Ch 28 Infection Prevention and Control

Identify the rationale for the following PPE: Protective eyewear

Protective eyewear should be worn for procedures that generate splashes or splatters

Portal of exit

Sites such as blood, mucus membranes, respiratory tract, genitourinary tract, and gastrointestinal tract

Isolation guidelines: Standard precautions (tier 1)

Standard precautions are designed for all patients in all settings regardless of the diagnosis; they apply to contact with blood, body fluid, nonintact skin, and mucous membranes

Method of controlling or eliminating infectious agents: Sterilization

Sterilization is the complete elimination or destruction of all microorganisms, including spores

Bacteriostasis

Illnesses such as viral meningitis or pneumonia

Infectious disease

Illnesses such as viral meningitis or pneumonia

Modes of transmission: surgical wounds

Keep drainage tubes and collection bags patent

Modes of transmission: bedside unit

Keep surfaces clean and dry

Droplet transmission

Large particles that travel up to 3 ft and come in contact with the host

Explain factor that influences a patient's susceptibility to infection: disease process

People with disease of the immune system (leukemia, AIDS) and chronic diseases (AODM_ have weakened defenses against infection

Direct transmission

Person-to-person or physical source and susceptible host

Indirect transmission

Personal contact of a susceptible host with a contaminated inanimate object

Carriers

Persons who show no symptoms of illness but who have the pathogens that are transferred to others

Modes of transmission: contaminated sharps

Place all needles, safety needles, and needleless systems into puncture-proof containers

Modes of transmission: contaminated articles

Place tissues, solid dressings, or soiled linen in fluid-resistant bags

Major route of transmission

Unwashed hands of health care worker

Modes of transmission: drainage bottles and bags

Wear gloves and protective eyewear and empty all drainage systems at the end of the shift

Modes of transmission: bathing

When bathing, use soap and water to remove drainage, dried secretions, and excess perspiration

Localized infection

Wound infection; patient experiences localized symptoms

Identify some common waste materials that are considered infectious

- Wounds - Blood - Stool - Urine

Identify the sites and causes of health care-associated infections

- urinary tract - surgical or traumatic wounds - respiratory tract - bloodstream

Systemic infection

An infection that affects the entire body instead of just a single organ

Communicable disease

An infectious disease

Elements of a respiratory hygiene or cough etiquette are:

- Education of health care facility staff and visitors - Posters and written material for agency and visitors - Education on how to cover your nose and mouth when you cough, using a tissue, and the prompt disposal of the contaminated tissue - Placing a surgical mask on the patient if it will not compromise respiratory function or is applicable - Hand hygiene after contact with contaminated respiratory secretions - Spatial separation greater than 3 ft from persons with respiratory infections

The expected outcome is the absence of signs and symptoms of infection. List some ways the nurse can monitor the patient

- Monitor patients postoperatively, including surgical sites, invasive sites, the respiratory tract, and the urinary tract - Examine all invasive and surgical sites for swelling, erythema, or purulent drainage - Monitor breath sounds - Review laboratory results

List ways a nurse can teach patients and their families to prevent an infection from developing or spreading

- Nutrition - Immunizations - Personal hygiene - Regular rest and exercise - Eliminate reservoirs of infection - Control portals of exit and entry

List four common goals for a patient with an actual or potential risk for infection

- Preventing exposure to infectious organisms - Controlling or reducing the textent of infection - Maintaining resistance to infection - Verbalizing understanding of infection prevention and control techniques

List nine responsibilities of infection control professionals

- Provide staff and patient education - Develop and review infection prevention and control policies and procedures - Recommend appropriate isolation procedures - Screen patient records - Consult with health departments - Gather statistics regarding the epidemiology - Notify the public health depart of incidences of communicable diseases - Consult with all departments to investigate unusual events or clusters - Monitor antibiotic-resistant organisms

Identify some common nursing diagnoses that apply to patients at risk or who have an actual infection

- Risk for infection - Imbalanced nutrition - Impaired oral mucous membrane - Impaired skin integrity - Social isolation - Impaired tissue integrity

List seven principles of surgical asepsis

- A sterile object remains sterile only when touched by another sterile object - Place only sterile objects on a sterile field - A sterile object or field out of the range of vision or an object held below a person's waist is contaminated - A sterile object or field becomes contaminated by prolonged exposure to air - When a sterile surface comes in contact with a wet, contaminated surface, the sterile object or field becomes contaminated surface, the sterile object or field becomes contaminated by capillary action - Because fluid flows in the direction of gravity, a sterile object becomes contaminated if gravity causes a contaminated liquid to flow over the object's surface - The edges of a sterile field or container are considered to be contaminated

Development of an infection occurs in a cycle that depends on the following elements

- An infectious agent or pathogen - A reservoir or source - A portal of exit from the reservoir - A mode of transmission - A portal of entry to a host - A susceptible host

List in order the steps for performing a sterile procedure

- Assemble all equipment - Don caps, masks, and eyewear - Open sterile packages - Open sterile items on a flat surface - Open a sterile item while holding it - Prepare a sterile field - Pour sterile solutions - Surgical scrub - Apply sterile gloves - Don a sterile gown

Identify clinical situations in which a nurse would use surgical asepsis

- During procedures that require intentional perforation of the patient's skin - When the skin's integrity is broken - During procedures that involve insertion of catheters

