NUR 372 CLASS 2 MEDICAL ASEPSIS Flashcards
INFECTION
- pathologic events that result from the invasion and multiplication of microorganisms in a host
- bacterial, viral, fungal
COMMON BACTERIAL PATHOGENS
- bacteria: single cell, independently living microorganisms
- examples: staph aureus/streptococcus: normal on skin; pseudomonas aeruginosa; enterococcus; e coli: GI, UTI in women
COMMON VIRAL PATHOGENS
- living microorganisms
- ex: influenza (flu); chicken pox / shingles; HIV; norovirus (west nile; ebola)
COMMON PARASITE PATHOGENS
- organisms that live on or in a host; get their food from or at the expense of its host.
- ex: protozoa; helminths (worms); ectoparasites (flees, lice
COMMON FUNGI PATHOGENS
- single cell organisms that include molds and yeasts
- ex: candidiasis; aspergillosis; dermatophytes; pneumocystis jiroveci
HEALTHCARE ASSOCIATED INFECTIONS
- infections that people acquire while they are receiving treatment for another condition in healthcare settings
- ex: inpatient hospitals
; ambulatory settings ; long-term care facilities
TYPES OF HAI’s
- central line-associated bloodstream Infections (CLABSI)
- catheter-associated urinary tract infection (CAUTI)
- ventilator-associated
pneumonia (VAP) - surgical site infection (SSI)
- clostridium difficile gastrointestinal infection
- methicillin-resistant staphylococcus aureaus (MRSA)
- vancomycin resistant enterococcus (VRE)
DISINFECTION
- chemical or physical processes used to reduce the numbers of potential pathogens on an object’s surface
- ex: bleach, chlorhexidine, betadine, scrubbing hands with antibacterial gels
STERILIZATION
- complete destruction of all microorganisms, including spores
- ex: autoclave
BACTERICIDAL
- chemical that kills microorganisms
BACTERIOSTATIC
- chemical that prevents bacterial multiplication but does not kill the bacteria
MEDICAL ASEPSIS
- practices aimed at reducing the number, growth or spread of microorganisms
- ex: hand hygiene before/after patient contact (20 seconds, happy b-day 2x); use of PPE as indicated by disease process; no items on floor; do not shake sheets; clean least soiled first; moist items in plastic bags
SURGICAL ASEPSIS
- measures aimed at eliminating all bacteria from an object
- ex: skin preparation; surgical hand washing;
sterile gloves & gowns;
sterile field
5 MOMENTS OF HAND HYGIENE
- before patient contact
- before an aseptic task
- after body fluid exposure risk
- after patient contact
- after contact with patient surroundings
CHAIN OF INFECTION
- infectious agent: bacteria, fungi
- source: blood, respiratory secretions
- portal of exit: drainage
- mode of transmission: dressing on bedside stand
- portal of entry: how it gest into other person’s body, patient coughs and nurse inhales
- susceptible Host
PERSONAL PROTECTIVE EQUIPMENT: GLOVES
- contact with blood or body fluids, mucous membranes, or non-intact skin of all patients, and when touching contaminated items or surfaces
PERSONAL PROTECTIVE EQUIPMENT: MASK, EYE PROTECTION, FACE SHIELD
- during patient activities that are likely to generate aerosols, splashes, sprays, etc. such as suctioning
PERSONAL PROTECTIVE EQUIPMENT: GOWNS
- worn if splashing blood or contact of body fluids is likely to occur.
ORDER OF DONNING PPE
- gown
- mask
- goggles or face shield
- gloves
ORDER OF REMOVING PPE
- gloves
- goggles or face shield
- gown
- mask
TYPES OF PRECAUTIONS
- standard/universal
- contact
- droplet
- airborne
- protective
STANDARD/UNIVERSAL PRECAUTION
- PPE as needed to prevent contact with body fluids (gloves, possibly gown, mask and goggles if splashing is possible).
