Ch 24: Asepsis and Infection Control

A client is admitted to the hospital with tuberculosis. Which statement by the nurse explains how to reduce the risk of transmission to others?

"All visitors who enter the room must wear special masks." Tuberculosis is an airborne respiratory disease, which requires a HEPA-style respirator or N95 mask when visitors or staff enter the room of a client with known or suspected disease. Gowning and gloving do not prevent airborne transmission. Visitors are permitted and there is no firm prohibition against touching the client.

The nurse is preparing to perform handwashing. Place the following steps in the correct order. Use all options.

1. Turn on the faucet and adjust force and temperature of the water. 2. Wet the hand and wrists. 3. Apply soap. 4. Wash the palms and backs of the hands for at least 20 seconds. 5. Pat the hands dry with a paper towel. 6. Turn the faucet off with a paper towel.

The nurse will assess a client who has a draining abscess. The nurse should perform what action to safely enter the room?

A draining abscess poses an infection control risk that is sufficiently addressed with contact precautions. Because there is no obvious risk of airborne or droplet transmission, masks, goggles and face shields are not warranted.

Which client presents the most significant risk factors for the development of Clostridium difficile infection?

An 81-year-old client who has been receiving multiple antibiotics for the treatment of sepsis Two common factors that increase a persons risk of becoming infected with C difficle are age greater than 65 and current or recent use of antibiotics. In this scenario, old age and recent, long-term antibiotic therapy are significant risk factors for C. difficile infection. These supersede the risks posed by recent HIV infection, skin grafts, and hemodialysis.

The nurse is caring for a client admitted with tuberculosis (TB). What would be the best action by the nurse?

Apply a nonparticulate (N-95) respirator when entering the room. TB is an airborne infection, and the nurse should wear a nonparticulate mask (N-95) respirator. Gown and gloves would be indicated for infections that are transmitted via direct contact. A mask with a face shield would be for infections that are transmitted via droplet. The client does not need to wear a mask during care.

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 The nurse should don the gown before entering the client's room to prevent soiling/contamination of the nurse's clothing with infectious bacteria/viruses and/or the client's blood and body fluids. The donning of the gown should be performed prior to assessing the client or performing a full set of vital signs (e.g., pulse, respirations).

The nurse and a colleague have admitted a client who is on contact precautions. The nurse and colleague are removing their personal protective equipment and the nurse sees the colleague perform the pictured action. What is the nurse's most appropriate response?

Encourage the colleague to remove the glove by grasping the cuff The colleague should grasp the outside of one glove with the opposite gloved hand and peel off, turning the glove inside out while peeling it off. The glove should not be pulled by the fingers, because this is unlikely to remove the glove, and it may snap back. Personal protective equipment should normally be removed while inside the room, and there is no need to maintain a wide distance from the colleague.

An experienced nurse is teaching a student nurse about the proper use of hand hygiene. Which guideline should the nurse provide to the student?

Hand hygiene is needed after contact with objects near the client. Hand hygiene must be performed when moving from a contaminated body site to a clean body site during client care and after contact with inanimate objects near the client. Using gloves does not eliminate the need for hand hygiene and, in some cases, gloves must still be used after hand hygiene. Lotions may be used to prevent irritation.

The nurse notices a student preparing to enter the room of a client with pulmonary tuberculosis with only gloves on. What is the appropriate nursing intervention?

Remind the student that a fitted N95 respirator is required. A fitted N95 respirator must be worn in addition to other precautions when caring for clients with pulmonary tuberculosis. Other answers do not recommend the appropriate precautions that must be used for this type of infection.

The nurse planning to insert an indwelling urinary catheter into a client should utilize which technique?

Surgical asepsis Surgical asepsis, also known as sterile technique, is utilized to keep objects and areas free from microorganisms when performing surgery and procedures such as insertion of an indwelling urinary catheter or IV catheter. Medical asepsis reduces the number and transfer of pathogens. Universal precautions and contact precautions help to decrease the risk of transmitting infection.

