Chapter 24: Asepsis and Infection Control

4 main categories of HAI's

1. Catheter-associated urinary tract infection (CAUTI) 2. Surgical site infection (SSI) 3. Central line-associated bloodstream infection (CLABS 4. Ventilator-associated pneumonia (VAP)

A nurse is caring for patients in an isolation ward. In which situations would the nurse appropriately use an alcohol-based hand rub to decontaminate the hands? (select all that apply) A. providing a bed bath for a patient B. visibly soiled hands after changing the bedding of a patient C. removing gloves when patient care is completed D. inserting urinary catheter in female patient E. assisting with a surgical placement of a cardiac stent F. removing old magazines from a patients table

A, C, D, F

Which of the following are names of the transmission based precautions defined by the CDC? (select all that apply) A. microbial precautions B. contact precautions C. respiratory precautions D. droplet precautions E. airborne precautions F. body fluid precautions

B, D, and E

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. the nurse moves the patient table away from the nurse's body when wiping it off after a meal Rationale: the nurse should carry soiled linens away from the body, and should not put them on the floor to prevent contamination, and should clean the least soiled items first to minimize contamination

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 waist strings, remove gloves, goggles, gown, mask; perform hand hygiene. D. Remove goggles, mask, gloves, gown, and perform hand hygiene.

C. untie gown waist strings, remove gloves, goggles, gown, mask; perform hand hygiene

The nurse conducting an in-service on hand hygiene determines that additional education is needed if a participant states which of the following? A. if I am able, I will wash hands after touching the clients surroundings B. I can wash my hands before a clean procedure C. I will wash my hands before touching a client D. I do not need to wash my hands if I am using gloves

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

The nurse caring for patients in a hospital setting institutes CDC standard precaution recommends for which category of patients? A. only patients diagnosed with infections B. only patients with visible blood, bodily fluids, or swear C. only patients with non-contact skin D. all patients receiving care at the hospital

D. all patients receiving care at the hospital Rationale: standard precautions apply to all patients receiving care in the hospital regardless of their diagnosis or possible infection

A nurse is caring for an obese 62- year old patient with arthritis who has developed an opened reddened area over his sacrum. Which risk factor would be a priority concern for the nurse when caring for this patient? A. imbalanced nutrition B. impaired physical mobility C. chronic pain D. infection

D. infection

Which piece of PPE should be removed first?

Gloves!

Portal of entry (cycle of disease)

How the germs enter the body. Can be through the respiratory tract, GI system, GU system, and skin (avoid this by practicing hand hygiene, wearing gloves, and wearing masks and PPE

Infection

a disease state that results from the presence of pathogens in or on a body

Infectious agent (cycle of infection)

bacteria, viruses, parasites (germs) (can avoid this by performing hand hygiene, social distancing, sterilization, and antibiotics/antimicrobials

WHO(2018) recommends using hang hygiene in 5 specific moments

before touching a patient, before a clean or aseptic procedure, after a body fluid exposure risk, after touching a patient, and after touching the patient's surroundings

Medical asepsis

clean technique, procedures and practices that reduce the number and transfer of pathogens (we use this in labs on a daily basis) this does not eliminate pathogens

Nurses role in infection

focus on breaking the cycle of infection to care for their patients

Health care-associated infections (HAI's)

formerly known as nosocomial infections are infections specifically acquired in the hospital and are seen as preventable by US Dept. of Health and Human Services

What is the most effective way to help precent the spread of organisms?

hand hygiene

Components to the cycle of infection

infectious agent, reservoir, portal of exit, means of transmission, portals of entry, and susceptible host

Eosinophil

may be increased due to allergic reaction and parasitic infection normal range is 1-4%

What is the number one way to reduce pathogens?

medical asepsis

If you are exposed to a large amount of an organism or agent you are _______ likely to become infected? more or less

more

Virulence

organisms ability to fight a disease (vulnerable populations are more at risk like the elderly and younger children)

Factors that increase risk for infection

skin and mucous membrane integrity, pH levels of GU GI and skin, white blood cells, immunizations, rest and activity level, stress level, and use of invasive or indwelling medical devices

Surgical asepsis

sterile technique, practices used to render and keep objects and areas free from microorganisms (eliminates all pathogens)

Incubation period

the time interval between when the person was infected and when symptoms start to show up

Transmission based precautions

used in addition to standard precautions for specific pathogens that can be transmitted via the air, droplets, or contact routes

Standard precautions

used in the care of all hospitalized patients regardless of their diagnosis of possible infections status, applies to all blood, bodily fluids, secretions, and excretions

Basophil

usually unaffected by infections normal range is 0.5-1%

Susceptible host (cycle of infection)

vulnerable people are more likely to get the infection from the germ or pathogen (avoid this by immunizing and screening staff for infections)

Routine nasal and rectal swabbing of a newly admitted hospital client has come back positive for methicillin-resistant Staphylococcus aureus (MRSA), indicating that the client is colonized with MRSA. The client is surprised at this finding, since he enjoys generally robust health. What should the client's nurse teach him about this diagnostic finding?

