Asepsis AND Infection Control PDF

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Summary of Chapter 34 from Fundamentals of Nursing Taylor 9th edition. The summary is organized in an outline form...

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CHAPTER 24 ASEPSIS AND INFECTION CONTROL Infection-dx that results fr pathogens centers for disease prevention and control (CDC) U.S. govt agency respnsible for Investigating Preventing Controlling Dx THE INFECTION CYCLE 1. INFECTIOUS AGENT 2. RESERVOIR → natural habitat of org 3. PORTAL OF EXIT→ respi,GI,GU,blood, skin break 4. MEANS OF TRANSMISSION → direct/indirect 5. PORTALS OF ENTRY→ same as portal of exit 6. SUSCEPTIBLE HOST→ degree of reistance potential host has for pathogen COMPONENTS OF INFECTION CYCLE Infectious agent: bacteria,viruses, fungi Reservoir: natural habitat of organism Portal of exit: point of escape of organism Means of transmission: direct contact, indirect contact-vector/fomite;airborne route Airborne-< 5 mcm; droplet >5mcm Portal of entry: point where org enter new host Susceptible host: must overcome resistance of host’s defenses HOW TO BREAK THE CHAIN OF INFECTION

1.Bacteria-most signfcnt/com obsrvd infxn-causing agnts in HC Shape- spherical-cocci;rod-bacilli;corkscrewspirochetes Gram +-thick cell wall resist decolorization, stained:violet,AB effective Gram- chem more complx cellwall,decolorized: alcohol;don’t stain Aerobic-require O2; anaerobic –don’t req O2 2.Virus-smallest org visible thru Electron Micr. - Common Cold,hepB/C,AIDS-not affected b antibiotics 3.Fungi-plant like org-athletes foot,ring worm,yeast 4.parsites-live in host-malaria Factors affecting Org potential to prod dx 1.Number of organisms 2.Virulence

3.Competence of immune system 4.Length /intimacy of contact bet person /microorganism STAGES OF INFECTION 1.Incubation Period – interval bet pathogen’s invasion of body and sx; Time varies, org growing/ multiplying 2.Prodromal Stage - Last sev hrs to days;most infectious,sx vague 3.Full Stage of illness - Time varies. Signs/ symptoms 4.Convalescent –varies. Signs/sx disappear, returns to healthy state stage of infection is the patient most contagious? Prodromal stage

WHAT TO DO AND/OR SAY?

THE BODY’S DEFENSE AGAINST INFECTION Normal flora- 1st line defnse; keeps pot harmful bact fr invding 1.inflammatory Response→ Elim invading pathogen/tissue repair. -- neutralize, control, eliminate offending agent/prep site for repair. 1. vascular stage • Small BV constrict, vasodilatation of arterioles/venules Inc in BF- redness/heat in area; Histamine –incr permeability of vessels, -protein-rich fluid inc swelling, pain, loss of function 2. cellular stage WBC arrive; Neutrophils- 1 phagocytes- engulf orgconsume cell debris / foreign mat Exudate- fluid, cells inflammatory byproducts releasd Serous-clear; sanguineous-RBC purulent-pus Repair of damg cellsregeneration ;-scar formation 2. Immune Response→ sp. body responses to invading foreign a Antigen-foreign mat;antibodyAntigen-Antibody- Humoral Immunity. Cell-mediated defense helps the body defend against invaders. Cellular Immunity-inc lymphocytes WBC; destroy/react w cells body recognizes as harmful FACTORS AFFECTING HOST SUSCEPTIBILITY -Intact skin/mucous membranes -Normal pH levels -WBC -Age, sex, race, -hereditary factors -Immunization,natural or acquired -Fatigue, climate, nutritional and general health status -Stress -Use of invasive or indwelling medical devices CARDINAL SIGNS OF ACUTE INFECTION Redness-Heat-Pain –Swelling-Loss of function Medical asepsis- clean technique, proc and practices,  pathogens Hand hygiene, PPE C difficile- soap and water

Surgical asepsis-sterile tehniquekeep obj free fr MOIV/urinary cath Labs indicating Infxn 1.  WBC ; N- 5,000 TO 10,000/mm3 2.  sp types WBC 3.  ESR-EYTHROCYTE SEDIMENTATION RATE 4. Presence pathogen:urine,bld, sputum,draining cultures Labs-Infxn-elevatedvWBC 1. WBC-.N-5,000 to 10,000/mm3. - sp types WBC (differential cnt/ percentage of each cell type) 2.Neutrophils-N =60%–70%. -acute infxn-prod pus - if decreased- risk-acute bacterial infxn stress 3.Lymphocyte- scavenger/phagocyte N = 20%–40% -chronic bacterial/viral infxn 4.. Monocytes N =2%–8% - severe infxn 5.Eosinophil-N 1%–4% - allergic rxn/parasitic infxn 6.Basophil-N 0.5%–1%- usu unaffected by infxn - ESR—RBC settle more rapidly to bottom of a tube of whole blood when inflammation is present 7.Pres of pathgen -urine,blood,sputum, draining cultures

