Fundamentals: Infection control (ch. 39)
_____ infectious agents attach to skin when in contact with something contaminated. Readily transmitted.
Transient
______ microorganisms attach to the skin when a person has contact with another person or object during normal activities.
Transient
When hands are visibly soiled or contaminated with blood or body fluids, wash them with
either a nonantimicrobial or an antimicrobial soap and water.
An DECREASE in normal Lymphocyte values (20%-40%) would indicate:
sepsis
Decreased values of normal Lymphocytes (below 20%) would indicate:
sepsis
Airborne:
smaller than 5 microns- these patients need a negative pressure room, need N95 mask
An infection will develop when ______.
the individual becomes susceptible to the strength and number of microorganisms
Transmission based precautions
Tier Two
The presence of infectious microorganism growth in cultures of blood or urine is an indication of :
infection
Signs and symptoms of Systemic Infection:
-fever -increased pulse and respiration -loss of energy -anorexia -enlarged lymph nodes
________ is the most effective way to break the chain of infection (CDC, 2008a; WHO, 2009).
Hand hygiene
Microorganism, causing the disease (infectious agent), include:
-Bacteria-staph -Viruses-hepatitis, HIV -Fungi-candida -Protozoa-worms, ticks
Which type of personal protective equipment are staff required to wear when caring for a pediatric patient who is placed into airborne precautions for confirmed chicken pox/herpes zoster? Select all that apply. -Disposable gown -N 95 respirator mask -Face shield or goggles -Surgical mask -Gloves
-Disposable gown -N 95 respirator mask -Gloves (The organism is dispersed into the air and is light enough to stay afloat for long periods of time. Wearing protective covering and the filtration mask or hood prevents the staff from breathing in the infected air particles.)
A patient has an indwelling urinary catheter. Why does an indwelling urinary catheter present a risk for urinary tract infection? Select all that apply. -It allows migration of organisms into the bladder. -The insertion procedure is not done under sterile conditions. -It obstructs the normal flushing action of urine flow. -It keeps an incontinent patient's skin dry. -The outer surface of the catheter is not considered sterile.
-It allows migration of organisms into the bladder. -It obstructs the normal flushing action of urine flow. (The presence of a catheter in the urethra breaches the natural defenses of the body. Reflux of microorganisms up the catheter lumen from the drainage bag or backflow of urine in the tubing increases the risk for infection. The indwelling catheter should always be placed under sterile conditions.)
Which of the following actions by the nurse comply with core principles of surgical asepsis? Select all that apply. -Set up sterile field before patient and other staff come to the operating suite. -Keep the sterile field in view at all times. -Consider the outer 2.5 cm (1 inch) of the sterile field as contaminated. -Only health care personnel within the sterile field must wear personal protective equipment. -The sterile gown must be put on before the surgical scrub is performed.
-Keep the sterile field in view at all times. -Consider the outer 2.5 cm (1 inch) of the sterile field as contaminated. (Keeping the sterile field in view at all times confirms that no contamination has occurred. The outer 2.5-cm (1-inch) of the sterile field is the most likely place for accidental contamination. The sterile table should be set up after the patient and staff are in the room to prevent a higher risk of contamination of the sterile field by air current. All surgical personnel will be wearing protective personal equipment in the surgical suite, not just those within the sterile field. The sterile gown and gloves are donned after the surgical scrub.)
For this pathogen, list the type of organism, it's major reservoir(s), and major infections/diseases it cause: Streptococcus (beta-hemolytic group B) organisms
-Organism: Bacteria -Major Reservoir: Adult genitalia -Major Infection/disease: Urinary tract infection, wound infection, postpartum sepsis, neonatal sepsis
For this pathogen, list the type of organism, it's major reservoir(s), and major infections/diseases it cause: Mycobacterium tuberculosis
-Organism: Bacteria -Major Reservoir: Droplet nuclei from lungs, larynx -Major Infection/disease: Tuberculosis
For this pathogen, list the type of organism, it's major reservoir(s), and major infections/diseases it cause: Neisseria gonorrhoeae
-Organism: Bacteria -Major Reservoir: GU tract, rectum, mouth -Major Infection/disease: Gonorrhea, pelvic inflammatory disease, infectious arthritis, conjunctivitis
For this pathogen, list the type of organism, it's major reservoir(s), and major infections/diseases it cause: Streptococcus (beta-hemolytic group A) organisms
-Organism: Bacteria -Major Reservoir: Oropharynx, skin, perianal area -Major Infection/disease: "Strep throat", rheumatic fever, scarlet fever, impetigo, wound infection
For this pathogen, list the type of organism, it's major reservoir(s), and major infections/diseases it cause: Staphylococcus epidermidis
-Organism: Bacteria -Major Reservoir: Skin -Major Infection/disease: Wound infection, bacteremia
For this pathogen, list the type of organism, it's major reservoir(s), and major infections/diseases it causes: Staphylococcus aureus
-Organism: Bacteria -Major Reservoir: Skin, hair, anterior nares, mouth -Major Infection/disease: Wound infection, pneumonia, food poisoning, cellulitis
For this pathogen, list the type of organism, it's major reservoir(s), and major infections/diseases it cause: Rickettsia rickettsii
-Organism: Bacteria -Major Reservoir: Wood tick -Major Infection/disease: Rocky Mountain spotted fever
For this pathogen list the type of organism, it's major reservoir(s), and major infections/diseases it causes: Escherichia coli
-Organism: Bacteria -Major Reservoir: colon -Major Infection/disease: Gastroenteritis, urinary tract infection
For this pathogen, list the type of organism, it's major reservoir(s), and major infections/diseases it cause: Candida albicans
-Organism: Fungi -Major Reservoir: Mouth, skin, colon, genital tract -Major Infection/disease: Candidiasis, pneumonia, sepsis
For this pathogen, list the type of organism, it's major reservoir(s), and major infections/diseases it cause: Aspergillus organisms
-Organism: Fungi -Major Reservoir: Soil, dust, mouth, skin, colon, genital tract -Major Infection/disease: Aspergillosis, pneumonia, sepsis
For this pathogen, list the type of organism, it's major reservoir(s), and major infections/diseases it cause: Plasmodium falciparum
-Organism: Protozoa -Major Reservoir: Blood -Major Infection/disease: Malaria
For this pathogen, list the type of organism, it's major reservoir(s), and major infections/diseases it cause: Hepatitis B virus
-Organism: Virus -Major Reservoir: Blood and certain body fluids, sexual contact -Major Infection/disease: Hepatitis B
For this pathogen, list the type of organism, it's major reservoir(s), and major infections/diseases it cause: Hepatitis C virus
-Organism: Virus -Major Reservoir: Blood and certain body fluids, sexual contact -Major Infection/disease: Hepatitis C
For this pathogen, list the type of organism, it's major reservoir(s), and major infections/diseases it cause: Human immunodeficiency virus (HIV)
-Organism: Virus -Major Reservoir: Blood, semen, vaginal secretions, sexual contact -Major Infection/disease: Acquired immunodeficiency syndrome (AIDS)
For this pathogen, list the type of organism, it's major reservoir(s), and major infections/diseases it cause: Hepatitis A virus
-Organism: Virus -Major Reservoir: Feces -Major Infection/disease: Hepatitis A
For this pathogen, list the type of organism, it's major reservoir(s), and major infections/diseases it cause: Herpes simplex virus (type 1)
-Organism: Virus -Major Reservoir: Lesions of mouth or skin, saliva, genitalia -Major Infection/disease: Cold sores, aseptic meningitis, STD, herpetic whitlow
Which of these statements are true regarding disinfection and cleaning? Select all that apply. -Proper cleaning requires mechanical removal of all soil from an object or area. -General environmental cleaning is an example of medical asepsis. -When cleaning a wound, wipe around the wound edge first and then clean inward toward the center of the wound. -Cleaning in a direction from the least to the most contaminated area helps reduce infections. -Disinfecting and sterilizing medical devices and equipment involve the same procedures.
