Medical Asepsis PDF

Preview

Summary

...

Description

Medical Asepsis OBJECTIVES • Explain what is medical asepsis. • Identify nursing care measures intended to break the chain of infection. ▪ Explain how each element of the infection chain contributes to infection. • Describe the factors that influence nursing staff compliance with hand hygiene. ▪ Perform proper procedures for hand hygiene. ▪ Perform correct isolation techniques. • Medical Asepsis ▪ The techniques used to reduce and prevent the spread of microorganisms (clean technique). ▪

• Infection Control ▪ Provides measures that reduce or eliminate sources and transmission of infection ▪ Protects patients and health care providers from disease INFECTION CONTROL • All patients in any setting are at risk • Health care–associated infections (HAIs) are acquired in health care settings • Patients at risk: ▪ becoming colonized ▪ infected as a result of an impaired immune response ▪ exposure to increased numbers of pathogenic organisms ▪ performance of invasive procedures ▪

• Health care–associated infections (HAIs) result from delivery of health services in a health care setting and were not present at the time of admission ▪ A hospital is one of the most likely settings for acquiring an HAI because staff, patients, and

environmental factors support a high population of pathogens that are resistant to antibiotics ▪ Health care workers transmit many HAIs by direct contact during delivery of care ▪ nurses are also at risk because of contact with infectious materials or exposure to a communicable disease CHAIN OF INFECTION • The presence of a pathogen does not mean that an infection will occur • Infection occurs in a cycle, depends on the presence of all six elements • An infection develops if this chain remains intact • Use infection control practices to break an element of the chain so as not to transmit infection •

• Development of an infection occurs in a cycle that depends on the presence of all of the following elements: ▪ An Infectious Agent (e.g. ecoli) ▪ A Reservoir or Source for Growth (e.g. client) ▪ A Portal of Exit from the Reservoir (e.g. feces) ▪ A Mode of Transmission (e.g. contact with soiled linens) ▪ A Portal of Entry to a Host (e.g. oral) ▪ A Susceptible Host (e.g. immune status, hydration, rest, nutrition) ▪

• Contact ▪ Direct – infectious agent to host (varicella secretion) ▪ Indirect – contaminated item (needle) • Droplet ▪ Inhaling or contact with mucous membrane ▪ Coughing, sneezing, suctioning ▪ Larger droplet particles • Airborne ▪ Smaller particles of evaporated droplets – suspended in air for longer time • Vehicle (HOW)

▪ Food, water or meds contaminated ▪ Instruments contaminated • Vectorborne ▪ Insects, West Nile SUSCEPTIBLE HOST (WHO) • Patients susceptible due to condition or procedure being done • Staff may be susceptible ▪ How can staff protect themselves? AGENTS (WHAT) • Bacteria ▪ Usually treatable with antibiotics (strep, staph) ▪ Some are becoming resistant (MRSA, VRE) • methicillin-resistant Staphylococcus aureus) • Vancomycin-resistant enterococci (VRE) • Viruses ▪ Antibiotics do not help ▪ Some antivirals may help ▪ Influenza, common cold, SARS, HIV • Others ▪ fungal SOME FACTORS THAT INFLUENCE A PATIENT’S SUSCEPTIBILITY TO INFECTION? • • • • •

age, nutritional status, stress, disease processes, medical therapy

ASEPSIS • Asepsis is the absence of pathogenic (disease-producing) microorganisms • Medical asepsis (clean technique) ▪ Reduces organisms ▪ Prevents transfer • Surgical asepsis (sterile technique)

▪ Destroys microorganisms and their spores HAND HYGIENE: SKILL 7-1 • Most important technique for infection control and prevention • Hand hygiene ▪ Hand washing: washing hands with plain soap and water ▪ Antiseptic hand wash: washing hands with water and soap or other detergents containing an antiseptic agent ▪ Antiseptic hand rub: applying an antiseptic hand rub product to all surfaces of the hands to reduce the numbers of microorganisms present ▪ Surgical hand asepsis: the use of an antiseptic hand wash or antiseptic hand rub before surgery by surgical personnel to eliminate transient and to reduce resident hand flora • Decision to perform hand hygiene based on: ▪ Degree of contact ▪ Amount of contamination ▪ Susceptibility to infection ▪ Procedure/activity to be performed ▪

