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NUR 104 Asepsis Infection Control 1 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 2 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 3 .Standard Precautions Principles/procedures to prevent and control infection and its spread. Break the chain of infection Applies to all blood and body fluid except sweat Nonintact skin and mucous membranes Protect patient and healthcare worked 4 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 5 Surgical Asepsis Sterile technique To 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 6 Medical Asepsis Clean technique Reduce number of organisms present and prevent the transfer of organisms Hand Hygiene Clean Gloves Contaminated objects Bedpans/Urinals Overbed tables Dirty Dressings 7 Infection Entry and multiplication of an infectious agent in the tissues of a host. Infectious agent—pathogen asymptomatic symptomatic 8 Health-Care Associated Infection HAI result from delivery of health services in a health care facility High population of virulent strains of microorganisms that may be resistant to antibiotics Increased hospital stays Surgical or traumatic wounds Urinary and Respiratory tracts Bloodstream 9 Healthcare Acquired Infection Clients in hospital are at risk for acquiring Low resistance to infectious microorganisms Increased exposure to the number and types of disease causing microorganisms Invasive procedures NON PAYMENT ISSUES 10 Infection Iatrogenic HAI from a diagnostic or therapeutic procedure 11 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 12 Risk factors Inadequate secondary defenses Reduced hemoglobin level Suppression of WBCs Suppressed inflammatory response Low WBC count (leukopenia) 13 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 14 Patients at Risk Inadequate primary defenses Broken skin or mucosa Traumatized tissue Decreased ciliary action Obstructed urine outflow Altered peristalsis Change in pH of secretions Decreased mobility 15 Chain of Infection CAUSATIVE AGENT SUSCEPTIBLE HOST Reservoir PORTAL OF ENTRY PORTAL OF EXIT MODE OF TRANSMISSION 17 Chain of Infection CAUSATIVE AGENT Infection occurs in a cycle that depends on the presence of all of the following: An infectious agent or pathogen Bacteria, fungi, virus, parasite Dose, Virulence, Enter/ survive, Host resistance 18 Chain of infection A reservoir or source for pathogen growth Human beings, animals, inanimate objects PORTAL OF EXIT Portal of exit from the reservoir Reservoir Sputum, emesis, stool, blood Sneeze/Cough UTI Drainage Saliva Exchange 19 Chain of Infection MODE OF TRANSMISSION Mode of transmission Contact Airborne Vectorborne Vehicle Portal of entry to a host Mucous membranes Nonintact skin GI tract GU tract Respiratory tract PORTAL OF ENTRY 20 Chain of Infection Susceptible Host Immunosuppressed Elderly Chronically Trauma ill SUSCEPTIBLE HOST Surgery 21 Infectious Process Severity of illness depends on: Extent of infection Pathogenicity of microorganism Susceptibility of host Localized Systemic—affects entire body 22 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 23 Inflammatory response Body’s cellular response to injury or infection = inflammation Inflammation = (1) protective vascular and cellular reaction that Delivers fluid, blood products, and nutrients to interstitial tissues in the area of injury Neutralizes and eliminates pathogens or dead (necrotic tissues) Establishes means of repairing body cells and tissues 24 Signs of inflammation Localized Swelling Redness Heat Pain or tenderness Loss of function Systemic: Fever, leukocytosis, malaise, anorexia, nausea, vomiting, lymph node enlargement 25 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 26 Cellular response WBCs arrive at the site WBC pass thru blood vessels into the tissues Phagocytosis—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 27 2. Inflammatory exudate Accumulation of fluid and dead tissue cells and WBCs form an exudate at the site of inflammation Serous—clear, like plasma Sanguineous—containing RBCs Purulent—containing WBCs and bacteria Cleared away by the lymphatic drainage 28 3. Tissue Repair Healing involves the defensive, reconstructive, and maturative stages Damaged cells replaced with healthy new cells New 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 29 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 30 Nursing Diagnosis Risk for infection Risk for injury Imbalanced nutrition Impaired skin integrity Impaired oral mucus membrane 31 Plan Prevent exposure to infectious organisms Controlling or reducing the extent of infection Maintain resistance to infection Education of client and family about infection control techniques 32 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 33 Blood Borne pathogens Hepatitis B HIV 34 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 35 Protection of susceptible hosts Isolation precautions Protective environment PPE Gloves, gowns, masks, eye protection Specimen collection Bagging trash/linen Transporting clients 36 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 37 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 38 39 Isolation Precautions Personal protective equipment Gloves Goggles Gown Mask Shoe covers Isolation/protective environments Client and family education 40 What’s Wrong With This Picture? 41 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 42 Isolation Precautions Contact (C-diff, E-coli, hepatitis, HSV, VRE, MRSA, etc.) Private room Gowns, gloves, masks (regular) - Stop Sign at Door Protective (Reverse Isolation) 43 Isolation Signage 44 Respirator Equipment 45 Isolation Precautions Psychological implications Environment Equipment Specimen collection Bagging of trash and linen Transporting clients 46 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 47 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 48 Handwashing Is important because __________________ 49