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Chapter 27 Asepsis and Infection Control Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of the Infection Cycle • Infectious agent—bacteria, viruses, fungi • Reservoir—natural habitat of the organism • Portal of exit—point of escape for the organism • Means of transmission—direct contact, indirect contact, airborne route • Portal of entry—point at which organisms enter a new host • Susceptible host—must overcome resistance mounted by host’s defenses Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins The Infection Cycle Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Infectious Agents • Bacteria—most significant and most prevalent in hospital settings • Virus—smallest of all microorganisms • Fungi—plantlike organisms present in air, soil, and water Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Classification of Bacteria • Spherical (cocci), rod shaped (bacilli), corkscrew shaped (spirochetes) • Gram positive or gram negative—based on reaction to Gram stain • Aerobic or anaerobic—based on need for oxygen Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Factors Affecting an Organism’s Potential to Produce Disease • Number of organisms • Virulence • Competence of person’s immune system • Length and intimacy of contact between person and microorganism Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Possible Reservoirs for Microorganisms • Other humans • Animals • Soil • Food, water, milk • Inanimate objects Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Common Portals of Exit • Respiratory • Gastrointestinal • Genitourinary tracts • Breaks in skin • Blood and tissue Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Laboratory Data Indicating Infection • Elevated white blood cell count—normal is 5000 to 10,000/mm3 • Increase in specific types of white blood cells • Elevated erythrocyte sedimentation rate • Presence of pathogen in urine, blood, sputum, or draining cultures Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Aseptic Technique • Includes all activities to prevent or break the chain of infection • Two categories – Medial asepsis—clean technique – Surgical asepsis—sterile technique Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Factors Predisposing Patients to Nosocomial Infections • Use of invasive medical devices • Antibiotic-resistant organisms developed in hospitals Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Measures to Reduce Incidence of Nosocomial Infections • Constant surveillance by infection-control committees and nurse epidemiologists • Written infection-prevention practices for all agency personnel • Hand hygiene recommendations • Infection control precaution techniques • Keeping patient in best possible physical condition Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Bacterial Flora • Transient—attached loosely on skin, removed with relative ease • Resident—found in creases in skin, requires friction with brush to remove Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Stages of Infection • Incubation period—organisms growing and multiplying • Prodromal stage—person is most infectious, vague and nonspecific signs of disease • Full stage of illness—presence of specific signs and symptoms of disease • Convalescent period—recovery from the infection Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Factors Affecting Host Susceptibility • Intact skin and mucous membranes • Normal pH levels • Body’s white blood cells • Age, sex, race, hereditary factors • Immunization, natural or acquired • Fatigue, climate, nutritional and general health status • Stress • Use of invasive or indwelling medical devises Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Body’s Defense Against Infection • Body’s normal flora • Inflammatory response • Immune response Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Factors Determining Use of Sterilization and Disinfection Methods • Nature of organisms present • Number of organisms present • Type of equipment • Intended use of equipment • Available means for sterilization and disinfection • Time Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Personal Protective Equipment and Supplies • Gloves • Gowns • Masks • Protective eye gear Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Evolution of Specialized Infection Control Precautions • Early CDC guidelines • Specific isolation techniques • Disease-specific isolation • Universal precautions • OSHA regulations for universal precautions • Body substance precautions • Current CDC guidelines Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Current CDC Guidelines • Standard precautions—used in care of all hospitalized patients – Apply to blood, body fluids, secretions, excretions, non-intact skin, mucous membranes • Transmission-based precautions—used in addition to standard precautions for patients with suspected infection – Include airborne, droplet, or contact precautions Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Type N95 Particulate Respirator Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Use of Surgical Asepsis • Operating room, labor and delivery areas • Certain diagnostic testing areas • Patient bedside – e.g., for procedures that involve insertion of urinary catheter, sterile dressing changes, or preparing and injecting medicine Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Teaching for Medical Asepsis at Home • Wash hands before preparing or eating food • Prepare foods at high enough temperatures • Use care with cutting boards and utensils • Keep food refrigerated • Wash raw fruits and vegetables • Use pasteurized milk and fruit juices • Wash hands after using bathroom • Use individual care items Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Evaluating Patient Goals • Use techniques of medical asepsis • Identify health habits and lifestyle patterns promoting health • State signs and symptoms of an infection • Identify unsafe situations in the home environment Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following is the most significant and commonly found infection-causing agent in healthcare institutions? A. Bacteria B. Fungi C. Viruses D. Mold Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer Answer: A. Bacteria Rationale: Bacteria are the most significant infection-causing agents in the healthcare system. Bacteria can be categorized by shape, by their reaction to the Gram stain, or according to their need for oxygen. Fungi (molds and yeasts) can cause infection and are present in the air, soil, and water. Viruses cause infections including the common cold, and do not respond to antibiotics. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which one of the following infections or diseases may be spread by touching a contaminated inanimate article? A. Rabies B. Giardia C. E. coli D. Influenza Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer Answer: D. Influenza Rationale: Influenza may be spread if a person touches a contaminated article and then touches his eyes or nose. The reservoir for rabies is animals; for Giardia, water; and for E. coli, water or food. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Question In which of the following stages of infection is the patient most contagious? A. Incubation period B. Prodromal stage C. Full stage of illness D. Convalescent period Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer Answer: B. Prodromal stage Rationale: The patient is most infectious during the prodromal stage when early signs and symptoms of the disease are present but are often vague and nonspecific. During this stage, the patient often does not realize he or she is contagious and spreads the infection. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false. Soaps and detergents (nonantimicrobial agents) are considered adequate for routine mechanical cleansing of the hands and removal of most transient microorganisms. A. True B. False Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer Answer: A. True Soaps and detergents (nonantimicrobial agents) are considered adequate for routine mechanical cleansing of the hands and removal of most transient microorganisms. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false. Standard precautions should be used when caring for a noninfectious, post-operative patient who is vomiting blood. A. True B. False Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer Answer: A. True Standard precautions should be used when caring for a noninfectious, post-operative patient who is vomiting blood. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins