Nursing Techniques - Infection and Prevention Control Flashcards
what are health care associated infections?
HAI’s aka nosocomial infections
what do HAIs do?
they prevent health care workers and visitors from acquiring these infections
what are the most common pathogen to cause HAIs?
staphylococcus aureus, pseudomonas aeruginosa + e-coli
what are the most common HAIs?
central line associated bloodstream infections (CLABSI), catheter associated urinary tract infections (CAUTI), respiratory pneumonia, surgical site wound infections (SSI), bacteremia, gastrointestinal + skin infections
define infection
invasion and multiplication of a pathogen in or on body tissues causing clinical manifestations
define pathogen
organism capable of causing an infection (bacteria, fungi, virus, parasite)
are all organisms pathogens?
no
localized VS systemic
localized: limited to specific part of body + has localized symptoms
- example: wound infection
- symptoms: redness, heat, swelling, pain, + loss function
systemic: affects more than one area of the body
- example: cold, flu, strep throat, mono
- symptoms: depend on type of systemic infection + extend to more than one system - fever, fatigue, loss of appetite
are pathogens always harmful
no
does a person need an identified infection to pass it to another person?
no
what are the three ways normal flora can cause infection when disrupted?
- when they enter another part of the body than where they are located
- when balance is not maintain
- when a person is immunocompromised
what are the 2 types of flora on the skin?
- resident (permanent)
- transient (attach to skin when there is contact with another person or object)
what is the difference between endogenous infections and exogenous infections
endogenous infections occur when a clients normal flora becomes altered - overgrowth of harmful organism occurs (ex. enterococci, yeasts, streptococci)
exogenous infections arise from microorganisms external to the individual (salmonella, influenza)
in order list the 6 links in the chain of infection
- infectious host
- reservoir
- portal of exit (POE)
- means of transmission
- portal of entry
- susceptible host
describe the infectious host
aka a pathogen
- microorganism can cause an infection if the chain remains intact
describe the reservoir
a place where microorganism can survive and possibly multiply
- most common one is a person (can be animal, person, or object)
- reservoirs in people include/l respiratory, gastrointestinal, reproductive, urinary, and circulatory systems
- most microorganisms require food, oxygen, moisture, warmth (35-37 degrees), basic pH (5-8), and minimal light
define the portal of exit (POE)
path a microorganism uses to leave the reservoir
- commonly in mucous membranes like the mouth, nose, vagina, rectum, and breaks in the skin
- blood, sputum, semen, faces are part of POE
- POE is related to the reservoir
what would the POE be if the reservoir was the respiratory or circulatory system
respiratory = coughing or sneezing
circulatory = blood
define the means of transmission
same as the mode of transmission, it is how the microorganism travels
- 5 routes: contact (most common - divided into direct + indirect), droplet, airborne, common vehicle, vectorborne
define the portal of entry
how the organism gets into the body (mucous membranes, breaks in the skin / bodily fluids)
- same route as POE
- decrease in body’s defences increases the chance of pathogens gaining entrance into the body
define susceptible host
anyone who is not immune to the infectious agent
- factors include: age, nutritional status, stress, immune status (ex. chemotherapy), disease process (ex. diabetes, asthma, HIV), heredity, medical therapy
what are some ways to break the chain of infection?
handwashing (the best way to prevent infection!), emptying bed pans, proper handling of soiled linen and equipment, sharps safety (needles)
define asepsis
absence of pathogens and can be achieved through the use of aseptic technique
2 techniques: medical + surgical
what is the difference between medical asepsis and surgical asepsis
medical asepsis = “clean technique” - reduces the number of microorganisms and prevents transmission, goal is to keep the area as clean as possible (ex. BP cuff clean)
surgical asepsis = “sterile technique” - free of all contaminants. eliminates all microorganisms (ex. operating room)
what does PCRA stand for?
point of care risk assessment
when should you perform PCRA?
