mod 3 ch 28 infection control Flashcards
asepsis
absence of disease-producing microorganisms called pathogens.
- technique refers to practice and procedures implemented before, during, or after clinical procedure to prevent transmission and reduce risk infections
2 types:
medical and surgical asepsis
medical asepsis
known as clean technique, implemented for all pts. it breaks the chain of infection and protect susceptible host include hand hygiene and PPE
surgical asepsis
known as sterile tech, prevents intro microorganisms from envir into pt’s incision or body cavities during spec procedures
hand hygiene
most important med asepsis
alcohol based- reduce but not eliminate all. best when contain at least 60% alcohol, hands not visibly dirty
wash soap and water - when visibly dirty, after known or suspected exposure to C-DIFF, before eating and after toilet
non-alcohol based sanitizers- reduce growth of some but not kill, more likely to irritate skin and may cause microorgs to develop resistance
PPE
gowns- if clothing may become soiled, one time use
masks-
- –against large particles travel short distances (3 ft) and small particles that stay in air, decreased effect when wet,
- -N95 mask (special particle respirator) used w contagious airborne disease (TB), must be prof measured and fit tested
googles/faceshield- protect from splashes, sprays, and resp droplets. face shield should have crown and chin protect and wrap around face to point of ear
head and shoe covers- high risk cont of pt, rn, or hcp like OR or L&D
gloves- decrease risk transfer orgs 1 to another
- sterile and nonsterile
donning ppe
- hand hygiene
- don gown
- adjust mask
- adjust eyewear
- apply head cover
- apply shoe covers
- don gloves- gloves over gown
removal ppe
- gloves
- eyewear- handle earpieces lift away from face
- gowns - waist, neck strings, the pull down and away rolling outside to inside
- masks- bottom ties then top, never touch front
- shoe and head covers
- hand hygiene
Which phrase describes medical asepsis?
Procedure known as clean technique
Which statement is correct regarding hand hygiene in the health care setting?
Soap and water effectively reduce microorganisms on visibly dirty hands.
An effective alcohol-based hand scrub must contain at least
percent alcohol.
60
Match the situation to the type of personal protective equipment required.
Head cover ---Surgery or labor and delivery Goggles ----Sprays from respiratory droplets Gloves ----Direct contact with body fluids Gown -----Patient on transmission precautions
Place the personal protective equipment (PPE) in the order in which the nurse would remove them.
Gloves Eyewear Gown Mask Shoe covers
standard precautions
minimum infection prevention for all pts
- hand hygiene
- use ppe
- safe injection practices
- safe handling potentially contaminated eq or surfaces
- respiratory hygiene/cough etiquette
During contact or potential contact with:
- Blood and bodily fluids (except perspiration), secretions, and excretions.
- Nonintact skin.
- Mucous membranes.
Other potentially infectious material.
respiratory hygiene/etiquette
use tissue when sneeze or cough
- documentation- pt and family education regarding standard precautious must be documented
transmission-based precautions (2nd type)
- Airborne precautious- pts w known or suspected pathogens transmitted small droplets or particles
- droplet precautious- infections pathogens transmitted by respiratory droplets
- contact precautious- prevent trans infectious disease from 1 to another
contact precautions
single room, share same infection if only single room
ppe- gloves and gown
conditions- multi-drug resistant orgs (MDROs)- vancomycin-resisant Enterococcus, methicillin-resistant Staphylococcus aureus, Clostridium difficile (C-DIFF), respiratory syncytial virus, hep A
- scabies or herpes simplex virus (HSV)
- excessive wound drain
- fecal incontinences
respiratory droplet precautious
- single room and close door, if not place w facemask and separate
ppe- facemask, if spraying anticipated - gloves gown googles (faceshield)
- pts wear facemasks when leaving room
conditions- pharyngeal diptheria mumps, rubella, pertussis streptococcal pharyngitis and scarlet fever pneumonias and pneumonic plague meningococcal sepsis influenza
airborne precautions
suspended in air prolonged time, travel over greater distances for longer time than larger droplets
precautions- pt placed in airborne infection isolation room (AIIR) and do NOT come through reception area
PPE- N95 or higher respirator, gown, gloves, googles/faceshield
pt wear facemask when exit room
conditions- varicella or disseminated varicella zoster (chicken pox), rubeola (measles) mycobacterium tuberculosis (pulmonary or laryngeal tuberculosis)
Which practices would be included by the nurse when teaching about standard precautions?
hand hygiene
cough etiquette
safe injection practices
use ppe
Which precaution would the nurse take when handling needles (sharps) to prevent an accidental needlestick?
Using a needleless system whenever possible
As a member of the infection control committee, which action would the nurse suggest to help control transmission of respiratory infections among staff during influenza season?
Post signs in bathrooms demonstrating cough etiquette.
This is a good suggestion and could be very effective. All nurses and many visitors go into bathrooms and can easily see signs that catch their attention.