-Proper cleaning requires mechanical removal of all soil from an object or area. -General environmental cleaning is an example of medical asepsis. -Cleaning in a direction from the least to the most contaminated area helps reduce infections. (Environmental surfaces (e.g., bedside table) potentially can contribute to cross-transmission by contamination of health care personnel from hand contact with contaminated surfaces, medical equipment, or patients. Cleaning from the least to the most contaminated area of a wound prevents recontamination of the cleaned area.)
Signs and symptoms of Localized Infection:
-Redness/erythema -Swelling/edema -Pain or tenderness -Warmth at site -Possible loss of function of affected area
How does stress affect risk for infection?
-Stress prolonged or intense stress results in elevated cortisone levels and decreased resistance to infection. -Increases glucose levels and decreases anti-inflammatory responses.
What does it mean when a patient is diagnosed with a multidrug-resistant organism in his or her surgical wound? Select all that apply. -There is more than one organism in the wound that is causing the infection. -The antibiotics the patient has received are not strong enough to kill the organism. -The patient will need more than one type of antibiotic to kill the organism. -The organism has developed a resistance to one or more broad-spectrum antibiotics, indicating that the organism will be hard to treat effectively. -There are no longer any antibiotic options available to treat the patient's infection.
-The antibiotics the patient has received are not strong enough to kill the organism. -The organism has developed a resistance to one or more broad-spectrum antibiotics, indicating that the organism will be hard to treat effectively. (Multidrug-resistant organisms are bacteria that have become resistant to certain antibiotics, and these antibiotics can no longer be used to control or kill the bacteria.)
Localized infections: a specific area is infected, wound, pain, redness, warmth, tenderness. Systemic infections: an infection affecting the entire body instead of one organ, can be fatal. How can nursing help control spread of infection??
-Use standard precautions, appropriate PPE, and hand hygiene when assessing the wound. The use of these precautions and hand hygiene blocks the spread of infection to other sites or other patients for localized. -The nurse is responsible for properly administering antibiotics, monitoring the response to drug therapy, using proper hand hygiene, and standard precautions. Supportive therapy includes providing adequate nutrition and rest to bolster defenses of the body against the infectious process. The course of care for the patient often has additional effects on body systems affected by the infection.
Portals of exit include sites such as:
-blood -skin and mucous membranes (breakdown allows exit) -respiratory tract (sneezing/cough) -genitourinary (GU) tract -gastrointestinal (GI) tract -transplacental (mother to fetus) -Reproductive tract
To thrive organisms require (survival needs):
-proper environment - food -oxygen -water, temperature -pH -light.
Resident skin microorganisms are not virulent. However, these skin microorganisms can cause serious infection when:
-surgery or other invasive procedures allow them to enter deep tissues or -when a patient is severely immunocompromised (has an impaired immune system).
Normal Adult Basophil count:
0.5%-1.5%
Normal Adult Eosinophil count:
1%-4%
What is the correct order of steps for removal of protective barriers after leaving an isolation room? -1. Remove gloves. -2. Perform hand hygiene. -3. Remove eyewear or goggles. -4. Untie top and then bottom mask strings and remove from face. -5. Untie waist and neck strings of gown. Remove gown, rolling it onto itself without touching the contaminated side.
1, 3, 5, 4, 2 (This sequence ensures that the risk of contamination to other surfaces or health care personnel is minimized.)
Respiratory hygiene/cough etiquette:
1. Have patients cover the nose/mouth when coughing or sneezing 2. use tissues to contain respiratory secretions and dispose in nearest waste container 3. perform hand hygiene after contacting respiratory secretions and contaminated objects/materials; 4. contain respiratory secretions with procedure or surgical mask 5. spatial separation of at least 3 feet away from others if coughing.
Many measures that control Portals of Exit/Entry:
1. Maintaining the integrity of skin and mucous membranes reduces the chances of microorganisms reaching a host. 2. Keep a patient's skin well lubricated by using lotion as appropriate. Patients who are immobilized and debilitated are particularly susceptible to skin breakdown. 3. Do not position patients on tubes or objects that cause breaks in the skin. 4. It is important to turn and position patients before their skin becomes reddened. 5. Frequent oral hygiene prevents drying of mucous membranes. 6. A water-soluble ointment keeps the patient's lips well lubricated. 7. Wear clean gloves if there is a chance of contact with any blood or body fluids and perform hand hygiene after providing care. 8. Be sure to bag contaminated items (e.g., linen) appropriately.
When should you perform hand hygiene? (Standard precautions for use with ALL PATIENTS)
1. Perform hand hygiene before, after, and between direct contact with patients. (Examples of between-contact activities are cleaning hands after a patient care activity, moving to a non-patient care activity, and cleaning hands again before returning to perform patient contact.) 2. Perform hand hygiene after contact with blood, body fluids, mucous membranes, nonintact skin, secretions, excretions, or wound dressings; after contact with inanimate surfaces or articles in a patient room; and immediately after gloves are removed. 3. Wear gloves when touching blood, body fluids, secretions, excretions, nonintact skin, mucous membranes, or contaminated items or surfaces is likely. Remove gloves and perform hand hygiene between patient care encountersPerform hand hygiene before, after, and between direct contact with patients. (Examples of between-contact activities are cleaning hands after a patient care activity, moving to a non-patient care activity, and cleaning hands again before returning to perform patient contact.) 4. When hands are visibly soiled or contaminated with blood or body fluids, wash them with either a nonantimicrobial or an antimicrobial soap and water. 5. When hands are not visibly soiled or contaminated with blood or body fluids, use an alcohol-based, waterless antiseptic agent to perform hand hygiene (WHO, 2009). 6. Wash hands with nonantimicrobial soap and water if contact with spores (e.g., Clostridium difficile) is likely to have occurred. 7. Do not wear artificial fingernails or extenders if duties include direct contact with patients at high risk for infection and associated adverse outcomes. 8. Wear gloves when touching blood, body fluids, secretions, excretions, nonintact skin, mucous membranes, or contaminated items or surfaces is likely. 9. Remove gloves and perform hand hygiene between patient care encounters and when going from a contaminated to a clean body site.
Human reservoirs are divided into two types:
1. Those with acute or symptomatic disease 2. Those who show no signs of disease but are carriers of it
What are lab tests used to screen for infection?
