asepsis and infection control Flashcards
what are the components or “chains” included in the infection cycle
- infectious agent
- reservoir
- portal of exit from reservoir
- means of transmission
- portals of entry
- susceptible host
what can break the chain between the susceptible host and infectious agent
- immunizations
- screenings of healthcare staff
what can break the chain between infectious agent and reservoir
- hand hygiene
- sterilization
- antibiotics/antimicrobials
what can break the chain between reservoir and portal of exit from reservoir
- transmission based precautions
- sterilization or use of disposable supplies
what can break the chain between portal of exit from reservoir and means of transmission
- dry contact dressing
- hand hygiene
- wearing gloves if contact with body fluids
- cover nose and mouth when sneezing
what can break the chain between means of transmission and portals of entry
- hand hygiene
- use pesticides to eliminate vectors
- adequate refrigeration
what can break the chain between portals of entry and susceptible host
- hand hygiens
- wear gloves
- use masks and ppe
- proper disposal of sharps
what are infectious agents
- bacteria
- viruses
- fungi
- parasites
describe bacteria
- most significant in healthcare setting
- ex. staph/strep
describe viruses
- smallest of all microorganisms
- ex. ecoli and influenza
describe fungi examples
- athletes foot
- ringworm
- yeast infection
describe parasites
- live in or on a host and require the host to survive
- malaria
are healthcare acquired infections never events?
yes
name three types of HAIS
- iatrogenic
- exogenous
- endogenous
describe iatrogenic
- results from a therapeutic or diagnostic procedure
- ex. UTI from foley
describe exogenous infection
- organisms external to patient/ not normally present
- ex. salmonella
describe endogenous infection
- microorganisms that exist as part of the normal flora become pathogenic
- ex. streptococci, ecoli, and yeasts
name some HAIs commonly seen in healthcare settings
- c diff (#1, generally happens to ppl on antibiotics and immunocompromised)
- VAE (ventilator associated events)
- CAUTI (catheter associated urinary tract infections)
- CLABSI (central line associated bloodstream infections)
- hepatitis A
- influenza
- TB
- MDRO
- blood borne pathogens
name some MDRO (multi-drug resistant organisms)
- MRSA (methicillin resistant staphaureus)
- VRE (vancomycin resistant enterococci)
- c diff (clostridium difficile)
name some different bloodborne pathogens
- hep B and C
- HIV
describe direct contact
must touch
describe indirect vector contact
insect os carrier of disease (ex. tics mosquitos)
describe indirect fomite transmission
inanimate object is used where pathogen can exist
describe the difference between droplet and airborne transmission
- difference is in the size of the particle and the distance it travels
- droplets are larger and transmission occurs within 5-6 feet range
- airborne particles are smaller (less than 5 mcm) and can travel over 5 feet
which of the following is the most significant and commonly found infection causing agent in healthcare settings?
A. bacteria
B. fungi
C. viruses
D. mold
bacteria
what is the first line of defense against infection
- healthy, well maintained, and intact skin
- normal flora (skin and GI tract)
what are the two protective responses in defending against infection
- inflammatory
- immune
describe inflammatory response
- can be acute or chronic
- occurs after trauma and infection
- purpose is to eliminate invader
- sets the stage for tissue repair
- signs are due to both the vascular and cellular response
describe the vascular response during inflammatory response
- vasoconstriction (decrease blood flow) followed by vasodilation (increase blood flow)
- histamine release
describe cellular response during inflammatory response
WBCs move into the area (bc of increased blood flow)
what are the hallmark signs of inflammation (usually localized response)
- redness
- swelling
- pain
- heat
describe immune response
- complex mechanisms to protect and defend
- humoral immunity (antigen-antibody response)
- cellular immunity (increase in lymphocytes)
what is an anitgen
an invader
what is an antibody and what produces them
- a blood protein produced in response to and counteracting a specific antigen
- chemically combine with substances which the body recognizes as foreign substances in the blood
- B lymphocytes produce antibodies
describe cellular immunity
increase in lymphocytes (type of white blood cell) that destroy harmful cells and also the infected cells
what do t lymphocytes do
attack cells of body that have been infected (have memories)
how can a person achieve acquired immunity
- vaccines
- exposure to disease
- another person antibodies (ex. breastfeeding newborn)
describe vaccines
- help develop immunity by imitating an infection. this type of infection almost never causes illness, but does cause the immune system to produce T-lymphocytes
- sometimes after getting a vaccine, imitation infection can cause minor symptoms, such as fever. these are normal and should be expected as the body builds immunity
- once imitation infection goes away, the body is left with a supply of “memory” T lymphocytes, as well as B lymphocytes that will remember how to fight the disease in the future.