A client has a diagnosis of HIV and has been admitted to the hospital with an opportunistic infection that originated with the client's normal flora. Why did this client most likely become ill from his resident microorganisms?

The client's immune system became further weakened Unless the supporting host becomes weakened, normal flora remains controlled. If the host's defenses are weakened, as in cases of HIV/AIDS, even benign microorganisms can cause opportunistic infections. This phenomenon is not due to mutations, spore production or the direct effects of a nutritional deficit.

Personal protective equipment (PPE) is used in health care facilities for primarily which

To protect both the staff and clients from becoming infected by one another

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

True Standard precautions are used in the care of all hospitalized clients regardless of their diagnosis or possible infection status. These precautions apply to blood, all body fluids, secretions, and excretions except sweat (whether or not blood is present or visible), nonintact skin, and mucous membranes. Additions are respiratory hygiene/cough etiquette, safe injection practices, and directions to use a mask when performing high-risk prolonged procedures involving spinal canal punctures.

When preparing a sterile field, the nurse notes that bottle of sterile saline was opened 48 hours ago and is half full. What should the nurse do?

discard the bottle Once a bottle of sterile saline is open, the contents must be used within 24 hours of opening. Lipping the opening of the bottle is appropriate, but contents in the bottle are expired. Shaking the contents in the bottle is not appropriate before use. The nurse should discard the bottle and get a new one.

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

use of one gown per person per shift A new gown should be used by the nurse each time the nurse enters the room.

The patient has asked the nurse to explain her WBC level of 8,000 cells/mm3. The nurse would identify the level of WBCs as:

within normal limits A normal white blood cell count is 5,000 to 10,000 cells/mm3.

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

an incontinent client in a nursing home who has diarrhea Standard precautions apply to blood and all body fluids, secretions, and excretions, except sweat. Transmission-based precautions are used in addition to standard precautions for clients hospitalized with suspected infection by pathogens that can be transmitted by airborne, droplet, or contact routes, such as is the case in answers A, B, and D.

A nurse follows surgical asepsis techniques for inserting an indwelling urinary catheter in a client. What is an accurate guideline for using this technique?

Hold sterile objects above waist level to prevent inadvertent contamination. Holding a sterile object above waist level ensures the object is kept in sight and prevents accidental contamination. The outside of the sterile package and the outer 1 in. (2.5 cm) of a sterile field are contaminated. Sterile packages should be opened so that the first edge of the wrapper is directed away from the nurse.

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

Immediately deposit uncapped needles into puncture-proof plastic container All uncapped needles should be placed in puncture-proof plastic units immediately after use.

A nurse has been exposed to urine while changing the linens of a client's bed. Which guideline is followed for performing hand hygiene after this client encounter?

Keep hands lower than elbows to allow water to flow toward fingertips. Handwashing, as opposed to hand hygiene with an alcohol-based rub, is required when hands are exposed to body fluids. Jewelry should be removed, if possible, and secured in a safe place, but a plain wedding band may remain in place. Wet the hands and wrist area, and keep hands lower than elbows to allow water to flow toward fingertips and pat hands dry with a paper towel, beginning with the fingers and moving upward toward forearms.

The nurse must assign a room for a client admitted with endocarditis and methicillin-resistant Staphylococcus aureus (MRSA) in the blood. A client with which diagnosis can share a room with this client?

MRSA in the wound In many situations, clients with like infections can be placed together. The presence of similar causative microorganisms negates the risks of cross-contamination. Each of the other listed clients would encounter a risk for MRSA.

A nurse is caring for a client who is diagnosed with tuberculosis. Which nursing intervention promotes infection control based on nursing practice standards for safety?

The nurse places the client in a private room with monitored negative air pressure. When a client is diagnosed with tuberculosis it is important for the nurse to remember that the client should be placed in a private room with monitored negative air pressure. The client should not be placed in a room with the door open. The nurse must wear the appropriate respirator when caring for the client, but visitors must wear masks. Simply being 3 feet away will not keep the visitor from being exposed to the client. The nurse would use airborne precautions, not droplet precautions when caring for a client diagnosed with tuberculosis.