1. WBC count 2. Erythrocyte sedimentation rate 3. Iron level 4. Cultures of urine and blood 5. Cultures and gram stain of wound, sputum, and throat 6. Differential count: -Neutrophils -Lymphocytes -Monocytes -Eosinophils -Basophils
The potential for microorganisms or parasites to cause disease depends on:
1. number of microorganisms present 2. their virulence, or ability to produce disease 3. their ability to enter and survive in a host 4. the susceptibility of the host.
Normal Adult Monocyte count:
2%-8%
Normal Adult Lymphocyte count:
20-40%
Microorganisms can live only in certain temperature ranges. Each species of bacteria has a specific temperature at which it grows best. The ideal temperature for most human pathogens is:
20° to 43° C (68° to 109° F)
A patient's surgical wound has become swollen, red, and tender. You note that the patient has a new fever, purulent wound drainage, and leukocytosis. Which interventions would be appropriate and in what order? 1. Notify the health care provider of the patient's status. 2. Reassure the patient and recheck the wound later. 3. Support the patient's fluid and nutritional needs. 4. Use aseptic technique to change the dressing.
4, 2, 1, 3 (The first three interventions require more immediate attention to the signs of suspected infection; supporting the patient's wound healing and hydration is important but can be addressed after action is taken to address early signs of infection.)
Most human pathogens prefer a pH level of:
5-7
Most microorganisms prefer an environment within a pH range of _____.
5.0 to 7.0
Normal Adult Values for White blood cell (WBC) count:
5000-10,000/mm3
Normal Adult Values for Neutrophils:
55-70%
Most human pathogens prefer temperatures that are:
68-109 degrees F
Measles, chickenpox (varicella), disseminated varicella zoster, pulmonary or laryngeal tuberculosis would require what kind of precautions?
AIRBORNE PRECAUTIONS (droplet nuclei smaller than 5 microns): -Private room -negative-pressure airflow of at least 6 to 12 exchanges per hour via high-efficiency particulate air (HEPA) filtration -mask or respiratory protection device -N95 respirator (depending on condition)
What transmission-based precautions would you use for a patient with Measles?
AIRBORNE PRECAUTIONS (droplet nuclei smaller than 5 microns): -Private room -negative-pressure airflow of at least 6 to 12 exchanges per hour via high-efficiency particulate air (HEPA) filtration -mask or respiratory protection device -N95 respirator (depending on condition)
What transmission-based precautions would you use for a patient with chickenpox (varicella)?
AIRBORNE PRECAUTIONS (droplet nuclei smaller than 5 microns): -Private room -negative-pressure airflow of at least 6 to 12 exchanges per hour via high-efficiency particulate air (HEPA) filtration -mask or respiratory protection device -N95 respirator (depending on condition)
What transmission-based precautions would you use for a patient with disseminated varicella zoster?
AIRBORNE PRECAUTIONS (droplet nuclei smaller than 5 microns): -Private room -negative-pressure airflow of at least 6 to 12 exchanges per hour via high-efficiency particulate air (HEPA) filtration -mask or respiratory protection device -N95 respirator (depending on condition)
What transmission-based precautions would you use for a patient with pulmonary or laryngeal tuberculosis?
AIRBORNE PRECAUTIONS (droplet nuclei smaller than 5 microns): -Private room -negative-pressure airflow of at least 6 to 12 exchanges per hour via high-efficiency particulate air (HEPA) filtration -mask or respiratory protection device -N95 respirator (depending on condition)
host produces own antibodies upon exposure
Active (secondary immunity)
An adult White blood cell (WBC) count value greater than 5,000-10,000 is an indication of
Acute infection
Which organism causes more infections in humans? Aerobic or Anaerobic?
Aerobic
______ bacteria require oxygen for survival and for multiplication sufficient to cause disease.
Aerobic
Pathogens that require oxygen to survive such as staph and strep are _____.
Aerobic (MOST COMMON TYPE IN HUMANS)
-smaller droplets, remain in air for long (measles, chickpox, TB) -Place in private room with negative pressure or place in room with client with same microorganism. -Wear special respiratory mask, N95 -Respirator mask/mask client if transport needed
Airborne (Tier Two)
Droplet nuclei or residue or evaporated droplets suspended in air during coughing or sneezing or carried on dust particles.
Airborne mode of Transmission
Focus on diseases that are transmitted by smaller droplets, which remain in the air for longer periods of time. This requires a specially equipped room with a negative air flow referred to as an airborne infection isolation room. Air is not returned to the inside ventilation system but is filtered through a high-efficiency particulate air (HEPA) filter and exhausted directly to the outside. All health care personnel wear an N95 respirator every time they enter the room.
Airborne precautions
What kind of patients would require a protective environment? (Private room; positive airflow with 12 or more air exchanges per hour; HEPA filtration for incoming air; mask to be worn by patient when out of room during times of construction in area)
Allogeneic hematopoietic stem cell transplant patients
_______ typically cause infections deep within the pleural cavity, in a joint, or in a deep sinus tract.
Anaerobes
Pathogens that survive on little to no oxygen such as C. Difficile are _____.
Anaerobic
______ bacteria thrive where little or no free oxygen is available.
Anaerobic
An example of an anaerobic organism is _______, an organism that is part of the normal flora of the human colon but can cause infection if displaced into the bloodstream or surrounding tissue following surgery or injury.
Bacteroides fragilis
_____ Values remain normal during infection.
Basophils (0.5-1.5%)
Some bacteria assume a form, called a spore, which is resistant to drying, and can live on inanimate surfaces for long periods of time. A common spore-forming bacterium is _____, an organism that causes antibiotic-induced diarrhea.
C. difficile
_____ is the national public health agency concerned with prevention and control of disease.
CDC
What transmission-based precautions would you use for a patient with Colonization or infection with multidrug-resistant organisms such as VRE and MRSA, Clostridium difficile, shigella, and other enteric pathogens?
CONTACT PRECAUTIONS (direct patient or environmental contact): -Private room or cohort patients (see agency policy) -gloves -gowns -(Patients may leave their room for procedures or therapy if infectious material is contained or covered, placed in a clean gown, and if hands are cleaned.)
What transmission-based precautions would you use for a patient with Scabies?
CONTACT PRECAUTIONS (direct patient or environmental contact): -Private room or cohort patients (see agency policy) -gloves -gowns -(Patients may leave their room for procedures or therapy if infectious material is contained or covered, placed in a clean gown, and if hands are cleaned.)
What transmission-based precautions would you use for a patient with herpes simplex?
CONTACT PRECAUTIONS (direct patient or environmental contact): -Private room or cohort patients (see agency policy) -gloves -gowns -(Patients may leave their room for procedures or therapy if infectious material is contained or covered, placed in a clean gown, and if hands are cleaned.)
What transmission-based precautions would you use for a patient with major wound infections?
CONTACT PRECAUTIONS (direct patient or environmental contact): -Private room or cohort patients (see agency policy) -gloves -gowns -(Patients may leave their room for procedures or therapy if infectious material is contained or covered, placed in a clean gown, and if hands are cleaned.)
What transmission-based precautions would you use for a patient with respiratory syncytial virus in infants, young children, or immunocompromised adults?
CONTACT PRECAUTIONS (direct patient or environmental contact): -Private room or cohort patients (see agency policy) -gloves -gowns -(Patients may leave their room for procedures or therapy if infectious material is contained or covered, placed in a clean gown, and if hands are cleaned.)