"This means that this organism is present on your skin, but it doesn't necessarily mean that you will become sick"

4 stages of infection

1. Incubation period 2. Prodromal stage 3. Full stage of illness 4. Convalescent period

Normal white blood cell count

5,000-10,000/mm3

In addition to standard precautions, the nurse would initiate droplet precautions for which patients? (select all that apply) A. Pt diagnosed with Rubella B. Pt diagnosed with diphtheria C. Pt diagnosed with varicella D. pt diagnosed with TB E. Pt diagnosed with MRSA F. an infant diagnosed with adenovirus infections

A, B, F

The nurse is caring for a client who has an infection spread by respiratory droplets and has droplet precautions isolation. The client asks if his spouse can visit him. Which response is correct?

A. "Yes as long as they wear a mask and stay 3 feet away from you"

A nurse is taking stock of the equipment in the room of an older adult client with pneumonia who has been on parenteral nutrition for a long time. Which equipment can transmit infection to older adult clients? A. indwelling catheter B. face shields C. specimen containers D. bath blanket

A. indwelling catheter Rationale: infections are often transmitted to older adults through equipment reservoirs like catheters, humidifiers, and oxygen equipment or through incisional sites like those for IV tubing and parenteral nutrition

A nurse is taking care of a client with tuberculosis who has developed residence to the ordered antibiotic. Which type of client is most likely at increased risk for infection? A. older adult B. child C. adult D. pregnant

A. older adult

The nurse is completing a sterile dressing change on a confused client. During the procedure, the client touches the contents of the opened dressing kit. What is the nurse's next action? A. open a new sterile dressing kit B. continue changing the dressing C. wash the client's hands D. restrain the client's hands

A. open a new sterile dressing kit

When accessing a client's central line, a drop of blood falls on the nurses gloved hand. Which of the following is the appropriate action by the nurse? A. perform hand hygiene after removing the glove B. have the client tested for HIV and Hep C C. report the indecent to the supervisor immediately D. follow the agency policy for exposure to communicable infections

A. perform hand hygiene after removing the gloves

The nurse is caring for a client who has active TB and is in airborne precautions. The PCP orders a CT exam of the chest. Which action by the nurse is appropriate?

A. place a surgical mask on the client and transport to the CT department at the specified time Rationale: transport clients in airborne precautions out of the room only when necessary and place a surgical mask on the client if possible

The nurse is caring for a client with a latex sensitivity. Which of these resources would be most appropriate for the nurse to access when developing the clients plan of care? A. policy for clients with a latex allergy B. the infectious disease nurse C. human resources D. ER charge nurse

A. policy for patients with a latex allergy

What is an accurate guideline for the use of PPE? A. replace gloves if they are visible soiled B. substitute personal glasses for protective eyewear if desired C. put on PPE after entering the patient room D. when wearing gloves, work from "dirty" areas to "clean" ones

A. replace gloves if they are visibly soiled

What nursing action will the nurse perform to reflect safe injection practices? A. using a sterile, single dose, disposable, syringes for each injection B. using multiple dose files when administering meds to multiple clients C. recapping needles if necessary D. cleaning injection equipment only when dirt and dust are visilbe

A. using a sterile single dose disposable syringe for each injection

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. removes all jewelry including a platinum wedding band B. washes hands to 1 in above the wrist C. uses approx. 1tsp of liquid soap D. keeps hands higher than elbow placing under faucet E. uses friction motion when washing for at least 20 seconds F. rinses thoroughly with water flowing toward fingertips

B, C, E, F

A nurse is performing a venipuncture on a client and notices a hole in one of the sterile gloves. What would be the appropriate action to take to maintain a sterile field?

B. Stop the procedure, remove the damaged gloves, wash hands, and open new sterile gloves

An acute medicine unit of a hospital currently has a number of clients who have tested positive for methicillin-resistant Staphylococcus aureus (MRSA). Which measures should the nursing staff prioritize in preventing the spread of MRSA to clients who are currently MRSA-negative? A. reduced length of stay for MRSA positive clients B. diligent hand washing practices C. prophylactic antibiotic therapy for MRSA negative clients D. constant use of gloves on the unit

B. diligent hand washing practices

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 period C. full stage of illness D. convalescent period

B. prodromal stage Rationale: during this stage vague symptoms present such as low grade fevers and fatigue. There are no obvious signs of infection during prodromal period, and they are more sever in the full stage of illness, and in the convalescent stage symptoms disappear and the patient gets better

A nurse is using PPE when bathing a patient diagnosed with C. diff 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" ones C. the nurse personalizes the care by substituting glasses for goggles D. the nurse removes PPE after the bath to talk with the patient in the room

B. the nurse works from "clean" areas to "dirty" ones Rationale: when using PPE, the nurse should work from cleaner areas to dirtier ones, put on PPE before entering the patients room and take it off after exiting, and should use goggles instead of personal eyewear

