Class 2 Asepsis & Infection Control Flashcards
Infection
a disease that results from a pathogen in or on the body
healthcare associated infections (HAI)
infections that develop during the course of treatment for other conditions; most can be preventable!!
Most common (top offenders) HAI
urinary tract infections
surgical site infections
bloodstream infections
pneumonia
Nosocomial
something that originated or occurred inside a hospital setting
Bloodborne Pathogens
infectious microorganisms in the blood/body secretions that can cause disease in humans
Iatrogenic?
something that wasn’t supposed to happen
Preventing health care associated infections
HAI in USA annually:
-2 million infections
-99,000 deaths
-$30.5 billion dollars in associated costs
Medicare/medicaid no pay list (10 conditions)..hospitals will not be paid for any costs related to (3)
-CAUTI: catheter associated urinary tract infections
-vascular catheter related infections
-surgical site infections
Factors predisposing patients to nosocomial infections
-being in hospital
-antibiotic-resistant organisms developed in hospitals (MRSA, VRSA, VRE)
-poor compliance with hand washing, standard precautions and transmission based precautions
Infectious agents
-bacterial: most significant and most prevalent in hospital settings
-virus: smallest of all microorganisms
-fungi: plant like organisms present in air, soil, and water (no flowers in ICU)
Components of the infection cycle
-infectious agent (pathogen-not all infectious)
-reservoir (where do live?)
-portal of exit
-means of transmission (how do travel? contact, airborne, droplet)
-portal of entry
-susceptible host
Possible reservoirs of micro-organisms
-other humans (TB)
-animals, insects (west nile, zika)
-soil (tetanus)
-food, water, milk (listeria, E. coli, salmonella)
-inanimate objects
common portals of exit/entry
pathogens generally enter and exit via the same portals
-respiratory
-gastrointestinal
-genitourinary tracts
-breaks in skin (intact skin is body’s 1st line of defense**)
-blood and body fluids (everything but sweat!)
How to break the chain of infection
-infectious agent–>reservoir (hand hygiene)
-reservoir–>portal of exit from reservoir (transmission-based precautions)
-portal of exit–>means of transmission (dry intact dressing/hand hygiene)
-means of transmission–>portals of entry (hand hygiene)
-portals of entry–>susceptible host (hand hygiene)
-susceptible host–>infectious agent (immunizations)
Factors affection host susceptibility
-intact skin & mucous membranes: this is the bodies first line of defense against infection**
-body’s white blood cells: low counts allow pathogens to multiply
-patients with splenectomy (filters bacteria)
-age: neonates and older adults are more susceptible to infection
-immunization, natural or acquired
-fatigue: decreased immune response
-nutritional status: poor nutritional status inhibits our ability to fight infection
-drug therapies: many drugs suppress our immune system response (steroids, chemo)
-stress: increased stress will adversely affect normal defense mechanisms
-use of invasive or indwelling medical devices:provides portal of entry for pathogens (IV)
Stages of infection
incubation period
prodromal stage
full stage of illness
convalescent period
incubation period
organisms growing and multiplying
-not feeling sick; no symptoms
-flu=1-4 days; Hep B=1-6 maths
prodromal stage
person is most infectious, vague and nonspecific signs of disease
-“I don’t feel well”
full stage of illness
presence of specific signs and symptoms of disease
convalescent period
recovery from the infection
-start to feel better
Manifestations of the presence of an infection
-local infection
-systemic infection
local infection
will see:
-swelling, heat at site, redness, pain
-loss of function
-purulent drainage
systemic infection
will see:
-elevated temperature (not in the elderly! their temp will be normal, but their level of consciousness will deteriorate)
-increased pulse and respiratory rate (increased metabolism)
-enlarged lymph nodes
-lethargy, anorexia (loss of appetite)
Laboratory data indicating infection CBC with differential (diff)
-elevated white blood cell count >10,000/mm3
-increase in specific types of white blood cells
-neutrophils(bands-immature, left shift):acute bacterial infections (should be less than 10%); generate fever response
-lymphocytes chronic bacterial (TB) and viral infections; important in synthesis of immunoglobulins
-eosinophil elevated in parasitic infection, fungus (cocci), allergic reaction; increase in response to allergic & parasitic conditions when an antigen-antibody response occurs
-C-reactive protein is non-specific and indicates inflammation (presence of pathogen in urine, blood, sputum, or drainage cultures)
-diagnostic tests such as CXR, lumbar puncture
hospital privacy curtains
are dirty!
