Chapter 28: Infection Prevention (Intro Wk) Flashcards
How does disease or infection result?
Disease or infection results only if the pathogens multiply and alter normal tissue function. You start looking for colonization, communicable diseases, look for vectors, look for symptomatic people
Define infection
Results when a pathogen invades tissues and begins growing within a host. It is the invasion of a susceptible host by pathogens or microorganisms — it results in disease
Define colonization
Presence and growth of microorganisms within a host but without tissue invasion or damage
Define communicable disease
infectious process transmitted from one person to another
What is the chain of infection include
- Infectious agent or pathogen
- Reservoir or source for pathogen growth
- Port of exit from the reservoir
- Mode of transmission
- Port of entry to a host
- Susceptible host
What is the most effective way to break the chain of infection
Hand Hygiene
What is the reservoir in the chain of infection
A place where microorganisms survive, multiply and await transfer to a susceptible host
Does the presence of a pathogen mean infection will occur?
No, the presence of a pathogen DOES NOT mean an infection will occur. Infection occurs in a cycle that depends on the presence of all of the elements in the chain of infection. If the chain is broken, you will hopefully not become symptomatic
What can be done to prevent infection
- Wash hands for 20 seconds or more
- Nutritious diet - lets of Vitamin C, Zinc, Calcium and protein
- PPE
- Prevent reservoirs for pathogens, time, date and initial all equipment and saline, sterile water
What 2 types are human reservoirs divided into
1 Those with acute or symptomatic disease
2. Those who show no signs of disease but are carriers of it
What kind of environment do organisms need to thrive
- Aerobic - bacteria that requires oxygen for survival and for multiplication sufficient to cause disease
- Anaerobic - bacteria thrive where little or no free oxygen is available
- Water or moisture for survival
- Ideal temperature between 68 - 109 F (20-43 C)
- pH between 5-7
- Dark environments such as those under dressings and within body cavities
Systemic
An infection that affects the entire body instead of just a single organ
What are modes of transmissions
- Direct
- Indirect
- Droplet
- Airborne
- Vehicles - contaminated items
- Vector - External mechanical transfer/internal transmission such as parasitic conditions
What are the 4 stages of the infectious process
- Incubation period - time interval between entrance of the pathogen and appearance of first symptoms
- Prodromal stage - may or may not see any symptoms. Most infectious. Interval from onset of nonspecific signs and symptoms to more specific symptom
- Illness stage - interval when the patient manifests signs and symptoms specific to the type of infection
- Convalescence - interval when acute symptoms of infection disappear
How do our bodies protect us against infection
Normal flora, body system defenses – our organs and by inflammation (inflammation is the cellular response of the body to injury, infection or irritation - it is also the reaction that delivers fluid, blood products and nutrients to injured area)
What is Normal flora
They are microorganisms that reside in the body and maintain a sensitive balance with other microorganisms to prevent infection
What are the inflammatory response events that take place
- Vascular and cellular responses - this process neutralizes and eliminates pathogens or dead (necrotic) tissues and establishes a means of repairing body cells and tissues
- Formation of inflammatory exudates
- Tissue repair
Explain the cellular response that occurs during inflammation
WBC arrive at the site – the WBC pass through blood vessels and into the tissues — then phagocytosis and leukocytosis
Phagocytosis
Specialized white blood cells called neutrophils and monocytes that ingest and destroy microorganisms or other small particles during the cellular response of inflammation
Leukocytosis
It is the increase in the number of circulating WBCs – response of the body to WBCs leaving blood vessels
What is the normal range of WBC in an adult
5,000 to 10,000/mm3
What does the WBC rise to during inflammation
15,000 to 20,000 or higher
What are inflammatory exudates
accumulation of fluid, dead tissue cells and WBCs forms an exudate. It can be serous (clear like plasma), sanguineous (containing RBCs) or purulent (containing WBC and bacteria)
What are signs of local vs. systemic inflammation
Local - swelling, redness, heat, pain, tenderness, loss of function in affected body part
Systemic - fever, increased WBC, nausea, vomiting, lymph node enlargement
What PPE would you wear if you were changing a wound dressing?
Wounds are purulents (contains WBCs and bacteria). First wash hands, if it smells waft it, wear goggles, mask and gloves
Where is normal flora located in the body?
Surface and deep layers of skin, in the saliva and oral mucosa, in the GI and GU tracts
What are Healthcare associated infections (HAI)
HAI results from delivery of health services in a health care facility. They occur as the result of invasive procedures, antibiotic administration, presence of multidrug resistant organisms and breaks in infection prevention
What are major sites for HAIs
surgical or traumatic wounds, urinary tract, respiratory tract and the bloodstream
What type of patients are at greater risk for HAI
- Multiple illnesses
- Older adults
- Poorly nourished
- Compromised immune system
What are the 3 types of HAIs
- Iatrogenic infection - from a procedure
- Endogenous - when the patient’s flora becomes altered and an overgrowth results (example Streptococci)
- Exogenous - from microorganisms outside the individual (example: Salmonella)
During a endogenous HAI what is often the reason this occurs
This often happens when a patient receives broad spectrum antibiotics that alter the normal floras
What are the factors that influence a patient’s susceptibility to infection
- Age
- Nutritional status
- Stress - elevated cortisone levels result in decreased resistance to infection
- Disease process - Example: leukemia, AIDS, lymphoma, and aplastic anemia
- Treatments or conditions that compromise immune response (example: burns)
What is the first step in the nursing process?
