Medical Asepsis Flashcards
Foundations
Medical asepsis
Clean, reduce number or spread of microorganisms
Surgical asepsis
Sterile, prevent introduction of microorganisms
Factors increasing susceptibility in older patients
Many factors go into this, some include: chronic disease, activity level, immune response, nutritional status, urinary function, circulation, skin, etc.
Factors increasing susceptibility in younger patients
Immune system and their tendency to put things in their mouth
What is a nosocomial infection?
A hospital-acquired infection that was neither present nor incubating at the time of admission; develops during hospitalization
What is VRE?
Vancomyacin-resistant Enterococci, a type of nosocomial infection
Colonized in the intestine and spreads through the bloodstream
What is MRSA?
Methicillin-resistant staph aureus
What is C-Diff?
Clostridium difficile, causes explosive diarrhea and inflammation of colon
What nosocomial infection does PURELL work for?
VRE and MRSA
What nosocomial infection does PURELL not work for?
C-Diff & Norovirus, you must use soap and water
What does HAI mean?
Healthcare associated infections
What does CLABSI mean?
This acronym describes a central line-associated bloodstream infections
What does CAUTI mean?
This acronym describes a catheter-associated urinary tract infection
What does SSI mean?
Surgical site infection
What does VAP mean?
Ventilator-associated pneumonia
How can nurses prevent the spread of nosocomial infections?
WASH YOUR HANDS!!
Can you recap a used needle?
No
What is the one inch border?
The border of one inch at the edge of the sterile drape is considered non-sterile
Are dry wounds sterile?
Yes
What does a lip solution mean?
Once you open something it has 24 hours until it is considered expired. So you can lip solutions by pouring out some saline so it can lip the bottle tip
Venus ulcers often occur on the
1) distal leg & ankle OR
2) anywhere on the extremities.
Distal leg & ankle
Where do you find Arterial ulcers (most often)?
1) distal leg & ankle OR
2) anywhere on the extremities.
Anywhere on the extremities
What type of ulcer is associated w diabetes?
Arterial ulcers
What type of ulcer is associated with DVT, CHF, and/or obesity?
Venous ulcers
Which ulcer has a punched out/scooped out appearance?
Arterial ulcers
What do you need to document for wound assessment?
Size (width, length, depth)
Drainage (serous, sanguinous, serosaguinous, purulent)
Odor
Bloody drainage is known as…
Sanguineous drainage
Pus drainage is known as…
Purulent
Cloudy drainage is known as…
Purulent drainage
Pinky drainage is known as…
Serosanguinous
What are the 3 types of wound healing?
Primary intention, secondary intention, tertiary intention
Primary intention
Surgical wound, the surgeon made a cut and sealed it up. There is lower risk of infection
Secondary intention
There is tissue missing. We have to heal the wound from the bottom up. Gradually filled with granulation tissue. Greater change for scarring and infection. Slower
Tertiary intention
Delayed primary closure. It might be purposefully left open because there is an infection or dead tissue.
Must remove dead tissue and infection before encouraging healing with dressing changes.
Greatest chance of scarring.
HAPI
Hospital Acquired Pressure Injury (decubitus/pressure ulcer)
What type of injury do dry sterile dressings go over?
Dressing that goes over incisions.
What is a Moist to Moist dressing?
If the patient is already in pain what can you do beforehand?
Open wound. Requires saline-moistened gauze that we put into the wound bed and re-apply with every dressing change.
Pt can be pre-medicated because this can be painful
Why do we use leeches/maggots?
To initiate vascularization and circulation to bring O2
What are some contraindications of the wound vac?
Eschar/Slough, untreated osteomyelitis, cancer, fistula, active bleeding, anticoagulation therapy, visible bone.
During admission, you find that the Pt is 77, is diabetic, feeling stressed, and has not been eating. Patient has PVD (Peripheral vascular disease). What increases risk of infection?
Age, decreased nutrition. stress (cortisol levels), poor circulation, diabetes
Pt X is now on contact precautions. What PPE will you be wearing to enter the room? (pre-COVID)
Gown and gloves
Pt X has been diagnosed with pneumonia and is put on droplet precautions. What PPE will you be wearing to enter the room? (pre-COVID)
Face shield, gown, gloves
Pt X is on multiple antibiotics which can cause C-Diff. What objective data might make you suspect that the patient has C-Diff?
Odor, explosive diarrhea, abdominal pain, dehydration, nauseous, loss of appetite
A pt has been admitted into the unit and has been placed in a negative pressure room. What kind of precaution is this?
