Promoting Asepsis and Infection Control - Nursing Fun Ch 20 Flashcards
What are the links in chain of infection?
Infectious Agent Reservoir Portal of exit Mode of transmission Portal of entry Susceptible host
What are possible infectious agents?
pathogens
bacteria, viruses, fungi, protozoa, and
prions
normal flora
may become pathogenic when entered into the
body
What is a reservoir?
a source of infection where infection can survive and multiply
Name some types of reservoirs.
Living
Humans, insects, animals
Nonliving
Soil, water, food, and environmental surfaces
What is a carrier?
An individual who has no symptoms despite carrying a disease which they can pass to others.
What are some portals of exit?
body fluids
blood, saliva, breast milk, urine, feces,
vomitus, semen or other
secretions
Cuts
Bites
Abrasions
Nosocomial sites
puncture sites, drainage tubes, feeding tubes,
IV lines, colostomy lines, catheters etc.
What are the modes of transmission?
Direct contact
Indirect contact with a fomite (contaminated
object)
droplet transmission
airborne transmission
a vectorWhat is a vector?
an organism that carries a pathogen to a susceptible host
What are examples of a portal of entry?
normal body openings
eyes, nostrils, mouth, urethra, vagina,
anus
abnormal body openings
cuts and scrapes, burns, bites by vectors
What three factors determine whether a person develops an infection?
- The virulence of the organism
- The number of organisms transmitted
- The ability of the host’s defenses to prevent infection
An infection that is limited to a specific region is called a _______.
Local infection
An infection that invades the blood or lymph and travels throughout the body is called a ________
Systemic infection
A primary infection is the
first infection that occurs in a patient
A secondary infection is the
one or more infections that occur in a patient who is already fighting an infection
What are the common portals of exit?
Respiratory Gastrointestinal Genitourinary tracts Breaks in skin Blood and tissue
An exogenous nosocomial infection is
where the pathogen is acquired from the healthcare environment
An endogenous nosocomial infection is
where the pathogen arises from the patients normal flora and some form of treatment
What is an acute infection
a rapid onset but short lasting infection
What is a chronic infection
infections that develop slowly and last for weeks, months or years
What is a latent infection
an infection that causes no symptoms for long periods of time (HPV, HIV)
What are the stages of infection?
Incubation Prodromal stage Illness Decline Convalescence
Describe the incubation stage
The stage between successful invasion and the appearance of symptomsMay be infectious
Describe the prodromal stage
characterized by the first appearance of vague symptomsstage not always present
Describe the illness stage
marked by the appearance of signs and symptoms characteristic of the diseaseMay result in death
Describe the decline stage
the infection stage during which the patient’s immune defenses and medial therapies successfully reduce the number of pathogenic microbes and signs and symptoms begin to fade
Describe the convalescence stage
characterized by tissue repair and a return to health as the number of microorganisms near zero.
may require anywhere from one day to a year or more
What are the laboratory data indicating infection?
- Elevated WBC count (>10,000 mm3)
- Increases in specific types of WBCs
- Elevated erythrocyte sedimentation rate
- Presence of pathogen in urine, blood, sputum or draining cultures
What are the factors affecting host suceptibility?
- Intact skin and mucous membranes
- Normal pH levels
- White blood cells
- Age, sex, race, hereditary factors
- Immunization, natural or acquired
- Fatigue, climate, nutritional and general health status
- Stress
- Use of invasive or indwelling medical devices
What are primary defenses?
- Skin
- The respiratory tree (spec. mucous membranes that trap pathogens)
- Eyes
- The mouth
- The GI tract
- The Genitourinary tract
What are the secondary defenses?
Phagocytosis
The complement cascade
Inflammation
Fever
What is the complement cascade?
a process by which a set of blood proteins called complement triggers the release of chemicals that attach the cell membranes of pathogens and cause them to erupt.
What are the tertiary defenses?
Humoral immunity
Cell-mediated immunity
What is the function of Basophils?
Release histamine and heparin granules as part of the inflammatory response
What is the function of Eosinophils?
Destroy helminths
mediate allergic reactions
have limited role in phagocytosis
What is the function of Neutrophils?
Phagocytize pathogens
What is the function of Lymphocytes?
T-cells - (Thymus)
cell-mediated immunity
recognize, attack, and destroy antigens
B-cells - (red bone marrow)
humoral immunity
produce immunoglobulins to attack and destroy
antigens
Humoral Immunity
acts directly against antigens
T-helper cells stimulate B-cells to become plasma and
produce Immunoglobulins (Ig) antibodies which
destroy antigens by
Phagocytosis
Neutralization
Agglutination
Activation of complement and inflammation
What is IgM?
An immunoglobulin produced when an antigen is encountered for the first time
What is IgG?
The most common immunoglobulin present after an antigen is recognized.
The length of time present in the body varies
May be passed from mother to fetus through the placenta
What is IgE?
