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Promoting Asepsis and Infection Control Teresa V. Hurley, MSN, RN Nosocomial Infections Worldwide Problem Acquired in health care facilities USA: Cost is in the billions for extended care and treatment A Leading cause of death Spread by health care workers who fail to wash hands or change gloves Asepsis The absence of contamination by disease causing microorganisms Needed to prevent nosocomial infections, limit transmission of infection and to protect clients and healthcare workers from infection Infection Pathogen is an organism capable of causing disease Bacteria Viruses Fungi includes yeast and molds Helminths (worms) Current Research Studies Intensive Investigations into the: Role of bacteria in producing heart disease Role of viruses in the development of cancer Mutation of microorganisms and their ability to resist antimicrobial drugs Center of Disease Control and Prevention Reports HIV Global HIV AIDS Pandemic 2006 Since 1981 65 million infections and 25 million deaths Identified at risk populations in the USA High school students engaged in unprotected sex High school students using injectable drugs (CDC, 8/11/2006) CDC Reports HIV testing, counseling and treatment recommendations for all people accessing health care: adolescents, adults and pregnant women as part of routine health care in order to prevent spread (CDC, 9/22/06) Antibiotic Resistance is WORLD’S MOST PRESSING PROBLEM (CDC, 4/21/06) CDC Reports MRSA Resistance to methicillin, oxacillin, amoxicillin Surgical wounds -Bacteremia Catheters -UTI Hospitals -Pneumonia Nursing Homes Dialysis Units where there exits clients with weakened immune systems CDC Reports Emergence of CA-MRSA Community Associated MRSA now occurring in people who have not been hospitalized within 1 year or even had a medical procedure (dialysis, catheter or surgery) s/s skin infections, pimples, boils, Clusters: crowded living conditions and poor hygiene practices CDC Reports Athletes Military Recruits Children Male to male sexual contact Prisoners Pacific Islanders Alaskan Natives Native Americans Spread skin to skin, cuts, abrasions, contaminated items and surfaces (CDC, 2/3/2005) CDC Reports CA-MRSA Tattoo recipients (6/22/06) Streptococcus Pneumoniae Disease Leading cause of morbidity and mortality in the USA Emergence and widespread Drug Resistant Strains (penicillin and multi-drug resistance) (CDC, 1/26/2001) CDC Reports Streptococcus Pneumoniae Transmission person to person Otitis media Pneumonia Bacteremia Sinusistis Peritonitis Arthritis Populations at risk: HIV infected, Sickle Cell Disease, Elderly, Children under 2 y/o and children attending group day care centers (CDC, 10/24/2005) CDC Reports Drug Resistant Tuberculois Emergence TB resistant to a least one MDRTB (multi-drug resistant TB) INH and Rifampin (CDC, 10/6/2004) June 2006 hc/Pro Briefings on Infection Control HIPPA regulations and infection control practices must protect privacy of patients. Door signs on patient doors with TB could lead to potential legal problems due to posting of a sign linked to patient CDC Reports VRE Vancomycin Resistant Enterocci -SPREAD BY DIRECT CONTACT, stool, urine and hands of health care workers -Normally present in intestines and female genital tract UTI Wound Infections Bacteremia Risk: long term antibiotic treatment; previous treatment with vancomycin and gentamycin; ICU, CA and Transplant Units; abdominal and chest surgeries; catheters (IV or urinary) (CDC, 11/2005) CDC Reports Clostridium Difficile Increased reports of outbreaks in USA Emergence of new and more virulent strains Resistant to antibiotic group: floroquinolones (CDC, July 2005) Acinertobacter Normally present in soil and water and skin of people---especially in health care workers Outbreaks reported in ICUs and in settings where very ill are housed Risk: people with weakenedd immune systems;chronic lung disease, ventilator patients, diabetics, open wounds and prolonged hospital stays (CDC, 9/24/2004) Airborne Transmission Agent Transferred by droplet nuclei (moisture) or dust particles coughing , talking, sneezing Vehicle Transmission Agent transferred to host by contaminated inanimate objects Food, milk, water, drugs, blood, urine Cholera by water Salmonellosis by meat E-coli by spinach Vectorborne Agent transferred to host by animate means Mosquitoes, fleas, ticks, lice, and other animals Lyme Disease, malaria, West Nile virus Chain of Infection Agent, Host and Environmental Interaction The links symbolize essential elements needed by microorganisms to invade and cause cellular injury Portal