Chapter 29 - Infection Prevention & Control PDF

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Chapter 29: Infection Prevention & Control Whose responsibility is infection control? • Nurse responsibility to prevent & control infections • Nurse has - Knowledge of infectious process - Critical thinking skills in aseptic technique & barrier protection Infection • Invasion of susceptible host by pathogens • Results in disease • Two categories - Community acquired - Nosocomial, health care acquired Community Acquired • Many contained or eliminated due to advances in prevention & treatment, as well as general health measures - Discovery of antibiotics - Immunizations - Guidelines for proper disposal of human waste - Legislation controlling preparation & sale of food - Government mandated programs - Public education • Did you know that antibiotics weren’t discovered until the late 1920s? That’s less than 100 years ago! Why are they on the rise? • Drug resistant microorganisms - MRSA (Methicillin-resistant Staphylococcus aureus) - VRE (Vancomycin-resistant enterococci) • Parental apathy toward immunization programs • No required mandatory immunization for enrollment in preschool • Homeless with incomplete record of health, no treatment of disease Nosocomial Infection • Infection not present or incubating at time of admission • Microbes most common - S. Aureus - E. Coli - Proteus - Pseudomonas Aeruginosa - Klebsiella - Enterobacter Nosocomial Infection Includes • Urinary tract infections (UTI) • Infection of wound - Surgical - Traumatic • Respiratory infections • Infections of bloodstream *These infections can even result in death! 1

Chapter 29: Infection Prevention & Control Nosocomial Infections can be spread by…. • Ventilators & IPPB machines • Physical therapy whirlpools • Wheelchairs • IV poles • Shared bathrooms, showers • Failure to cleanse skin properly before inserting IV • Improper care of IV insertion sites • Placing urinary catheter bag on floor What is the ICC? • Infection Control Committee • Composed of medical, nursing, lab, OR, housekeeping & dietary • Responsible for surveying & educating staff • Provides guidelines for prevention & spread of infection • Informs hospital personnel of accepted method of reducing nosocomial infections • Investigates nosocomial outbreaks & recommends corrective actions Methods of Prevention • Periodic bacteriologic cultures from various departments to detect source of infection • Cultures obtained from various surfaces - Counters - Floors - Shelves - Walls - Curtains - Sinks - Refrigerator • Pre-employment & annual physicals - TB skin test - Chest x-rays - Throat & nose cultures Infecting Agents • Bacteria - Aerobic - Anaerobic • Virus • Fungus - Yeast - Mold • Rickettsia’s

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Chapter 29: Infection Prevention & Control What’s the Difference? • Colonization - condition whereby organisms are present in the host’s body but does not show s/s of infection or disease • Infection - condition whereby the organism is harmful to the host, s/s are evident • Pathogen - microorganism capable of causing an infection • Communicable disease - an infection that spreads from one person to the other What happens when pathogens enter the body? • Body’s defense may eliminate pathogen • Pathogen may reside in body without causing disease • Pathogen causes infectious disease Chain of Infection • Certain factors must be present for infection to spread • Breaking links in chain of infection stops the infection • Infectious agent - Depends on number of microbes - Depends on virulence of organism • Reservoir or Carrier - Reservoir include humans, animals, fomites, insects, food & water - Carriers include human or animal harboring microorganism without evidence of active infection • Portal of exit • Mode of transmission • Portal of entry • Susceptible host Quiz! A patient is admitted to a medical unit for a home-acquired pressure ulcer. The patient has Alzheimer’s disease and has been incontinent of urine. The nurse inserts a Foley catheter. You will identify a link in the infection chain as a. Restraints b. Poor hygiene. c. Foley catheter bag. d. Improper positioning. Types of Carriers • Convalescent: recovering from infection • Healthy carrier: carries microorganism without s/s of infection • Incubatory carrier: s/s not showing yet, but will show

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Chapter 29: Infection Prevention & Control Mode of Transmission • Direct - Person to person - Touching client - Fecal-oral route • Indirect - Soiled dressing - Used needle - Contaminated blood pressure cuff Factors Affecting Susceptibility to Infection • Diet • Age • Heredity • Stress • Medical illness • Physical & mental wellness • Immunity status • Nutritional status • Rest & exercise • Personal habits Factors that Determine Ability to Cause Infection • Must be able to live outside of body • Must be able to overcome body’s physical & mechanical barriers • Number of organisms & length of exposure time • Ability to resist host defense mechanism • Ability to release toxins in host Stages of Infections – stages differ depended on the infectious agent • Incubation period – the organism reproduce. There are no recognizable S/S. • Prodromal stage – initial S/S appear. May be vague. Ex. Fever, and headache (H/A). • Acute stage – S/S become sever and is more specific. • Convalescent stage – S/S subside • Resolution – The pathogen is destroyed. The client recovers. Localized Infection • Similar to local inflammation • Infection confined to specific area • Vascular response - Redness - Leakage of fluid - Swelling & pain - Limited movement • Fibrin barrier formed to keep infection from spreading • Pus accumulates inside barrier (abscess)