Assessment - Gathering objective and subjective data
Name some ways that makes for a thorough assessment
Review the following:
- Medications
- Travel history
- Stressors
- Risk factors
- Defense mechanisms, susceptibility and knowledge of how infections are transmitted
- Review of systems
- Immunizations/vaccines
- possible existing infections
And analyze lab data
What is the second step in the nursing process
Diagnosis - analyzing the assessment data
What are examples of diagnoses commonly associated with infection prevention and control
- Risk for infection
- Imbalanced nutrition: less than body requirements
- Impaired oral mucous membrane
- Risk for impaired skin integrity
- Social isolation
- Impaired tissue integrity
- Readiness for enhanced immunization status
What is the third and 4th step in the nursing process?
Third - outcome identification
Fourth - Planning
During the planning and outcome identification stage what kind of goals and outcomes should the nurse set
- Realistic outcomes so interventions are purposeful, direct and measurable
- S.M.A.R.T Goals
Specific (simple, sensible, significant)
Measurable (meaningful, motivating)
Achievable (agreed, attainable)
Relevant (reasonable, realistic and resourced, results-based)
Time Bound (time based, time limited, time/cost limited, timely and time sensitive)
What are some common goals of care applicable to patients with infection
- Preventing exposure to infectious organisms
- Controlling or reducing the extent of infection
- Maintaining resistance to infection
Describe what happens during the planning and outcome identification stage of the nursing process
- Set Goals and outcomes
- Set priorities - establish priorities for each dx and for related goals of care
- Teamwork and collaboration
What is the Fifth step in the nursing process?
Implementation
What does the nurse do during the implementation stage
Health promotion – > preventing an infection from developing or spreading by promoting
- Nutrition support
- Rest/exercise
- Maintenance of physiological protective mechanisms (hand hygeine)
- Immunizations
What is Asepsis
This is the absence of pathogenic (disease producing) microorganisms
What are the 2 types of aseptic techniques
- Medical - use for all patients even when no infection is diagnosed
- Surgical
What are examples of medical asepsis
Hand hygiene, use of PPE and routine environmental cleaning
standard precautions - designed to be used for all patients
alcohol based hand rub
What is surgical asepsis
Includes procedures used to eliminate all microorganisms including pathogens and spores from an object or area
- An area or object. is considered contaminated if touched by any object that is not sterile
- Demands the highest level of aseptic technique and requires that all areas be kept free of infectious microorganisms
What is sterile field
An area free of microorganisms and prepared to receive sterile items
It requires a work area in which objects can be handled with minimal risk of contamination
Can a nurse turn their back on a sterile field?
NO. Never leave sterile field (i.e. sterile tray) unattended. DO NOT TURN YOUR BACK. Anything out of range of vision is no longer sterile
Is sterile field below or above your waist?
Above your waist to be considered sterile.
What is anything within a 1 inch border considered? STERILE or CLEAN
It is considered clean. IT IS NOT STERILE. The edges of a sterile field or container are not sterile
Can a sterile object or field become contaminated by prolonged exposure to air?
YES
What happens when a sterile surface comes in contact with a wet surface?
Becomes contaminated by capillary action
What is disinfection
a process that eliminates many or all microorganisms with the exception of bacterial spores from inanimate objects
What are the 2 types of disinfection
- Disinfection of surfaces
- High level disinfection which is required for some patient care items such as endoscopes
What is sterilization
the complete elimination or destruction of all microorganisms including spores
What are some sterilization methods
Using steam, dry heat, hydrogen peroxide plasma, or ehtylene oxide
What order do you remove your PPE
Gloves, Faceshield or goggles, gown and mask
What is isolation
Isolation is the separation and restriction of movement of ill persons with contagious disease
What are the 4 types of transmission based precautions which are based on the mode of transmission
- Airborne
- Droplet
- Contact - Direct and indirect contact with patients
- Protective environment
These precautions are for patients with highly transmissible pathogens
What do contact precautions require
Requires gown and gloves
What are the droplet precautions
Requires wearing surgical mask when within 3 feet of the patient, proper hand hygiene, and some dedicated care equipment
Example: Sepsis, Pneumonia, influenza, adenovirus
What are the airborne precautions
Requires a specifically equipped room with negative air flow referred to as an airborne infection isolation room. All health care personnel wear a N95 respirator every time they enter. If mask is moist, not being protected anymore. Other PPE needed is gown, N95 and gloves. No faceshield is needed
Example: TB patients
What type of isolation precaution is appropriate for meningitis
Droplet precaution