What transmission-based precautions would you use for a patient with varicella zoster (disseminated)?
CONTACT PRECAUTIONS (direct patient or environmental contact): -Private room or cohort patients (see agency policy) -gloves -gowns -(Patients may leave their room for procedures or therapy if infectious material is contained or covered, placed in a clean gown, and if hands are cleaned.)
What transmission-based precautions would you use for an immunocompromised adult?
CONTACT PRECAUTIONS (direct patient or environmental contact): -Private room or cohort patients (see agency policy) -gloves -gowns -(Patients may leave their room for procedures or therapy if infectious material is contained or covered, placed in a clean gown, and if hands are cleaned.)
What transmission-based precautions would you use for a patient with meningococcal pneumonia or sepsis? pneumonic plague
DROPLET PRECAUTIONS (droplets larger than 5 microns; being within 3 feet of the patient): -Private room or cohort patients; -mask or respirator required (depending on condition) (refer to agency policy)
What transmission-based precautions would you use for: Colonization or infection with multidrug-resistant organisms such as VRE and MRSA, Clostridium difficile, shigella, and other enteric pathogens; major wound infections; herpes simplex; scabies; varicella zoster (disseminated); respiratory syncytial virus in infants, young children, or immunocompromised adults
CONTACT PRECAUTIONS (direct patient or environmental contact): -Private room or cohort patients (see agency policy) -gloves -gowns -(Patients may leave their room for procedures or therapy if infectious material is contained or covered, placed in a clean gown, and if hands are cleaned.)
Increased values of normal Lymphocytes (above 40%) would indicate:
Chronic bacterial and viral infection
Microorganisms require nourishment. Some such as ________, the microbe that causes gas gangrene, thrive on organic matter.
Clostridium perfringens
______ is the presence and growth of microorganisms within a host but without tissue invasion or damage.
Colonization
microorganism present and grows but without tissue invasion or damage
Colonization
If an infectious disease can be transmitted directly from one person to another, it is termed a _______.
Communicable disease
Used for direct and indirect contact with patients and their environment. Direct contact refers to the care and handling of contaminated body fluids. Contact precautions require a gown and gloves. An example includes blood or other body fluids from an infected patient that enter the health care worker's body through direct contact with compromised skin or mucous membranes. Indirect contact involves the transfer of an infectious agent through a contaminated intermediate object such as contaminated instruments or hands of health care workers. The health care worker may transmit microorganisms from one patient site to another if hand hygiene is not performed between patients
Contact precautions
•VRE = Vancomycin-resistant enterococci, C-diff, MRSA •Use Standard and contact precautions •Use equipment assigned to that room only •Isolation until 3 negative cultures taken 1 week apart
Contact precautions
After elimination instruct women to clean the rectum and perineum by wiping from the urinary meatus toward the rectum. Cleaning in a direction from the least to the most contaminated area helps reduce GU infections. Meticulous and frequent perineal care is especially important in older-adult women who wear disposable incontinence pads. These are all examples of
Control of Portals of Exit/Entry
Interval when acute symptoms of infection disappear. (Length of recovery depends on severity of infection and patient's host resistance; recovery may take several days to months.)
Convalescence
A normal Iron level (80-180 in men, 60-160 in women) is ____ in a chronic infection.
DECREASED
The normal White blood cell (WBC) count value (5,000-10,000) is _____ in certain viral or overwhelming infections.
DECREASED
Diphtheria (pharyngeal), rubella, streptococcal pharyngitis, pneumonia or scarlet fever in infants and young children, pertussis, mumps, Mycoplasma pneumonia, meningococcal pneumonia or sepsis, pneumonic plague would all require what kind of precautions?
DROPLET PRECAUTIONS (droplets larger than 5 microns; being within 3 feet of the patient): -Private room or cohort patients; -mask or respirator required (depending on condition) (refer to agency policy)
What transmission-based precautions would you use for a patient with Diphtheria (pharyngeal)?
DROPLET PRECAUTIONS (droplets larger than 5 microns; being within 3 feet of the patient): -Private room or cohort patients; -mask or respirator required (depending on condition) (refer to agency policy)
What transmission-based precautions would you use for a patient with Mycoplasma pneumonia?
DROPLET PRECAUTIONS (droplets larger than 5 microns; being within 3 feet of the patient): -Private room or cohort patients; -mask or respirator required (depending on condition) (refer to agency policy)
bacteria that naturally reside in a closed system. Disease occurs when the client's own flora are altered and an overgrowth results or when normal bacterial flora enter a sterile body area.
Endogenous
What transmission-based precautions would you use for a patient with mumps?
DROPLET PRECAUTIONS (droplets larger than 5 microns; being within 3 feet of the patient): -Private room or cohort patients; -mask or respirator required (depending on condition) (refer to agency policy)
What transmission-based precautions would you use for a patient with pertussis?
DROPLET PRECAUTIONS (droplets larger than 5 microns; being within 3 feet of the patient): -Private room or cohort patients; -mask or respirator required (depending on condition) (refer to agency policy)
What transmission-based precautions would you use for a patient with pneumonia or scarlet fever in infants and young children?
DROPLET PRECAUTIONS (droplets larger than 5 microns; being within 3 feet of the patient): -Private room or cohort patients; -mask or respirator required (depending on condition) (refer to agency policy)
What transmission-based precautions would you use for a patient with pneumonic plague?
DROPLET PRECAUTIONS (droplets larger than 5 microns; being within 3 feet of the patient): -Private room or cohort patients; -mask or respirator required (depending on condition) (refer to agency policy)
What transmission-based precautions would you use for a patient with rubella?
DROPLET PRECAUTIONS (droplets larger than 5 microns; being within 3 feet of the patient): -Private room or cohort patients; -mask or respirator required (depending on condition) (refer to agency policy)
What transmission-based precautions would you use for a patient with streptococcal pharyngitis?
DROPLET PRECAUTIONS (droplets larger than 5 microns; being within 3 feet of the patient): -Private room or cohort patients; -mask or respirator required (depending on condition) (refer to agency policy)
Person-to-person (fecal, oral) physical contact between source and susceptible host (e.g., touching patient feces and then touching your inner mouth or consuming contaminated food)
Direct Contact mode of Transmission
-particle droplets > 5 microns (large), -Influenza, mycoplasma pneumonia, pertussis, mumps -Private room, or with same DX -Wear mask if working within 3 feet -Move client outside of room only for essential purposes, and place mask on client
Droplet (Tier Two)
Large particles that travel up to 3 feet during coughing, sneezing, or talking and come in contact with susceptible host
Droplet mode of Transmission
Focus on diseases that are transmitted by large droplets (greater than 5 microns) expelled into the air and by being within 3 feet of a patient. Droplet precautions require the wearing of a surgical mask when within 3 feet of the patient, proper hand hygiene, and some dedicated-care equipment. An example is a patient with influenza.
Droplet precautions
A patient is diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. Which type of isolation precaution is most appropriate for this patient? -Reverse isolation -Droplet precautions -Standard precautions -Contact precautions
Droplet precautions and Contact precautions (The patient has a multidrug resistant organism within his respiratory tract that has become pathogenic. The route of transmission for this type of condition is respiratory; thus whenever the patient coughs or sneezes, organisms are sprayed into the air and then drop onto surfaces in the room. In addition to gown and gloves, a mask must also be worn.)