prior to every patient interaction
to perform a PCRA you must consider infection transmission risk for:
- interaction / task
- environment
- person receiving care
- health care worker
list the routine practices that all HCW should perform
- PCRA
- HH
- source control
- accommodation, placement, and flow
- aseptic technique
- PPE
- specimen collection
- shapes safety, + prevention of blood borne transmission
- management of patient care environment
- visitor mangement + education
define hand hygiene (HH)
- follow the 4 moments of HH
1. before patient contact (before entering a room)
2. before aseptic / clean procedure
3. after body fluid exposure risk
4. after patient environment contact (leaving a room) - wash hands for a minimum of 20 seconds
- finger nails kept short
- no jewlery should be worn
- ABHR is used when hands are not visibly soiled + client does not have c diff
- soap + water when hands are visible soiled
define source control
includes triage, early diagnosis + treatment, respiratory hygiene + etiquette + spatial separation
define accommodation, placement + flow
accommodation of inpatients in single rooms facilities IP&C activities
- when available single rooms is limited, priorities for placement of patients in single rooms are determined by PCRA
define aseptic technique (medical + surgical)
technique refers to practices designed to render the skin of the person receiving care, medical supplies, + surfaces as maximally free of germs
- ex. HH, gowns, masks, sterile fields, sterile gloves, cleansing vitals with alcohol swabs prior to puncture
personal protective equipment (ppe)
provides a barrier between the uninfected and an infective agent or infected source such as sprays of blood, body fluids, sputum or other secretions
- ex. gloves, goggles, masks, gowns
what does PPE depend on?
- probability of exposure
- amount of blood and or body fluid expected to be exposed to probable route and transmission
what are important things to remember about wearing a mask?
- do not dangle or position the mask on your head or around you neck for later use or store it in your pocket
- change your mask if it becomes wet from diaphoresis or soiled from a splash
define specimen collection
all are considered infectious and need to be handled carefully to prevent contamination
define sharps safety + prevention of blood borne transmission
prevention of sharps injury to exposure to blood borne pathogens + important for all individuals who handle or are exposed to sharps
define management of patient care environment
HCW need to maintain a safe, clean, hygienic environment, minimization of microbial contamination of surfaces, items and equipment
define visitor management + education
visitors transmit infections including TB, pertussis, influenza, etc.
- visitors are to comply with routine practices + staff are to teach them
how to use medical gloves
-gloves are not a substitution for HH
gloves are considered like “clean” freshly washed hands
- ABHR before don gloves and after gloves are doffed
- doffing gloves uses “glove to glove, and skin to skin”
what is the purpose of mitering the corners on a bed?
to keep the bed linens in place with client movement
what is a vertical tow pleat used for?
helps prevent plantar flexion leading to contractures
describe means of transmission - contact
contact is divided into direct + indirect
- direct: most common means of transmission, occurs when microorganisms are transferred by direct physical contact with infected client (ex. kissing, sexual contact, contact with oral secretions, or contact with bodily lesions) - microorganisms spread by this route = hepatitis A, c diff, staphylococcus, MRSA, VRE
- indirect: transfer of microorganisms via intermediate objects like fomite (inanimate object that can transmit infection) (ex. door knobs, bedside tales, equipment, gloves, etc.) microorganisms spread by this route include c diff, staphylococcus, RSV, MRSA, VRE
describe the means of transmission - droplet
transmission occurs when droplets that contain infectious microorganisms propelled a short distance (up to 2m) through air and deposit on mucous membranes (eyes, nose, mouth)
- bigger so doesn’t go as far as airborne + has to land on mucous membranes
- ex. = coughing, sneezing, + talking
- microorganisms spread by this route = influenza, rubella, ebola, SARS
describe the means of transmission - airborne
transmission occurs when viable microorganism contained in aerosolized secretions containing infectious microorganisms are propelled over short distances + inhaled by susceptible hosts, symptoms can occur after prolonged period of time, highly contagious
- hangs around longer than droplet
- ex. = coughing, sneezing, talking, AGMPs
- microorganisms spread by this route = tuberculosis, varicella, measles
describe the means of transmission - common vehicle
transmission occurs when a single contaminated source results in a large-scale outbreak or spreads to multiple hosts
- ex. = food, medication, water, IV fluid, equipment
- microorganisms spread by this route = pseudomonas, e coli, salmonella
describe the means of transmission - vector borne
transmission occurs via hectors, vectors are living organisms that can transmit infectious disease between humans or from animals to humans
- most common vector = mosquito
- other ex. = flies, mites, fleas, ticks, rats, dogs
- illness spread by this = west nile virus, hantavirus, Lyme disease
what are the chains of infection for Hepatitis B?