A nurse teaches a patient at home to use clean technique when changing a wound dressing. What would be a consideration when preparing this teaching plan? A. it is the personal preference of the nurse whether or not to use clean technique B. the use of clean technique is safe for the home setting C. surgical asepsis is the only safe method to use in a home setting D. it is grossly negligent to recommend clean technique for changing a wound dressing

B. the use of clean technique is safe for the home setting

A nurse who is caring for a patient diagnosed with HIV/AIDS insures a needle stick injury when administering the patients medications. What would be the first 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 PEP at appropriate time D. set up counseling sessions regarding safe practices to protect self

B. wash exposed area with warm water and soap Rationale: when a needle stick injury occurs, the nurse should wash the exposed area with warm water and soap immediately, report the incident to the appropriate person and file an incident report, consent to and wait results of blood test, consent to PEP, and attend counseling sessions

A nurse is caring for a child who is hospitalized with diphtheria. Which guideline would be appropriate when caring for this client? A. place them in a room that has negative air pressure B. wear PPE when entering the room for all interactions that may involve contact C. use a private room with the door closed D. use respiratory protection when entering the room

B. wear PPE when entering the room for all interactions that may involve contact

When is hand hygiene with an alcohol-based rub appropriate, as opposed to using hand-washing? A. before eating and after using the bathroom B. when hands are not visibly soiled C. when hands have been in contact with blood or bodily fluids but there is no visible soiling D. when hands have been in contact with blood or bodily fluids

B. when hands are not visibly soiled

The nurse assesses patients to determine their risk for HAI's. Which hospitalized patient would the nurse consider most at risk for developing this type of infection? A. a 60 y/o who smokes 2 packs of cigarettes a day B. a 40 y/o who has a white blood cell count of 6,000mm3 C. a 65 y/o who has an indwelling urinary catheter in place D. a 60 y/o who is a vegetarian and slightly underweight

C. a 65 y/o with an indwelling catheter

For which client would the use of standard precautions alone be appropriate? A. a child with chickenpox B. a client with diphtheria C. an incontinent client in a nursing home who has diarrhea D. a client with TB who needs meds

C. an incontinent patient in a nursing home

The friend of a long-term care patient comes to visit despite having an upper respiratory infection. What is the appropriate nursing response? A. the client cannot have visitors today B. thanks for coming to visit, the client has missed you C. please use a mask when visiting with the client to prevent infection D. you may visit for a short period of 5 minutes

C. please wear a mask when visiting to prevent infection

The nurse begins a task and then realizes that personal protective equipment (PPE) is needed. What is the correct action by the nurse? A. complete the task then obtain PPE B. ask a colleague to perform the task C. stop and obtain appropriate PPE D. leave PPE in the room

C. stop and obtain appropriate PPE

Upon review of a client's microbiology culture results, the nurse recognizes which organism as indicative of normal flora? A. shigella in the urinary tract B. E. coli in the urinary tract C. Shigella in the intestinal tract D. E. coli in the intestinal tract

D. E. coli in the intestinal tract Rationale: it resides in the GI tract and is normal flora that does not cause harm or infection

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. consider the outer 1 inch of the sterile field as contaminated

An infection control nurse is discussing needlestick injuries with a group of newly hired nurses. The nurse informed then that most needlestick injuries result from: A. faulty needles and syringes B. needles left in the clients linens C. full needle boxes D. recapping a needle

D. recapping a needle Rationale: nurses are instructed to never recap needles so that these sticks do not occur

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 the waist to prevent inadvertent contamination

Portal of exit (cycle of infection)

how the pathogen leaves the reservoir. Can be from the mouth via vomit and saliva, from cuts in the skin via the blood, during diapering and toileting via the stool (avoid by having dry dressings, using hand hygiene, and wearing gloves)

Mode of transmission (cycle of infection)

how the pathogen or virus is contracted. Can be by contact, or droplet and is indirect or direct (avoid this by using hand hygiene, pesticides, and food safety precautions)

Neutrophils

increased in acute infections that produce pus, may also be increased due to stress Normal range- 60-70%

Lymphocytes

increased in chronic bacterial and viral infections Normal range is 20-40%

Monocytes

increased in severe infections normal range is 2-8%

Prodromal stage

patient is unaware they are infected, the organism multiplies and the symptoms are vague (ex: you have a runny nose or a headache)

Convalescent period

recovery, the timing is dependent on how sick the patient is and how severe the illness got, the patient is getting better at this stage

Elevated erythrocyte sedimentation rate (SED rate)

red blood cells settle more rapidly to the bottom of the tube of whole blood when inflammation is present

How to reduce HAI's

use proper hand hygiene recommendations, follow infection prevention protocols, keep patients in the best possible physical conditions to help them fight infections, and learn to deal with multi drug resistant organisms

Reservoir (cycle of infection)

where the germs live (ex: ticks on dogs; the dog would be the reservoir for the tick) can also include humans (avoid this by using transmission based precautions)

Full stage of illness

you see the major signs of illness, severity depends on whatever the illness is (strep- throat is raw and you are running a fever)