Which transmission-based precaution would the nurse take for a seriously ill patient being admitted for influenza?
Provide a mask for the patient if leaving the room.
immunizations
important for preventing the spread of communicable infections within a community. Immunization is the process by which an individual develops active acquired immunity against a specific agent.
reasons for underutilization immunizations
- herd immunity (indirect protection provided by large population who have been immunized) and seeing no reason
- conflicts religious, cultural, personal beliefs
- belief contracting disease gives stronger response than immunization
- vaccine refusal belief over toxic
infection protection at home
- perform hand hygiene
- avoid sharing personal care products
- clean reusable eq and disinfect w 10% bleach
Teach wound care- signs and symptoms, infection potential, changing and disposal, moisture proof bags for disposal
self-injections: puncture resistant container screw-top lid and label
do teach back for understanding
isolation
separate people contagious disease
protective isolation - protect pts who have compromised immune systems who may or may not be sick.
quarantine
separates and restricts movement who were exposed to contagious disease but not yet ill. keep from others to prevent spread
enforcement (commerce clause US constitution section 361 public health service act)
gives us secretary of health and human services authority - CDC fulfils these actions
communicable diseases isolation and quarantine authorized: cholera diptheria infectious tb plague small pox yellow fever viral hemorrhagic fevers severe acute respiratory syndromes influenza that causes pandemic
Which activities can a nurse easily participate in if interested in slowing infection transmission within the community?
Participating in local handwashing campaigns
Working locally to encourage immunizations
Which source is best for the nurse to recommend for patients interested in information about the updated immunization schedule for adults?
The Centers for Disease Control and Prevention (CDC) immunization website
The CDC website is the best source for information about immunization schedules for children and adults. It is constantly updated.
Which home care intervention helps reduce the transmission of infections?
Reporting infections as early as recognized
Reporting signs of infection early is an intervention that helps reduce the transmission of infections in the home. Treatment or precautions can be implemented to reduce transmission.
Which diseases can the federal government order patients to be isolated and/or quarantined for?
small pox
cholera
yellow fever
diptheria
medical asepsis: pt safeguards
- Maintaining asepsis of intravenous access ports
- Emptying urinary drainage bags routinely and before they become half full
- Keeping urinary drainage bags below the level of the patient’s bladder and off the floor
- Keeping equipment clean: IV poles, bedside trays, etc.
- Changing damp or soiled dressings
- Ensuring sharps are disposed of in puncture-proof containers
- Promoting regular bathing and oral hygiene to remove and control transient microorganisms
- Encouraging fluid intake to promote healing and ensure flushing of microorganisms from urinary bladder and urethra
- Encouraging a well-balanced diet to promote immune system function
- Teaching patients and caregivers/visitors to cover their mouths or noses when coughing/sneezing (respiratory hygiene/cough etiquette)
- Providing fluid-resistant containers for patients to use for tissue disposal
Medical Asepsis: Environmental Safeguards
- Discard disposable items in proper receptacles (e.g., items contaminated with blood-borne pathogens may be discarded in biohazard bags, depending on the amount of blood requiring disposal).
- Clean from less soiled to more soiled areas to avoid increasing contamination.
- Place items that are moist from body fluids in the appropriate receptacle immediately.
- Wrap heavily soiled items in plastic to prevent direct contact with the substance by others.
- Pour liquids (e.g., bath water, mouthwash) directly into the drain to avoid splashing.
- Avoid allowing soiled items, such as linens, to touch clothing to decrease the chance of spreading infectious material to other patients.
- Keep soiled items off the floor to decrease the chance of contamination.
- Avoid shaking linens to decrease the chance of infectious particles becoming airborne.
- Remove clutter from the patient’s room.
The Nurse’s Role in Medical Asepsis
- Maintaining personal hygiene.
- Keeping fingernails short to avoid scratching patients, which opens a portal of entry for infectious agents.
- Avoiding artificial nails because they harbor microorganisms.
- Keeping hair short or pulled back.
- Avoiding wearing rings with grooves or stones, which can harbor microorganisms.
- Donning protective eyewear and gloves before cleaning equipment contaminated with infectious organic material for self-protection.
- Avoiding working when ill to prevent spreading infections to susceptible patients or other staff members.
set up and maintain sterile field
- facemask
- hand hygiene and surgical scrub
- estab sterile field above waist height
- check packages sterility, intactness, and exp date
- open sterile pack away from body
- keep surfaces dry
- slowly pour liquid within sterile field, do not reach across
- to add to sterile field, peel packaging away from item while maintaining sterility of item. do not touch field with outside of packaging
- 1-inch outer margin of sterile field not sterile
- do not sneeze, cough, laugh or talk over sterile field
- never turn away/out of sight
sterilization
destroy all microorganisms
Sterilization methods include:
Physical sterilization through use of steam, boiling water, dry heat, or radiation.
Chemical sterilization through use of gases, such as ethylene oxide gas, or solutions.
