preventing infxn Flashcards
etiologic agent
- Bacteria, viruses, fungi, protozoa
- S. Aureus, E. coli, enterococcus
reservoir (source of the microorg)
- Patient’s endogenous flora (E. coli from gut, S. aureus from skin)
- Medical equipment & devices (not sanitized)
- Hospital environment
- HC Personnel (comes in sick to work)
- Contaminated food, drugs, equip
direct transmission
- touching, kissing, hand-holding, sex
indirect transmission
- transferred to HC worker and then transferred to pt
- most common
- lots of diarrhea diseases and abx resistant come from this
respiratory droplets transmission
- goes from mucosal surfaces and to env surfaces
airborne spread transmission
- microorg remain in the air after speaking or breathing out
- TB, varicella, covid, etc
common vehicle for transmission
- contaminated water, food, bacteria can multiply, viruses can’t
portal of entry
- broken skin and mucous membranes
- more susceptible
susceptible host (if)
- intrinsic factors
- immunocompromised (due to age so very young or very old)
- ex: someone who had pneumonia is more likely to develop covid
susceptible host (ef)
- Extrinsic factors
- Surgical & invasive procedures
- Prolonged hospitalization –> sicker and increased chance of having more invasive devices
HAI
- infxn that you get after you have been admitted to the hospital
- common ones: UTI, surgical site infxn, bloodstream infxn, pneumonia, Clostridium difficile associated disease, Methicillin Resistant Staph Aureus (MRSA)
UTI
- Most common
- 75% associated with urinary catheters (CAUTI)
surgical site infxn
- 2/3 confined to incision (incision itself gets infected),
- 1/3 involve organs or spaces accessed during operation (infxn is in gut rather than incision)
- extends stay for 7 to 10 days
pneumonia
- VAP—Ventilator Associated Pneumonia
- Most common HAI in critically ill patients
- vent w/ tube down their lungs
- 10% that develop this die
clostridium difficile infxn (CDI)
- tends to live in intestinal track but gets out of control due to the abx
- Common cause of antibiotic associated diarrhea (15% of the severe abx associated diarrhea)
- Symptoms—watery diarrhea, fever, loss of appetite, nausea and abdominal pain/tenderness
- Risk factors
- Antibiotic exposure
- GI surgery/ manipulation
- Long stay in HC settings
catheter related bloodstream infxns
- Presence of bacteremia in patient with an intravascular catheter with one positive blood culture and clinical signs of infection
- Colonization of distal part of catheter
central line
- straight shot to the heart if it gets infected
PICC Line Peripherally Inserted
Central Catheter
- goes all the way up into the heart
nursing process: assessment
- Nursing History
- Symptoms of illness (Ex: cough, nasal drainage, pain, burning w/ urination, cuts, or wounds w/ drainage or that are healing)
- Recent travel outside of US
- Medications (steroids or chemo will lower your defenses. more susceptible)
- Chronic Illness
physical assessment: localized infxn
- just in one area –> skin, joint, incision, etc.