• The task of hand hygiene is performed by all caregivers • Hand hygiene is not optional • Wash hands with plain soap and water or with antibacterial soap and water when ▪ hands are visibly dirty or soiled with blood or other body fluids, before eating, and after using the toilet ▪ Wash hands if exposed to spore-forming organisms (Clostridium difficile and Bacillus anthracis) • If hands are not visibly soiled, use an alcohol-based hand rub for routinely decontaminating hands in clinical situations 5* MOMENTS OF HAND HYGIENE

SPECIAL CONSIDERATIONS

• Teaching ▪ Hand hygiene instruction • Instruct patient and family caregiver on proper techniques and situations for hand hygiene ▪ Risks for infection • Gerontologic ▪ Impact of infection is greater in older adults

• Home care/ before discharge ▪ Evaluate patient/primary caregiver on understanding of infection control/hand hygiene ▪ Evaluate hand hygiene facilities in the home for possibility of contamination, proximity to patient, and maintenance of supplies CARING FOR PATIENTS UNDER ISOLATION PRECAUTIONS • Use procedures to reduce cross-contamination to other patients • Use standard precautions • All body substances contain potentially infectious organisms • Use recommended isolation precautions TYPE OF ISOLATIONS (P. 173) • Contact precaution • Droplet precaution • Airborne precaution WHEN SHOULD YOU WEAR GLOVES, MASKS, OR PROTECTIVE EYEWEAR WHEN TENDING TO A PATIENT • wear gloves routinely when performing a variety of procedures (e.g., nasogastric tube insertion). • Standard precautions require you to : ▪ wear clean gloves before coming in contact with mucous membranes, non-intact skin, blood, body fluids, or other infectious material

• Masks are worn when there is the risk of splash during a procedure, or when certain sterile procedures such as changing a central line dressing are performed. • Protective eyewear and masks become important when there is risk for splash of blood or other body fluids to the eyes or mouth. ▪ Body substances such as feces, emesis, urine, mucus, and wound drainage contain potentially infectious organisms (PPE) • Assess the need for personal protective equipment (PPE) for each task you plan and for all patients, regardless of their diagnoses RECORDING AND REPORTING • Document procedures performed and patient’s response to social isolation. Also document any patient education performed and reinforced • what are some concerns that patients may have about isolation? How can you address these concerns? • Document type of isolation in use and the microorganisms (if known) PATIENT-CENTERED CARE • Teach patients about infection prevention • Patients in isolation ▪ Watch patient for signs of loneliness ▪ Explain purpose for isolation to patient and family members ▪ Cultural awareness • Teaching ▪ Teach visitors how to follow isolation precautions when visiting the patient SPECIAL CONSIDERATIONS, CONT. • Pediatric ▪ Isolation causes a sense of separation from family and loss of control

▪ Give children simple explanations (age appropriate) ▪ Let the child see your face before you apply the mask • Gerontologic ▪ Watch for signs of confusion or depression • Home care ▪ Be aware of potential sources of contamination CARING FOR PATIENTS WITH MULTIDRUG-RESISTANT ORGANISMS AND CLOSTRIDIUM DIFFICILE PROCEDURAL GUIDELINE 7-1 • Multidrug-resistant organisms increasingly common as causes of HAIs ▪ MRSA (methicillin-resistant Staphylococcus aureus) : increased mortality ▪

▪ VRE (ncomycin-resistant Enterococcus).: greater risk to immune-compromised and debilitated patients ▪

▪ C. difficile: spore-forming and difficult to eliminate; can stay dormant for a long time

EVIDENCE-BASED PRACTICE • Alcohol-based hygiene products more effective than soap; reduce infections ▪ With emollients, cause less skin irritation and dryness than soap • Soap and water still necessary ▪ For visibly soiled hands ▪ When caring for patients with Clostridium difficile or multidrug-resistant organisms (MDROs) SAFETY GUIDELINES Hand hygiene with an appropriate alcohol-based hand antiseptic or soap and water is an essential part of patient care and infection prevention. 2. Always know a patient’s susceptibility to infection.

3. Recognize the elements of the chain of infection and initiate measures to prevent its onset and spread. 4. Consistently incorporate the basic principles of asepsis into patient care. 5. Ensure that patients cover the mouth and nose when coughing or sneezing; and use and dispose of tissues properly. 6. Use clean gloves when you anticipate contact with body fluids, nonintact skin, or mucous membranes when there is a risk of drainage. 7. Use gown, mask, and eye protection when there is a splash risk. 8. Protect fellow health care workers from exposure to infectious agents through proper use and disposal of equipment. 9. Be aware of body sites where HAIs are most likely to develop (e.g., urinary or respiratory tract). This enables you to direct preventive measures....