N1 Unit 6 Isolation & Asepsis/Infection

Infectious agents: Bacteria

*most significant and most prevalent* in hospital settings

CDC Recommendations to Precent C. Diff Infections

- Avoiding the use of electronic equipment that is difficult to clean (electronic thermometers) - Disinfecting dedicated patient care items and equipment (*stethoscopes*) between patients - Using full-barrier contact precautions (gown and gloves) - Placing patients in private rooms; cohort patients with the same strain of CDI - Performing meticulous hand hygiene (soap and water)

Hand Hygiene Criteria

- Before and after contact with each patient - Before putting on gloves & donning PPE - Before performing invasive procedures - After accidental contact with body fluids or excretions, mucous membranes, nonintact skin, and wound dressings, even if hands are not visibly soiled - When moving from a contaminated body site to a clean one during patient care - After contact with inanimate objects near the patient - After removal of gloves

Body's Defenses Against Infection:

- Body's normal flora (use probiotics if diminished) - Inflammatory response - Immune response

PPE includes:

- Clean (nonsterile) and sterile gloves - Impervious gowns/aprons - Surgical and high-efficiency particulate air (HEPA) masks, - N95 disposable masks - Face shields - Protective eyewear/goggles

Risk Factors for Vancomycin-Resistant Enterococci (VRE)

- Compromised immune systems - Recent Surgery - Invasive devices - Prolonged antibiotic use (especially vancomycin) - Prolonged hospitalization

Nursing Diagnoses for Isolation

- Deficient Knowledge - *Social Isolation* - Fear - Impaired Social Interaction - Risk for loneliness

(Continued) Basic Principles of Medical Asepsis

- Disposing of soiled or used items in appropriate containers - Pouring discarded liquids directly into the drain - Sterilizing items suspected of containing pathogens - Using personal grooming habits that prevent the spread of microorganisms - Following guidelines for infection control or barrier technique

Lab Data Indicating Infection

- Elevated white blood cell count— *normal is 5,000 to 10,000/mm3* - Increase in specific types of white blood cells - Elevated erythrocyte sedimentation rate (ESR) - Presence of pathogen in urine, blood, sputum, or draining cultures

Standard Precautions criteria

- Follow hand hygiene techniques. - Wear clean, nonsterile gloves when touching body fluids, contaminated items, mucous membranes, & nonintact skin. - Wear PPE during procedures and care activities likely to generate splashes or sprays of blood or body fluids. - *Avoid recapping used needles*; use safe injection practices. - Use gloves to handle used pt-care equipment that is soiled. - Wear a face mask if placing a catheter or injecting material into the spinal or epidural space.

Stages of Infection

- Incubation period: organisms growing and multiplying - Prodromal stage: person is MOST infectious, vague and nonspecific signs of disease. *Often pt doesn't realize they are contaminated.* - Full stage of Illness: presence of specific signs & symptoms of disease - Convalescent period: recovery from the infection. Normally asymptomatic.

Isolation: Nursing Interventions

- Inform pt of need for isolation, including use/purpose - Instruct pt of importance of proper hygiene/cover mouth when coughing, etc - Instruct patient to limit visitors - Inform pt of PPE required - Maintain isolations precautions, with appropriate PPE - Maintain isolation signs on room door - Assess pt for signs of isolation/loneliness

Factors Affecting Host susceptibility

- Intact skin and mucous membranes - Normal pH levels - Body's white blood cells - Age, sex, race, hereditary factors - Immunization, natural or acquired - Fatigue, climate, nutritional and general health status - Stress; how appropriate are the pt.'s coping methods? - Use of invasive or indwelling medical devices

Additional Precautions

- Limit patient exposure, only essential staff should enter the room - Limit visitors - Clean all equipment after patient use/limit equipment - Disposable plate/plastic ware for meals - *Limit the transport of the patient. If appropriate, tests should be portable.*

What diseases indicate the implementation of airborne precautions?