of Entry Agent enters the Host by: Integumentary system (skin breaks, mucous membranes as in surgical wounds) Respiratory tract (inhale droplets as colds, measles, influenza) Genitourinary (infected vaginal secretions, semen, as in STDs) Gastrointestinal (ingestion food, water contaminates, as typhoid and Hepatitis A) Circulatory (insect bites as malaria from mosquito bite Transplacental (mother to fetus as HIV and Hepatitis B) Host Human being is a susceptible host that can be affected by an agent If you have not received measles vaccine more likely to get it because you lack immunity. Host Characteristics Age (immunity declines as age increases) Illness and Injury Stress (decreases immune response) Immunization/Vaccination Status Lifestyle (sharing needles, multiple sex partners, smoking, alcohol and drug abuse) Occupation (chemical agents,needle sticks Skin breaks which is the first line of defense (surgical, pressure ulcer, IV) Host Characteristics Nutritional Status (overweight, underweight) Heredity Medications (steroids, non-steroidal antiinflammatory agents NSAIDs (ibuprofen, aspirin), chemotherapy, antibiotics lead to vaginal yeast infections Nursing and Medical Procedures (urinary catheters, IV’s) Breaking Chain of Infection Infection Control is the First Line of Defense HAND HYGIENE IS THE SINGLE MOST PRACTICE IN PREVENTING THE SPREAD OF INFECTION JCAHO June 2006: Hand washing is the top priority National Patient Safety Goal (USA Government) Breaking the Chain of Infection Wear gloves, masks, gowns and goggles Client Hygiene Dressing Changes using aseptic technique Clean linens Clean Equipment Educate on covering mouth and nose when coughing and sneezing; throwing tissues into garbage bag Breaking Chain of Infection Nutrition (protein needed to maintain and repair tissues, production of antibodies, and acid-base balance Exercise Immunizations (measles, mumps, rubella, tetanus every 10 years and flu every year MUMPS reported by CDC (8/6/2006) as being beyond historical limits. Cummulative for 2006 in selected states 5,482 Body Defenses Immune system recognizes its self Antigen is non-self “pathogen” and the immune system will attack it Non-Specific Immune Responses are Skin and its normal flora Mucous membranes (as cilia in respiratory tract keep from entering lungs) Non-Specific Immune Responses Coughing, sneezing, tearing reflexes Elimination and acid environment Flora in the large intestine prevent growth of pathogens and peristalsis removes them with feces Natural urine acidity prevents growth and urination rids bladder neck and urethra of microorganisms Non-Specific Immune Responses Vaginal Flora is acidic; puberty lactobacilli ferment and produce sugars lowering the pH preventing growth of microorganisms Inflammation is cellular response to tissue injury by bacteria, trauma, chemicals, heat etc…. Erythema (redness) increased blood flow to area Heat (increased blood flow and metabolism) Pain (pressure on pain receptors) Edema (swelling) fluid and leukocytes Function Loss (pain, swelling) Purulent Exudate (WBCs, dead cells, bacteria, debris) Specific Immune Response Response to invading antigen Phagocytes do not destroy antigen completely T-cells (T lymphocytes) produce and release lymphokines thus attracting phagocytes and lymphocytes to destroy the antigens; T-cells stimulate B-cell production which leads to antibody production against antigen Medical Asepesis Medical Asepsis is used to prevent the spread of microorganisms. Hand washing is the most effective means to prevent the spread of infection. It is critical that Healthcare workers CLEAN HANDS with alcohol based solution or wash with soap and water as recommended by CDC 2002 Basic Principles of Medical Asepsis Clean Technique used to prevent the spread of microorganisms Hand washing AGAIN Carry soiled items away from body Do not place soiled items on floor Client instructed not to cough, sneeze, breathe on anyone; expectorate into tissues; cover mouth and nose when coughing and sneezing; (Airborne) Medical Aseptic Principles Do not shake linens. Clean from least soiled to most soiled. Dispose of soiled or used items directly into receptacles. Place bodily discharge and drainage into plastic bags or containers (e.g. briefs, diapers; linens; specimens). Pour bath water, mouth wash directly into sink drain. Medical Aseptic Principles Personal Grooming Shampoo hair Fingernails short, free of broken cuticles, ragged edges Do not wear false nails Do not wear rings with grooves and stones Keep hair off shoulder Handwashing Five Key Factors Time: 15 seconds Water: warm Soap: 1 teaspoon liquid