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Chapter 29: Infection Prevention & Control Lymphadenitis • Condition of infection in lymphatic system • Lymph nodes become swollen, tender & firm • If number of microorganisms increases, defense mechanism may be ineffective • Lymph nodes drain into vascular system & spread infection to blood stream • Results in septicemia or sepsis Specimen to ID cause • Blood • Feces • Throat & nasal smears • Urine • Sputum • Wound drainage • Vaginal drainage • Organisms placed on medium in an incubator and observed for 48-72 hrs to note growth of the organism • Sensitivity studies done to determine which antibiotic will inhibit growth of microorganism & will be effective in treating the infection Defenses Against Infection • Normal flora - Skin - Saliva - Oral mucosa - Intestinal walls • Body system defenses • Inflammation - The cellular response of body to injury or infection - s/s: swelling, redness, heat, pain or tenderness, and loss of function in the affected body part • Immune response - The body’s response to foreign material (antigens) - Antibodies bind to antigens &neutralize, destroy, or eliminate them Case Study  Mrs. Eldredge is a 63-year-old woman who underwent a total hip replacement. Kathy Jackson is a nursing student caring for Mrs. Eldredge on her home health clinical rotation.  Two weeks after surgery, Mrs. Eldredge complains to Kathy that she has increased pain in her hip and low-grade fever.  Kathy observes the incision and notes that it is red, swollen, and warm. Ask the class: What do the fever and the warm, swollen incision likely indicate?] • The inflammatory response has been engaged. The incision may have become infected. [Ask the class: Is an infection at a wound site likely to be systemic or localized?] • Wound site infections are usually localized

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Chapter 29: Infection Prevention & Control Gerontological Considerations • Decreased body defenses • Decreased respiratory muscles • Decreased gastrointestinal function • Decreased lymphocytes or immunity Quiz! You are caring for a patient who underwent surgery 48 hours ago. On physical assessment, you notice that the wound looks red and swollen. The patient’s WBCs are elevated. You should a. Start antibiotics. b. Notify the physician. c. Place the patient on isolation precautions. d. Document the findings and reassess in 2 hours. How do I decrease Infections in the Workplace? • Medical asepsis - Also referred to as clean technique - Practices that reduce number of microorganisms - Used for non-sterile procedures • Surgical asepsis - Also referred to as sterile technique - Measures that make equipment & supplies totally free of microorganisms - Used with invasive procedures Is Hand Washing that Important? • Single most important measure to prevent spread of infection • must have these to reduce organisms on hands - Friction - Cleansing agent - Running water - Time • Wash hands for minimum of 15 seconds • Recommend two-minute hand washing at beginning of shift • Remove jewelry • Clean under nails • Bar soap harbors bacteria • Use warm water • Rinse from area above wrist towards fingertips • Pat hands dry from fingertips to forearms • Turn off faucet using paper towel

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Chapter 29: Infection Prevention & Control Isolation • Includes use of personal protective equipment (PPE) - Gloves - Gown - Mask - Respirator - Eye wear • Recommended by CDC & OSHA - Centers for Disease Control - Occupational Safety and Health Administration • Only wear uniforms when working with clients Routine Environmental Cleaning • Concurrent • Terminal • Sterilization • Disinfection - Heat - Chemical Disinfection by Heat • Boiling water does not kill spores - Boil at 212°F for 15 minutes - Effective only for home use • Free flowing steam - 212°F - Difficult to expose all surface of some contaminated equipment • Dry heat • Steam under pressure - Effective sterilization - Most dependable for destroying all forms of microbes & spores - Hotter temperatures possible Disinfection by Chemicals • Ethylene oxide gas - Penetrates wrapper - Effective for equipment that could be damaged by heat & water - Destroys broad spectrum of spores & viruses - Must expose contaminated items for three hours at 86°F • Alcohol - Soak in 70% solution - Expose contaminated items for 10-20 minutes Surgical Asepsis • There is no partial sterility • If any doubt, it’s not sterile • Sterile to sterile= sterile • Sterile to clean= clean • Sterile to contaminated= contaminated • Sterile to questionable= contaminated 7