- Measles/Rubeola - Tuberculosis - Varicella - Severe Acute Respiratory Syndrome (SARS) - Covid - Ebola

What diseases indicate the implementation of contact precautions?

- Methicillin Resistant Staphylococcus Aureus (MRSA) - Vancomycin Resistant Enterococci (VRE) - Extended Spectrum Beta-Lactamase (ESBL) - Multi drug Resistant Organisms (MDRO) - Clostridioides Difficile (C diff) - Monkey Pox - Lice/Scabies - Rotavirus/ Norovirus/ Hepatitis A - RSV

Factors Determining Use of Sterilization and Disinfection Methods

- Nature and number of organisms present - Type of equipment - intended use of equipment - available means for sterilization and disinfection - Time

Factors Affecting an Organism's Potential to Produce Disease

- Number of organisms - Virulence (how potent) - Competence of person's immune system - Length and intimacy of contact between person and microorganism

Basic Principles of Surgical Asepsis

- Only a sterile object can touch another sterile object. - Open sterile packages so that the first edge of the wrapper is directed AWAY from the worker. - Avoid spilling solution on a sterile setup. - Hold sterile objects *above waist level.* - Avoid talking, coughing, or reaching over a sterile field or object. - Never walk away from or turn your back on a sterile field. (Always want to keep it w/in your eye of vision.)

Other C. Diff Precautions

- Performing environmental contamination of rooms - Educating health care providers (and patients/families as appropriate) on clinical presentation, transmission, and epidemiology of CDI - Using antimicrobials at an appropriate dose and only when indicated

Skills to Assist in Preventing the Spread of Infection

- Performing hand hygiene - Using personal protective equipment (PPE) - Preparing a sterile field (& not breaking the sterile field. If it happens --> start over.) Ex. Of breaking sterile field: coughing over it - Adding sterile items to a sterile field - Putting on and removing sterile gloves appropriately

What diseases indicate the implementation of droplet precautions?

- Pneumonia - Influenza - Mumps - Diphtheria - Meningitis (Neisseria) - Rhinovirus

Basic Principles of Medical Asepsis

- Practicing good hand hygiene - Carrying soiled items AWAY from the body - Keeping soiled items off the floor - Avoiding having patients cough, sneeze, or breathe directly on others - Moving equipment away from the body when cleaning articles - Avoiding raising dust - *Cleaning least-soiled areas first*

Contact Precautions

- Prevent transmission of infectious agents which are spread by direct or indirect contact with the patient or the patient's environment - Private room or cohort patients infected or colonized with the same organism - Gloves, Gown, mask

PPE Guidelines

- Put on PPE before contact with the patient. - Choose appropriate PPE based on type of exposure. - When wearing gloves, work from clean to dirty areas. - Touch as few surfaces and items with PPE as possible. - Avoid touching or adjusting other PPE. - Keep gloved hands away from the face. - Remove and replace torn or heavily soiled gloves. - Do not substitute goggles with personal glasses.

Bacteria is classified by..

- Shape: Spherical (cocci), rod shaped (bacilli), corkscrew shaped (spirochetes) - Gram positive or gram negative—based on reaction to Gram stain - Aerobic or anaerobic (based on need for oxygen)

(Continued) Basic Principles of Surgical Asepsis

- Sterilize all items brought in contact with broken skin or sterile body cavities. - Use dry, sterile forceps when necessary. - *Consider outer 1 inch of sterile field to be contaminated.* - When in doubt, consider all suspect items contaminated. (start over)

Additional Hand Hygiene Guidelines

- The use of gloves does not eliminate the need for hand hygiene. - The use of hand hygiene does not eliminate the need for gloves. - Natural fingernails should be kept less than ¼ inch long and artificial nails and extensions should not be worn in direct contact with high-risk patients. - Gloves should be worn when contact with blood, infectious material, mucous membranes, and nonintact skin could occur. - Hand lotions or creams are recommended to moisten and protect skin.