NURSING PROCESS FOR INFECTION CONTROL (ADPIE) 1.Assessment 2.Diagnosis 3.Plan 4.Implement 5.Evaluate -What are some nursing diagnosis (NANDA approved) related to an infectious process? HOW CLEAN IS CLEAN?Depends… Medical Asepsis→ “Clean Technique” Clean technique- reduce no of pathogens - healthcare professionall perform hand hygiene and don gloves Surgical Asepsis → “Sterile Technique” -used to keep objects/ areas free from MO USE OF SURGICAL ASEPSIS 1. OR, labor/delivery areas 2. certain Dx-diagnostic testing areas 3. patient bedside -proc inv insertion of urinary catheter, sterile deressing changes or prep/injecting meds A QUICK REVIEW PRACTICING BASIC PRINCIPLES OF MEDICAL ASEPSIS IN PATIENT CARE • Practice good hand hygiene. • Keep soiled items/equipment from touching the clothing. • Carry soiled linens/used articles so it doesnt touch your clothing. • Dont place soiled bed linen or any other items on floor, - grossly contaminated;contamination of both surfaces. • Avoid allowng pxto cough, sneeze, or breathe directly on others.

• Provide disposable tissues, instruct to cover mouth/ nose to prevent spread by airborne droplets. Move equip away fr u when brushing, dusting, scrubbing articles. prevent contaminated particles from settling on hair, face, clothing. • Avoid raising dust. Use specially treated cloth / dampened cloth. Dont shake linens. Dust/lint particles -vehicle transport • Clean least soiled areas 1st then more soiled onesprevent having the cleaner areas soiled by the dirtier areas. • Dispose of soiled/ used items directly into appropriate containers. • Wrap moist items fr body disx/ drainage in waterproof cont, like plastic bags, before discarding in refuse;avoid contact in handlers • Pour liquids - bath water, mouth rinse, directly to drain to avoid splattering in sink. Sterilize items suspected of cont pathogens. • After sterilization, they can be managed as clean items,if approp. • Use personal grooming practice tot help prevent spreading MO –ex. Shmpoo reg, keep short/pinned up, keep fingernails short, free of brokn cuticles/ragged nail edges, avoid ring w/stonesharborMO keeping it short or pinned up to limit the possibility of carrying • Follow guidelines conscientiously for standard and transmission-based precautions as prescribed by your agency. ASEPSIS- HAND HYGIENE - most effective way to help prevent the spread infectious agents. - most health care–assoc pathogens transmitted via contaminated hands of health care workers. - CDC-each yr- 2 million patients or 1 in 20 people get hospitalacquired infection. CDC issued-initial guidelines for hand hygiene in health care settings in 2002. hand hygiene - handwashing w/plain soap & water, use of antiseptic hand rubs inc waterless alcohol-based products, or surgical hand antisepsis. -hand hygiene -most impt proc for preventing infxn,not performed Compliance rates-below 50% and < 41% when gloves are used. HOW TRANSMISSION BARRIERS HELP PREVENT

TRANSPORTATION OF PATHOGENS

4 CATEGORIES HOSPITALACQUIRED INFECTIONS (HAIS) 1.Urinary tract infections 2.Surgical site infections 3.Bloodstream infections 4.Pneumonia Risk factors VANCOMYCIN-RESISTANT ENTEROCOCCI (VRE)-gram + cocci 1. Compromised immune systems 2. Recent abdominal /chest surgery 3. Pres of urinary/central IV catheter 4. Prolonged AB use,esp. w/vancomycin 5. Lengthy hospitalstay, esp ICU

FIVE MOMENTS FOR HAND HYGIENE (WHO) 1.Moment 1– Before touching a patient 2.Moment 2-b4 a clean/aseptic procedure 3.moment 3- after a bbody fluid exposure risk 4.Moment 4-after touching a patient 5.Moment 5- after touching patient surrounding WHAT IS ON GRUBBY LITTLE HANDS? bacterial flora Transient Flora: attached loosely on skin, removed w relative ease Resident Flora: skin creases;req friction wbrush to remove What my nails have to do w/it: • Transient bacteria-potential to adjust to skin envt, pres in no. over pd-become resident bacteria Resident bacteria- bcome carriers .- prev transient become resident-clean hands promptly when visibly soiled, after contact w/cntamnted mats, after glove removal. CDC guideline for hand hygiene in healthcare settings (2002)-HC personell w/patient care- not wear artificial nairls- bac counts - artificial nails in (OR) - citable offense dur- The Joint Commission accreditation process. Natural nails -...