Module 04: Asepsis and Infection Control Flashcards
What are the nature of microorganisms in the human body?
Most microorganism are harmless and may even be beneficial.
These microorganisms are the collective vegetation in a given area.
Resident Flora
These are the microorganisms that are microbial species that can be cultured from body surfaces under certain circumstances.
Transient Flora
What are four (4) major microorganisms causing infections in humans?
(1) Bacteria
(2) Viruses
(3) Fungi
(4) Parasites
This is the growth of microorganisms in body tissues where they are not usually found.
Infection
This is the detectable alteration in normal tissue function.
Disease
This infections pertains to the one with no clinical evidence of disease.
Asymptomatic or Subclinical
This is the ability produce disease.
Pathogenicity
This can be transmitted to an individual.
Communicable Disease
These cause disease only in susceptible individuals.
Opportunistic Pathogens
This pertains to the freedom of disease-causing microorganisms.
Asepsis
What are the two (2) types of asepsis?
(1) Medical Asepsis
(2) Surgical Asepsis
This type of asepsis pertains to the practices intended to confine a specific microorganisms to a specific area.
Medical Asepsis
This type of asepsis pertains to the practices that intend to keep an area or object free from all microorganisms.
Surgical Asepsis
What are the four (4) types of infection?
(1) Colonization
(2) Local Infection
(3) Systematic Infection
(4) Bacteremia
This type of infection pertains to process by which strains of microorganisms become resident flora.
Colonization
This type of infection is limited to the specific part of the body where the microorganisms remain.
Local Infection
This type of infection pertains to when the microorganisms spread and damage different parts of the body.
Systematic Infection
This type of infection pertains to when the culture of the individual’s blood reveals microorganisms.
Bacteremia
These are infections that originate in any healthcare setting.
Healthcare-Associated Infections
This source of Healthcare-Associated Infections pertains to when the infection originates from the client themselves.
Endogenous
This source of Healthcare-Associated Infections pertains to when the infection originates from the hospital environment and hospital personnel.
Exogenous
According to the Centers for Disease Control and Prevention, this type of HAI pertains to the serious infection that occurs when microorganisms enter the bloodstream through a large catheter placed in a large vein.
Central Line-Associated Blood Stream Infections (CLABSI)
According to the Centers for Disease Control and Prevention, this type of HAI pertains to any infection involving any part of the urinary system (urethra, ureters, bladder or kidneys) acquired from the hospital?
Catheter-Associated Urinary Tract Infection (CAUTI)
According to the Centers for Disease Control and Prevention, this type of HAI pertains to an infection that occurs after surgery in the part of the body where the surgery took place.
Surgical Site Infection (SSI)
According to the Centers for Disease Control and Prevention, this type of HAI pertains to the lung infection that develops in a person on a machine used to help the client to breathe.
Ventilator Associated Pneumonia (VAP)
Explain the chain of infection.
(1) Etiologic Agent
(2) Reservoir
(3) Portal of Exit
(4) Mode of Transmission
(5) Portal of Entry
(6) Susceptible Host
What are the factors that can be considered as an etiologic agent?
(1) Numbers of organisms present
(2) Virulence and potency
(3) Ability to enter the host’s body
(4) Susceptibility of the host
(5) Ability to live in the host’s body
What are the factors that can be considered as a reservoir or the source of microorganisms?
(1) Humans or carriers
(2) Plants
(3) Animals
(4) Medical Equipment
(5) General Environment
This factors pertains to when an infectious agent may be transmitted from its natural reservoir to a susceptible host in different ways.
Chain of Infection or Modes of Transmission
What are the different types of Direct Modes of Transmission?
(1) Direct Contact
(2) Droplet Spread
What are the different types of Indirect Modes of Transmission?
(1) Airborne
(2) Vehicle-borne
(3) Vector-borne (mechanical or biologic)
This mode of transmission occurs through skin-to-skin contact, kissing, and sexual intercourse. Also refers to contact with soil or vegetation harboring infectious organisms.
Direct Contact
This mode of transmission pertains to the spray with relatively large, short-ranged aerosols produced by sneezing, coughing, or even talking. This can be classified as direct because the transmission is by direct spray over a few feet, before the droplet falls to the ground.
Droplet Spread
This mode of transmission occurs when infectious agents are carried by dust or droplet nuclei suspended in the air.
Airborne
What are the sizes of microorganisms transmitted through airborne?
