Infection Prevention & Control
what is an important step to remember when using sterile solution in a procedure?
"lip solution" bottle before actually pouring solution in sterile container (removes any pathogens on lip of bottle before pouring into sterile field)
What are the six components of the chain of infection?
-Infectious agent -reservoir -portal of exti -mode of transmission -portal of entry -host
What do airborne precautions ential?
-N95 respirator (duck bill mask) - on before entering room -HEPA filtration in private room -door closed -monitor airflow -eye protection (if splashes likely)
what are five situations in which an RN uses an alcohol-based waterless antispetic agent?
-before going into pt room -before putting on gloves -after putting on gloves -after leaving pt room -before taking VS
when washing hands in preparation for sterile environment (surgical scrub) what are the steps/what is important?
-don mask and hat before starting handwash process -start with fingers then to elbow -3 minutes -clean under finger nails -pat dry with sterile towel inside OR -have assistant put on gloves
what are five examples of objective data indicating an infection?
-elevated WBC -cloudy, foul smelling urine -productive cough with yellow sputum -fever -lymphandenopathy (enlarged lymph nodes)
whats important to remember for reduction of infection risk when using a condom catheter on a patient?
-keep closed system so no portal of entry for pathogen -keep bag lower than the bladder
what are some ways to prevent VAP?
-keep head of bed at 30-45 degree angle -wash hands -check pt ability to breathe on own
in assessing a pt's defense mechanisms what are some things to consider?
-overall health -skin intact - if not, portal of entry for pathogen available -chronic disease - possible weakend immune system -medications in use - possible weakened immune system -smoking - many issues - i.e. cilia immobilization in airway
what happens if a pt tests positive for TB exposure during PPD screening?
-pt gets chest x-ray -if chest x-ray reports positive for TB infection, must take 6-12 mothns of antibiotics -if chest x-ray reports negative for TB infection, annual survey to follow
what information is reported on a CBC (complete blood count)?
-red blood cells - hemotology -white blood cells - immunology -platelets - coagulation -hemoglobin - oxygenation of RBC -hematocrit - how many RBC
during a patient assessment what are the three general things to address?
-status of defense mechanisms -patient susceptibility -clinical appearance (localized vs systemic infection)
what are common sites for HAIs to occur?
-urinary tract -wounds -respiratory tract -bloodstream -CLABSI - central line associated blood stream infection -CAUTI - catheter associated urinary tract infection SSI - surgical site infection
What do droplet precautions entail?
-visitors in room must wear gown, gloves, mask and eye protection
what percentage of basophils should be present?
0.5-1.5%
how many patients will contract HAI?
1 in 20
what percentage of eoisinophils should be present?
1-4%
temperature of 101 - when is it ok and when is it not ok?
101 degrees F is potentially ok in an adult, not ok in an infant, transplant patient, HIV+ patient or cancer patient
what percentage of lymphocytes should be present?
20-40%
Droplet precautions - how close does a person have to be to transfer pathogens?
3-5 feet
what is a noraml WBC level?
5,000 - 10,000
what percentage of monocytes should be present?
5-10%
what percentage of segs and bands should be present?
55-70%
what's an example of a systemic infection that did not start as a localized infeciton?
?
what patient populations have low WBC?
AIDS Cancer - radiation supresses bone marrow and therefore productoin of blood cells
what common disease process has spores?
C difficile
what do we learn from looking at C-reactive protein on a lab report?
C-reactive protein is elevated in patients with chronic stressors (i.e. smoking)
if an RN is wearing a gown and gloves and is using patient dedicated equipment what type of precaution is in place?
Contact precaution
what does ESR stand for?
Erythrocyte Sedimentation Rate
if a patient is required to wear an N95 mask when they leave the room, they have a HEPA filter in their room, and their door is kept closed - what type of precaution is in place?
Reverse isolation
if there's a positive flow HEPA filter in a pt room and the RN is wearing gloves and a surgical mask - what type of precaution is in place ?
Reverse isolation
on a C&S report, what tells us that a drug will be effective against a bug?
S next to the drug indicates that the bug is sensitive to that drug
whats another term for ESR?
Sed Rate
PPD screens for what disease process?