The normal Erythrocyte sedimentation rate value (men=15, women=20) is ___ in the presence of inflammatory process.
ELEVATED (indicates infection)
Some viruses such as ______ are transmitted through direct contact with the blood or body fluids of a person who is sick with Ebola. However, droplets (e.g., splashes or sprays) of respiratory or other secretions from a person who is sick with _____ could also be infectious. Therefore certain precautions (called standard, contact, and droplet precautions) are recommended for use in health care settings to prevent the transmission of the virus from patients who are sick with ____ to health care personnel and other patients or family members.
Ebola virus, Ebola
emptying urinary drainage bags are examples of
Eliminating reservoirs of infection
What is the protective environment?
Environment where allogeneic hematopoietic stem cell transplant patients need. Private room with positive airflow with 12 or more exchanges, HEPA filtration for incoming air, mask worn by patient if leaving the room.
Microorganisms require nourishment. Some such as _______ consume undigested foodstuff in the bowel. Carbon dioxide and inorganic material such as soil provide nourishment for other organisms.
Escherichia coli
HAIs microorganisms are external to host (outside the client), not normal flora.
Exogenous
A patient is isolated for pulmonary tuberculosis. The nurse notes that the patient seems to be angry, but he knows that this is a normal response to isolation. Which is the best intervention? -Provide a dark, quiet room to calm the patient. -Reduce the level of precautions to keep the patient from becoming angry. -Explain the reasons for isolation procedures and provide meaningful stimulation. -Limit family and other caregiver visits to reduce the risk of spreading the infection.
Explain the reasons for isolation procedures and provide meaningful stimulation. (Patients on isolation precautions may interpret the needed restrictions as a sign of rejection by the health care worker.)
______ is an example of a communicable disease that can be asymptomatic. It is most efficiently transmitted through the direct passage of blood into the skin from a percutaneous exposure, even if the source patient is asymptomatic.
HCV (Hepatitis C virus-major cause of liver cancer/liver disease)
What is the most effective way to control transmission of infection? -Isolation precautions -Identifying the infectious agent -Hand hygiene practices -Vaccinations
Hand hygiene practices (Hands contaminated with transient bacteria are a primary source for transmission of infection.)
The normal White blood cell (WBC) count value (5,000-10,000) is _____ when there is an acute infection.
INCREASED
An Erythrocyte sedimentation rate value elevated higher than 15 (for men) or higher than 20 (for women) would indicate:
INFECTION/INFLAMMATION (Elevated in presence of inflammatory process)
direct result from invasive diagnostic or therapeutic procedures
Iatrogenic
Interval when patient manifests signs and symptoms specific to type of infection. For example, strep throat is manifested by sore throat, pain, and swelling; mumps is manifested by high fever, parotid and salivary gland swelling.
Illness Stage
Client manifest signs and symptoms specific to infection. Sore throat, pain, and swelling due to step throat. Or mumps manifested by high fever, parotid and salivary gland swelling.
Illness stage
directed towards a specific infectious agent
Immunity (secondary)
Interval between entrance of pathogen into body and appearance of first symptoms (e.g., chickenpox, 14 to 16 days after exposure; common cold, 1 to 2 days; influenza, 1 to 4 days; measles, 10 to 12 days; mumps, 16 to 18 days; Ebola 2 to 21 days
Incubation Period
Personal contact of susceptible host with contaminated inanimate object (e.g., needles or sharp objects, dressings, environment)
Indirect Contact mode of Transmission
Invasion of host by pathogen resulting in disease
Infection
Bedside Unit • Keep table surfaces clean and dry.
Infection Prevention and Control to Reduce Reservoirs of Infection
Bottled Solutions • Do not leave bottled solutions open. • Keep solutions tightly capped. • Date bottles when opened and discard in 24 hours.
Infection Prevention and Control to Reduce Reservoirs of Infection
Change dressings that become wet and/or soiled
Infection Prevention and Control to Reduce Reservoirs of Infection
Contaminated Sharps • Place all needles, safety needles, and needleless systems into puncture-proof containers, which should be located at the site of use. Federal law requires the use of needle-safe technology. Blood tube holders are single use only
Infection Prevention and Control to Reduce Reservoirs of Infection
Drainage Bottles and Bags: • Wear gloves and protective eyewear if splashing or spraying with contaminated blood or body fluids is anticipated. • Empty and dispose of drainage suction bottles according to agency policy. • Empty all drainage systems on each shift unless otherwise ordered by a health care provider. • Never raise a drainage system (e.g., urinary drainage bag) above the level of the site being drained unless it is clamped off.
Infection Prevention and Control to Reduce Reservoirs of Infection
For contaminated articles, Place tissues, soiled dressings, or soiled linen in fluid-resistant bags for proper disposal.
Infection Prevention and Control to Reduce Reservoirs of Infection
Surgical Wounds • Keep drainage tubes and collection bags patent to prevent accumulation of serous fluid under the skin surface.
Infection Prevention and Control to Reduce Reservoirs of Infection
When Bathing, Use soap and water to remove drainage, dried secretions, or excess perspiration. This is a technique used for
Infection Prevention and Control to Reduce Reservoirs of Infection
protective vascular response, delivers fluid, blood products and nutrients to area
Inflammation
_____ grows best in water at 25° to 42° C (77° to 108° F).
Legionella pneumophila
During this time microorganisms grow and multiply, and patient may be capable of spreading disease to others.
Prodromal Stage
Aerobic organisms cause _______ infections in humans than anaerobic organisms.
MORE
Airborne precautions (droplet nuclei smaller than 5 microns) are used for which infections/conditions?
Measles, chickenpox (varicella), disseminated varicella zoster, pulmonary or laryngeal tuberculosis
Normal Adult Values for Iron Level:
Men: 80-180 mcg/mL Women: 60-160 mcg/mL
Normal Adult Values for Erythrocyte Sedimentation Rate:
Men: Up to 15 mm/hr Women: Up to 20 mm/hr
Infectious Agents are the ___ causing the disease:
Microorganism
______ are bacteria that have become resistant to certain antibiotics, and these antibiotics can no longer be used to control or kill the bacteria.
Multidrug-resistant organisms
Cough etiquette has become more important because of concerns for transmission of respiratory infections such as ________.
Mycobacterium tuberculosis, severe acute respiratory syndrome (SARS), and H1N1 influenza.
Organisms such as _____ exit through a man's urethral meatus or a woman's vaginal canal during sexual contact.
Neisseria gonorrhea and HIV
Normal Adult Values for cultures and gram stain of wound, sputum, and throat:
No WBCs on gram stain, possible normal flora
normal floras, intact skin, cilia in the nares, saliva, tears, acidity of the stomach, resident flora in the intestine, low pH of the vagina
Nonspecific (primary)
Normal Adult Values for Cultures of urine and blood:
Normally Sterile, without microorganism growth
Health Care Associated Infections (HAIs):
Occurs while the client is receiving health care
What transmission-based precautions would you use for Allogeneic hematopoietic stem cell transplant patients?