Prepackaged sterile containers or packages are sterilized through physical or chemical means before purchase. These items must be inspected for damage and sterility expiration dates before use.
disinfection
destroy or remove all pathogenic microorganisms except spores. Disinfectants are used to clean medical equipment and skin. These techniques are used for equipment that cannot be sterilized, such as tubing, and skin
Disinfecting agents include:
Germicidal agents such as chlorhexidine, formaldehyde, ammonium compound, phenol compounds, and bleach
Antiseptic agents such as alcohol, hydrogen peroxide, iodine, and benzalkonium chloride
Place in order the steps of establishing a sterile field.
- Don a facemask if required.
- Perform thorough hand hygiene.
- Establish the sterile field above waist level.
- Open sterile packages away from the body.
- Do not turn away from the sterile field.
Match the cleaning method with its use.
Germicide --Uses chlorhexidine Chemical sterilization --Process that uses gases Physical sterilization ---Process that uses steam or radiation Disinfection ---Cleans medical equipment and skin
Which personal protective equipment (PPE) would the nurse don before observing a sterile procedure in the operating room?
mask
types of nursing interventions
independent: nurse initiated, do not require prescription from hcp
ex: teaching, ADLS, counseling
dependent: hcp initiated, require written order or prescription
ex: med admin
interdependent: collaborative, requires expertise rn and hcp/team
ex: PT or participating in pt care conference
Which actions would a nurse take when caring for a patient with cellulitis?
- implement wound care
- obtain wound culture
- review complete blood count
- admin antibiotics
Which intervention would a nurse anticipate specifically for a patient suspected of meningitis?
lumbar puncture
Which term describes the administration of a medication by a nurse?
dependent intervention
Which phrases describe the purpose of hand hygiene?
- prevents spread of infection
- breaks chain of infection
- ## interrupts organism transmission
Which nursing student’s note would the nurse correct?
standard precautions used during bed, bath, and mouth care
reasoning.. documentation not needed
By which means are pathogens transmitted through droplets, requiring infected patients to be placed on protective precautions?
- coughing
- sneezing
- suctioning (pathogens can be transmitted by droplets)
- talking
Which group(s) does the Centers for Disease Control and Prevention (CDC) apply the term quarantine to?
- people
- animals
- cargo
- buildings
Which medical asepsis interventions by the nurse directly protect the patient from infection?
- cleaning pt bedside eq routinely
- disposing used needles in sharps container
- provide leak-proof receptacles at bedside for tissues
- preventing contamination of iv sites and ports
A nurse caring for a patient with an infection would anticipate a temperature less than __°F when the infection has resolved.
100.4
Which step is first in the sequence for donning personal protective equipment (PPE)?
hand hygiene
Which infection would require a nurse to don a fitted N95 respiratory mask?
tb
Which statements best describe the purpose for greeting the patient and explaining the need for personal protective equipment (PPE)?
- eases fear and misunderstanding
- creates prof relationship
- builds trusting relationship
Which piece of personal protective equipment (PPE) would the nurse consistently don when anticipating that contact with a patient’s body secretions will be possible?
gloves
In which situation is it permissible for the nurse to use an alcohol-based hand sanitizer?
when hands are not visibly soiled
Which behavior indicates the need for additional teaching after educating a patient about respiratory etiquette?
reusing tissues for productive cough
Which infection would prompt the nurse to implement contact precautions?
hep a
Which infection would require a patient to be admitted to the airborne infection isolation room?
varicella zoster
Match the transmission-based precaution with the mode of transmission it prevents.
Person to person —–Contact
Coughing, sneezing —Droplet
Suspended particles
—Airborne
Match the type of transmission-based precaution with the infection for which it is implemented.
Herpes simplex virus (HSV) ---Contact Rubella -----Droplet Rubeola ---Airborne
Which type of action is the nurse taking to reduce the spread of infections by not going to work when sick?
- personal
Which action can communities engage in to help reduce infections among their citizens?
encouraging and facilitating immunization programs
Match the precaution with its corresponding description.
Separates sick and contagious people from others
—Isolation
Separates people exposed to a contagious disease —-Quarantine
Separates people with weak immune systems
—-Protective isolation
Which actions are required by the nurse when preparing for a sterile procedure?
- keeping sterile surfaces dry
- setting up sterile field
- checking package integrity
- monitor activity of others
Which action would the nurse recognize as a breach in surgical asepsis that contaminated the sterile field?
hcp reached over sterile field to pick up towel
Which procedure is necessary for equipment being used to enter a sterile body cavity?
sterilization
Which type of infection would a nurse suspect when caring for a patient who has a prescription for a Clostridium difficile test?
Gastrointestinal infection
Clostridium difficile is associated with gastrointestinal infections that typically present with diarrhea and abdominal pain.
Which actions by the nurse would be considered independent nursing interventions?
- counseling pt
- repositioning to enhance comfort
- teaching postop pt how prevent surg site infection
