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Chapter 27
Asepsis and Infection Control
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Objectives (pp. 3 & 4)
• The Infection Concept is presented in this lecture. MRSA,
VRE, Cellulitis, Shingles, C-Difficile, and UTI are the
exemplars for the Infection Concept and are in a separate
lecture.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nature of Infection
• Infection—disease state resulting from the presence of
pathogens in the body. May be acute or chronic
• Pathogens are disease-producing microorganisms, such as
bacteria, viruses, fungi, and parasites.
• The presence of these pathogens usually produces an
inflammatory response.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Components of the Infection Cycle
• Infectious agent—bacteria, viruses, fungi
• Reservoir—natural habitat of the organism (water, food,
soil, animals, humans, fomites)
• Portal of exit—point of escape for the organism (body
tracts, body fluids, breaks in skin or mucous membrane)
• Means of transmission—direct contact, indirect
contact, airborne, droplet, vector, vehicles
• Portal of entry—point at which organisms enter a new
host (same as exit)
• Susceptible host—must overcome resistance mounted
by host’s defenses
Copyright © 2011 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 © 2011 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 © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Factors Affecting an Pathogen’s
Potential to Produce Disease
• Number of organisms and ability to reproduce. Depends
on warmth, darkness, food, water, moisture, pH, and
presence or absence of O2.
• Virulence—hardiness and invasiveness. Some produce
spores when conditions are not favorable and some
mutate in order to survive.
• Competence of person’s immune system
• Length and intimacy of contact between person and
microorganism
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Body’s Defense Against Infection
• Body’s normal flora
• Body’s system defenses—skin, mouth, eyes, respiratory,
urinary, and GI tracts, vagina
• Inflammatory response
• Immune response
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Factors Affecting Host Susceptibility
• Condition of body defense systems
• Diseases that impair immunity
• Normal pH levels
• Body’s white blood cells
• Age, sex, race, hereditary factors
• Immunization, natural or acquired
• Nutritional and general health status
• Stress, fatigue
• Use of invasiveCopyright
or ©indwelling
medical devises
2011 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 © 2011 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 © 2011 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 © 2011 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 © 2011 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.
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Clinical Appearance of Infection
Localized
Systemic
–
Warmth
–
Changes in VS
–
Swelling
–
Fatigue
–
Redness
–
N/V/D
–
Drainage
–
Malaise
–
Pain/tenderness
–
Lymphadenopathy
–
Restricted movement
–
Confusion
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Laboratory Data Indicating Infection
• Elevated white blood cell count—normal is 5,000 to
10,000/mm3
• Increase in specific types of white blood cells
(differential). “Left shift” usually indicates severe
infection.
• Elevated erythrocyte sedimentation rate—non-specific
inflammatory marker
• Presence of pathogen in urine, blood, sputum, or
draining cultures
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nosocomial Infections (HAIs)
• Greek for “hospital acquired” Now called “health care
associated infections.”
• Approximately 2 million cases/yr. Affects 1 in 20 patients.
• A nosocomial infection is specifically one that was not
present or incubating prior to the patient being admitted to
the hospital, but occurred within 72 hours after admittance
to the hospital.
• Iatrogenic—caused by procedure
• Exogenous—external or outside body
• Endogenous—internal
or inside
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Kluwer Health |body
Lippincott Williams & Wilkins
Types of HAIs
• Top infections:
– UTI
– Wound
– Respiratory
– Bloodstream
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Factors Predisposing Patients
to Nosocomial Infections
• Use of invasive medical devices
• Antibiotic-resistant organisms developed in hospitals
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Prevention: Aseptic Technique
• Includes all activities to prevent or break the chain of
infection
• Two categories
– Medical asepsis—clean technique
– Surgical asepsis—sterile technique
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Medical Asepsis
• Handwashing
• Cleaning and disinfecting surfaces
• Applying clean dressings
• Applying standard and transmission-based precautions
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Surgical Asepsis
• Sterile procedures such as catheterization, starting an IV,
and changing a sterile dressing
• Opening and maintaining a sterile field
• Sterile scrub and surgical skin prep (OR)
• Gowning and gloving (OR)
• Sterilization of surfaces and instruments
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Principles of Surgical Asepsis
• Only touch a sterile object to another sterile object or surface.
• A sterile field not observed is considered contaminated.
• An object held below the waist is considered contaminated.
• A sterile object or field becomes contaminated by prolonged
exposure to air.
• A sterile field or object that comes in contact with a
contaminated wet surface or liquid becomes contaminated.
• The outer 1 inch border of a sterile field is considered
contaminated.
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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
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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
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Interventions
• Protect clients:
– Regular bathing with skin lubrication
– Regular oral hygiene
– Adequate fluid intake
– Optimal nutrition
– TCDB
– Immunizations
– Rest and comfort
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Interventions
• Maintain own health
• Stay at home when fever and diarrhea are present
• Be aware of S&S of infection
• Practice medical and surgical asepsis
• Practice standard and transmission-based precautions
• Give antimicrobials as ordered
• Teach clients to take as prescribed and finish
antimicrobial therapy
Copyright © 2011 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, postoperative patient who is vomiting
blood.
A. True
B. False
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
Answer: A. True
Standard precautions should be used when caring for a
noninfectious, postoperative patient who is vomiting
blood. Healthcare workers need to treat all patients as if
they were infectious.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Noteworthy Precautions
• Although it is allowed by CDC and JCAHO, keep in mind
that the following require extra care to prevent the spread of
pathogens:
– Medical and surgical patients not being separated
– Peds patients with adult patients
– Patients with drains in same room as infectious patients
– Lack of private baths
– Nurses caring for both infectious and noninfectious
patients
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Personal Protective Equipment
and Supplies
• Gloves
• Gowns
• Masks
• Protective eye gear
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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 © 2011 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,
nonintact skin, mucous membranes
• Transmission-based precautions—used in addition to
standard precautions for patients with suspected
infection
– Include airborne, droplet, or contact precautions
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Type N95 Particulate Respirator
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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.
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