Friction: rub in circular motions from fingers to 1 inch above wrist if not visibly soiled (moving from dirtiest to cleanest) and 1 inch above area of contamination Drying: begin with fingers and move upward DRY HANDS FIRST THAN TURN OFF FAUCET WITH PAPER TOWEL Personnel Protective Equipment (PPE) Purpose is to lessen or prevent exposure to infectious material OSHA (1992) mandated that health care agencies must provide its employees with equipment to protect against infection Gloves Wear once Do not wear outside client’s room which includes and is not limited to: Charting Telephoning Using the computer Cell phones, pagers, blackberries Double gloving is acceptable practice when working with blood and bodily fluids. Latex Allergies Is a critical concern in health care facilities Clients and health care workers have developed latex allergies. Handwashing CDC (2002) recommendations for hand hygiene Use soap and water if visibly soiled Alcohol based hand rub if not visibly soiled PPE Personal Protective Equipment (PPE) is any equipment or supplies used to protect clients and healthcare workers. Clean and sterile gloves Impervious gowns Surgical and high-efficiency particulate air (HEPA) masks, Face shields PPE Protective eye wear Surgical caps Shoe covers Splash guards Nursing Diagnosis : Risk for Infection Goal: Transmission of microorganisms will be contained Risk for Infection Assessment: determine need for use Diagnosed infection, communicable disease Likelihood of contact with bodily fluids or blood Check infection control manual Risk for Infection Use of PPE interrupts chain of infection and protects client and nurse. Implementation Wash Hands Don gown, gloves, mask, and eyewear Remove gloves, mask, gown, protective eyewear and discard Wash hands Risk for Infection Outcomes: Transmission of microorganisms contained Client free of exposure to potentially infectious microorganisms Client verbalizes rationale for use of PPE Surgical Asepsis Sterile means without life Nurse creates an environment free from microorganisms Sterile Technique is used to perform a variety of procedures as giving an injection, starting and IV, sterile dressing change, insertion of urinary catheter, suctioning) Basic Principles of Surgical Asepsis Sterile Technique Sterile objects can only touch sterile objects If Un-sterile touches sterile = contaminated Outside of sterile package is contaminated Inside of sterile package is sterile Open sterile package by making sure the first edge is away from you. Sterile Principles Spilling solution on paper or cloth used for a sterile field = contaminated Sterile objects are held above waist level to keep object in sight Limit talking, coughing, sneezing, or reaching over a sterile field or object. Never turn your back or walk away from a sterile field. Sterile Principles The outer 1 inch edge of the sterile filed is contaminated. Use dry sterile forceps to place sterile items on the sterile field. Every item that comes in contact with broken skin, to penetrate skin, inject into body, or enter sterile body cavities is to be sterile ( e.g. dressings, needles, tubes). Sterile Technique Wash your hands Check expiration date on package labels Check to make sure package is intact Check for signs of wetness Horizontal plane on a field is considered sterile Anything dropping over the edges contaminated One inch border around the sterile plane is considered not sterile Preparing a Sterile Field Purpose: Maintain sterile asepsis Explain procedure to client Gather equipment Perform hand hygiene Work area flat and waist high Prepare sterile field with drape Place sterile objects on field Check solution three times Place cap on table with edges up Pour with label facing palm from height 4-6 inches into sterile basin Unexpected Outcomes What would you do if: part of the sterile field becomes contaminated? forgot something? client touches your hand or sterile field? Donning and Removing Sterile Gloves Purpose: provide barrier against infection spread Wash hands Obtain correct size glove and bring to work area Surface is clean and dry Open outside package Open inside package Don gloves using non-dominant hand to put on dominant hand glove than later for non-dominant Remove using dominant first Discard gloves in hazardous waste container Wash hands Be careful that you do not touch your face when you have gloves on. If you sneeze or cough and cover your nose or mouth you must re-glove. Risk for Latex Allergy Response Assess for Latex Allergy Hx allergies etc. Use latex-free gloves Goal: Client will not exhibit signs and symptoms of latex allergy response