PROTECTIVE ENVIRONMENT: -Private room; -positive airflow with 12 or more air exchanges per hour; -HEPA filtration for incoming air; -mask to be worn by patient when out of room during times of construction in area
obtaining from another source such as a nursing infant or an injection of an immune serum
Passive (secondary immunity)
Interval from onset of nonspecific signs and symptoms (malaise, low-grade fever, fatigue) to more specific symptoms. (During this time microorganisms grow and multiply, and patient may be capable of spreading disease to others.) For example, herpes simplex begins with itching and tingling at the site before the lesion appears.
Prodromal Stage
Onset of nonspecific symptoms such as malaise, low grade temperature, fatigue to more severe symptoms is
Prodromal Stage
Assume everyone has the potential for infection transmission: Protect yourself against exposure to all body fluids, blood, secretions and excretions.
Tier One/Standard Precautions
A family member is providing care to a loved one who has an infected leg wound. What would you instruct the family member to do after providing care and handling contaminated equipment or organic material? -Wear gloves before eating or handling food. -Place any soiled materials into a bag and double bag it. -Have the family member check with the health care provider about need for immunization. -Perform hand hygiene after care and/or handling contaminated equipment or material.
Perform hand hygiene after care and/or handling contaminated equipment or material. (Clean hands interrupt the transmission of microorganisms from family members.)
The site from which the organism leaves the reservoir:
Portal of Exit
A site through which a micro-organism may enter a susceptible host and cause disease/infection. They enter through the same routes as exiting. Sites can include: -Starting an IV -Mucous membranes -Skin -Respiratory tract -Gastrointestinal tract
Portal of entry
An example of this stage would be how herpes simplex begins with itching/tingling at sight before the lesion appears.
Prodromal Stage
Focuses on a very limited patient population. This form of isolation requires a specialized room with positive airflow. The airflow rate is set at greater than 12 air exchanges per hour, and all air is filtered through a HEPA filter. Patients must wear masks when out of their room during times of construction in area.
Protective environment
•: Special room with positive airflow, air is filtered through a HEPA filter. No fresh or dried flowers. No potted plants. Patients must wear mask-these are the stem cell transplant patients-allogenic
Protective environment
Your assigned patient has a leg ulcer that has a dressing on it. During your assessment you find that the dressing is saturated with purulent drainage. Which action would be best on your part? -Reinforce dressing with a clean, dry dressing and call the health care provider. -Remove wet dressing and apply new dressing using sterile procedure. -Put on gloves before removing the old dressing; then obtain a wound culture. -Remove saturated dressing with gloves, remove gloves, then perform hand hygiene and apply new gloves before putting on a clean dressing.
Remove saturated dressing with gloves, remove gloves, then perform hand hygiene and apply new gloves before putting on a clean dressing. (Gloves need to be changed, and hand hygiene performed to prevent transfer of microorganisms from one source to another. Gloves may have microscopic holes that allow microorganisms to have contact with the caregiver's skin. Therefore gloves are removed, and hand hygiene is performed whenever the nurse moves from an activity requiring gloves to another nursing action or leaves the patient's room and whenever all patient tasks are completed.)
Normally present in a part/area of the body, may produce infection in another area. Not easily removed, need to use friction.
Resident flora/Normal Flora
_______ are permanent residents of the skin and within the body, where they survive and multiply without causing illness.
Resident organisms (normal flora)
______ are the primary strategies (including barrier precautions) for prevention of infection transmission and apply to contact with blood, body fluids, nonintact skin, mucous membranes, and equipment or surfaces contaminated with potentially infectious materials.
Standard Precautions
The first and most important tier is called _______, which are designed to be used for the care of all patients, in all settings, regardless of risk or presumed infection status.
Standard Precautions
Tier 1 used for _____
Standard precautions: using gloves, gown, mask and goggles when needed.
An example of an aerobic organism is ______.
Staphylococcus aureus
_______ to an infectious agent depends on an individual's degree of resistance to pathogens.
Susceptibility
If the pathogens multiply and cause clinical signs and symptoms, the infection is ______.
Symptomatic
The infection control nurse has asked the staff to work on reducing the number of iatrogenic infections on the unit. Which of the following actions on your part would contribute to reducing health care-acquired infections? Select all that apply. -Teaching correct handwashing to assigned patients -Using correct procedures in starting and caring for an intravenous infusion -Providing perineal care to a patient with an indwelling urinary catheter -Isolating a patient who has just been diagnosed as having tuberculosis -Decreasing a patient's environmental stimuli to decrease nausea
Teaching correct handwashing to assigned patients Using correct procedures in starting and caring for an intravenous infusion Providing perineal care to a patient with an indwelling urinary catheter (Iatrogenic infections are infections associated with a procedure or therapy. The patient with tuberculosis was probably infected outside of the health care environment, and preventing nausea is not associated directly with infection prevention.)
When should a nurse wear a mask? (Select all that apply). Select all that apply. -The patient's dental hygiene is poor. -The nurse is assisting with an aerosolizing respiratory procedure such as suctioning. -The patient has acquired immunodeficiency syndrome (AIDS) and a congested cough. -The patient is in droplet precautions. -The nurse is assisting a health care provider in the insertion of a central line catheter.
The nurse is assisting with an aerosolizing respiratory procedure such as suctioning. The patient is in droplet precautions. The nurse is assisting a health care provider in the insertion of a central line catheter. (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.)
A patient who has been isolated for Clostridium difficile (C. difficile) asks you to explain what he should know about this organism. What is the most appropriate information to include in patient teaching? Select all that apply. -The organism is usually transmitted through the fecal-oral route. -Hands should always be cleaned with soap and water versus alcohol-based hand sanitizer. -Everyone coming into the room must be wearing a gown and gloves. -While the patient is in contact precautions, he cannot leave the room. -C. difficile dies quickly once outside the body.
The organism is usually transmitted through the fecal-oral route. Hands should always be cleaned with soap and water versus alcohol-based hand sanitizer. Everyone coming into the room must be wearing a gown and gloves. (C. difficile enters a person's body via ingestion of the spores that are spread via the fecal-oral route. Alcohol-based hand sanitizers have proved ineffective with C. difficile because of the spore that surrounds the organism, thus thorough handwashing is recommended. The most common way C. difficile is spread in a health care environment is through workers' contaminated hands; therefore barriers such as gloves and gowns are an important part of preventing transmission between patients.)
• Contaminated items • Water • Drugs, solutions • Blood • Food (improperly handled, stored, or cooked; fresh or thawed meats)
Vehicles of Transmission
What do you do if you come into contact with spores/C-diff?
Wash hands with nonantimicrobial soap and water if contact with spores (e.g., Clostridium difficile) is likely to have occurred.
Examples of Endogenous HAIs:
Yeast, E-coli moving from GI to Urinary system
How does nutritional status influence infection risks?
a reduction in intake reduces body defenses against infection and wound healing.
