Unit 5 Microbiological Safety

Infection

Invasion of body tissues by microorganisms that proliferate and grow, causing infection

Infection Sources

Endogenous, Exogenous

Endogenous

Within patient (from normal flora)- Healthy microorganisms

Ex) candida – yeast infection, thrush

Exogenous

From the environment / transmitted from person to person

Infection Sites

Local, Systemic

Local Infection Sites

Specific/confined area

Ex) UTI – confined to the bladder/urinary region/inflammation

Systemic Infection Sites

Organisms spread to multiple systems

Ex) bacteremia, sepsis, MODS (multiple organ dysfunctional syndrome)

Nosocomial/Healthcare Acquired Infection (HAI)

Caught in hospitals/healthcare facilities

Iatrogenic

Physician induced, therapeutic or diagnostic procedures (can cause infection)

Ex) CAUTI, CLABSI, VAP

Opportunistic

Disruption of body defenses, and then normal microorganisms that are present in the body proliferate

Ex) antibiotics causing normal flora disruption and causing a yeast infection

Defenses Against Infection

Nonspecific, Specific

Nonspecific

Barriers- First line of defenses

• Anatomic (ex. Skin, mucous membranes) – Dust Particles

• Physiologic (Ex. Phagocytosis – engulfing foreign pathogen, saliva, sweat)

Inflammatory Response (LAS)

• GAS – how body defends itself

  »By confining the injury to the smallest part of the body as possible!

Specific - GAS

Antibody-mediated (humoral) Immunity

• Active immunity (immunization)

• Natural vs. artificial immunity (nurses are exposed to many organisms, hospital workers are more immune to some diseases because of this – natural) – develops only through deliberate actions of exposure

Cell-Mediated (Cellular) Immunity

• Killer T cells

• Lymphatic system

Older Adults & Infections

All body systems decrease in function in older ages including the immune system

Contributing Factors in Infection

Increasing Risk: Chemical, Developmental, Iatrogenic, Physical, Physiological, Psycho-socio-cultural

Microbiological etiologic agents: Bacteria, fungus, virus, C-Diff, E. Coli, MRSA/VRE.

Chemical (Increasing Risk of Infection)

• Ex) anesthesia – slows BMR (Basal metabolic rate)

• Ex) harsh soap – can decrease essential oils in the skin causing skin tears

• Ex) antimicrobials (antibiotics) – build immunity among microorganisms because we don’t complete treatment (antibiotics should be the last mode of intervention)

Developmental (Increasing Risk of Infection)

The very old and very young are more suscep

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Physical (Increasing Risk of Infection)

• Radiation

• Hot water- can cause burns and damage skin

• Sheering forces- pulling patients up in bed can cause skin tears

Physiological (Increasing Risk of Infection)

• Those immunocompromised individuals – disease-causing

• Those that are malnourished, pregnant, neutropenic precautions (decrease in WBC count – seen often in oncology patients)

• Interference of urine flow – stasis – urine isn’t being excreted = UTI

• Changes in G.I.

Psycho-socio-cultural (Increasing Risk of Infection)

Stress, anxiety, other cultural factors

Bacteria, fungi, viruses

Pathogenic in nature

C-Diff (NO GEL, wash hands)

Spore-forming organism, hard to get rid of, chief cause = diarrhea, yellow/watery stool, must get stool culture to test

E. Coli

Normal flora found in G.I. tract, seen 40 hours after birth in our stomachs, when it gets into other systems outside the G.I. tract is when it causes infection (Anus: always wipe front to back)

MRSA/VRE

Methicillin-Resistant Staphylococcus Aureus & Vancomycin-Resistant Enterococci

Found on the skin- make sure not to spread it

Clinical Manifestations of Infections

• Inflammation (LAS)- Abbreviation (HELPE or HELPS)

• Exudate (drainage)- Characteristic of infection, 4 types

Inflammation (LAS) - (HELPE/HELPS)

• Heat

• Erythema

• Loss of function

• Pain

• Edema aka Swelling

Exudate (drainage)

Serous, purulent (pus), sanguineous (blood), serosanguineous (serous and bloody)

Serous

• Clear/yellow (drainage from wounds)

• This occurs when in the healing process!!!

• Occurs in abrasions (other breaks in the skin that aren’t as deep)

Purulent (pus)

• Contains bacteria – makes it cloudy

• Can range in color – depending on what organism is in the exudate

Sanguineous (blood)

Would see this kind of exudate when there is a tear in the tissue

Serosanguineous (serous and bloody)

• Pinkish in nature

• Would see this kind of exudate in the healing process (Looks like cranberry juice)

Systemic Manifestations

• Fever

• Leukocytosis

• Malaise

• Anorexia

• Nausea, vomiting

  • Organism is in the G.I. tract – body wants to expel it! (“stomach virus”)

• Headache

• Lymphadenopathy

• Other manifestations related to specific infection

Modes of Transmission

3 modes:

• Direct transmission, Airborne Transmission, Indirect Transmission

Direct Transmission

If host Is susceptible, it can be transmitted through touch.