- all patients
- handle all blood and body fluids as if contaminated
- hand hygiene before/after
TRANSMISSION-BASED PRECAUTIONS
- used in addition to standard precautions for patients who are known or suspected to be infected or colonized with an infectious organism
- ex: airborne precautions; droplet precautions; contact precautions; protective Isolation
AIRBORNE PRECAUTIONS
- my - measles
- stupid - SARS
- chicken - chickepox
- hez - herpes zoster
- TB - TB
- private room with negative pressure
- door closed at all times
- PPE: N95 respirator; surgical mask to patient if needing to leave room
DROPLET PRECAUTIONS
- protects transmission of pathogens through close contact with mucous membranes or respiratory secretions
- PPE: mask
- streptococcal pharyngitis
- pneumonia
- scarlet fever
- rubella
- pertussis
- mumps
- mycoplasma pneumonia
- meningococcal disease
- pneumonic plague
DROPLET PRECAUTIONS NURSING INTERVENTIONS
- private room preferred (same cohort of pts can room together).
- door can be open since the risk area for transmission is 3-6 ft of direct contact with the pt.
- mask is required to enter room for everyone including visitors.
CONTACT PRECAUTIONS
- prevents transmission of infectious agents that are spread by direct/indirect contact with patient’s and their environment
- used with: wound drainage, fecal drainage or other discharge that is suggestive of contamination and risk of transmission to others.
- PPE: gloves, gown (mask and goggles may be needed depending on splash risk)
CONTACT PRECAUTIONS NURSING INTERVENTIONS
- private room (may cohort pt’s with same infective process)
- dedicated equipment for pt (thermometer, stethoscope, BP)
- pt to leave room for special tests/procedure only
- clean hands prior to and after entering room
- gown and glove prior to entering room.
- remove PPE before exiting room.
- clean hands (use soap and water if C-diff) prior to exiting the room.
- dispose of infectious dressings in non-porous bag (biohazard trash for blood/body fluids).
CONTACT PRECAUTIONS PNEUMONIC
- M - Multidrug resistant organism
- R - Respiratory infection - RSV
- S - Skin infections
- W - Wound infections
- E - Enteric infections (c. diff)
- E - Eye infections
PROTECTIVE PRECAUTIONS
- used to protect patients who have increased risk to infections
- ex: cancer/chemotherapy; immunocompromised; neutropenic
PROTECTIVE PRECAUTIONS NURSING INTERVENTION
- hand hygiene before entering and before leaving
- private room
- no persons with infections
- no drive or live plants or flowers
- no non-reelable fresh fruit or vegetables
- PPE: mask, gloves, gown
EXAMPLES OF CLEAN TASKS
- administering medication
- obtaining vital signs
- assessing the patient
- obtaining a medical history
- feeding the patient
- putting on clean bed linens
EXAMPLES OF DIRTY TASKS
- administering medication vaginally or rectally
- caring for a wound
- changing a wound dressing or I.V. site dressing
- caring for a urinary catheter
- performing suctioning
- removing used or soiled bed linens
- bathing the patient
performing oral care - changing a depends or brief
- obtaining body fluid specimens (urine, blood, sputum)
HIV PRECAUTION
- standard/universal
HIV DURATION OF PRECAUTION
- duration of illness
HIV RESRVOIR
- body fluids: blood, semen, vaginal secretions, breast milk, saliva, CSF
HIV TESTING
- positive result from ELISA
- confirm by positive results from western blot.