The nurse who is caring for a client in contact isolation is preparing to conduct an assessment. How will the nurse listen to the client's heart?

stethoscope that remains in the client's room A dedicated stethoscope and blood pressure cuff should remain in the client's room when a client has been placed in contact isolation. Therefore, the nurse would not use the nurse's personal stethoscope, or one that hangs outside the client's room or that was purchased by the client.

The nurses on a busy surgical ward use hand hygiene when caring for postsurgical patients. Which action represents an appropriate use of hand hygiene?

The nurse keeps fingernails less than 1/4 in (0.63 cm) long. The nurse needs to keep fingernails less than 1/4 in (0.63 cm) long. Gloves should never be used in place of hand hygiene. Gloves should always be worn when the nurse is in contact with blood. The nurse could use a hospital sanctioned hand moisturizer after hand hygiene, but this is not the best answer.

The nurse is caring for a client with a draining abscess. Which precautions will the nurse begin?

contact Fluids from a draining abscess can transmit infection through contact; therefore, contact precautions are appropriate.

The nurse is caring for an older adult with a recurrent wound infection. Which precautions will the nurse begin?

contact Wound infectious agents are transmitted through contact; therefore, contact contact precautions are appropriate.

The nurse is donning a pair of sterile gloves. The nurse correctly dons the first glove, but inadvertently inserts the thumb and index finger into the thumb hole of the second glove. The glove remains intact. Which action is most appropriate?

Continue to don the glove, then use the other gloved hand to carefully insert the finger into the proper hole. It is appropriate to adjust the gloves as long as the nurse only touches sterile surface to sterile surface. Leaving the thumb and finger in the thumb hole or only using the correctly gloved hand to perform the sterile procedure would not be appropriate, nor would donning a second pair of gloves, in this case.

A nurse is caring for a client with ringworm. Which microorganism causes ringworm in a client?

Fungi Ringworm is caused by a fungal infection. Fungi include yeasts and molds, which cause infections in the skin, mucous membranes, hair, and nails. Rickettsiae are microorganisms that resemble bacteria but cannot survive outside of another living species. They are responsible for Lyme disease. Protozoans are single-celled animals classified according to their ability to move. They do not cause ringworm. Helminths are infectious worms that may or may not be microscopic. They include roundworms, tapeworms, and flukes.

The nurse is caring for a client on the unit. During change of shift, another nurse is observed doing what is pictured in the image. What is the most important reason this technique does not adhere to the standards of care for dressing changes? - nurse blowing on wound

Increases the risk of infection by contaminating the wound Using the mouth to blow air into a wound bed or to dry the wound edges does not adhere to the standards of care or of ethics for nurses. This action will increase the risk of wound contamination and the wound is more likely to become infected as our mouths and the air we blow out harbors many kinds of bacteria that can adhere to the wound and increase the risk for infection and contamination. Every effort should be taken into consideration to use sterile equipment, solutions and medical aseptic, or clean technique to remove old dressings. Coolness to a site decreases blood flow and to heal a wound more blood flow to the site assists with healting and reducing the risk of infection. Blowing on a wound bed may cause a uncomfortable sensation to the skin or funny sensation but it will not reduce the risk of the infection. The effect of the blowing sensation and contaminants in to the wound bed demonstrates non-adherence to the standards of safe and effective wound care and management.

The nurse is preparing a client in airborne precautions for severe acute respiratory syndrome (SARS) to be transported to radiology. Which intervention will the nurse select to transport the client? Select all that apply.

Prepare the transport stretcher with a clean sheet. Place a mask on the client. Communicate about precautions with the health care team. Cover the client with a sheet during transport. The nurse will provide interdepartmental coordination, use methods to prevent the spread of pathogens (such as placing a clean sheet on the stretcher, and placing a sheet over the client during transport), and ensure that the client is wearing a mask before being transported. The nurse will not refuse to transport the client.

