Tier 2 = transmission based precautions -used to protect the nurse and others from acquiring an infectious organism -infections may be airborne, droplet, or contact

Pathogenicity is the ability to produce disease; thus a pathogen is a microorganism that causes disease. T/F

True

Sepsis is the state of infection and can take many forms, including septic shock. T/F

True

Virulence is the ability to produce disease. T/F

True

Airborne isolation procedures

Use standard precautions as well as the following: -place client in AIIR room w/negative pressure -private room-if not available, put client in room with person with same microorganism -wear respiratory mask with client suspected of having TB -if susceptible people must enter room with measles or varicella, they must wear respiratory mask -client must wear surgical mask during transport (essential movement only)

Contact isolation procedures

Use standard precautions as well as the following: -private room-if not available, put client in room with person with same microorganism -wear gloves as described in standard precautions -remove gloves before leaving client's room -cleanse hand immediately after removing gloves -can use antimicrobial agent, but must use soap & water with C-diff -wear gown if possibility of contact with infected surfaces, if client is incontinent, has diarrhea, colostomy, wound drainage not contained by dressing -remove gown before leaving room -limit movement of client outside room -noncritical client care equipment dedicated to single client or clients w/same infecting organism

Droplet isolation procedures

Use standard precautions as well as the following: -private room-if not available, put client in room with person with same microorganism -wear mask if working within 3 feet of the client --client must wear surgical mask during transport (essential movement only)

_______ consist primarily of nucleic acid and therefore must enter living cells in order to reproduce.

Viruses

_______ is the replacement of destroyed tissue cells by cells that are identical or similar in striation and function. a. Regeneration b. Antigen c. Immunity d. Antibodies

a.

Which of the following means freedom from disease-causing microorganisms? a. medical asepsis b. asepsis c. surgical asepsis d. sepsis

b.

_______ are agents that inhibit the growth of some microorganisms.

b. (antiseptics--skin)

_______ is a local and nonspecific response of the tissues to an injurious or infectious agent. a. Hyperemia b. Leukocytes c. Inflammation d.Leukocytosis

c. inflammation

A person or animal reservoir of a specific infections agent that usually does not manifest any clinical signs of disease is called a _______.

carrier

Cell mediated defenses

cellular immunity, occurs through T cell system no cellular immunity? body is defenseless against bacteria, viruses, fungi

If the infectious agent can be transmitted to an individual by direct or indirect contact or as a in airborne infection, the resulting condition is called a ________ disease.

communicable

A person at increased risk, or an individual who for one or more reasons that is more likely that others to acquire an infection is called a _______ host.

compromised

In medical asepsis, objects are considered clean or _______.

dirty

Helper T cells

help the function of the immune system

Method of transmission

how microorganism reaches another host *Direct transmission* -touching, biting, kissing, sexual intercourse -droplet spread (1-3 feet): coughing, sneezing, spitting, talking *Indirect transmission* -Vehicle borne: toys, soiled clothes, eating utensils, water, blood, etc that serve as intermediate between microorganism and susceptible host -Vector borne: animal or flying/crawling insect that serves as intermediate means of transporting infectious agent (i.e., injecting saliva through bite or dropping feces on wound) *Airborne transmission* -droplets or dust that become airborne (TB, C-diff) -usually enters respiratory tract

A (an) _______ pathogen causes disease only in a susceptible individual.

opportunistic

Surgical asepsis

practices that keep an area or object free of all microorganisms; also called sterile technique

Reservoir

sources of microorganisms -other humans -client's own microorganisms -plants/animals -general environment ***people are the most common source of infection for others and for themselves

Suppressor T cells

suppress functions of helper T cells and cytotoxic T cells

A _______ is an animal or flying or crawling insect that serves as an intermediate means of transporting the infectious agent.

vector

A _______ is any substance that serves as an intermediate means to transport and introduces an infection agent into a susceptible host through a suitable portal of entry.

vehicle