An immunoglobulin primarily responsible for the allergic response
What is IgA?
An immunoglobulin secreted by the mucous membrane of body openings/ portal of entries
What is IgD?
An immunoglobulin antibody on B cells that attach to potential pathogens to prevent replication of the disease
Cell-mediated Immunity includes
Cytotoxic T cells (killer T cells)
Helper T cells
Memory T cells
Suppressor T cells
What do Cytotoxic T cells (killer T cells) do?
directly attack and kill body cells infected with pathogens
What do Helper T cells do?
help regulate the action of B cells in humoral immune responses and of killer T cells in cell-mediated responses
What do Memory T cells do?
They help speed the T cell response to known antigens
What do Suppressor T cells do?
stop the immune response when the infection has been contained
How can host defenses be supported?
Adequate nutrition Good hygiene Rest and Exercise Reduce stress Immunizations
What factors increase the risk for infection?
Developmental age (young children and elderly) Breaks in the primary defense Illness or injury Smoking Substance abuse Multiple sexual partners Environmental factors Chronic disease Medications Nursing and medical procedures
What questions should be asked when obtaining a nursing history?
-Any symptoms of illness
-Any known exposure to pathogens at
work, recent travel, contact with ill, unprotected sex
-Any unusual foods/products ingested
-Past and present disease or injuries
-Medications, over-the-counter preparations, herbal products, alcohol intake, or other substances
-Current level of stress
-Immunization history
What should the nurse look for during a physical assessment when infection is indicated?
-General appearance
tiredness or fatigue, sweating, chilled, well nourished,
state of mucous membranes, turgor of skin?
-Skin
signs of local infection (pain, swelling, rashes, breaks,
redness, skin discoloration, lymph swelling,
temperature, elevated pulse rate)
What are some common diagnostic tests for infection?
WBC count w/ differential Blood cultures Disease titers Panels to evaluate specific disease exposure Immunoglobulin levels (IgG, IgM) C-reactive protein Agglutinins, warm or cold Erythrocyte sedimentation rate
When is it appropriate to use Risk for Infection as a nursing diagnosis?
When a patient is at an increase/higher than normal risk
examples
Risk for Infection r/t altered immune response secondary to corticosteroid therapy
Risk for Infection r/t impaired skin integrity and poor nutritional status
What are the standardized outcomes for Risk for Infection?
- Community Risk Control: Communicable Disease
- Immune Status
- Immunization Behavior
- Knowledge: Infection Control
- Nutritional Status
- Risk Control: Sexually Transmitted Diseases (STD)
What are the global interventions of Risk of Infection diagnosis?
- Reduce exposure to pathogens through the use of aseptic technique
- Maintain skin integrity and natural defenses against infection
- Reduce stress
- Promote immune function through collaborative care
What are the NIC standardized interventions for Risk for Infection?
- Communicable Disease Management
- Immunization/Vaccination Management
- Infection Protection
- Nutrition Management
- Skin Surveillance
- Vital Signs Monitoring
- Wound Care
What is medical asepsis?
a state of cleanliness that decreases the potential for the spread of infection
What does disinfection do?
it removes pathogens by physical or chemical means including steam, gas, chemicals, and UV light
What does sterilization do?
eliminates all microorganisms (except prions) in or on an object
When must healthcare workers wash their hands with either soap and water or alcohol-based solutions?
- When arriving on a patient care unit
- When leaving the patient care unit
- Before and after using the restroom
- Before and after any contact with a patient or articles in the patient’s vicinity
- Before putting on gloves
- After removing gloves
- Before and after touching any area on the face
- Before and after eating
- After touching anything that may be contaminated
- Whenever the hands are visibly dirty
If there is a potential for contact with bacterial spores you must wash with
soap and water
alcohol-based solutions are ineffective against spores
What is best-practice in hand hygiene?
- Push up sleeves and take off any jewelry and watches
- Use warm water to wet hands prior to soap
- Keep hands lower than wrists and forearms
- Avoid touching the sink or splashing
- Use 3-5mL of agency approved soap
- Rub all surfaces of the hands and wrists, including the backs of hands, between fingers and underneath fingernails for at least 15 sec (2 min if visibly soiled)
- Completely wash off soap
- Dry hands from the fingertips up
- Turn off faucet with paper towel
What is the CDC Tier One used for?
Standard precautions or Universal precautions used whenever their is the possibility of coming in contact with
blood, body fluids (except sweat), excretions and
secretions, mucous membranes, and breaks in the
skin
What are the CDC Tier One precautions?
- Immediately wash hands w/ soap and water after contact with body fluids regardless of glove use
- Wear clean gloves whenever potential for contact with body fluids, secretions, excretions, non-intact skin or contaminated materials is present
- remove gloves immediately after use
- Change gloves between tasks or procedures if contact with potential contaminants has occurred.
