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NUR 104

Asepsis

Infection Control

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Standard Precautions

Good health depends in part on a safe environment.

Practice or techniques that control or prevent transmission of infection help to protect clients and health care workers from disease

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Standard Precautions

Employees are to follow precautions to prevent contact with blood or other infectious materials during the routine care of clients

Personal protective equipment (PPE) must be provided at no cost to the employees who are at risk for exposure and must be used by the employee

.Standard Precautions

Principles/procedures to prevent and control infection and its spread.

Break the chain of infectionApplies to all blood and body fluid except

sweatNonintact skin and mucous membranesProtect patient and healthcare worked

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Asepsis

Asepsis—absence of pathogenic microorganisms

The nurse’s efforts to minimize the onset and spread of infection based on principles of aseptic technique

Aseptic technique refers to practices that keep a client as free from microorganisms as possible

Two types: medical and surgical

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Surgical Asepsis

Sterile techniqueTo eliminate all microorganisms,

including pathogens and spores from an object or area

If an area or object is touched by any object that is not sterile it is considered contaminated

Medical AsepsisClean techniqueReduce number of organisms present

and prevent the transfer of organismsHand HygieneClean Gloves

Contaminated objectsBedpans/UrinalsOverbed tablesDirty Dressings

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Infection

Entry and multiplication of an infectious agent in the tissues of a host.

Infectious agent—pathogen

asymptomatic

symptomatic

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Health-Care Associated Infection

HAI result from delivery of health services in a health care facilityHigh population of virulent strains of

microorganisms that may be resistant to antibiotics

Increased hospital staysSurgical or traumatic woundsUrinary and Respiratory tractsBloodstream

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Healthcare Acquired Infection

Clients in hospital are at risk for acquiringLow resistance to infectious

microorganismsIncreased exposure to the number and

types of disease causing microorganisms

Invasive procedures

NON PAYMENT ISSUES

Infection

IatrogenicHAI from a diagnostic or therapeutic

procedure

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Infection

Exogenous infection—from organisms external to the person that do not exist as normal flora

Endogenous infection—when person’s flora becomes altered and an overgrowth results—yeasts, streptococci

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Risk factors

Inadequate secondary defensesReduced hemoglobin levelSuppression of WBCsSuppressed inflammatory

responseLow WBC count (leukopenia)

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Patient Susceptibility

Age—infant, child, older adults Nutritional status—protein, carbohydrates,

fats Stress Heredity Disease process—immune system,

chronic diseases, burn patients Medical therapy—some drug and medical

therapies compromise immunity to infection

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Patients at Risk

Inadequate primary defensesBroken skin or mucosaTraumatized tissueDecreased ciliary actionObstructed urine outflowAltered peristalsisChange in pH of secretionsDecreased mobility

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Chain of Infection

CAUSATIVE AGENT

Reservoir

PORTAL OF EXIT

MODE OF TRANSMISSION

PORTAL OFENTRY

SUSCEPTIBLEHOST

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Chain of Infection

Infection occurs in a cycle

that depends on the presence

of all of the following:An infectious agent or pathogen

Bacteria, fungi, virus, parasiteDose, Virulence, Enter/ survive,

Host resistance

CAUSATIVE AGENT

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Chain of infection

A reservoir or source for pathogen growth Human beings,

animals, inanimate objects

Reservoir

Portal of exit from the reservoir Sputum, emesis,

stool, blood Sneeze/Cough UTI Drainage Saliva Exchange

PORTAL OF EXIT

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Chain of Infection

Mode of transmission Contact Airborne Vectorborne Vehicle

Portal of entry to a host Mucous

membranes Nonintact skin GI tract GU tract Respiratory tract

MODE OF TRANSMISSION

PORTAL OFENTRY

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Chain of Infection

Susceptible HostImmunosuppressedElderlyChronically illTraumaSurgery

SUSCEPTIBLEHOST

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Infectious Process

Severity of illness depends on:Extent of infectionPathogenicity of microorganismSusceptibility of host

LocalizedSystemic—affects entire body

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Sepsis

The spread of an infection from its initial site to the blood stream, initiating a systemic response that adversely affects blood flow to vital organs

Bacterial infections are the most common source of initial infection

When organisms overwhelm local defenses and enters the bloodstream the resulting condition is called septicemia

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Inflammatory responseBody’s cellular response to injury or

infection = inflammationInflammation = (1) protective vascular

and cellular reaction thatDelivers fluid, blood products, and nutrients

to interstitial tissues in the area of injuryNeutralizes and eliminates pathogens or

dead (necrotic tissues)Establishes means of repairing body cells

and tissues

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Signs of inflammation

LocalizedSwellingRednessHeatPain or tendernessLoss of function

Systemic: Fever, leukocytosis, malaise, anorexia,

nausea, vomiting, lymph node enlargement

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Vascular response

Injury/infection: Arterioles supplying the area dilate, allowing more

blood into the local area. This causes redness, localized warmth is from greater blood volume. Vasodilation delivers blood and WBCs to injured tissues