5 microns in size
This mode of transmission is the indirect transmit of an infectious agent via food, water, biologic products (blood), and fomites (inanimate objects such as handkerchiefs, bedding or surgical scalpels).
Vehicle
This mode of transmission is when the infection is transferred via mosquitoes, fleas and ticks that may carry an infectious agent through purely mechanical means or may support growth or changes in the agent.
Vector
What are the different types of the portal of entry?
(1) Before an individual can become infected, microorganisms must enter the body.
(2) The skin is a barrier to infectious agents; however, any break in the skin can readily serve as a portal of entry.
(3) Medical interventions such as tubes, catheters, and surgical wounds are common portals of entry
This pertains to any individual who is at risk for infection.
Susceptible Host
This pertains to an individual who has increased risk and who for one or more reasons is more likely than others to acquire an infection.
Compromised Host
What are the different factors affecting a person’s susceptibility?
(1) Impairment of immune system
(2) Age (the very young or the very old);
(3) Clients receiving immune suppression treatment
(4) Immune deficiency conditions.
What are the different types of body defenses?
(1) Non specific
(2) Specific
This type of body defense protects the individual against all microorganisms?
Non specific Body Defense
This type of body defenses is directed against identifiable infectious agent.
Specific Body Defense
This type of non specific defense pertains to the first line of defense.
Intact Skin Mucous Membranes
What are the different types of intact skin mucous membranes?
(1) Skin Factors: Dryness of the skin, Resident bacteria and normal secretions that is slightly acidic
(2) Nasal Passages have cilia and moist mucous that trap MOs
(3) Oral Cavity that sheds epithelium to rid of mouth MOs, saliva has lactoferrin, lysozyme and IgA
(4) Eye is protected by tears to wash MOs
(5) GI tract have the high acidity of the stomach and resident flora of the colon
(6) Vagina has a pH that inhibits growth of MOs
This type of non specific defense is the local and nonspecific defensive response of the tissues to an injurious or infectious agent.
Inflammatory Response
The inflammatory response is characterized by what?
(1) Pain (dolor)
(2) Swelling (tumor)
(3) Redness (rubor)
(4) Heat (calor)
(5) Impaired function (functio laesa)
Infectious agents are classified as either:
(1) Physical Agents
(2) Chemical Agents
(3) Microorganisms
What are the three (3) Stages of inflammatory response?
(1) Vascular and cellular response
(2) Exudate Production
(3) Reparative Phase
Enumerate the vascular and cellular responses.
(1) Vasoconstriction at the site of injury
(2) Dilation of small blood vessels due to histamine release
(3) Hyperemia (increased blood supply) that leads to redness and heat
(4) Vascular permeability increases and release of chemical mediators (bradykinin, serotonin, prostaglandin) and histamine
(5) WBC, fluids and proteins leaks into the interstitial spaces leading to swelling and pain
(6) Pain is caused by pressure of accumulating fluid on nerve endings and irritating mediators
(7) Fluid pouring into joints will impair function
(8) Leukocytosis ensues (increase production of WBC from bone marrow)
Enumerate what happens when there is tissue injury caused by physical or chemical agent and pathogenic microorganism.
(1) Heat - Capillary Widening and increased blood flow
(2) Redness - Increased permeability and fluid release into tissues
(3) Swelling and Tenderness - Attraction of leukocytes and extravasation of leukocytes to site of injury
(4) Pain - Systematic response and fever and proliferation of leukocytes
This is produced consisting of fluid that escaped from blood vessels, dead phagocytes and dead tissue cells.
Exudate
What are the steps of exudate production?
(1) Exudate is produced consisting of fluid that escaped from blood vessels, dead phagocytes and dead tissue cells
(2) Fibrinogen is converted to fibrin and thromboplastin and platelets from a network to wall off area
(3) Exudate is then cleared by lymphatic drainage
Explain the reparative phase.
(1) Regeneration is the replacement of destroyed tissue cells by cells that are identical or similar in structure and function.
(2) When regeneration is not possible, repair occurs by scar formation.
(3) Damaged tissues are replaced with the connective tissue elements of collagen blood capillaries, lymphatics and other tissue bound substances.
(4) Granulation tissue. It is a fragile gelatinous tissue appearing pink or red because of the many newly formed capillaries.
(5) Later the tissue shrinks and a firmer tissue remains called cicatrix or scar.
It is a fragile gelatinous tissue appearing pink or red because of the many newly formed capillaries.
Granulation tissue
Later the tissue shrinks and a firmer tissue remains called __________.
Cicatrix or scar.