Airborne (TB, measles, SARS, COVID, MERs)
For airborne precautions what PPE will you donn?
N95 or PAPR
Purpose of negative pressure room?
Protects everyone outside of the room by drawing air into the room from the hallway and ante room. Up into the ventilation system which includes HEPA filters.
What are the specific changes in donning and doffing PPE for airborne patients in negative pressure rooms?
PPE is donned and doffed in the ante room.
How will you perform the moist-to-moist dressing change?
Irrigate the wound, place pre-moistened gauze in the wound, then cover with a thick bandage (ABD pad)
Why are moist-to-moist dressing changes considered sterile?
This dressing requires the use of sterile supplies
What is tertiary intention?
Purposeful delay of closure due to an infection or need to first remove eschar/slough
What is primary intention?
Well approximated edges
What is secondary intention?
Open wound, edges not approximated due to tissue loss
What is the purpose of an external fixator?
To stabilize fractured bones while they heal. Pins align the bone.
What kind of dressing is good for wounds with a lot of drainage?
Calcium Alginate
What kind of dressing is good for packing tunnel wounds?
Nu Gauze
Pt X states there was a program on TV that showed maggots being used to treat a wound. Pt asks why maggots would be used and why don’t they eat off the whole leg and then turn to flies. How do you respond?
Maggots are only attracted to dead tissue. They are raised in a sterile lab so they do not turn into flies.
You have a nursing student with you and the student is doing the dressing change for pt X. You notice the student flipped the gauze onto the sterile field, and it landed at the very edge. What do would you tell the student to do next?
You leave the gauze on the edge and use a different gauze because that piece of gauze is no longer sterile. There is the one-inch border rule!
A nursing student is doing a dressing change for pt X. You notice the student has donned sterile gloves before pouring saline on the gauze, and the bottle of the saline is sitting on the opposite side of the sterile field. Why does this concern you?
Reaching over contaminates the sterile field. They also will contaminate their sterile gloves by touching the bottle of saline.
You notice a pinkish-clear fluid on the dressing when it is removed from the wound. How would you document this?
Serasanguineous
What would you document for bright red drainage?
Sanguineous
What would you document for clear drainage?
Serous
What would you document if a patient’s drainage was a milky, white pus with a yellow, or greenish tinge (and with odor)?
Purulent
Indicative of infection
New admission patient Y needs a dressing change for a decubitis ulcer. Upon first assessment, you note that tendons are visible in the wound. How would you stage this wound?
Stage IV, full thickness tissue loss with exposed bone, tension, or muscle. This may include tunneling. Increased risk for osteomyelitis
Infection of the bone is known as…
Osteomyelitis
The patient has an area of redness, which may be painful, with the skin intact. What stage is this?
Stage I
The patient has full-thickness tissue loss and significant amounts of slough/eschar. What stage is this?
Unstageable.
We don’t know what is under the eschar/slough.
The patient has partial thickness loss of the dermis, a red/pink wound bed. What stage is this?
Stage II
The patient has a purple/red colored area of intact bone, blood filled area, that may be painful, and boggy to touch. What stage is this?
Deep tissue injury
The patient has full-thickness tissue loss, and may see subcutaneous tissue but no bone, tendon, or muscle. May include tunneling. What stage is this?
Stage III
Patient X is complaining of pain where the nasal cannula rests on the pts ear. You take a look and see a blister has formed. What is this an example of?
HAPI (Hospital acquired pressure injury), the cannula has rubbed the patient’s ear causing a wound.
Pt tells you that after a previous surgery, the pt had a drain, right near the surgical site, that the nurse had to empty. What did the pt mean by that?
The pt may have had a Hemovac, Jackson Pratt (JP drain), or Davol
How do drains work?
You take off the cap, measure the drainage, pour out the contents (q4), squeeze the bottle, and place the cap back on to create a suction document.
What is santly cream and what is it for?
Santly is used to liquefy tissue (both alive and dead). You only want to put it on the dead tissue.
What is a woundvac and what does it does for a wound?
It is a vacuum-like device that is placed inside the wound and drains the wound.
A student nurse asks if the wound vac is used for every wound. With your great knowledge of wound vacs, how do you respond?
No, not every patient has a wound vac.
While standing at the nurse’s station, you hear the pts will be going to the hyperbaric chamber for wound healing. How would the hyperbaric chamber assist in wound healing?
A hyperbaric chamber is a pressurized oxygen tank.