- Redness, Warmth, swelling, pain
- Drainage
- Symptoms specific to body systems –> Ex: cloudy, foul smelling urine = specific to a UTI
physical assessment – systemic infxn
- thruout the persons system
- Fever
- Enlarged lymph nodes
- Change in mental status, energy level
- UTI for older adults = confused
- be weary of lower temps for adults
be alert for the development of sepsis
- blood born infxn
- Suspected infection
- Fever or hypothermia
- Heart rate > 90 beats per minute
- Respiratory rate >20 breaths per min
- Altered mental status
- Oxygen saturation < 90%
- Systolic blood pressure < 90 mmHg
WBC count
- 5000-10,000
Erythrocyte Sedimentation Rate
- Elevated with inflammation
- how fast your RBC settle out
- increase for someone with sepsis
cultures
- urine, blood, sputum, CSF, stool, etc
serum lactate
- Normal 0.5-1 mmol/L
- Levels >2 may indicate sepsis
- when levels are climbing, you need to start broad spectrum abx
- need an order
risk for infxn
- An increased chance the body will be invaded by a pathogen,
including microorganisms or viruses
risk for infxn transmission
- like covid
- Vulnerable to transferring an
opportunistic or pathogenic agent to others
intervention – hand hygiene
- Antiseptic hand soaps (containing chlorhexidine) & alcohol based hand rubs
- Hospitals with low nurse staffing and patient overcrowding lead to poor adherence to hand hygiene
- C diff = ALWAYS soap and water
interventions – environ cleanliness
- Contaminated surfaces
- Clean and disinfect high touch surfaces
- When patient on contact precautions
- Disposable patient care items
- Families & visitor hand hygiene
standard precautions
- Handwashing
- Gloves when touching blood, body fluids
- Goggles if spray, splash of blood, body fluids expected
- Gowns if spray, splash of blood, body fluids expected
- for all patients
airborne precautions
- Tuberculosis, rubeola, varicella, Covid
- Private room
- Appropriate mask
- N95 respirator mask
- Patient wears mask during transport
- if you hae a neg pressure isolation room or a filtration system = pt should be in there
droplet precautions
- Strep throat, pneumonia
- Wear mask if working within 3 feet of patient
- Patient wears mask during transport
- wear surgical masks
- if mask gets wet it is no longer useful
- put in priv room if we can
contact precautions
- Multidrug resistant bacteria, Clostridium difficile, HepatitisA
- Gloves, gown whenever in room
- Dedicated equipment (disposable stethoscope, BP cuff, etc)
- Do not bring clipboards etc into room
support pt defenses
- Optimize nutrition: vit c and zinc = imp for wound healing. also need a good intake of protein, carbs, and fats
- Immunizations
- Hygiene: ex: if someone is on a vent, clean their mouths every 12 hrs to decrease risk of infxn
- Maintain intact skin & mucous membranes
- Maintain sterility of systems
- Adequate rest/ regular exercise
- TCDB as necessary
teach patients about what
- Food safety: don’t eat food that’s been sitting out
- Appropriate use of antibiotics: only used for bacterial infxns
- Immunizations
The most effective nursing action for controlling the spread of infxn
A. thorough hand washing (correct)
B. wearing gloves and masks when providing direct patient care
C. implementing appropriate isolation precautions
D. administering broad spectrum prophylactic antibiotics
Your patient needs an indwelling urinary catheter. Which of
the following are important nursing actions? Select all that
apply.
A. Reassess the continued need for the catheter daily.
D. Use good handwashing before and after handling the catheter.
E. Secure the catheter to the patient’s leg to prevent trauma to the meatus.
The lab has just notified you that the stool specimen you sent down on your patient is positive for Clostridium Difficile. You should
- Implement contact precautions immediately
A patient who has been isolated for Clostridium difficile (C.difficile) asks you to explain what they should know about this organism. What is the most appropriate information to include in patient teaching? (Select all that apply.)
A. The organism is usually transmitted through the fecal-oral route.
B. Hands should always be cleaned with soap and water versus alcohol-based hand sanitizer.
C. Everyone coming into the room must be wearing a gown and gloves (even visitors)
incidents in patients
- When accident occurs
- Assess client: vital signs, ask abt pain, if they know why they fell
- Provide for safety: then get them to a bed or chair
- Implement measures to treat injury
- Prevent further injury
- Notify Health care Provider
- Implement orders
documentation of incidents
- Document facts in nurses notes
- Incident report
- Record for agency
- Used to make facts available
- Used to contribute to statistical
data - Used to prevent future incidents
incident report
- Includes
- Client identifying information
- Facts of incident
- Client’s account of
incident - Identify
- Witnesses
- Equipment by number
- Medication by name and dosage
- Complete report ASAP
- Don’t mention in chart
The nurse finds an elderly client wandering the hallway exhibiting signs of confusion. The client states they are looking for the bathroom. Which interventions are appropriate for this client? Select all that apply.
- Provide scheduled toileting rounds every 2-3 hours
- Keep the pathway from the bed to bathroom clear
A patient is placed on Airborne Precautions for pulmonary tuberculosis. The patient states they are angry they have to be on precautions. The nurse recognizes that this is a normal response to isolation. Which is the nurse’s best intervention?
- Explain the reasons for isolation procedures and provide meaningful stimulation.
The nurse assesses the following data from a patient with diabetes
mellitus who is 4 days postop for repair of an abdominal aortic aneurysm. Which assessment finding is of greatest concern for the nurse?
- Temperature 38.5o C (101.4o F)