These are the substances that induces a state of sensitivity or immune responses.
Antigen
This type of antigen originates from the body.
Autoantigen
What are the two (2) types of immune response?
(1) Antibody-Mediated Defense
(2) Cell-Mediated Defense
This is also called humoral immunity as it resides in the B lymphocytes and mediated by antibodies produced by B cells
Antibody Mediated Defense
These are also called immunoglobulins are part of the body’s plasma proteins. They defend primarily against bacterial and viral infections
Antibodies
This antigen or antibody source are produced by the body in response to an antigen.
Active
Duration: Long
This antigen or antibody source are formed in the presence of active infection in the body.
Active - Natural
Duration: Lifelong
This antigen or antibody source are administered to stimulated antibody production.
Active - Artificial
Duration: Many years: need to be reinforced
This antigen or antibody source are produced by another source, animal or human.
Passive
Duration: Short
This antigen or antibody source are transferred naturally from an immune mother to her baby through her placenta or in the colostrum.
Passive - Natural
Duration: 6 months to 1 year
This is an immune serum (antibody) are produced from an animal or another human injected.
Passive - Artificial
Duration: 2 to 3 weeks
This is a serologic testing involves measurement of several hepatitis B virus (HBV)-specific antigens and antibodies. Different serologic “markers” or combinations of markers are used to identify different phases of HBV infection and to determine whether a patient has acute or chronic HBV infection, is immune to HBV as a result of prior infection or vaccination or is susceptible to infection.
HBV Serologic Test Interpretation
This type of immunity occurs through the T cell system,
Cell-Mediated Defense
What are the three (3) Types of Cell-Mediated Defense?
(1) Helper T cells
(2) Cytotoxic T cells
(3) Suppressor T cells
What composes the nursing process?
(1) Assessment
(2) Diagnosis
(3) Planning
(4) Implementation
(5) Evaluation
What composes the process of planning?
(1) Maintain or restore defenses
(2) Avoid the spread of infectious organisms
(3) Reduce or alleviate problems associated with the infection
This is considered one of the most effective infection prevention measures.
Hand Hygiene
These kill bacteria more effectively and more quickly than hand washing with soap and water.
Alcohol based hand rubs (foam or gel)
What are the benefits of alcohol based hand rubs (foam or gel)?
(1) Kill bacteria more effectively and more quickly than hand washing with soap and water.
(2) Are less damaging to skin than repeated soap and water, resulting in less dryness and irritation.
(3) Require less time than hand washing with soap and water.
(4) Can be placed at the point of care in bottles or dispensers so they are more accessible.
This is a chemical preparation used on skin or tissue.
Antiseptic
This is a chemical preparation, such as phenol or iodine compounds used on inanimate objects.
Disinfectant
This approach intends to destroys bacteria,
Bactericidal preparation
This approach intends to prevent the growth and reproduction of some bacteria.
Bacteriostatic preparation
This is known as the process that destroys all microorganisms, including spores and viruses.
Sterilization
What are the four (4) approaches of sterilization?
(1) Moist heat
(2) Gas
(3) Boiling Water
(4) Radiation
This approach on sterilization uses steam under pressure to attain temp higher than boiling point.
Moist heat
This approach on sterilization uses ethylene oxide destroys Mos by interfering with metabolic process (toxic to humans).
Gas
This approach on sterilization is the most practical and inexpensive, some spores and viruses are not killed. Min 15 mins for disinfection at home.
Boiling water
This approach on sterilization uses ionizing (alpha, beta and x-ray) and non-ionizing (UV light) , rays do not penetrate deeply.
Radiation
This is designed for all clients in hospital and designed to reduce risk of transmission of microorganisms from recognized and unrecognized sources.
Standard Precautions
Standard Precautions apply to what?
These precautions apply to (a) blood; (b) all body fluids, excretions, and secretions except sweat; (c) nonintact (broken) skin; and (d) mucous membranes.
What are the different standard precautions?
(1) Perform hand hygiene
(2) Use PPE if anticipating exposure to infectious material
(3) Follow respiratory hygiene/ cough etiquette
(4) Ensure appropriate patient placement
(5) Proper handling and cleaning of equipment and instruments
(6) Handle textiles and laundry carefully
(7) Follow safe injection practices
(8) Ensure healthcare worker safety
What are the three (3) types of transmission based precautions?
(1) Airborne precaution
(2) Droplet precaution
(3) Contact precaution
This type of transmission based precaution is used for clients known to have or suspected of having serious illnesses transmitted by airborne droplet nuclei smaller than 5 microns. Examples of such illnesses include measles (rubeola), varicella (including disseminated zoster), and tuberculosis.