CLABSI
Central Line Associated Bloodstream Infections
Has to do with a patient who has a central line
CAUTI
Catheter Associated Urinary Tract Infection
From placement of a urinary catheter.
T/F a urinary catheter is a skilled performed sterile
True
What does the WASH acronym mean?
When – Before/after
Agents – Alcohol and water
How long – Alcohol until dry, water 15 seconds
Scrub under nails
Proper PPE for Droplet Precautions
Hand hygiene + Gown + Mask + Eye protection + Gloves
Put on gown, mask, eyewear, and then gloves
Remove gloves, gown, mask, and eyewear
Proper PPE for Contact Precautions
Hand hygiene + Gown + Gloves
Put on gown, and then gloves before patient contact
Remove PPE (Gloves, and then gown) just before exiting!
Proper PPE for Airborne Precautions
Hand hygiene + Gown + N95 respirator/PAPR
What is the anteroom?
Where you’ll don your PPE and how you’ll enter patient’s room (Negative Pressure Room) on airborne precautions
If the exudate drips into the sterile field, is it still sterile?
No longer sterile EVEN THOUGH it’s for the same patient
T/F Dry wounds are NOT considered sterile
False, Dry wounds are considered sterile.
Describe the visual characteristics of Arterial ulcers
Full thickness
Even margins
Often associated with diabetes
Anywhere on extremities
When you are assessing a wound, what are you assessing for?
Size, Drainage, Odor
What decubitus ulcer stage is most at risk for osteomyelitis?
Stage IV
Suspected Deep Tissue Injury (DTI)
Purple/dark red colored area (bruising) of intact tissue or blood-filled blister.
Skin is intact, but injury underneath.
May be painful, firm, boggy.
Is a mucosal membrane wound stagable?
No
What are medical device wounds and what is another name for medical device wounds?
Related to medical device such as TEDS or nasal cannula
Type of HAPI (Hospital acquired pressure injury)
Hemovac
Removes blood and fluid from a surgical wound. It’s a closed-suction system that helps wounds heal and reduces the risk of infection.
Nurse’s job: open, pour out contents, describe drainage, measure drainage, and document
Press top deck down and put cap back on → Creates a seal
What is a Davol and when is it used?
A wound drain where you squeeze the bulb til empty. It’s used after surgery to help prevent fluid or gas from building up
Hydrocolloid duoderm
– American salonpas
Applied to deter skin breakdown (ulcers)
Allows ulcer to heal and prevent it from getting worse
Allows oxygen exchange and keeps out bacteria
Patient can shower with it.
Has extra padding → Good for sacral area
Hydrocolloid opsite
Allows oxygen exchange and keeps out bacteria. Can be put over an IV (clear) and/or placed over skin graft area to visualize healing
When is Xeroform used?
For burns
What is Xeroform?
Gauze that’s impregnated with Vaseline (feels gooey, doesn’t dry wound).
Placed on the burn and then covered with a larger pad outside. Keeping burned tissue moist and protected from the environment as it heals
What is Silver used for and what are its properties?
Silver is used to treat burns because it has antimicrobial properties that help prevent and treat infections.
What is Calcium alginate and what is it used for?
It is made from algae and absorbs fluid. It can hold 10x its weight in fluid. It turns grayish-green, gets a weird smell, and feels a little gelatinous as it absorbs fluid.
Placed dry into a wound with a lot of drainage → Protects the good skin around the wound
If the skin is constantly wet, it’s going to break down
What is Nu gauze and what is it used for?
Nu gauze is used for deep tracking wounds. It is very sturdy, can’t be torn (has to be cut), sterile in its bottle. Describe healing of the wound (depth) by the amount of gauze
Collagenase enzymatic debriding ointment
Aka Santyl!
The ointment is spread on the dead tissue and then covered. It eats good tissue too, so only apply on dead tissue.
During dressing change, the ointment eats away at the dead tissue (which is wiped away and then irrigated) → Allows the wound to heal
What does HBOT do?
Forces O2 into tissue to help it heal
When and why do we use HBOT?
HBOT is a last resort option if wounds do not heal. Treatment of burns, skin grafts, diabetic wounds, anaerobic bacterial infections.
The chamber is filled w/ pressurized oxygen 2.5x normal air pressure. It encourages oxidative killing of bacteria, angiogenesis, collagen synthesis.
Benefits of Wound VAC (Vacuum Assisted Closure)
Used for oddly shaped and weepy wounds (w/ lots of drainage). Can decrease edema, increase blood flow, increase capillary regrowth, etc.
