Infection Prevention

Basic Medical Aseptic Techniques

-Break the chain of infection -Use these on all patients, even when no infection is diagnosed Ex: Hand hygiene, barrier techniques, and routine environmental cleaning

Airborne Precautions

-Focus on diseases that are transmitted by smaller droplets, which remain in the air for longer periods of time -Room with negative air pressure -N95 respirator

Protective Environment

-Focuses on a very limited population -Room with positive airflow -Patients must wear masks when out of their rooms

Droplet Precautions

-Focuses on diseases transmitted by large droplets expelled into the air and by being within 3 feet of the patient -Require surgical mask when within 3 feet of patient Ex: influenza

6 Elements of the Chain of Infection

1. An infectious agent or pathogen 2. A reservoir or source for pathogen growth 3. A port of exit rom the reservoir 4. A mode of transmission 5. A port of entry to a host 6. A susceptible host

Proper Method of putting on PPE

1. Apply cover gown 2. Apply mask or respirator 3. If needed, apply goggles 4. Apply clean gloves

Surgical Asepsis

"Sterile technique" -Prevents contamination of an open wound, serves to isolate an operative area from the unsterile environment, and maintains a sterile field for surgery -Procedures used to eliminate all microorganisms from an object or area

Contact Precautions

-Used for direct and indirect contact with patients and their environment -Direct contact refers to the care and handling of contaminated body fluids -Require gown and gloves Ex: blood from an infected patient that enter the health care worker's body through direct contact with compromised skin -Indirect contact involves the transfer of an infectious agent through a contaminated intermediate object like instruments or hands of health care workers

When do you use surgical asepsis?

1. During procedures that require intentional perforation of the patient's skin, such as insertion of peripheral IV catheters or a central IV 2. When the integrity of the skin is broken as a result from trauma, surgical incision, or burns 3. During procedures that involve invasive procedures such as insertion of a urinary catheter or surgical instruments into sterile body cavities such as insertion of a wound drain

4 Goals of Care for patients with Infection

1. Preventing further exposure 2. Controlling or reducing the extent of infection 3. Maintaining resistance to infection 4. Verbalizing understanding of infection prevention and control techniques

Proper Method of taking off PPE

1. Remove gloves 2. Remove goggles 3. Untie waist and neck strings of gown 4. Remove mask

What 6 steps ensure an object is clean?

1. Rinse the contaminated object with cold running water to remove organic material. Hot water causes the protein in organic material to coagulate and stick to objects, making removal difficult 2. Wash the object with soap and warm water. Soap reduces surface tension of water and emulsifies dirt. Rinse object thoroughly 3. Use a brush to remove dirt in grooves. 4. Rinse object in warm water 5. Dry the object and prepare it for disinfection or sterilization 6. The brush, gloves, and sink used to clean the equipment are contaminated and are cleaned and dried

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. A. 1, 3, 5, 4, 2 B. 1, 5, 3, 4, 2 C. 1, 3, 4, 5, 2 D. 3, 1, 5, 4, 2

A. 1,3,5,4,2

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.) A. Disposable gown B. N 95 respirator mask C. Face shield or goggles D. Surgical mask E. Gloves

A. Disposable gown B. N 95 Respirator mask E. 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.) A. It allows migration of organisms into the bladder. B. The insertion procedure is not done under sterile conditions. C. It obstructs the normal flushing action of urine flow. D. It keeps an incontinent patient's skin dry. E. The outer surface of the catheter is not considered sterile

A. It allows migration of organisms into the bladder C. 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.

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.) A. Teaching correct handwashing to assigned patients B. Using correct procedures in starting and caring for an intravenous infusion C. Providing perineal care to a patient with an indwelling urinary catheter D. Isolating a patient who has just been diagnosed as having tuberculosis E. Decreasing a patient's environmental stimuli to decrease nausea

A. Teaching correct handwashing to patients B. Using correct procedures in starting and caring for an IV infusion C. 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.

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.) A. The organism is usually transmitted through the fecal-oral route. B. Hands should always be cleaned with soap and water versus alcohol-based hand sanitizer. C. Everyone coming into the room must be wearing a gown and gloves. D. While the patient is in contact precautions, he cannot leave the room. E. C. difficile dies quickly once outside the body.

A. The organism is usually transmitted through fecal-oral B. Hands should always be cleaned w/ soap/water vs alcohol-based hand sanitizer C. 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.

