Download Promoting Asepsis And Preventing Infection

JUDITH M. WILKINSON LESLIE S. TREAS
KAREN BARNETT MABLE H. SMITH
FUNDAMENTALS OF
NURSING
Chapter 23:
Promoting Asepsis & Preventing Infection
Infection
When microorganisms capable of producing disease
invade the body
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The Spread of Infection: Six Links
Infectious agents
• Pathogens
• Normal flora that
become pathogenic
Reservoir
• Where pathogens live and multiply
• May be living
• Humans, animals, insects
• May be nonliving
• Food, floors, equipment, contaminated water
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The Spread of Infection: Six Links (cont’d)
Portal of exit
Mode of transmission
• Via
• Contact
– Bodily fluids
– Coughing,
sneezing, diarrhea
– Seeping wounds
– Tubes, IV lines
– Direct—touching, kissing,
sexual contact
– Indirect—contact with
a fomite
• Droplet: cough, sneeze
• Airborne: via air conditioning,
sweeping
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The Spread of Infection: Six Links (cont’d)
Portal of entry
• Eye, nares, mouth, vagina,
cuts, scrapes
• Wounds, surgical sites, IV or
drainage tube sites
• Bite from a vector
Susceptible host
• Person with
inadequate defense
• Four determining factors
• Virulence
• Organism’s ability to
survive in the
host’s environment
• Number of organisms
• Host’s defenses
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Stages of Infection
• Incubation: from time of infection until
manifestation of symptoms; can infect others
• Prodromal: appearance of vague symptoms; not all
diseases have this stage
• Illness: signs and symptoms present
• Decline: number of pathogens decline
• Convalescence: tissue repair, return to health
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Classification of Infections
By location
• Local
– Occurs in a limited region in the body (e.g., urinary tract
infection)
• Systemic
– Spread via blood or lymph
– Affects many regions (e.g., septicemia)
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Classification of Infections by Duration
Acute: rapid onset of short duration (e.g., common
cold)
Chronic: slow development, long duration (e.g.,
osteomyelitis)
Latent: infection present with no discernible
symptoms (e.g., HIV/AIDS)
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Healthcare-Related Infection
An infection acquired as a result of healthcare
• Cost to the healthcare system = $4.5 billion/year
• Leading cause of death
• Preventable with use of aseptic principles/techniques
Exogenous healthcare-related infection: Pathogen
acquired from healthcare environment
Endogenous healthcare-related infection: Normal flora
multiply and cause infection as a result of treatment
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Lines of Defense Against Infection
Primary defenses
• Anatomical features, limit pathogen entry
– Intact skin
– Mucous membranes
– Tears
– Normal flora in gastrointestinal (GI) tract
– Normal flora in urinary tract
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Lines of Defense Against Infection (cont’d)
Secondary defenses
• Biochemical processes activated by chemicals released by
pathogens
• Phagocytosis
• Complement cascade
• Inflammation
• Fever
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Lines of Defense Against Infection (cont’d)
Tertiary defenses
• Humoral immunity
• B-cell production of antibodies in response to an antigen
• Cell-mediated immunity
• Direct destruction of infected cells by T cells
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Tertiary Defenses: Humoral; Cell Mediated
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Factors That Increase Infection Risk
•
•
•
•
•
•
•
Developmental stage
Breaks in the skin
Illness/injury, chronic disease
Smoking, substance abuse
Multiple sex partners
Medications that inhibit/decrease immune response
Nursing/medical procedures
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Factors That Support Host Defenses
• Adequate nutrition
• To manufacture cells of the immune system
• Balanced hygiene
• Sufficient to decrease skin bacterial count
• Not overzealous; causes skin cracking
• Rest/exercise
• Reducing stress
• Immunization
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Preventing Infection: Implementing Medical
Asepsis
Medical asepsis
• “A state of cleanliness that decreases the potential for the
spread of infections”
• Promoted through
• Maintaining a clean environment
• Maintaining clean hands
• Following guidelines from the Centers for Disease Control
and Prevention (CDC)
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Maintaining a Clean Environment
• Clean spills and dirty surfaces promptly.
• Remove pathogens through chemical
means (disinfect).
• Remove clutter.
• Consider supplies brought to the client room
as contaminated.
• Consider items from the client’s home
as contaminated.
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Wash Your Hands
• When you arrive in
the unit
• When you leave the unit
• Before and after
restroom use
• Before and after
client contact
• Before and after contact
with client belongings
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Wash Your Hands (cont’d)
• Before gloving
• After glove removal
• Before and after touching your face
• Before and after eating
• After touching a contaminated article
• When you see visible dirt on your hands
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Handwashing Guidelines
• Wash for at least 15 sec in nonsurgical setting; 2 to 6 min in
surgical setting.
• Remove jewelry and clean beneath fingernails.
• Use a bactericidal solution or use water if hands are
visibly soiled.
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–
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Use warm water, not hot.
Apply soap to wet hands.
Use friction.
Rinse soap.
Towel or hand dry.
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Implementing CDC Guidelines
Standard precautions
• Protects healthcare workers from exposure
• Decreases transmission of pathogens
• Protects clients from pathogens carried by healthcare
workers
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Transmission-Based Precautions
Contact precautions
Pathogen is spread by direct contact
• Sources of infection: draining wounds,
secretions, supplies
• Precautions include
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–
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Possible private room
Clean gown and glove use
Disposal of contaminated items in room
Double-bag linen and mark
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Transmission-Based Precautions (cont’d)
Droplet precautions
Pathogen is spread via moist droplets
• Coughing, sneezing, touching contaminated objects
• Precautions include
– Same as those for contact
– Addition of mask and eye protection within 3 ft of client
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Transmission-Based Precautions (cont’d)
Airborne precautions
Pathogen is spread via air currents
• Transmission via ventilation systems, shaking
sheets, sweeping
• Precautions include
– Same as those for contact, with addition of special room, special
mask, and mask for patient when transported
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Protective Isolation
“Protective environment”
• Protects the client from organisms
• Used in special situations with immune-compromised
client population
• Precautions include
• Room with special ventilation and air filters; no carpeting;
daily wet-dusting
• Avoiding standing water in the room (e.g., humidifier)
• Nurse not assigned to other clients with active infection
• Standard and transmission-based precautions, plus mask and other
personal protective equipment (PPE) (to protect patient)
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Implementing Surgical Asepsis
Includes
• Creation of a sterile
environment
• Use of sterile
equipment/supplies
• Sterilization of reusable
supplies
• Surgical hand scrub
• Surgical attire
• Sterile gloves
• Sterile field
• Use of sterile technique
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Think Like a Nurse
You are working as a nurse on a medical-surgical unit. What roles
might you play in the chain of infection? That is, what “links”
might you be?
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