-in study 92% of curtains showed contamination in 1 week (30 curtains)
-8 curtains yielded VRE at multiple time points
-privacy curtains are rapidly contaminated with potentially pathogenic bacteria
Paper study
4 pathogens were prepared on paper
-e. coli
-staph
-pseudomonas
-enterococcus
still stable on paper for up to 72 hours and still cultured after 7 days
**don’t bring paper in isolation room
MDRO
multi drug resistant organisms
CAUTI
catheter associated urinary tract infections
VAP
ventilator associated pneumonia
HAP
hospital associated pneumonia
CLASBI’s
central line associated bloodstream infections
bloodborne pathogens
live in body/body secretions except sweat
-these pathogens include, but are not limited to:
-Hepatitis B virus (HBV)
-Hepatitis C virus (HCV)
-Human immunodeficiency virus (HIV)
**hep vowels are bowels; consonants are blood
How are bloodborne pathogens transmitted?
-needle stick
-cuts from contaminated sharps
-mucous membrane transmission
-perinatal transmission (mother to child)
-aerosol transmission
Standard precautions used to prevent blood borne pathogens
-treat all blood and body fluids as if they are infected=everyone
-treat potentially contaminated materials as if they are infected
-have an ESSENTIAL role in preventing transmission
Standard precautions (tier 1)
-wash hands
-wear gloves
-wear mask
-wear gown
-sharps disposal (never recap dirty needle)
Standard precautions include
- hand hygiene & wearing gloves
- using appropriate PPE
-masks, goggles, face shields, gowns, booties, head coverings - safe work practices
-never recap a dirty needle
-respiratory hygiene/couch etiquette - engineering controls
-needless IV’s, safety lancets
1 hand hygiene
when to use hand sanitizer:
-wash in/wash out of rooms
-before direct patient contact
-after direct contact with patient skin
-after contact with body fluids or non
-before putting on gloves
-after removing gloves
-before procedures
-after touching patient surroundings
**use soap and water when hands are visibly soiled and after caring for patient with C diff (have spores)
-Wash and change gloves between patients
compliance with hand hygiene guidelines CDC May 12, 2023
-average hand hygiene compliance without specific improvement interventions remains at around 40% while in critical care, such as intensive care units, average compliance levels are around 60%
-our study shows that only during one-fifth of the observations did healthcare workers do hand washing, and less than 10% did it appropriately by following all the essential steps of hand hygiene
2 wear appropriate ppe (not sterile)
before beginning a task, you should ask yourself:
1. what am I going to do?
2. is there any likelihood of contact with body substances?
3. if yes, where is contact anticipated-eyes, mouth, hands, clothes?
4. what equipment do I need to protect these areas?
PPE
-gloves
-gowns
-masks
-protective eye gear
-surgical caps and shoe covers
Donning
putting on PPE
-gown
-eyeware
-mask
-gloves (pull over sleeves)
Doffing
taking off PPE
-gloves, gown, eyeware, mask
**most contaminated comes off first
Glove guidelines
-wash hands before putting on gloves
-wash hands after taking off gloves
-do not wear dirty gloves outside of a patient’s room
-change gloves between tasks on the same patient
-wash hands and change gloves between patients
-do not do any charting with gloves
So what do we do in isolation room with EPIC?