TB
what does TDaP mean?
Tetanus, diphtheria, acellular protessus
what's an example of a localized infection that turned into a systemic infection?
UTI turns into kidney infection -->septicemia
what are the major things to review when looking at labs?
WBC, RBC, platelet count, ESR, C-Reactive Protein, C&S
explain a vehicle as a mode of transmission
a vehicle is a reservoir i.e. standing water, food, fomite (inanimate object)
whats most important, tending to an acute pt issue or a chronic pt issue?
acute
vericella is transmitted through what mode?
airborne
If an RN puts on an N95 respirator before entering a pt room, has on eye protection, closes the door behind her and is entering a room that is private, has a HEPA filtration system and has negative air flow - what precautions are in place?
airborne precautions
pumonary or laryngeal TB, chicken pox, disseminated Herpes Zoster (shingles), TB, Rubeola (measles), Epidemic influenza are examples of reasons to implement what precautions.
airborne precautions
standard precautions entail?
all PPE as needed
on a C&S report, what tells us that a drug will not be effective against a bug?
an R next to the drug name indicated that the bug is resistant to that drug
what is the name of an immature neutrophil?
band
in a chain of inefction what is an agent?
bug or organism causing infection -bacteria, virus, fungus, protozoa
what does C, D & I mean?
clean, dry and intact
removal of all organic and inorganic material from objects and surfaces
cleaning
what does sterilization do?
completely eliminates or destroys all microorganisms including spores
what type of catheter is safest for men? (less likely to cause CAUTI)
condom catheter
multidrug resistant organisms, wounds or abcesses with uncontained drainage, clostridium difficile infection (diarrhea), scabies are examples of reasons to implement what precautions?
contact precautions
explain transmission of an infection via droplets
coughing or sneezing in close proximity -i.e. meningitis can be contracted this way
what does C&S mean?
culture and sensitivity
what are the six modes of transmission?
direct, indirect, droplet, airborne, vehicle, vector
a process which eliminates many or all microorganisms, except spores is called?
disinfection
in assessing a pt's clinical appearance what are some things to consider?
does a person present infection? if so is it localized or systemic?
seasonal influenza, bacterial meningitis, pertussis (whooping cough) and mumps are examples of reasons to implement what precautions?
droplet
if an RN is wearing a gown, gloves, mask and eye protection what type of precautions are in place?
droplet precautions
what does it mean if a patient has a high ESR?
either infection or inflammation
what does disinfection do?
eliminates many or all microorganisms, except spores
if someone is splashed with bodily fluid or stuck with a needle, what is the first thing to do?
first aid
Assuming all forms of PPE are in use, PPE should be removed in what order? GETM
gloves eye cover ties on gown mask
Assuming all forms of PPE are necessary, PPE should be put on in what order?
gown mask eye cover gloves
What do contact precautions entail?
gown, gloves, patient dedicated equipment
what does HAI mean?
healthcare associated infection
what is a strong host?
healthy individual - can get exposed and not contract infection -strong immune system -received immunizations -good nutrition -no chronic illness
in a chain of infection what is the mode of transmission?
how an agent travels from host to another -i.e. airborne, bloodborne, droplets -determines what PPE we wear
in a chain of infection what is the portal of entry?
how an infection is contracted -i.e. respiratory tract, mucous membranes
in a chain of infection what is the portal of exit?
how the organism leaves the reservoir -i.e. punctured finger with glucometer
explain a vector as a mode of transmission
i.e. mosquitos - malaria, ticks - lyme disease, fox - rabies
why is it important to know about immunization history?
if child has not had vaccination... -determines increased risk of infection -determines who should be around child (keep child away from cancer patient b/c cancer pt more susceptible to catching infection)
how can use of an antibiotic cause a supra infection?
imbalance of normal flora b/c cleaned out good organisms/bacteria in addition to the bad
in what situation would a person's CBC show a high number of bands?
immune system is in over drive and working to produce WBCs (specifically neutrophils) to fight infection, can't produce fast enough so it just sends what it's got which are immature netrophils
what is a susceptible host?
individual most likely to contract infection upon exposure -weakened immune system -on medications that might limit ability to fight infection -chronic stressors - smoking, drinking -chronic illness - COPD, Diabetes
what is a localized infection?