Airborne precaution
This type of transmission based precaution is used for clients known to have or suspected of having serious illnesses transmitted by particle droplets larger than 5 microns. Examples of such illnesses are diphtheria (pharyngeal); mycoplasma pneumonia; pertussis; mumps; rubella
Droplet Precaution
This type of transmission based precaution is used for clients known to have or suspected of having serious illnesses easily trans- mitted by direct client contact or by contact with items in the client’s environment.
Contact precaution
What are the standard precautions to take under airborne precautions?
(1) Place client in an airborne infection isolation room (AIIR). An AIIR is a private room that has negative air pressure, 6 to 12 air changes per hour, and either discharge of air to the outside or a filtration system for the room air.
(2) If a private room is not available, place client with another client who is infected with the same microorganism.
(3) Wear an N95 respirator mask when entering the room
(4) Susceptible individuals should not enter the room of a client who has rubeola (measles) or varicella (chickenpox). If they must enter, they should wear a respirator mask.
(5) Limit movement of the client outside the room to essential purposes. Place a surgical mask on the client during transport.
What are the standard precautions to take under droplet precautions?
(1) Place client in private room.
(2) If a private room is not available, place client with another client who is infected with the same microorganism.
(3) Wear a mask if working within 1 m (3 ft) of the client.
(4) Limit movement of client outside the room to essential purposes. Place a surgical mask on the client while outside the room.
This is a specific type of aseptic technique with a unique Theoretical and Clinical Practice Framework based upon the original concept of Key- Part and Key-Site Protection where staff identify and protect key parts and key sites (Rowley 2011)
Aseptic Non Touch Technique
This is the critical part of equipment that comes into contact with a key site
Key Part
This is the part of the body that is at risk of contamination if ANTT is not used e.g. wound, urethral meatus, insertion and access sites for medical devices.
Key Site
What is the importance of identifying key sites and key parts?
The competency to identify the key parts of an equipment and key sites of the patient that need to be aseptic and protect them at all times. In this, the nurse can use basic precautions like hand cleaning and PPE, plus a combination of aseptic fields and non touch technique.
Enumerate the principles of ANTT.
(1) A – Always ensure hands are decontaminated effectively prior to the procedure
(2) N – Never contaminate key parts of sterile materials/equipment or the patient’s susceptible key sites
(3) T – Touch non-key parts with confidence
(4) T –Take appropriate infection prevention and control precautions e.g. use of PPE, safe waste management
What protects key parts?
(1) individually - micro critical aseptic fields
(2) together - large critical aseptic field
Enumerate the steps of ANTT risk assessment.
(1) Does this procedure need the ANTT principles applied? Is a Standard or Surgical-ANTT required?
(a) Gain patient’s consent and explain procedure
(b) Draw curtains around patient or take to appropriate room
(2) Decontaminate hands
(3) Clean trolley/tray with appropriate detergent wipe
(a) Gather equipment including alcohol hand rub
(4) Create suitable working environment. If procedure is performed at the bedside ensure no cleaning or bed making are on-going within the area for at least 30 minutes. Ensure windows are closed and no fans are on
(5) Decontaminate hands
(6) Apply single use disposable apron
(7) If required open dressing pack/sterile drape
(8) Open and prepare all equipment on the tray/trolley. Keep all equipment within their packaging. Identify Key-Parts
(9) Decontaminate hands
(10) Apply gloves if required
(11) Perform procedure using ANTT
(12) Remove gloves and aprons and other Personal Protective Equipment (PPE)
(13) Dispose of waste
(14) Decontaminate hands
(15) Take patient back to the bedside if required and ensure patient is comfortable (16) Clean trolley/tray/environment
(17) Decontaminate hands
What are some common microorganisms in the skin?
(1) Staphylococcus epidermidis
(2) Propionibacterium acnes
(3) Staphylococcus aureus
(4) Corynebacterium xeroxis
(5) Pityrosporum ovale (yeast)
What are some common microorganisms in the nasal passages?
(1) Staphylococcus aureus
(2) Staphylococcus epidermidis
What are some common microorganisms in the oropharynx or mouth?
(1) Streptococcus pneumoniae
(2) Streptococcus mutans
(3) Lactobacillus
(4) Bacteroides
(5) Actinomycoses
What are some common microorganisms in the intestine?