-do not wear gloves when there is no chance of coming in contact with blood or body secretions
N95 particulate respirator
protect the wearer from small particles in the air that may contain virus and pathogens (FILTERS INHALED AIR) -each wearer is fitted for their personal mask
-filters what breathing in/out
PPE masks
protect large droplets from escaping the wearers nose or mouth; protect the wearer from splashes; they do NOT prevent inhalation of small airborne contaminants (FILTERS EXHALED AIR)
-filters what exhaling
PAPR
powered air purifier respirators
3 safe work practices
in areas where there is a chance of exposure to bloodborne pathogens:
-do not eat or drink in the work area
-do not store food or drink in the areas where blood or body substances may be present
-do not apply cosmetics, lip balm or contact lenses in these areas
-bag laundry in rooms with leak proof bags
4 engineering controls
-sharps containers
-self sheathing needles
-needless systems
regulated waste and proper disposal
see slide 35
What to do if you have a body substance exposure
Immediately clean the area
-eyes: remove contact lenses and rinse eyes with continuous water for at least 5 minutes
-cuts, scrapes, punctures: immediately bleed out the wound and wash with large amounts of soap and water (tell instructor)
-mouth: immediately rinse the mouth with large amounts of water for at least 5 minutes
REPORT EXPOSURE TO CLINICAL FACULTY
contaminated clothing
-minimally contaminated by a body substance (inner surface not wet), it should be removed as soon as possible and replaced with hospital scrubs
-remove garment by rolling it up, as it is pulled up, to avoid facial contact with outer surfaces
-if amount of exposure soaks through clothing (inner surface wet) it is recommended clothing be cut off
What do we do when standard precautions (bbp) are not enough?
Transmission-based precautions tier 2
Transmission-based precautions tier 2
used in addition to standard precautions
-contact: C. diff, MRSA
-droplet: influenza, pertussis, whooping cough
-airborne: covid 19, TB, measles, chickenpox (airborne + contact)
^^require negative pressure rooms; door closed, n95 masks
other precautions
-neutropenic=protective (protecting patient)
used alone or in combination but always in addition to standard precautions
contact precautions
visitors: please report to the nurses’ station before entering this room
GLOVES AND GOWN ARE REQUIRED TO ENTER THIS ROOM
-placement: private room, may cohort with others with same organism and no other infection
-equipment: use disposable equipment. dedicate non-critical care items (stethoscope, thermometer, BP cuff). if common equipment is used, clean and disinfect between patients. do not take patient charts into the room
-transport: limit to essential purposes. when transporting take proper precautions (ex. cover infected area). notify destination area of isolation status
MDRO’s
multi drug resistant organisms
-MRSA
-VRSA
-VRE
-C diff
MRSA
methicillin resistant staph aureus
VRSA
vancomycin resistant staph aureus
VRE
vancomycin resistant enterococci
C diff
clostridium difficile
droplet (bigger) precautions
visitors: please report to the nurses’ station before entering this room
A MASK IS REQUIRED TO ENTER THIS ROOM
-placement: private room, may cohort with others with same organism and no other infection
-transport: limit to essential purposes. instruct patient to wear surgical mask. no mask required for transporter. notify destination area of isolation status.
airborne precautions
visitors: please report to the nurses’ station before entering this room
A RESPIRATOR IS REQUIRED TO ENTER
-placement: designated airborne isolation (negative pressure) room
-the door to the room must be kept closed at all times. visitors should wear a surgical mask when entering the room unless they have had prolonged exposure to the patient prior to hospitalization and choose not to
-transport: limit to essential purposes. instruct patient to wear surgical mask. cover varicella/shingles lesions if applicable. respirator required for transporter. notify destination area of isolation status.
a note about patient’s in isolation
research verifies patients in isolation suffer consequences
-depression
-anxiety
-fewer visits from the health care staff
-increased adverse events
medical asepsis
clean technique
-hand washing
-PPE
surgical asepsis (sterile)
-operating room, labor and delivery areas
-certain diagnostic testing areas: interventional radiology, cardiac catheterization
-patient bedside
-anytime you are penetrating the skin: blood draws, injections, IV’s
-invasive procedures, sterile dressings, central line dressings, urinary catheter insertion
sterile field
-don’t turn back on sterile field
-only sterile from neck to waist
-only sterile from top of bed and above
principles of surgical asepsis
-allow only a sterile object to touch another sterile object
-avoid talking, coughing, reaching over a sterile field
-do not turn your back on a sterile field
-consider any object contaminated if you have any doubt
-date and time solutions to expire in 24 hours
-pour fluids with the label in the palm of your hand
-without sterile gloves handle outer 1 inch of sterile field
-drapes