Basically, in the ______ setting a nurse will follow standard precautions in all aspects of care.
acute care
Organisms such as S. aureus with resistance to key antibiotics are becoming more common in all health care settings, but especially in ______. The increased resistance is associated with the frequent and sometimes inappropriate use of antibiotics over the years in all settings (i.e., acute care, ambulatory care, clinics, and long-term care)
acute care
An INCREASE in normal Neutrophil values (55-70%) would indicate:
acute suppurative (pus-forming) infection
Increased values of normal Neutrophils (above 70%) would indicate:
acute suppurative (pus-forming) infection
Immature neutrophils the body is releasing to help fight off an overwhelming infection:
bands (0-3%)
A person's natural defenses against infection and certain risk factors such as _______, affect susceptibility (resistance).
age, nutritional status, presence of chronic disease, trauma, and smoking
Bacteria in particular thrive in urine with an ______ pH.
alkaline
Standard precautions applies to:
all patients because every patient has the potential to transmit infection via blood and body fluids, and the risk for infection transmission is unknown.
If hands are not visibly soiled, use of _________ for disinfecting hands of health care workers.
an alcohol-based hand product or handwashing with soap and water is acceptable
Exogenous HAIs Terrestrial bacteria:
anthrax, botulism
Respiratory hygiene/cough etiquette applies to:
any person with signs of respiratory infection, including cough, congestion, rhinorrhea, or increased production of respiratory secretions when entering a health care site. (Educating health care staff, patients, and visitors to follow respiratory hygiene/cough etiquette protect both patients and health care workers.)
Do not wear ________ if duties include direct contact with patients at high risk for infection and associated adverse outcomes.
artificial fingernails or extenders
the absence of pathogen
asepsis
If clinical signs and symptoms are not present, the illness is termed _____.
asymptomatic.
Eliminating reservoirs of infection (e.g., emptying urinary drainage bags), controlling portals of exit and entry (e.g., using antiseptic wipes on IV tubing ports), and avoiding actions that transmit microorganisms All prevent:
bacteria from finding a new site in which to grow
Staph is a ____ infection.
bacterial
A temperature or chemical that destroys bacteria is:
bactericidal
Cold temperatures tend to prevent growth and reproduction of bacteria this is called:
bacteriostasis
Nurses are responsible for the ____
biological safety of the client's environment.
Standard precautions (for use with ALL patients) apply to:
blood, blood products, all body fluids, secretions, excretions (except sweat), nonintact skin, and mucous membranes.
In order to control or eliminate the numbers and types of organisms in reservoir sites, eliminate sources of:
body fluids, drainage, or solutions that possibly harbor microorganisms.
Preventing infections involves
breaking the chain of infection (infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host)
Mosquitos and ticks are examples of
carriers
-Sufficient number of organisms -Virulence-ability to produce disease/survive -Ability to enter and survive in the host -Susceptibility of the host (a carrier is a person or person or animal who harbors but does not have symptoms of the disease) These are all factors that _____.
cause disease
An adult White blood cell (WBC) count value less than 5,000-10,000 is an indication of
certain viral or overwhelming infections
An INCREASE in normal Lymphocyte values (20%-40%) would indicate:
chronic bacterial and viral infection
An adult Iron level lower than 80 (men) or lower than 60 (women) would indicate:
chronic infection (Decreased iron levels= chronic infection).
Tier 2 is used when _____
contagious organism is suspected or confirmed. Organism such as flu, TB, measles, mumps, C-diff.
using antiseptic wipes on IV tubing ports is an example of
controlling portals of exit and entry
To control organisms exiting via the respiratory tract:
cover your mouth or nose when coughing or sneezing. Teach patients, health care staff, patient's families, and visitors about respiratory hygiene or cough etiquette.
Sharing bedpans, urinals, bath basins, and eating utensils among patients easily leads to _______.
cross-infection
Most human pathogens prefer light to be _____ in their environment.
dark
Susceptibility depends on the:
degree of resistance the individual has
Organisms enter the body through the same routes they use for exiting. For example, during venipuncture when a needle pierces a patient's skin, organisms enter the body if proper skin preparation is not performed first. Factors such as a ______ that reduce body defenses enhance the chances of pathogens entering the body.
depressed immune system
Contact precautions:
direct patient or environment contact.
Organisms that are normal floras in one person can be pathogens in another. For example, organisms exit when a person expectorates saliva. In addition, gastrointestinal portals of exit include:
emesis, bowel elimination, drainage of bile via surgical wounds, or drainage tubes.
fluid, dead tissue and WBCs form the exudate
exudate (inflammation)
An example of an External Vector mode of transmission mechanical transfer would be
flies
Candida is a ___ infection.
fungi/yeast
Basically, in the acute care setting a nurse will follow standard precautions in all aspects of care. This includes barrier precautions and the appropriate use of PPE such as:
gowns, gloves, masks, eyewear, and other protective devices or clothing
Each disease has a specific mode of transmission. Many times you are able to do little about the infectious agent or the susceptible host; but, by practicing infection prevention and control techniques such as _______, you interrupt the mode of transmission.
hand hygiene
The MOST COMMON reservoir is the _____.
human body
Common reservoirs are:
humans and animals (hosts), insects, food, water, and organic matter on inanimate surfaces (fomites).
Why are infants at greater risk for infection?
immature defenses
Why are older adults at greater risk for infection?
immune response declines
An _____ is the invasion of a susceptible host (e.g., human being) by pathogens or microorganisms, resulting in disease.
infection
Chain of infection
infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host
Pathogens that infect the respiratory tract such as the _____ are released from the body when an infected person sneezes or coughs.
influenza virus
Droplet:
larger than 5 microns if you are going to be within 3 feet of this patient you need to protect yourself.
Disease process- clients with diseases of the immune system are at greater risk for infection. Diseases such as ________
leukemia, lymphoma, AIDS
If an infection is _______ (e.g., a wound infection), a patient usually experiences localized symptoms such as pain, tenderness, warmth, and redness at the wound site.
localized
Normally urine is sterile. However, when a patient has a urinary tract infection (UTI)......
microorganisms exit during urination.
Most human pathogens prefer a _____ environment.
moist
Most organisms require water or moisture for survival. For example, a frequent place for microorganisms is the _______.
moist drainage from a surgical wound
Clients with burns and febrile conditions require ______ for infection prevention.
more protein
The ______ is one of the most bacterially contaminated sites of the human body, but most of the organisms are normal floras.
mouth
____ protect against microorganisms of prior exposure
natural defenses
A DECREASE in normal Neutrophil values (55-70%) would indicate:
overwhelming bacterial infection (older adult)
Decreased values of normal Neutrophils (below 55%) would indicate:
overwhelming bacterial infection (older adult)
An INCREASE in normal Eosinophil values (1-4%) would indicate:
parasitic infection, allergic reactions
Increased values of normal Eosinophils (above 4%) would indicate:
parasitic infection, allergic reactions
Disease or infection results only if
pathogens multiply and alter normal tissue function.
In tier two, we can _____
place two like organisms in the same room, you don't want to put someone with C-diff in a room with someone who does not have it.
After microorganisms find a site to grow and multiply, they need to find a ______ if they are to enter another host and cause disease.
portal of exit
The skin is considered a _____ because any break in the integrity of the skin and mucous membranes allows pathogens to exit the body. This may be exhibited by the presence of purulent drainage.
portal of exit
Protective environment:
positive airflow room with 12 or more air exchanges, HEPA filtration
What would indicate infection for cultures/gram stain of wound, sputum and throat?
presence of infectious microorganism growth and WBCs on Gram stain
Worms and ticks are ___ microorganisms/infectious agents.
protozoa
An INCREASE in normal Monocyte values (2-8%) would indicate:
protozoan, rickettsial, and tuberculosis infections
Increased values of normal Monocytes (above 8%) would indicate:
protozoan, rickettsial, and tuberculosis infections
Aseptic technique
refers to practices that keep a client as free from pathogens as possible.