(1) Bacteroides
(2) Fusobacterium
(3) Eubacterium
(4) Lactobacillus
(5) Streptococcus
(6) Enterobacteriaceae
(7) Shigella
(8) Escherichia coli
What are some common microorganisms in the urethral orifice?
Staphylococcus epidermidis
What are some common microorganisms in the urethra?
Proteus
What are some common microorganisms in the vagina?
(1) Lactobacillus
(2) Bacteroides
(3) Clostridium
(4) Candida albicans
What are the most common microorganisms in the urinary tract?
(1) Escherichia coli
(2) Enterococcus species
(3) Pseudomonas aeruginosa
What are the causes for the most common microorganisms in the urinary tract?
(1) Improper catheterization techniques
(2) Contamination of closed drainage system
(3) Inadequate hand hygiene
What are the most common microorganisms from surgical sites?
(1) Staphylococcus aureus (including methicillin resistant strains or MRSA)
(2) Enterococcus species (including vancomycin-resistant strains or VRE)
(3) Pseudomonas aeruginosa
What are the causes of the most common microorganisms from surgical sites?
(1) Inadequate hand hygiene
(2) Improper dressing change technique
What are the most common microorganisms in the blood stream?
(1) Coagulase-negative staphylococci
(2) Staphylococcus aureus
(3) Enterococcus species
What are the causes of the most common microorganisms in the blood stream?
(1) Inadequate hand hygiene
(2) Improper intravenous fluid, tubing and site care technique
What are the most common microorganisms from pneumonia?
(1) Staphylococcus aureus
(2) Pseudomonas aeruginosa
(3) Enterobacter species
What are the causes of the most common microorganisms from pneumonia?
(1) Inadequate hand hygiene
(2) Improper suctioning technique
What are the common infections in the respiratory tract?
(1) Parainfluenza virus (Mycobacterium tuberculosis)
(2) Staphylococcus aureus
What are the common infections in the gastrointestinal tract?
(1) Hepatitis A Virus
(2) Salmonella Species
(3) C.difficile
What are the common infections in the urinary tract?
(1) Escherichia coli
(2) Enterococci
(3) Pseudomonas aeruginosa
What are the common infections in the reproductive tract?
(1) Neisseria gonorrhoeae
(2) Treponema pallidum
(3) Herpes Simplex virus type 2
(4) Hepatitis B Virus (HBV)
What are the common infections in the blood?
(1) HBV
(2) HIV
(3) Staphylococcus aureus
(4) Staphylococcus epidermidis
What are the common infections in the tissue?
(1) Staphylococcus aureus
(2) Escherichia coli
(3) Proteus species
(4) Streptococcus beta-hemolytic A or B
What are the portals of exit of microorganisms in the respiratory tract?
(1) Nose or mouth through sneezing, coughing, breathing, or talking
What are the portals of exit of microorganisms in the gastrointestinal tract?
(1) Mouth: Saliva or Vomitus
(2) Anus: Feces
(3) Ostomies: Feces
What are the portals of exit of microorganisms in the urinary tract?
Urethral meatus and urinary diversion
What are the portals of exit of microorganisms in the reproductive tract?
(1) Vagina: Vaginal discharge
(2) Urinary meatus: semen, and urine
What are the portals of exit of microorganisms in the blood?
(1) Open wound
(2) Needle puncture site
(3) Any disruption of intact skin or mucous membrane surfaces
What are the portals of exit of microorganisms in the tissue?
Drainage from a cut or wound
This is known as the susceptibility to invasion and multiplication of pathogenic organisms, which may compromise health.
Risk for Infection
What are the risk factors for risk for infection?
(1) Difficulty managing long-term invasive devices
(2) Difficulty managing wound care
(3) Dysfunctional gastrointestinal motility
(4) Exclusive formula feeding
(5) Impaired skin integrity
(6) Inadequate access to individual protective equipment
(7) Inadequate adherence to public health recommendations
(8) Inadequate environmental hygiene
(9) Inadequate health literacy
(10) Inadequate hygiene
(11) Inadequate knowledge to avoid exposure to pathogens
(12) Inadequate oral hygiene habits
(13) Inadequate vaccination
(14) Malnutrition
(15) Mixed breastfeeding
(16) Obesity
(17) Smoking
(18) Stasis of body fluid
This is the susceptibility to invasion of pathogenic organisms at surgical site, which may compromise health.
Risk for surgical site infection
What are the risk factors for risk for surgical site infection?
(1) Alcoholism
(2) Obesity
(3) Smoking
