CH 14 - Fundamentals of Nursing Care: Medical Asepsis and Infection Control PDF

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Fundamentals of Nursing Care ...

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Medical Asepsis and Infection Control Infection A. Cause of Infection 1. Microorganisms: Miniscule living bodies that cannot be seen without a microscope. Microorganisms that cause infections are known as pathogens. 2. Pathogens reproduce rapidly and can spread from one area of a person’s body to another. 3. Normal flora and fauna: Normally found in the human body Microorganisms living in and on our body that preform needed functions to protect from harmful pathogens as well as help break down and digest food. B. Types of Pathogens 1. Bacteria: one celled microorganisms found virtually everywhere - it is only when they invade an area outside of their normal location that problems result a) Rickettsia are types of bacteria but are different from most because they reproduce inside the cells of the host. (1) Rickettsia are spread through vectors - bites of insects like ticks and mites. (2) The insects are carriers of the microbes so when they bite a human, the human becomes ill due to infection from the bacteria. b) Antibiotics are prescribed to treat infections caused by bacteria. (1) Antibiotics are only effective against bacteria c) Identifying Bacteria: (1) Cocci: Sphere shaped bacteria (a) Staphylococcus - cocci in clusters (b) Streptococcus - cocci in chains (c) Diplococci - pairs of cocci (2) Bacilli: rod shaped bacteria (3) Spirilla: long cells that spiral or coil 2. Viruses: very tiny parasites that live within the cells of the host and reproduce there a) Can only be seen using electron microscope - too small b) Not endemic to the human body - all viruses can potentially cause illness c) Very few antiviral medications exist - many viral infections are mild and will resolve in time without medication d) Antibiotics can be ordered to prevent secondary infection - we do not use antibiotics to treat viruses 3. Protozoa: single celled animals that live in water a) Can be ingested by water or food, causing intestinal illness b) Some protozoa are parasites that remain in the digestive tract -

treated with antiparasitic drugs c) Other illnesses are treated with anti-infectives specific to the

protozoan 4. Fungi: may be made of one or more cells - do not require microscope to

view - mold on bread or mushrooms in yard a) Cause illness when they enter the human body through cuts/cracks in skin b) Fungal infections in immunosuppressed individuals can become systemic - spread throughout body c) Antifungal medications to treat - ointments, creams, oral, IV 5. Helminths: parasitic worms that can inhibit the digestive tract of humans. Some worms enter through the mouth, others through food a) Once in intestine, may attach to intestinal wall and absorb food. b) Pinworms: inhabit intestines and lay eggs around anus. Person feels intense itching around anus - eggs then lodge beneath the fingernails after itching allowing infection easy to spread or selfreinfect. (1) ½ an inch long but numerous - fill appendix and mimic appendicitis c) Anthelmintics (antihelmintics) treat - designed to kill parasitic worms. 6. Common Illnesses Caused By Microbes MICROORGANISM

DISEASE

TREATMENT

Staphylococcus aureus

Boils, TSS, osteomyelitis, MRSA(nosocomial)

Antibiotics - most not killed by penicillin MRSA - vancomycin

Streptococcus group A (gram positive coccus)

Strep, ear infections, scarlet fever, endocarditis - can lead to rheumatic fever, heart valve damage, transient kidney damage Flesh eating strep

antibiotics

Streptococcus group B (gram positive coccus)

Neonatal infections (premature births) pneumonia, meningitis septicemia in newborns

IV antibiotics

Clostridium perfringens (gram positive bacillus) *SPORE*

Gas gangrene - spores live in dead tissue and produce toxins that destroy more tissue so bacteria spreads - gas forms bubbles in dead tissue

Amputation of affected limb

Clostridium difficile (gram positive bacillus) *SPORE*

Severe diarrhea, often develops with antibiotic therapy significant nosocomial pathogen pseudomembranous

2 antibiotics vancomycin & metronidazole

BACTERIA

enterocolitis Escherichia coli (gram negative bacillus)

Normally found in colon but cause infection if enerts urinary tract - nosocomial

Antibiotics

Escherichia coli 0157:H7 (gram negative bacillus)

Infection of colon causing bloody diarrhea and kidney failure - hemolytic uremic syndrome (can be fatal) Undercooked ground meat

antibiotics , kidney dialysis

Mycobacterium tuberculosis (bacillus)

TB that destroys lung tissue leaving large cavities - drug resist strains common

Antituberculosis meds

Borrelia burgdorferi (spirochete)

Lyme disease - transmitted by deer tick causing flu like symptoms, irregular heart beat and possible arthritis

antibiotics

Herpes Simplex Herpes Virus 3 (Varicella-zoster)

Type 1 - fever bisters Type 2 - genital herpes Chickenpox contracted first, virus lies dormant in nerve endings, if reactivated causes shingles.