Droplet Precautions Criteria

- Use for patient with infection spread through large-particle droplets. - Use a private room (door may remain open). - Wear PPE upon entry into the room for all interactions that may involve contact with the patient and potentially contaminated areas in the patient's environment. - Transport the patient out of the room only if necessary; place surgical mask on patient. - Keep visitors 3 feet from patient.

Contact Precautions Criteria

- Use for patients infected by a microorganism spread by direct or indirect contact. - Place patient in private room, if available. - Wear PPE when entering the room for all interventions involving contact with the patient; change infected gloves and remove PPE before leaving the room. - *Wash hands with antimicrobial or waterless antiseptic agent.* - Wear gown if in contact with infectious agent. - Limit movement of the pt out of the room. - Avoid sharing patient care equipment.

Airborne Precautions Criteria

- Use for patients who have infections spread through air. - Place patient in private room with monitored negative air pressure and door closed; keep patient in room. - Use respiratory protection when entering the patient's room. - *Transport patient out of room only when necessary*; place surgical mask on patient. - Consult CDC guidelines for prevention strategies for tuberculosis.

Droplet Precautions

- Used for patients for known or suspected infection with pathogens transmitted by respiratory droplets - Transmitted through coughing, sneezing, talking - PPE: Gloves, Gowns, Goggles, *Surgical Mask*

Airborne Precautions

- Used for patients with known or suspected infected pathogens transmitted by the airborne route - Prevents transmission of infections that reman infectious over long distances when suspended in the air - PPE: Gloves, Gowns, Goggles/Eye Shield, *N95 or higher* - Negative Pressure Private Room

Standard Precautions

- Used on ALL patients to prevent the spread of infection. We assume that blood & body fluids are contaminated. - Hand hygiene before and after patient contact - Respiratory Hygiene: cover cough/sneeze - Properly clean equipment/supplies and proper disposal - Exercise proper Sharps disposal - Use gloves when coming in contact with blood or body fluids

Other Conditions Requiring Hand Hygiene

- When hands are visibly dirty - When hands are visibly soiled with or in contact with blood or other body fluids - Before eating and after using the restroom - If exposure to certain organisms, such as those causing anthrax or Clostridium difficile, is known or suspected

Asceptic Technique

-Includes all activities to prevent or break the chain of infection Two categories: medical and surgical

What are the 4 major hospital-acquired infections (HAIs)?

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

Which of the following is the most significant and commonly found infection-causing agent in health care institutions? A. Bacteria B. Fungi C. Viruses D. Mold

A. Bacteria

Controlling Infection: Minimizing complications and reducing adverse outcomes

Antimicrobials, PPE, clean equipment

For what patient care would the nurse use surgical asepsis? A. Administering medications B. Inserting an IV catheter C. Providing a bed bath D. Changing the linens on a bed

B. Inserting an IV catheter

During which stage of infection is the patient most contagious? A. Incubation period B. Prodromal stage C. Full stage of illness D. Convalescent period

B. Prodromal stage

The nurse is using medical asepsis when providing patient care on a hospital unit. Which nursing actions are performed correctly? A. The nurse places soiled bed linens on the floor. B. The nurse carries soiled items close to the body. C. The nurse moves equipment away from the body when cleaning it. D. The nurse cleans the most soiled areas first.

C. The nurse moves equipment away from the body when cleaning it.

*What type of precautions must be taken when a is suspected of being infected with C-Diff?*

CONTACT isolation Hand hygiene with *soap and water* Hand sanitizer is ineffective!

Medical Asepsis

Clean technique. - Involves procedures and practices that reduce the number and transfer of pathogens - For example, performing hand hygiene and wearing gloves. Also pt. catheter insertion @ home

What are the transmission precautions?

Contact Droplet Airborne

Which infection or disease may be spread by touching a contaminated inanimate article? A. Rabies B. Giardia C. E. coli D. Influenza

D. Influenza Influenza may be spread if a person touches a contaminated article and then touches one's eyes or nose. *The reservoir for rabies is animals; for Giardia, water; and for E. coli, water or food.*

T/F: It is not necessary to perform hand hygiene prior to performing a procedure using clean technique.