infection in a small contained area i.e. spider bite - caused erythema, edema and pain in location directly around bite
what is systemic infection?
infection throughout entire system of pt body i.e. kidney infection (affects renal system)
what is required to remove potential presence of spores from hands?
mechanical hand washing - soap and water -antibacterial gel is not sufficient!
what technique does a CNA use when taking vital signs?
medical asepsis
what is an imporant thing for an RN to remember in keeping resistance to infection in regards to hand hygeine?
moisturize! hand washing often leads to dry skin which leads to cracks in skin. cracks in skin are portals of entry for pathogens!
what are common conditions that require contact precautions?
multidrug resistant organisms, wounds or abcesses with uncontained drainage, clostridium difficile infection (diarrhea), scabies
what type of WBC should be predominant type of WBC?
neutrophil
does a systemic infection always begin as a localized infection?
no - it can but that's not always the case
what dose afebrile mean?
no fever
for droplet precautions can prescription eye glasses be used as eye protection?
no, need side coverage for proper protection
do i have to be wearing glove to perform sterile technique?
no?????
what does clean technique mean?
objects and surfaces are free of all organic and inorganic material
what populations are most at risk for protessus?
older adults and children
who is more likely to contract an HAI?
older patients and patients with multiple illnesses
what is the proper way to remove a mask?
only touch ties, don't touch front/dirty area
YMEG means?
order in which to don PPE - yellow gown, mask, eye wear, gloves
pnemonia vaccinations are given to what patient population?
over age 65
why is impaired tissue integrity more commin in older adults?
oxygenation, hematocrit levels
explain direct transmission of an infection
person to person -i.e. shaking hands
explain indirect transmission of an infection
person to person via a fomite -i.e. bacteria on door knob from kid #1, kid #2 comes into bathroom and touches door knob -door knob is fomite
in a chain of infection what is the host?
person who has infection and passes it or who contracts the infection
in asessing a pt's susceptibility what are some things to consider?
persona background (possible exposure) -homeless person more at risk vs individual with shelter, regular nutrition and medical care -person with multiple sexual partners requires more screening
vericella is very dangerous for what patient population?
pregnant women - causes high risk for miscarriage and birth defects
What does reverse isolation entail?
pt doesnt have infection but efforts are in place to prevent contraction of infection -visitors in room must wear gloves and surgical mask -pt room must include positive airflow HEPA filter -keep door closed -no flowers or gifts
what patient populations have chronically high ESR?
pts with autoimmune disorders, arthritis, IBS
What are common conditions that require use of airborne precautions?
pumonary or laryngeal TB, chicken pox, disseminated Herpes Zoster (shingles), TB, Rubeola (measles), Epidemic influenza
what type of gloves are used when giving injections?
regular (not sterile)
if a patient is free of infection but is at high risk for contracting an infection, what percautions should be put into place?
reverse isolation
when is it common for a hospital to restrict patient's from recieving gifts and flowers?
reverse isolation
what are common conditions that require droplet precautions?
seasonal influenza, bacterial meningitis, pertussis (whooping cough), mumps
Patients with bloodborne pathogens get what form of precautions?
standard/universal
what type of precautions are used for patients with HIV and HepB?
standard/universal
what technique is being used when we give injections?
sterile
what is another term for surgical asepsis?
sterile technique, sterile asepsis
complete elimination or destruction of all microorganisms including spores
sterilization
explain aiborne transmission of an infection
strict percausion in place when knowledge of airborne disease b/c cannot be seen -i.e. requires use of duck bill mask (N95 mask) -TB can be contracted this way
what is it called when a person contracts a secondary infection due to use of antibiotics?
supra infection
what is the proper way of removing a gown?
untie string around neck, reach inside neckline (area not exposed/dirty), fold dirty side inward
what does VAP mean?
ventilator associated pneumonia
what type of infection will antibiotics not help?
virus
what does C&S tell us?
what drugs cause sensitivity or resistance to a certain bug (i.e. E. coli)
in a chain of infection what is the reservoir?
where the agent survives and multiplies -food, water, bug, human
can TB be cured?
yes with 6-12 months of antibiotics