Chapter 29: Infection Prevention & Control • See pp. 10-11 of notes Transmission Based Precautions • Refers to use of barriers to keep pathogens in confined area • Client already has an identified pathogen • Barriers - Isolation room - Closed door - Protective gown - Mask & goggles - Gloves & shoe covers • Negative airflow isolation - Airborne precautions - Droplet precautions - Contact precautions Tuberculosis • Stress early identification & treatment of persons with suspected & known TB • Screen for TB in health care facilities & provide respiratory protective devices • Use proper transmission-based precautions (airborne precautions) Tuberculosis (TB) Airborne Precautions • Private negative pressure room • Keep door closed • Daily monitor negative room pressure • Use disposable equipment, isolation cart, double bagging & biodegradable bags • UV germicide irradiation • Use HEPA filter to reduce number of droplet nuclei • Personal respiratory protective devices capable of filtration of 95% • Client with known or suspected TB, must wear face mask when outside of room Principles of Infection Control Precautions • Thoroughly wash hands before & after client care • Know necessary precaution & barriers to be used • Dispose of contaminated equipment & articles properly • Place mask on client, sheet in wheelchair & cover with gown for transport to another area • Private room with sink & toilet • Negative pressure room if infectious to others • All articles in room are considered contaminated • Nurse should place watch in plastic bag or on paper towel while in room • Keep waste removed from room at least every 8 hours • Cleanse isolation room last in order to prevent spreading organism • Use disposable food trays, BP cuffs & thermometers • Use isolation set up for linen & trash • Instruct family, visitors on infection control precautions • Restrict visitors if client is infectious • Spend time & communicate with client to address social & psychological deprivations

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Chapter 29: Infection Prevention & Control Protective Isolation • Immunosuppressed client - Chemotherapy - Severe burns • At risk for infections which could lead to death of client • Protective isolation guard’s client from infection • Also called neutropenic precautions • Positive pressure if isolation for client’s protection Case Study Mrs. Eldredge is discouraged to learn that she has acquired a surgical site infection. Her surgeon has ordered that she receive 2 weeks of intravenous antibiotics at home. She is grateful that the therapy can be provided through home health services, but she was hoping for a quicker recovery. She is aware that this infection will create a minor delay in her recovery. The physician states that she can continue with home physical therapy but at a slightly slower pace, because her body needs rest for healing. 1. It is determined that Mrs. Eldredge has an area of infectious fluid around her surgical incision. Body excretions are known as the ____________ in the chain of infection. a. Reservoir b. Infectious agent c. Portal of exit d. Susceptible host 2. a. b. c. d.

What is the protective reaction that neutralizes pathogens and repairs body cells? Inflammatory response Pathogenicity Flora Inflammation

3. In her treatment plan, Kathy is aware that good hand hygiene is important to prevent the spread of further infection to health care workers and other patients. What are these measures known as? a. Aseptic technique b. Sterile technique c. Standard precautions d. Transmission-based precautions

Answers and Rational 9

Chapter 29: Infection Prevention & Control Question #1 ANS: A Rationale: A place where microorganisms survive, multiply, and wait to transfer to a susceptible host is called a reservoir. The infectious agent is responsible for the development of an infection and depends on the number of microorganisms present. After microorganisms find a site in which to grow and multiply, they must find a portal of exit if they are to enter another host and cause disease. Susceptibility to an infection depends on the individual’s degree of resistance to pathogens.

Question #2 ANS: A Rationale: The body’s inflammatory response is a protective reaction that neutralizes pathogens and repairs body cells. The severity of infection depends on the extent of the infection, the pathogenicity and virulence of the causative microorganism, and the host’s susceptibility. Normal flora does not usually cause disease but instead helps to maintain health. Inflammation is the body’s response to injury or infection. Question #3 ANS: C Rationale: When a patient develops an infection, continue preventive care to reduce the risk for transmission to health care workers and other patients. Good hand hygiene and use of barriers, such as gloves or masks, minimize everyone’s exposure to infection. These measures are known as standard precautions, which are used routinely with every patient regardless of diagnosis. Patients with communicable diseases and infections that are easily transmissible to others require special precaution called transmission-based precautions. Aseptic and sterile techniques are not associated with this situation.

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