Injury causes tissue necrosis. Fluid, protein, and cells enter interstitial spaces, accumulated fluid appears as localized swelling (edema)

Pain is caused by the swelling of inflamed tissues increasing pressure on nerve endings

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Cellular response

WBCs arrive at the siteWBC pass thru blood vessels into the

tissuesPhagocytosis—specialized WBCs called

neutrophils and monocytes ingest and destroy microorganisms or other small particles

Leukocytosis—increased # of circulating WBCs in response to WBCs leaving the blood vessels

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2. Inflammatory exudate

Accumulation of fluid and dead tissue cells and WBCs form an exudate at the site of inflammationSerous—clear, like plasmaSanguineous—containing RBCsPurulent—containing WBCs and

bacteria

Cleared away by the lymphatic drainage

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3. Tissue Repair

Healing involves the defensive, reconstructive, and maturative stagesDamaged cells replaced with healthy new

cellsNew cells undergo gradual maturation until

they have the same structural and appearance as previous cells

Chronic inflammation—tissue defects may fill with fragile granulation tissue—not as strong as tissue collagen--scar

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Nursing Assessment

Review of disease history, exposure to CD

Review of clinical condition—signs and symptoms of actual infection or risk for infection

Analysis of lab findings

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Nursing Diagnosis

Risk for infectionRisk for injuryImbalanced

nutritionImpaired skin

integrityImpaired oral

mucus membrane

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Plan

Prevent exposure to infectious organisms

Controlling or reducing the extent of infection

Maintain resistance to infectionEducation of client and family about

infection control techniques

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Management of Infection

Asepsis Handwashing is the MOST EFFECTIVE

means for preventing the spread of organisms Basic Practices:

- Wash hands before and after each patient- Cleans from clean to dirty- Do not hold soiled items close to body- Wear gloves when exposure is expected

UCSF dress code includes:- Clean uniforms- Short nails, non-acrylic- No rings with grooves or stones that may harbor organisms

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Blood Borne pathogens

Hepatitis BHIV

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Transmission of pathogens

Control or elimination of infectious agents Cleaning Disinfection and sterilization

Control or elimination of reservoirs Control of portal of exit Control of transmission

Handwashing, sharing of equipment, carrying dirty linen out from the body

Control of portals of entry

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Protection of susceptible hosts

Isolation precautionsProtective environmentPPE

Gloves, gowns, masks, eye protectionSpecimen collectionBagging trash/linenTransporting clients

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Isolation Precautions

Standard Precautions Universal precautions Neutropenia Respiratory Contact

Hand hygiene Most important and most basic in controlling

transmission of infection Use alcohol hand antiseptic before and after

providing care Handwashing is a vigorous, brief rubbing together of

the surface of the hands lather with soap, followed by rinsing under a stream of water

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Isolation Precautions

Standard Precautions (Tier One)- Assumes that all patients are potentially infectious- Sometimes referred to as Body Substance or Universal Precautions (body fluids, secretions, excretions, blood)

Transmission-Based (Tier Two)- Airborne - Droplet - Direct

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Isolation Precautions

Personal protective equipment Gloves Goggles Gown Mask Shoe covers

Isolation/protective environmentsClient and family education

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What’s Wrong With This Picture?

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Isolation Precautions (cont.)

Airborne (measles, varicella, TB)- Private, negative pressure room- Wear fit-tested (N 95 respirators) masks- Stop Sign at Door

Droplet (diphtheria, rubella, mumps, (p663) etc.)- Private room- Mask (regular) when within 3 feet of patient- Stop Sign at Door

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Isolation Precautions

Contact (C-diff, E-coli, hepatitis, HSV, VRE, MRSA, etc.)Private roomGowns, gloves, masks (regular)

- Stop Sign at Door

Protective (Reverse Isolation)

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Isolation Signage

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Respirator Equipment

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Isolation Precautions

Psychological implicationsEnvironmentEquipmentSpecimen collectionBagging of trash and linenTransporting clients

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Disposal Techniques

Bagging

- Contaminated materials (i.e. blood, feces etc.) in Biohazard Bag- Slightly soiled and disposable equipment go in regular trash

Soiled linen in linen hampers- Bring hamper to bedside, do not carry soiled linens down the hall

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Disposal Techniques

Sharps- Needles, syringes, scalpels etc. in puncture resistant Sharps containers- Do NOT recap used needles

Isolation Rooms- May require special disposable equipment (i.e. food trays, blood pressure cuffs, thermometers etc.) that remain in room until patient leaves

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Handwashing

Is important because

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