- Wash hands w/ soap and water after removing gloves, between patient contacts, and between procedures even on one client
- Wear a mask and eye protection or face shield if splashes or sprays are possible
- Wear a clean, non-sterile gown to protect skin and prevent soiling of clothing if splashes or sprays are possible
- Clean reusable equipment that has been soiled
- Do not use soiled equipment on multiple patients
- Disposes of single-use equipment
- Handle contaminated items (including linens) with care
- Never recap used needles using both hands or in a way that directs the needle towards the body
- Use sharps containers
- Use mouth barriers when giving respirations
What are the CDC Tier Two precaution categories?
Contact Precautions
Droplet Precautions
Protective Isolation
Airborne precautions
What are the contact precautions and when are they used?
Used when direct contact can lead to spread of the pathogen
- Follow all standard precautions
- Place the patient in a private room or with a patient with the same infection
- Wear a clean gown and gloves when you anticipate any contact with the patient or with any contaminated items in the room
- Either dispose of all items entering the room within the room, or disinfect them per institution policy prior to removing them from the room.
- Double bag all linen and trash, and clearly mark as contaminated
- Follow any additional precautions specific to the microorganism
What are the droplet precautions and when are they used?
Used when the pathogen can spread via moist droplets (e.g., sneezing, coughing, talking)
- Follow standard precautions
- Follow all contact precautions
- Wear a mask and eye protections when working within 3 feet of the patient
What are the airborne precautions and when are they used?
Used when the pathogen can spread via air currents
- Follow standard precautions
- Follow all contact precautions
- Place patient in private room or with patient with same infection and no others
- Make sure the room has negative pressure and discharged through a filtration system
- Wear a clean gown and gloves when you anticipate contact with patient or any items in the room
- Wear a special mask (N95 respirator) if the patient is suspected to have TB
- If the patient is known or suspected to have measles or varicella, only immune caregivers should provide care and they do not need to wear masks.
What is protective (reverse) isolation and when it is used?
Used for patients at high risks for infection
- Follow standard precautions
- Healthcare workers caring for isolation patients should not also be caring for other patients with active infections
- When patients in isolation need to leave the room, they should wear a mask and have minimal contact with others
- All persons entering a patient’s room should wear a mask and wash their hands thoroughly with soap and water
- After hand washing, clean or sterile gowns should be worn and contact with items should be avoided
- After a gown is placed, don gloves
- If the mask or gown becomes wet, change it.
- On exiting the room, remove the mask, gloves, and gown. Do not use them again.
What should the nurse do the support the psychological needs of a patient in isolation?
- When wearing PPE, touch the patient
- Organize time you have in the room to include discussion about how the client is coping with the isolation
- If the patient is in droplet isolation remember that the danger area is only 3 feet. You can talk to the patient without a mask beyond this point.
If you must use non-disposable equipment in protective isolation…
- Be sure the equipment has been disinfected before it is taken into the room.
- Take linen and dishes directly to the room and hand them to someone wearing the required PPE
If you must use non-disposable equipment in transmission-based isolation…
- Disinfect the equipment upon removal from the room.
- When removing equipment or linens from the room place them in special isolation bags. This requires two workers, the worker in the rooms handles contaminated items and the worker outside the room holds the isolation bag open.
What is the procedure for donning and removing PPE?
- Prior to exposure don appropriate PPE according to precautions in place
- Avoid contaminating self or others when removing equipment
- Remove the most soiled item first
What is the procedure for surgical hand washing?
- Apply surgical shoe covers, cap, and face mask
- Use warm water
- Perform initial hand wash lather 2in above hands
- Clean under nails
- Wet scrub brush, apply generous amount of antimicrobial soap
- Using circular motion, scrub all surfaces of nails, hands and forearms at least 10 times
- Rinse hands and arms by keeping your fingertips higher than your elbow
- Grasp a sterile towel, and back away from the sterile field
- Thoroughly dry hands before donning sterile gloves
What is the procedure for Donning Sterile gown and gloves?
- Grasp the gown at the neckline and slide your arms into the sleeves without extending your hands through the cuffs
- Have a co-worker pull the shoulders of the gown up and tie the neck tie
- Don gloves using the closed method by keeping your hands covered at all times, first with the gown cuffs, and then with sterile gloves
- Secure the waist tie on your won by handing it to a co-worker
- Keep your hands within your field of vision at all times
What is the procedure for preparing and maintaining a sterile field?
- Check to ensure that all supplies are ready for the procedure
- Clear the area for the sterile field
- Position the patient appropriately for the procedure
- Establish the sterile field with a sterile drape or package wrapper
- Add items to the sterile field by gently dropping them onto the sterile field (6in above)
- Pour sterile solutions into a sterile bowl or receptacle without touching the bowl or splashing onto the sterile field
- Don sterile gloves, and perform the procedure
When would surgical attire be appropriate
Burn units Labor units some surgical wards intensive care units nurseries oncology wards surgical procedures