HIV NURSING CONSIDERATIONS
- hand hygiene, PPE if high potential contact with blood, secretions
- assess risk factors
- teach ways of prevention (condoms), not sharing IV needles
- teach about medication compliance
- monitor fluid intake/urinary output
- daily weights to monitor weight-loss
- monitor nutritional intake
- monitor electrolytes
HIV BLOOD SPILL DISINFECTION
- 10% bleach solution after initial cleaning if you have a blood spill
C. DIFF DEFINITION
- bacterium that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon
- most commonly affects older adults in hospitals or in long-term care facilities and typically occurs after use of antibiotic medications
C. DIFF PRECAUTIONS
- contact
C. DIFF DURATION OF PRECAUTIONS
- until there is one negative stool culture
C. DIFF RESERVOIR
- stool
SIGNS/SYMPTOMS OF C. DIFF
- liquid diarrhea
- abdominal cramps
- N/V
TESTING FOR C. DIFF
- stool culture
- need one negative culture before d/c precautions
HEPATITIS DEFINITION
- inflammation of liver cells
HEPATITIS MAY RESULT IN….
- chronic hepatitis
- cirrhosis of the liver
- liver cancer
- liver failure
HEPATITIS A RISK FACTORS
- fecal oral route
- ingestion of contaminated food or water
- close personal contact with an infected individual
- vaccination available
HEPATITIS B RISK FACTORS
- unprotected sex with infected individual
- infants born to infected mothers
- contact with infected blood
- IV drug users
- vaccination available
HEPATITIS C RISK FACTORS
- drug abuse
- sexual contact
- health care workers who get needle sticks
HEPATITIS C PRECAUTIONS
- standard unless high potential for splashing
DURATON OF HEPATITIS C PRECAUTIONS
- duration of illness
RESERVOIR OF HEPATITIS C
- blood and body fluids
VIRAL MENINGITIS
- most common form of meningitis
- commonly resolves without treatment
- risk factors for viral: acute illness such as mumps, measles, and herpes
BACTERIAL MENINGITIS
- contagious infection with high mortality rate
- risk factors include bacterial infections (such as Streptococcus Pneumonia, Haemophilis influenza) upper respiratory infections (pneumonia, sinusitis, otitis media); immunosuppression; invasive procedures (skull fractures, penetrating head wound); overcrowded living conditions
- vaccine available for high-risk (college)
- maintain at least 3 feet distance when in same room as pt.
MENINGITIS PRECAUTIONS
- droplet
DURATION OF MENINGITIS PRECAUTION
- 24 hours of continuous tx
RESERVOIR OF MENINGITIS
- respiratory
NURSING CONSIDERATIONS FOR MENINGITIS
- report to infection control department
- quiet room
- little stimuli
- decrease light
- seizure precautions
SIGNS/SYMPTOMS OF MENINGITIS
- headache
- nuchal rigidity
- photophobia
- fever
- chills
- N/V
- altered LOC
- tachycardia
- Kernig’s sign (stiffness/pain in hamstrings)
- Brudzinski’s sign (pain with neck flexion)
DIAGNOSIS FOR MENINGITIS
- spinal tap to collect CSF
- high WBC
- high protein
- decreased glucose
PRECAUTIONS FOR MRSA
- standard/contact
DURATION OF PRECAUTIONS FOR MRSA
- duration of illness
RESERVOIR OF MRSA
- body fluids contaminated with MRSA
NURSING CONSIDERATIONS FOR MRSA
- no longer considered for contact precautions unless they have open wound with MRSA drainage
PRECAUTIONS FOR VANCOMYCIN RESISTANCE ENTEROCOCCI
- contact
DURATION OF PRECAUTIONS FOR VRE
- duration of illness
RESERVOIR OF VRE
- stool, body sites from which VRE is isolated
TB PRECAUTIONS
- airborne
DURATION OF PRECAUTIONS FOR TB
- 3 sputum smears are negative on consecutive days or TB is r/o
RESERVOIR OF TB
- respiratory
NURSING CONSIDERATIONS FOR TB
- N95 Mask
- HEPA filter
- pt wears surgical mask when transported outside negative flow room
TESTING FOR TB
- PPD annually
- chest xray
- induration > 5 mm
- sputum positive for mycobacterium tuberculosis