Antivirals - acyclovir

Influenza

Flu symptoms - muscle ache, fever, respiratory congestion, cough

Tamiflu and Relenza Prevention: flu immunization

Zika

Aedes Mosquitos Once a person is infected can be spread from mother to unborn baby fever, headache, joint pain, muscle aches

Antipyretics, NSAIDs, fluids

Ebola

Transmitted through infected blood, body fluids, large droplet secretions Diarrhea, vomiting, fever, severe headache, fatigue, muscle weakness

Provide IV fluids and electrolytes, maintain O2 saturation

West Nile

Found in birds spread by mosquitos Causes headache, confusion, asymptomatic in some

No antiviral - provide supportive treatments

Ringworm (tinea) found on skin or scalp - itchy, red, round patches

Antifungals

VIRUSES

FUNGI Microsporum epidermophyton

Also causes athletes foot Yeast infections - called thrush in mouth - may result bc antibiotics kill normal bacteria allowing overgrowth of yeast Can cause pneumonia and heart infections

Antifungals

Entamoeba histolytica

Amoebic dysentery, causing bloody diarrhea and abscesses in body organs (liver, lungs, brain)

Amebicides and antibiotics

Giardia lamblia

Giardiasis, causes diarrhea, found in water or spread though food prepared by people who are infected

Antibiotics

Plasmodium

Malaria - destruction of RBC and anemia - can lead to severe form affecting brain

Antimalarials

Enterobius

Pinworms - white threads, grow in intestines - most common

Antihelmintics

Taenia

Tapeworm - may enter through uncooked meat containing worm cysts - head of worm attaches to wall of intestine causing bloating, constipation, diarrhea

Antihelmintics

Candida albicans

PROTOZOANS

HELMINTHS

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Infection - CONT.. A. Chain of infection: chain of events allowing infection to spread from one person to another involving following “links” 1. Infectious agent (causative organism) 2. Reservoir - place organism grows 3. Portal of exit - method where organism leaves reservoir 4. Mode of transmission - vehicle by which organism is transferred 5. Portal of entry - method by which organism enters new host 6. Susceptible host - person whose body the organism has entered

B. Types of Infections 1. Health care associated infection (HAI): an infection acquired while

patient is being cared for in any health care setting. a) Also known as nosocomial infections 2. Hand hygiene is the most important step in breaking the change of

infection and preventing HAIs a) Primary Infections: Initial infections caused by one pathogen only b) Secondary Infections: Caused by a second, different pathogen 3. If an infection is in one area of the body it is a localized infection. However if the infection spreads to all other organs and through the bloodstream, it becomes a systemic infection C. Defenses against Infection 1. Primary Defenses: Body Systems - block/trap pathogens a) Skin: protects body from microbes that would cause disease in subcue or deeper tissue (1) Skin breaks - cuts, scrapes, burns - portal of entry for pathogens b) Mucous Membrane: Sticky mucous traps invading pathogens (1) In RT, mucous can be coughed up or blown out - taking organisms with it (2) In UT - urethra secretes mucus to trap pathogens and wash out with acidic urine (3) In vagina - mucus traps pathogens - pH of vaginal secretions and normal bacteria in vagina are hostile to most microbes c) GI System: Mouth provides entry into GI system and contains some bacteria (1) Saliva has enzymes that remove microbes from teeth normal flora helps (2) If pathogens make it to the stomach, hydrochloric acid in digestive juices usually kills them 2. Secondary Defenses: Cellular Level - rxn to toxins a) Inflammatory Process: WBC release histamine and other chemicals causing BV to dilate - redness/warmth in area of injury. BV become more permeable and allow more WBC (phagocytes) into injured area (1) Phagocytes surround invading pathogens and consume them b) Elevated Temperature: Body creates hostile environment to pathogens (1) Increase body temp to 101 because it is too warm for microbes to live and multiply (2) Microbes can take protection in spores, but most killed c) Complement cascade: Complement is released when pathogens are detected. (1) Complement: Group of specialized proteins that attack pathogens by releasing chemicals and make their cell membranes rupture