infectious agent: Hep. B virus
reservoir: human - in respiratory + circulatory systems
POE: through contact with blood or other body
mode of transmission: contact with blood or bodily fluids
portal of entry: opening in the body that fluids containing the virus (open wounds, mucous membranes)
susceptible host: anyone not vaccinated
what are HAIs commonly caused by?
antibiotic resistant organisms (ARO)
what are common AROs?
clostridioides difficile (c. diff)
methicillin-resistant staphylococcus aureus (MRSA)
vancomycin-resistant enterococcus (VRE)
a few more we have been seeing:
- extended spectrum bata lactamase (ESBL)
- carbapenamase producing enterobacericacease (CPE)
what are AROs?
become difficult to treat, especially in people with weakened immune systems
- happens when pathogens mutate and thus gain ability to defeat the drugs designed to kill them
what are the two tire precautions?
- tier 1= routine practices (standard practices)
- tier 2 = additional practices (isolation practices)
what are routine practices?
- used to minimize the spread of infection between people
what are additional precautions?
- implemented as soon as a client assessment indicates a possible communicable disease or clinical syndrome
- based on mode of transmission of infectious agent (airborne, droplet, contact)
- additional precautions are practices REQUIRED in addition to routine practices
describe the routine practices for contact
- accommodation = single room preferred when available if not available then privacy curtain between beds should be pulled and beds separated at minimum 1m apart, door can remain open
- HH = soap + water
- gloves = don prior to entry, doff upon exit
- gown = don before entering room
- mask = not required, follow routine practices
- facial protection = not required but follow routine practices
- equipment = dedicated equipment is preferred, clean equipment if shared between patients
- transportation = allowed out of room, but not encouraged unless medically necessary
describe the routine practices for droplet
- accommodation = single room preferred when available if not available then privacy curtain between beds should be pulled and beds separated at minimum 1m apart, door can remain open
- HH = follow routine practices (4 moments of HH) - ABHR or soap + water
- gloves + gown = not required but follow routine practices
- mask = required for care of client with acute respiratory viral infection when HCW is 2m of coughing client
- facial protection = mask with visor, safety glasses or face shield is required when 2m of client for procedures where coughing, splashes, sprays may be present
- equipment = dedicated equipment is not required, follow routine practices for cleansing of equipment
- transport = client is allowed out of room, not encouraged unless medically necessary
describe the routine practices for airborne
- accommodation = airborne infection isolation room (AIIR) required and door remains closed
- HH = follow 4 moments of HH, ABHR or soap + water
- gloves + gown = not required but follow routine practices
- mask = N95 required
- facial protection = not required but follow routine practices
- equipment = dedicated equipment not required but follow routine practices for cleansing
- transport = client restricted to room except for medically essential procedures
what does signage on a patients door tells us?
signs are placed on patients doors if they require additional precautions
what are examples of illnesses for contact illness?
MRSA, VRE, CPO, c. diff, impetigo, scabies, pediculosis
what are examples of illnesses for droplet illness?
influenza, rubella, ebola, SARS, diphtheria, pertussis, mumps, scarlet fever, pneumonia
what are examples of illnesses for airborne illness?
tuberculosis (TB), varicella zoster, measles, shingles
what does AGMP stand for?
aerosol generating medical procedure
what are AGMPs?
medical procedures that can generate aerosols as a result of artificial manipulation of a clients airway
- ex. = intubation, endotracheal suctioning CPR, bronchoscopy, nebulized therapy, noninvasive positive pressure ventilation such as CPAP/BiPAP + autopsy
- must wear N95 + eye protection when performing these
the following strategies can be used to reduce level of AGMPs with clients who are suspected of or confirmed of having a communicable respiratory pathogen:
- only medically necessary, aerosol-generating medical procedure should be undertaken
- anticipate + plant for AGMPs
- use appropriate patient sedation
- limit the number of personnel in room
- perform AGMP in AIIR when available
- maintain appropriate ventilation
- use a single room
- ensure respirators are worn by all personnel in room
- use closed endotracheal suction systems when possible
define respiratory hygiene
- combination of measures taken by the infected person to minimize the spread of respiratory pathogens
- cover mouth and nose against a sleeve or shoulder while coughing to sneezing
- use tissues to contain respiratory mucous or saliva covering the mouth + nose
- turn head away from others when coughing or sneezing