- usually takes a few weeks to produce T and B lymphocytes after vaccination
describe a compromised host
- breaks in skin and mucous membranes
- invasive devices
- stasis of body fluids
- inadequate nutrition
- stress/hyperglycemia
- immune system dysfunction
- co-existing medical problems
- drug therapy
describe some lifespan considerations to take with newborns/infants
- only immune system they have is what they got from their mother
- immune system is not fully functional until 6 months
describe some lifespan considerations to take with toddlers/preschoolers
- finish up vaccinations
- require help with hygiene
- stick everything in their mouths- gross
describe some lifespan considerations to take with children/adolescents
- go to school → immune system is exposed to more/new infections
- more susceptible to skin diseases
describe some lifespan considerations to take with adults/older adults
- immunity is well established
- nutritional status/hospitalization/chronic disease
- as we age immune system may diminishes (booster may be required)
describe the CDC
- center for disease control
- federal agency (department of health and human services)
- tracks data
- makes recommendations
describe TJC
- the joint commission
- not a federal agency
- accreditation is required to bill for medicare and medicaid services
- inspections are unannounced
- has chapters and standards for infection control
describe OSHA
- occupational safety and health administration
- federal agency (department of labor)
- has a right to conduct work inspections without notice
- requires employers use:
- universal precautions
- -PPE*
- -hep B vaccine*
- -exposure follow up*
- -employee training*
- -monitoring compliance*
true or false
standard precautions should be used when caring for a noninfectious postoperative patient who is vomiting blood
true
standard precautions is also referred to as…
universal precautions
describe standard precautions
- decrease transmission from blood borne pathogens regardless of diagnosis
- treat all bodily fluids as if they are contaminated with infectious substance
- wear gloves when handling: blood, nonintact skin, mucous membranes and all body fluids, secretions, and excretions except sweat
- new additions are respiratory hygiene/cough etiquette, safe injections practices, and directions to use a mask when performing high risk prolonged procedures involving spinal canal punctures
name some of the many interventions to prevent or minimize the risk of transmission of infections within the healthcare setting
- bundles (VAP, CAUTI, Time-outs)
- needle-less devices
- hand hygiene
- PPE
- isolation of infectious or at risk patients
- immunizations of HCWs
- protocols for disinfecting medical equipment
- proper waste disposal
describe isolation
isolating infectious people to prevent or reduce the spread of illness
describe nursing responsibilities with isolation
- educate pt and family and other HCWs
- limit pt movement outside of room
- ensure appropriate signage
- private room or cohorting
- ensure proper PPE is available
- help police and enforce this with other providers
describe reverse isolation
- used with neutropenia (not enough WBC to fight infection)
- no infection but pt is highly susceptible
describe contact precautions
- PPE - usually gloves, impervious gown
- ex. cdiff (must use soap and water)
describe droplet precautions
- wear PPE - gloves, mask, face shield
- keep visitors 3 ft from pt
- ex. influenza, rubella, mumps, diptheria
describe airborne precautions
- most restrictive
- wear PPE - N95 particulate respirator mask, gloves, impervious gown
- negative pressure room
- ex. TB, varicella, rubeola (measles)
describe medical asepesis (clean)
- includes all measures aimed at reducing the number or spread of microorganisms
- examples: hand washing, gloving, gowning, disinfecting
describe surgical asepsis (sterile)
- prevent the introduction of microorganisms from the environment into the patient
- examples:
- surgical procedures
- procedures involving: the bloodstream, broken skin or mucous membranes (certain dressings), insertion of medical equipment into body cavities
describe different types of sterile technique
- strict sterile → everything is sterile
- sterile no touch → dont touch, injections are no touch sterile
describe subjective data in assessment r/t asepsis and infection control
- risk identification (exposure, comorbidities, medications)
- nutrition (use of vitamins/herbs/supplements)
- sleep
- knowledge (prevention and isolation)
describe objective data in assessment r/t asepsis and infection control
- general survey
- VS
- auscultation
- diagnostic tests and procedures
what diagnostic tests and procedures are part of objective data in assessment
- WBCs (4500-11000)
- ESR (erythrocyte sedimentation rate) → increased with inflammation
- lactate → increased with infection
- cultures
- radiologic tests
what are the 4 stages of infection
- incubation
- prodromal
- acute phase/illness
- convalescence
describe incubation
- time between pathogens entrance and appearance of symptoms
- can vary based on pathogen
describe the prodromal stage
- nonspecific symptoms (fever malaise, pain, nausea begin)
- inflammatory response
describe the acute phase/illness
specific symptoms caused by pathogen occur
describe convalescence
antibodies are present in the blood and body systems begin to return to normal
what are the manifestations of infection
- fever (38C or 100.4F) - 104-107f is dangerous, fevers can get higher in the evening
- increased pulse and respiratory rate
- inflammation
- pain
- purulent drainage
- enlarged lymph nodes
- rash
- GI symptoms - anorexia, nausea, vomiting, diarrhea
describe sepsis
- systemic inflammatory response to an infection → leads to multiple body systems failing
- SIRS = systemic inflammatory response syndrome
- remember: inflammation → vasodilation → first sign is hypotension (systolic less than 90)
describe symptoms of septic shock
- hypotension (SBP < 90mmhg)
- T > 100.4 or < 96.8
- WBC >12 or <4
- HR > 90bpm
- RR >20/min
- altered mental status
infection + 2 other symptoms = sepsis
name some different nursing diagnoses r/t asepsis and infection control
- risk for infection
- knowledge deficit
- imbalanced nutrition
- impaired physical mobility
- impaired skin integrity
describe planning r/t asepsis and infection control
- establish outcomes and pts goals
- set priorities
- communicate for continuity
- ex. pt will exhibit no signs or symptoms of infection by discharge AEB: temp WNL and WBCs WNL
describe implementing and prevention r/t asepsis and infection control
- standard precautions
- medical and surgical asepsis
- education
- promote activities (hygiene, ambulation/positioning, pulmonary toileting)
- EBP bundles
describe pulmonary toileting
- getting rid of stuff in the lungs
- coughing and deep breathing and incentive spirometry are important
describe implementation and treatment r/t asepsis and infection control
- administer medications (antibiotics, analgesics, antipyretics)
- education
- isolation
- monitor labs, radiologic test results
- comfort measures (treat pain and fever, increase oral fluid intake, tepid baths, and rest)
describe evaluating r/t asepsis and infection control
- evaluate outcomes and interventions
- coordinate with other members of the HC team and with the pt and support person