3. Tertiary Defenses: Third line of defense that involved WBC called

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lymphocytes. a) Lymphocytes are found in lymph tissue (thymus, spleen, lymph nodes, tonsils) and fight infection either as B cells or T cells b) Circulate in blood - identify pathogens by surface proteins c) When pathogens are found, B and T cells signal phagocytes to destroy invaders (B&T cells have a major role in antigen-antibody response) 4. Factors Decreasing Body’s Defenses a) Age: infants/young children not well developed - can not assist as well as immune system of older children. Immune system gradually decreases as we get older - becoming more vulnerable to pathogens again. b) Chemical Exposure: Toxicity from chemicals impairs body’s defense and ability to fight infection c) Chronic Illness: Body’s defenses responding on a frequent basis so they have no reserves to attack new infection d) Lack of Exercise: without adequate exercise, circulation slows and flow of WBC decreases e) Lack of Rest: Body needs rest to repair damage and restore energy, increases chance of infection occurring bc immune system cannot repair itself at its highest capacity f) Increased Stress: Body is frequently reacting to stressors so immune function is impaired - increasing risk g) Nonintact Skin: open wounds provide a portal of entry h) Poor Nutrition: diet lacking in fruits, veggies, dairy products because a lack of vitamin and support for normal flora Preventing Infections A. Prevent your possibility of becoming a mode of transmission in the chain of infection - MOST EFFECTIVE: Hand Hygiene B. Hand Hygiene: Nurses wash hands repeatedly during pt care. All surfaces must be cleaned thoroughly to remove all pathogens-avoid rings 1. When to perform: a) After touching blood, body fluids, secretions, excretions or contaminated items b) Immediately after removing gloves c) Upon entering pt room d) Before touching pt or tubes connected e) Btw caring for two patients in same room f) When arriving on nursing unit g) After returning from breaks/meals h) After using restroom i) Anytime hands are visibly dirty 2. Guidelines:

a) Alcohol based gels before and after pt care - just as gloves should

be changed before and after. Use alcohol based gels correctly, apply to palm then rub hands together covering all surfaces b) Hands visibly soiled - wash with soap and water c) Hand hygiene does not eliminate need for gloves and vice versagloves reduce contamination by 70%-80% d) No artificial nails - keep nails less than ¼ inch long e) Alcohol based gels do not kill spores and not recommended when working w pt with C. Diff C. Standard Precautions 1. Group of safety measures preformed to prevent transmission of pathogens found in blood and body fluids 2. Perform hand hygiene, wear PPE, use coughing etiquette 3. Performed with all patients - protect healthcare workers as well as patients a) Hand hygiene: 20 sec soap and water (or sanitizer) b) PPE (1) Gloves: wear when touching blood, body fluids, secretions, contaminated items, when touching mucous membrane and nonintact skin (2) Gown: wear when performing procedures and patient care if theres a possible exposure of skin/clothing coming in contact w blood, etc. (3) Mask, eye protection, face shield: wear during procedures that can cause splashing of blood, etc. endotracheal intubation (4) Needles/Sharps: Never recap, do not bend or break, use safety needles, place in puncture resistant sharps container (5) Cough Etiquette: cover mouth and nose with tissue, or upper sleeve, use hand hygiene immediately after cough/sneeze. D. Transmission Based Precautions 1. Used to prevent spread of known infection through contact, droplets, or air. Gown, gloves, masks, eye protection, head covers. 2. Always use in addition to standard precautions - for visitors and staff a) Airborne Transmission: occurs when infectious particles are small and lightweight - float in air and spread - can inhale (1) TB or chickenpox (2) N95 required and must be fitted so there is no leak. Filtered to remove airborne microbes (3) Airborne infection isolation rooms (negative pressure rooms) - lower pressure gradient in the hallway designed to prevent microbes from floating into hallway

b) Droplet Transmission: transmitter from respiratory system through

small droplets that occur when coughing, sneezing, or talking. (1) 3 ft distance unless wearing PPE (2) 2 patients with droplet transmission illness sharing a room - beds at least 3 ft apart and curtain closed (3) Communicable (4) Wear a mask and follow standard precautions (5) Influenza, bacterial meningitis, pneumonia, strep (6) Tissues must be disposed in biohazard bag - hand hygiene after cough/sneeze into tissue c) Contact Transmission: Most common transmission of microorganisms is through direct contact (1) Direct Contact: microbe spreads from one person directly to another usually on hands. (2) Indirect Contact: occurs when microbes leave one person (reservoir) and contaminate an object (mode of transformation) second patient becomes ill after contact with that object (3) Wash hands, gloves, gown in room. When touching skin or items/surfaces close to patient - wear gloves E. Medical Asepsis 1. Medical Asepsis: practices performed to prevent the spread of infection 2. “Clean technique” 3. Hand hygiene, clean pt environment, standard and transmission-based precautions 4. Surgical Asepsis: maintaining a sterile environment in operating rooms a) Sterile technique: performing procedures in such a way that no pathogens enter pt body when you insert tubes/injections 5. EX) Nurse enters pt room to assist with commode. Nurse washes hands, puts on gloves, assists in cleaning genital area, assists pt onto bed. Nurse then empties, rinses, replaces pan of commode. Nurse removes gloves and washes hands 6. Clean Environment: clean environment = safe environment a) Clean spills asap, wipe dirty, dusty surfaces, remove food b) Disinfectant: cleaning agent to remove pathogens - disinfect equipment from one pt to the next...