A ______ is a place where microorganisms survive, may or may not multiply, and await transfer to a susceptible host.
reservoir
Microorganisms on the skin are either
resident or transient flora
Water or foodborne exogenous HAIs:
salmonella, cholera
When using a stethoscope, always wipe off the bell, diaphragm, and ear tips with a disinfectant such as an alcohol wipe before proceeding to the next patient. Ear tips are a common location for ______.
staphylococcal organisms
Although everyone is constantly in contact with large numbers of microorganisms, an infection does not develop until an individual becomes susceptible to the _____ and _____ of the microorganisms.
strength and numbers
An infection that affects the entire body instead of just a single organ or part is ______ and can become fatal if undetected and untreated.
systemic
Wear personal protective equipment (PPE) when:
the anticipated patient interaction indicates that contact with blood or body fluids may occur.
A private room is unnecessary unless _______.
the patient's hygiene is unacceptable (e.g., uncontained secretions, excretions, or wound drainage).
damaged cells replaced with new cells, tissue granulation
tissue repair (inflammation)
When you touch a contaminated gauze dressing or cleanse a patient following diarrheal episode, _____ bacteria adhere to your skin. These organisms may be readily transmitted unless removed using hand hygiene.
transient
Equipment used within the environment (e.g., a stethoscope, blood pressure cuff, or bedside commode) often becomes a source for the _____ of pathogens.
transmission
Microorganisms are everywhere, most are harmless. True or false.
true
Discard all contaminated sharp instruments and needles in a puncture-resistant container. Health care facilities must make available needleless devices. Any needles should be disposed of _______.
uncapped, or a mechanical safety device is activated for recapping.
Microorganisms thrive in dark environments such as those______ and within ______.
under dressings and within body cavities.
Infection can develop if the chain of infectious (infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host) remains ______.
uninterrupted
The major route of transmission for pathogens identified in the health care setting is the ________.
unwashed hands of the health care worker
When hands are not visibly soiled or contaminated with blood or body fluids, _______.
use an alcohol-based, waterless antiseptic agent to perform hand hygiene
The same microorganism is sometimes transmitted by more than one route. For example, ______ (chickenpox) is spread by the airborne route in droplet nuclei or by direct contact.
varicella zoster
vasodilation causes redness warmth and edema
vascular inflammation
The acidity of an environment determines the _____ of microorganisms.
viability
HIV is a ___ infection
viral
Hepatits is a _____ infection.
viral
Some infectious diseases such as ______ and ______ have a low or no risk for transmission. Although these illnesses can be serious for patients, they do not pose a risk to others, including caregivers.
viral meningitis and pneumonia
If hands are visibly soiled with proteinaceous material or care is being provided to a patient with Clostridium difficile (C. difficile), ________ is the preferred practice (Oughton et al., 2009).
washing with soap and water
The blood is normally a sterile body fluid; however, in the case of communicable diseases such as HBV, HCV, or HIV, it becomes a reservoir for pathogens. Organisms exit from ______.
wounds, venipuncture sites, hematemesis, and bloody stool.
The presence of a pathogen does not mean that an infection will occur. Infection occurs in a cycle that depends on the presence of all of the following elements (CHAIN OF INFECTION):
• An infectious agent or pathogen • A reservoir or source for pathogen growth • A port of exit from the reservoir • A mode of transmission • A port of entry to a host • A susceptible host
Internal transmission such as parasitic conditions between vector and host are:
• Mosquito • Louse • Flea • Tick
Standard Precautions (Tier One) for Use with All Patients:
• Standard precautions apply to blood, blood products, all body fluids, secretions, excretions (except sweat), nonintact skin, and mucous membranes. • Perform hand hygiene before, after, and between direct contact with patients. (Examples of between-contact activities are cleaning hands after a patient care activity, moving to a non-patient care activity, and cleaning hands again before returning to perform patient contact.) • Perform hand hygiene after contact with blood, body fluids, mucous membranes, nonintact skin, secretions, excretions, or wound dressings; after contact with inanimate surfaces or articles in a patient room; and immediately after gloves are removed. • When hands are visibly soiled or contaminated with blood or body fluids, wash them with either a nonantimicrobial or an antimicrobial soap and water. • When hands are not visibly soiled or contaminated with blood or body fluids, use an alcohol-based, waterless antiseptic agent to perform hand hygiene (WHO, 2009). • Wash hands with nonantimicrobial soap and water if contact with spores (e.g., Clostridium difficile) is likely to have occurred. • Do not wear artificial fingernails or extenders if duties include direct contact with patients at high risk for infection and associated adverse outcomes. • Wear gloves when touching blood, body fluids, secretions, excretions, nonintact skin, mucous membranes, or contaminated items or surfaces is likely. Remove gloves and perform hand hygiene between patient care encounters and when going from a contaminated to a clean body site. • Wear personal protective equipment (PPE) when the anticipated patient interaction indicates that contact with blood or body fluids may occur. • A private room is unnecessary unless the patient's hygiene is unacceptable (e.g., uncontained secretions, excretions, or wound drainage). • Discard all contaminated sharp instruments and needles in a puncture-resistant container. Health care facilities must make available needleless devices. Any needles should be disposed of uncapped, or a mechanical safety device is activated for recapping. • Respiratory hygiene/cough etiquette: Have patients cover the nose/mouth when coughing or sneezing; use tissues to contain respiratory secretions and dispose in nearest waste container; perform hand hygiene after contacting respiratory secretions and contaminated objects/materials; contain respiratory secretions with procedure or surgical mask; spatial separation of at least 3 feet away from others if coughing.
Factors influencing infection prevention:
•Age-infants immature defenses, old-immune responses declines •Nutritional status: a reduction in intake reduces body defenses against infection and wound healing. Clients with burns and febrile conditions require more protein •Stress prolonged or intense stress results in elevated cortisone levels and decreased resistance to infection. Increases glucose levels and decreases anti-inflammatory responses. •Disease process- clients with diseases of the immune system are at greater risk for infection. Diseases such as leukemia, lymphoma, AIDS
Tier One/Standard Precautions:
•Assume everyone has the potential for infection transmission: Protect yourself against exposure to all body fluids, blood, secretions and excretions. •Wash hands before and after contact •Wear gloves when potential for secretion contact •Mask and eye protection if potential for splash •Gown •Wash hands before and after contact •Wear gloves when potential for secretion contact •Mask and eye protection if potential for splash •Gown •Properly clean/disinfect contaminated equipment •Proper linen handling •Prevent injury from sharps •Wash hands after coming in contact with soiled equipment, even if gloves were worn. •Respiratory hygiene/cough etiquette
Risk factors for HAIs
•Inadequate hand washing •Compromised host •Presence of invasive devise •Poor personal hygiene, poor nutrition •Skin breakdown •Decreased oxygenation, impaired circulation, •Aging, stress, lifestyle, habits •Poor medical and surgical aseptic techniques