Types of infections for Protective Environment

Allogeneic hematopoietic stem cell transplants

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. A. 4, 1, 2, 3 B. 4, 2, 1, 3 C. 4, 2, 3, 1 D. 2, 4, 1, 3

B. 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.

A patient is diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. Which type of isolation precaution is most appropriate for this patient? A. Reverse isolation B. Droplet precautions C. Standard precautions D. Contact precautions

B. Droplet 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.

Which of these statements are true regarding disinfection and cleaning? (Select all that apply.) A. Proper cleaning requires mechanical removal of all soil from an object or area. B. General environmental cleaning is an example of medical asepsis. C. When cleaning a wound, wipe around the wound edge first and then clean inward toward the center of the wound. D. Cleaning in a direction from the least to the most contaminated area helps reduce infections. E. Disinfecting and sterilizing medical devices and equipment involve the same procedures.

B. General environmental cleaning is an example of medical asepsis. C. When cleaning a wound, wipe around the wound edge first and then clean inward toward the center of the wound. D. 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.

What does it mean when a patient is diagnosed with a multidrug-resistant organism in his or her surgical wound? (Select all that apply.) A. There is more than one organism in the wound that is causing the infection. B. The antibiotics the patient has received are not strong enough to kill the organism. C. The patient will need more than one type of antibiotic to kill the organism. D. The organism has developed a resistance to one or more broad-spectrum antibiotics, indicating that the organism will be hard to treat effectively. E. There are no longer any antibiotic options available to treat the patient's infection.

B. The antibiotics the patient has received are not strong enough to kill the organism. D. 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

Which of the following actions by the nurse comply with core principles of surgical asepsis? (Select all that apply.) A. Set up sterile field before patient and other staff come to the operating suite. B. Keep the sterile field in view at all times. C. Consider the outer 2.5 cm (1 inch) of the sterile field as contaminated. D. Only health care personnel within the sterile field must wear personal protective equipment. E. The sterile gown must be put on before the surgical scrub is performed.

B.Keep the sterile field in view at all times C. Consider the outer 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.

When should a nurse wear a mask? (Select all that apply). A. The patient's dental hygiene is poor. B. The nurse is assisting with an aerosolizing respiratory procedure such as suctioning. C. The patient has acquired immunodeficiency syndrome (AIDS) and a congested cough. D. The patient is in droplet precautions. E. The nurse is assisting a health care provider in the insertion of a central line catheter.

B.The nurse is assisting with an aerosolizing respiratory procedure (suctioning) D. Pt is in droplet precautions E. 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 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? A. Provide a dark, quiet room to calm the patient. B. Reduce the level of precautions to keep the patient from becoming angry. C. Explain the reasons for isolation procedures and provide meaningful stimulation. D. Limit family and other caregiver visits to reduce the risk of spreading the infection.

C. Explain the reasons for isolation procedures and provide meaningful stimulation

What is the most effective way to control transmission of infection? A. Isolation precautions B. Identifying the infectious agent C. Hand hygiene practices D. Vaccinations

C. Hand hygiene practices

Types of Infections for Contact Precautions

Colonization with MRSA, C. diff, shigella, herpes, scabies

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? A. Wear gloves before eating or handling food. B. Place any soiled materials into a bag and double bag it. C. Have the family member check with the health care provider about need for immunization. D. Perform hand hygiene after care and/or handling contaminated equipment or material.

D. Perform hand hygiene after care and/or handling contaminated equipment or material.

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? A. Reinforce dressing with a clean, dry dressing and call the health care provider. B. Remove wet dressing and apply new dressing using sterile procedure. C. Put on gloves before removing the old dressing; then obtain a wound culture. D. Remove saturated dressing with gloves, remove gloves, then perform hand hygiene and apply new gloves before putting on a clean dressing.

D. 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.

Types of Infections for Droplet Precautions

Diphtheria, Rubella, Stretpococcal pharyngitis, pneumonia, pertussis, mumps, mycoplasma pneumonia, meningococcal pneumonia or sepsis, pneumonic plague

Type of Infections for Airborne Precautions

Measles, Chickenpox, Disseminated varicella zoster, pulmonary/laryngeal TB

Barrier protection for Contact Precautions

Private room, gloves, gowns

Barrier protection for Droplet Precautions

Private room, mask or respirator required

Barrier protection for Airborne Precautions

Private room, negative pressure airflow, mask or respiratory protection device, N95 respirator

Barrier protection for Protective Environment

Private room, positive airflow, mask

Aseptic Technique

Refers to the practices/procedures that help reduce the risk for infection

Asepsis

The absence of pathogenic microorganisms