• Touching- Contact— Gloves and gown

  » MRSA, C.Diff (contact-plus)

• Droplet - Respiratory infection (Mucus membrane)

  » Through cough or sneeze from one to another (within 3 ft)

Airborne Transmission

Very small particles (N-95)

• Inhalation of droplet/dust particles

• Can remain suspended in the air for longer periods (cough and sneeze)

  • Ex; tb, rsv, legions diseases

Indirect Transmission

• Vehicle-borne

  • Soiled linens, soiled furniture

• Vector-borne- animals or insects

  • Ex; animal/insect transport or transmit disease

  • Live host- either bitten, scratched (ticks, mosquitos)

Asepsis

Absence of infection. Try to reduce as many microorganisms in the patient’s environment as possible.

Contaminated

Contain disease producing organisms

Historical Perspective

Germ Theory:

Asepsis types

Medical & Surgical

Medical

• Decrease the amount of microorganisms by eliminating gross contamination

• Confine organisms to the smallest area possible to prevent the spread

“Clean” technique

Surgical

• Specific process to keep area free of microorganisms

• IV, Foley, OR, Dressing, Trac care

“Sterile” technique

Principles of Surgical Asepsis

• All objects in a sterile field must be sterile

• Sterile objects become unsterile when touched by unsterile objects

• Sterile objects become unsterile when below waist or out of vision

• Prolonged exposure can lead to contamination

• Fluids flow by gravity

• Moisture increases conduction of microbes

• Edges of sterile field (1 inch) are contaminated

• Skin cannot be sterilized

  • Anything touched with your hands = contaminated

  • Use a scapel to cut skin

Nursing Diagnoses and Goals

Ex; Risk for contamination, risk for infection

Methods to Decrease Number of Microorganisms

• Simple Cleaning (Clean Environment)

• Physical Methods

• Antiseptics

• Disinfection

• Sterilization

• Antimicrobial agents- stop growth of infection

Simple Cleaning (Clean Environment)

Limit food at bedside, report any bugs that are on the unit

Physical Methods

Opening blinds/shades- UV light can kill some microorganisms

Antiseptics

Alcohol, chlorhexidine, showers

Disinfection

Sani-wipes (different color tops kill different microorganism)

Sterilization

More in the OR/surgical setting, destroys all of microorganisms

Ex; auto claving (under heat), boiling equipment, chemicals, radiation, ethylene gas

Antimicrobial agents

Stops growth of infection

Precautions

• 2 tiers

• Tier 1: Standard Precaution

• Tier 2: Transmission Based Precautions

Tier 1 (Standard Precaution)

• Hand Hygiene: wash vs gel; nails

  • Washing is more effective than gel

  • No artificial nails! – they can chip and harbor bacteria under the polish

• PPE (protective personal equipment) – gown, gloves, mask, etc.

• Patient Care Materials – linens

• Cleaning Equipment

• Needle disposal (sharps container)

• Patient placement

  • Isolate a patient if they have an infectious disease, cohort them if possible, etc.

Tier 2 (Transmission Based Precautions)

• Airborne

• Droplet- (respiratory infection)

• Contact- (approach a patient)

• Protective

• Combination / Strict – (Droplet/Contact)

Decrease Host Susceptibility

Immunizations, nutrition, fluids, smoking cessation, control stress levels, chronic disease management, maintaining non-specific defenses

Immunizations

Increase immunity when you decrease your susceptibility (active immunity – artificial)

Nutrition

• Increase protein (WBC production, tissue maintenance

• Increase vitamin C

• Zinc (boosts energy)

Fluids

Keeps skin moist (dry skin = possible breaks), thin secretions, flushes out microorganisms in the urinary tract

Smoking Cessations

Smoking destroys passageways

Control of Stress Level

Stress decrease immune system - inflammatory response

Maintaining Non-specific Defenses

Skin integrity: Breaks in skin = easy for microbes to enter

Hygiene (Personal Hygiene)

Science of health and its maintenance/preservation of health and cleanliness

Those who need help with hygiene

• Blind

• Morbidly obese

• Those who have ROM issues

  • Stroke patients

  • Paralysis

Purposes of Hygiene

• Interpersonal relationship with patient

• Assess the patient’s skin, and whole body

• Stimulates circulation (*** DO NOT massage calves – could dislodge thrombus)

• Promotes health

• Improves self-image

• Promotes Cleanliness

• Conditions skin

Clinical Manifestations indicating increased need (hygiene)

Smegma

Smegma

White cheesy like build up in the perineum

Patients & Hygiene

If they can assist during this time they can do so

Shower/bathing

Must have MD order

Eye Care

• Cleanse with clean water

• Clean with washcloth or cotton balls

• Clean from inner canthus outward

• Check for care of contact lenses, prosthetic eyes

Check for care of contact lenses , prosthetic eyes

• Contacts should be taken out every so often

• Prosthetics should be taken out daily and cleaned

Hair Care

• Combing and brushing

• Styling

• