Infection Control: Protecting the Susceptible Host Flashcards
How can regular bathing help protect normal defenses?
- Removes transient microorganisms from skin surface
- Helps keep skin hydrated and intact when lubricated
What does regular oral hygiene help remove?
- Proteins in saliva that attract microorganisms
- Tartar and plaque that can cause infection
How does adequate fluid intake help?
- Promotes normal urine formation
- Allows outflow of urine to flush bladder/urethral lining
For immobilized patients, what should nurses encourage?
- Routine coughing and deep breathing
- Keeps lower airways clear of mucus
What should nurses encourage for patients?
- Proper immunization
How can nurses help maintain healing processes?
- Encourage adequate fluid intake
- Encourage well-balanced diet with proteins, vitamins, carbs, fats
- Use measures to increase patient’s appetite
- Promote patient’s comfort and sleep
- Assist patient in learning stress reduction techniques
What is the risk of transmitting HAIs or infectious diseases among patients?
- The risk is high
- Healthcare workers may not be aware patients have infections
- Majority of nosocomial infection organisms found in patients’ body substances
What body substances always contain potentially infectious organisms?
- Feces
- Saliva
- Mucus
- Wound drainage
What guidelines did the CDC issue for isolation precautions?
- Two-tiered approach issued in 1996, updated in 2007
- Adopted by most healthcare agencies
- Similar to PHAC’s guidelines
What is the first tier of isolation guidelines called?
- Routine practices
- Designed for all patients regardless of diagnosis/presumed infectiousness
When do routine practices apply for healthcare workers?
- Potential exposure to blood, body fluids, secretions, excretions (except sweat)
- Exposure to non-intact skin or mucous membranes
What does routine practices include?
- Appropriate use of gowns, gloves, masks, eye protection
- Handwashing
- Cleaning equipment
- Proper disposal of contaminated linen and sharps
What is the second tier of isolation guidelines called?
- Additional precautions
- Also known as isolation precautions
- Designed to contain pathogens in one area, usually patient’s room
When are isolation precautions used?
- For patients infected/colonized with highly transmissible pathogens
- For epidemiologically significant pathogens
- Used in addition to routine practices
What are the three categories of isolation precautions?
- Airborne precautions
- Droplet precautions
- Contact precautions
How are isolation precautions determined?
- Depends on how the pathogen is spread
- E.g. Active TB requires airborne precautions with special mask/ventilated room
Basic principles for any isolation precaution category:
- Observe thorough hand hygiene before entering/leaving isolation room
- Properly dispose of contaminated supplies to prevent microorganism spread
- Apply knowledge of disease process and transmission mode when using barriers
- Ensure exposed persons are protected during patient transport
What psychological impact can isolation have on patients?
- Can lead to loneliness due to disrupted social relationships
- Potentially psychologically harmful, especially for children
- May alter body image, feeling unclean, rejected, lonely or guilty
- Limits sensory contact which can interfere with recovery
What should be explained to patients before isolation?
- Nature of the disease/condition
- Purposes of isolation
- Steps for carrying out specific precautions
- How infectious organisms are transmitted
- Difference between contaminated and clean objects
How can involving patients/families help?
- Participating in infection prevention increases chances of reducing spread
- Should be taught hand hygiene and barrier protection use
- Allows them to practice procedures
How can nurses improve sensory stimulation during isolation?
- Keep room clean and pleasant - open drapes, remove excess supplies
- Listen to patient’s concerns and interests
- Have conversations, especially during mealtimes
- Provide comfort measures like repositioning, massage, baths
- Encourage mobility and recreational activities when appropriate
What are routine practices for?
- Care of all patients
- Incorporates precautions against bloodborne pathogens and body substance isolation
When must hand hygiene be performed?
- Before and after direct patient contact
- Before and after contact with patient’s environment
- After contact with blood, body fluids, secretions, excretions or contaminated equipment
- Before putting on gloves and after removing gloves
When should gloves be worn?
- When touching blood, body fluids, secretions, excretions, non-intact skin or mucous membranes
- When touching contaminated items
- Gloves should be removed and hand hygiene performed between patients
- Gloves should be changed and hand hygiene performed between procedures on same patient
When should masks, eye protection or face shields be worn?
- If patient care may generate splashes or sprays of blood or body fluids
- If there is risk of droplet transmission
When should gowns be used?
- To protect uncovered skin and prevent soiling of clothing
- During procedures likely to generate blood or body fluid splashes/sprays
How should patient care equipment be handled?
- Reusable equipment must be properly cleaned and reprocessed
- Single-use items must be discarded
How should soiled linen be handled?
- All soiled linen should be handled the same for all patients
- If bag soaks through, use an additional bag
How should used sharps be discarded?
- Discarded in puncture-resistant container
- Container located in area where item is used
When is a single room needed for routine care?
- Generally unnecessary for routine care
- Needed if patient visibly soils environment or cannot maintain hygiene
What are airborne precautions for?
- Known or suspected infections transmitted by airborne droplets
- Examples: measles, chickenpox, disseminated zoster, tuberculosis
What barrier protection is needed for airborne precautions?
- Private room with door kept closed
- Negative pressure airflow of at least 6 air exchanges per hour
- Respiratory protection device (e.g. N95 respirator) when patient has TB, varicella, disseminated zoster, measles and worker is not immune
What are droplet precautions for?
- Known or suspected infections transmitted by droplets from coughing, sneezing, talking
- Examples: diphtheria, rubella, influenza, pertussis, mumps, meningococcal pneumonia, coronavirus, sepsis
What barrier protection is needed for droplet precautions?
- Private room or cohort patients (door closed unless bed >2m from door)
- Mask worn when within 2m of patient
What are contact precautions for?
- Known or suspected infections caused by direct or indirect contact
- Examples: MDROs, C. difficile, major wound/GI/respiratory/skin infections
What barrier protection is needed for contact precautions?
- Private room or cohort patients (door can be open)
- Gloves and gown upon entry to isolation room
- Limit patient movement outside room except for necessary treatments
- Clean/disinfect or discard items before removal from room
What should nurses discuss with families for isolated patients?
- Explain patient’s risk for depression or loneliness
- Teach principles of isolation
- Encourage avoiding expressions of revulsion, fear or disgust
- Discuss ways to provide meaningful stimulation
What types of airflow are used in isolation rooms?
- Negative pressure airflow to prevent infectious particles from leaving the room
- Positive pressure airflow for highly susceptible patients like organ transplant recipients
What should be posted outside the isolation room?
- A card listing the required precautions for that isolation category
- Serves as a reference for healthcare workers and visitors
- Alerts anyone entering that special precautions must be followed
What facilities should an isolation room contain?
- Hand hygiene facilities with soap/water and alcohol-based hand rub
- Bathing facilities
- Toilet facilities
When should hand hygiene be performed in an isolation room?
- Before approaching the patient’s bedside
- Before leaving the room
- Special procedures if no toilet facilities available
Where should personal protective equipment be stored?
- In an anteroom between room and hallway
- Or in a convenient location close to point of use
What containers should be in patient rooms for disposal?
- Impervious bag for soiled/contaminated linen
- Waste receptacle with plastic liners
- Rigid disposable container for used needles/syringes/sharps
How should nurses handle equipment in isolation rooms?
- Evaluate what can be taken in based on microorganism and transmission mode
- Dedicate use of items like stethoscopes for patients with MRSA
- Clean and disinfect devices before using on other patients
- Avoid touching/removing exposed articles to prevent transmission