False

Order of removing PPE

Gloves --> Gown --> mask --> face shield/goggles Removed inside pt. care area, but mask needs to be removed outside the room. Careful not to touch outside of gloves when removing them (contaminated). Remove gown by the ties. Try not to touch front of gown (contaminated)

Order of donning PPE

Gown --> Mask --> goggles/face shield --> gloves last PPE should be donned BEFORE entering the patient room

Methods to break chain of infection?

Hand hygiene, PPE, patient education, antimicrobials.

Infection Control: Preventing & Breaking the chain of infection

Hand hygiene, teach pt. importance of hand hygiene. Educate pt about infection

Infection Control: Identifying the Infection

Lab tests: blood cultures, CNS test, wound culture, stool culture, sputum culture, CBC, etc.

*What is the difference between medical and surgical asepsis?*

Medical: reducing the number of pathogens transferred. Surgical: ensuring NO pathogens are present; sterile

According to WHO, what are the five moments for Hand Hygiene?

Moment 1 - Before touching a patient Moment 2 - Before a clean or aseptic procedure Moment 3 - After body fluid exposure risk Moment 4 - After touching a patient Moment 5 - After touching patient surroundings

Reservoir

Natural habitat of the organism.

Use of Surgical Asepsis

Operating room, labor and delivery areas Certain diagnostic testing areas Patient bedside For example, for procedures that involve insertion of urinary catheter, sterile dressing changes, or preparing and injecting medicine

Possible Reservoirs for Microorganisms

Other people Animals Soil Food, water, milk Inanimate objects

Prophylaxis

Preventative treatment. Ex: A covid pt needing both antivirals and antibiotics bc the disease makes them more susceptible to bacterial infections.

Alcohol-Based hand rubs

Recommended if hands are not visibly soiled. Advantages: saves time, more accessible, easy to use, reduces bacterial count on the hands.

It is important to educate the pt. about the importance of immunizations because?

Reduces chances of contracting the disease and promotes faster recovery time.

Common Portals of Exit

Respiratory Gastrointestinal Genitourinary tracts Breaks in skin Blood and tissue

T/F: Soaps and detergents (nonantimicrobial agents) are considered adequate for routine mechanical cleansing of the hands and removal of most transient microorganisms.

True.

T/F: Standard precautions should be used when caring for a noninfectious, postoperative patient who is vomiting blood.

True.

Evaluating Patient Goals

Use techniques of medical asepsis. Identify health habits and lifestyle patterns promoting health. State signs and symptoms of an infection. Identify unsafe situations in the home environment. Assess pt. ability to perform healthy practices.

Patient Teaching for Medical Asepsis at Home

Wash hands before preparing or eating food. Prepare foods at high enough temperatures. Use care with cutting boards and utensils. Keep food refrigerated. Wash raw fruits and vegetables. Use pasteurized milk and fruit juices. Wash hands after using bathroom. Use individual care items.

Transient Bacterial Flora

attached loosely on skin, removed with relative ease

Infectious agent

bacteria, viruses, fungi

Means of transmission

direct contact, indirect contact, airborne route. Decides which isolation to be placed in.

Resident Bacterial Flora

found in creases in skin, requires friction with brush to remove. (Resident= lives INSIDE)

Susceptible host

must overcome resistance mounted by host's defenses

Infectious agents: Fungi

plant-like organisms present in air, soil, and water

Portal of entry

point at which organisms enter a new host. Mainly through the skin and mucous membranes

Portal of exit:

point of escape for the organism

Cardinal Signs of Acute Infection

redness, heat, swelling, pain, loss of function

Infectious agents: Virus

smallest of all microorganisms

Surgical asepsis

sterile technique. Includes practices used to render and keep objects and areas free from microorganisms. For example, inserting an indwelling urinary catheter or inserting an intravenous catheter, IV insertion (all taking place in the hospital). the edges of a sterile package, once opened, are considered unsterile.