Which nursing actions will be performed to assist in the prevention of health care-associated infections (HCAIs)? Select all that apply.

Recommend vaccinations to clients. Wash hands between caring for clients. Educate clients regarding why antibiotics are not used for viral illnesses. Washing hands often, recommending vaccinations, using PPE for all clients, and educating clients on why antibiotics are not used for viral infections are appropriate interventions to decrease HCAIs. It is not appropriate to place clients with similar conditions in the same room, or use personal protection equipment only for clients in isolation. Personal protection should be used for all clients if there is a danger of pathogenic transmission.

A client is to have an indwelling urinary catheter inserted. Which precaution is followed during this procedure?

Surgical asepsis technique Surgical asepsis technique is the technique followed to insert an indwelling urinary catheter. Surgical asepsis techniques, used regularly in the operating room, labor and delivery areas, and certain diagnostic testing areas, are also used by the nurse at the client's bedside. Procedures that involve the insertion of a urinary catheter, sterile dressing changes, or preparing an injectable medication are examples of surgical asepsis techniques. An object is considered sterile when all microorganisms, including pathogens and spores, have been destroyed. Medical asepsis, or clean technique, involves procedures and practices that reduce the number and transfer of pathogens. Medical asepsis procedures include performing hand hygiene and wearing gloves. Strict reverse isolation is an isolation technique where the client is protected from the nurse, other health care providers, and visitors. A client that has immune system disorders, in which the client might not be able to fight off an organism, would be kept in an environment to minimize exposure to the organism. Droplet precaution is a technique where appropriate personal protective equipment (PPE) is worn so as not to carry the organism via droplet from exposed client to others

The nurse is teaching a new nurse about preparing a sterile field. Which action made by the new nurse would indicate further teaching is required?

The new nurse touches 1.5 in. (4 cm) from the outer edges. The outer 1 in. (2.5 cm) of the sterile package is safe to touch. It is necessary to call for help if supplies are needed before leaving the sterile field unattended and never turn away from a prepared field so direct visualization is imperative to protect the sterility. The top flap of the sterile packaging should always be opened away from the body.

The nurse is preparing to apply a prescription ointment to the client's would. After reviewing the image, what is the most important step for the nurse to take?

Use a sterile cotton-tipped applicator to apply the prescription to the site Applying the ointment with the gloved finger contaminates the prescription ointment. Sterile cotton-tipped applicators are used to apply ointments or solutions to the wound bed to avoid contaminating the wound. A 4 × 4 gauze pad should not be applied until the wound is cleansed properly with sterile supplies. Soiled dressing supplies should be placed in a biohazardous trash bag or container.

Which personal protective equipment (PPE) should the nurse don to enter the room of a client who is diagnosed with Clostridium difficile?

gown and gloves A client with Clostiridium difficile requires contact isolation. Gown and gloves are the most appropriate options for this client; more so than goggles and gloves, respirator masks and gowns, and masks and shoe covers.

The nurse observes an unlicensed assistive personnel (UAP) collecting a urine specimen from a client with Staphylococcus aureus infection. Which action by the UAP would require the nurse to intervene?

removes gloves and walks out of the room The nurse should intervene if the UAP removes gloves and walks out the room without performing hand hygiene. Personal protective equipment (PPE), including gloves, gowns, masks, and googles, are used as barriers to prevent direct contact with blood, body fluids, secretions, and excretions. PPE is also used to protect clients from microorganisms transmitted by nursing personnel when performing procedures or care. Hand hygiene should be performed before and after wearing gloves and direct contact with clients. Asking the client to state his or her name and date of birth is important to make sure the specimen is collected with the correct laboratory label. To protect the UAP from direct contact with the urine, a face mask is indicated.

A client has an inguinal hernia repair and later develops a methicillin-resistant Staphylococcus aureus (MRSA) infection. What is the most important factor to prevent this infection?

surgical asepsis Clients are at risk for health care-associated infections when the health care staff does not follow safety guidelines. Medical and surgical asepsis are the primary safety interventions for preventing disease in the health care environment.