Identify the rationale for the following PPE: gloves

Gloves prevent the transmission of pathogens by direct and indirect contact

Identify the rationale for the following PPE: Masks

A mask should be worn when you anticipate splashing or spraying of blood or bloody fluid into your face and to satisfy droplet or airborne precautions

Reservoir

A place where a pathogen survives

Explain factor that influences a patient's susceptibility to infection: nutritional status

A reduction in the instake of protein, barbs, and fats reduces the body's defenses and impairs wound healing

Bactericidal

A temperature or chemical that destroys bacteria

When a patient on respiratory isolation must be transported to answer part of the hospital, the nurse: a. Places a mask on the patient before leaving the room b. Obtains a health care provider's order to prohibit the patient from being transported c. Instructs the patient to cover his or her mouth and nose with a tissue when coughing or sneezing d. Advises other health team members to wear masks and gowns when coming in contact with the patient

A. Placing a mask on the patient before leaving the room; Patients who are transported outside of their rooms need to wear surigical masks to protect other patients and personnel

The nurse sets up a nonbarrier sterile field on the patient's over-bed table. In which of the following instances is the field contaminated? a. Sterile saline solution is spilled on the field b. The nurse, who has a cold, wears a double mask c. Sterile objects are kept within a 1-inch border of the field d. The nurse keeps the top of the table above his or her waist

A. Sterile saline solution is spilled on the field; If moisture leaks through a sterile package's protective covering, organisms can travel to the sterile object

The severity of a patient's illness depends on all of the following except: a. incubation period b. extent of infection c. susceptibility of the host d. pathogenicity of the microorganism

A. incubation period; The incubation period is the interval between the entrance of the pathogen into the body and appearance of first symptoms

Virulence

Ability to survive in the host or outside the body

pH

Acidity of the environment

Vascular and cellular responses

Acute inflammation; rapid vasodilatation that causes redness at the site and localized warmth, allowing phagocytosis to occur

Method of controlling or eliminating infectious agents: Alcohol-based hand rubs

Alcohol-based hand rubs are recommended by Centers for Disease Control and Prevention to improve hand hygiene practices, protect health care workers' hands, and reduce pathogens to patients

Identify the rationale for the following PPE: Gowns

Gowns prevent soiling clothing during contact with patients

Aerobic bacteria

Bacteria that require oxygen for survival

Anaerobic bacteria

Bacteria that thrive with little or no free oxygen

Explain factor that influences a patient's susceptibility to infection: stress

Basal metabolic rate increases; increase serum glucose levels and decrease anti-inflammatory responses with elevated cortisone levels

Which of the following is not an element in the development or chain of infection? a. Means of transmission b. Infectious agent or pathogen c. Formation of immunoglobulin d. reservoir for pathogen growth

C. Formation of immunoglobulin; infection occurs in a cycle that depends on the presence of certain elements

Modes of transmission: dressing changes

Change dressings when they are wet or soiled

Medical asepsis

Clean technique: hand hygiene, using clean gloves, cleaning the environment routinely

Vehicles transmission

Contaminated items

Which of the following best describes an iatrogenic infection? a. It results from a diagnostic or therapeutic procedure b. It results from an extended infection of the urinary tract c. It involves an incubation period of 3 to 4 weeks before it can be detected d. It occurs when patients are infected with their own organisms as a result of immunodeficiency

D. It occurs when patients are infected with their own organisms as a result of immunodeficiency; An iatrogenic infection occurs when part of the patient's flora becomes altered and an overgrowth results

Method of controlling or eliminating infectious agents: Hand hygiene

Hand hygiene includes washing hands with soap and water following by a stream of water for 15 seconds

Immunocompromised

Having an impaired immune system

Tissue repair

Healing involves the defensive, reconstructive, and maturative stages

Method of controlling or eliminating infectious agents: Disinfection

Disinfection is a process that eliminates many or all microorganisms with the exception of bacterial spores from inanimate objects

Modes of transmission: bottled solutions

Do not leave bottle solutions open; date and discard them in 24 hours

Airborne transmission

Droplets that suspend in the air

Endogenous

Endogenous infection occurs when part of the patient's flora becomes altered an an overgrowth results

Exogenous

Exogenous infection comes from microorganisms outside the individual that do not exist in normal floras

Susceptibility

Individual's degree of resistance to pathogens

Explain factor that influences a patient's susceptibility to infection: age

Infants have immature defenses, breastfed babes have greater immunity, viruses are common in middle-aged adults, older adult cell-mediated immunity declines

Pathogen

Infectious agent

Inflammation

Inflammation is the body's response to injury, infection, or irritation. It is a protective vascular reaction that delivers fluid, blood products, and nutrients to an area of injury

Inflammatory exudate

Inflammatory exudate is the accumulation of fluid and dead tissue cells; WBCs form at the site. Exudate may be serious, sanguineous, or purulent

Vector transmission

Internal and external transmissions

Isolation guidelines: Isolation precautions (tier 2)

Isolation precautions are based on the mode of transmission of disease. They are termed airborne; droplet; contact; and a new category, protective environment

Colonization

Organism that multiples within a host but does not cause an infection

Concept of asepsis

The absence of pathogenic microorganisms; the technique refers to the practices or procedures that assist in reducing the risk for infection

Normal flora

The body contains microorganisms that reside on the surface and deep layers of the skin, in saliva and oral mucosa, and in the intestinal walls and genitourinary tract that maintain health

Body system defenses

The skin, mouth, eyes, respiratory tract, urinary tract, genitourinary tract, and vagina have unique defenses against infection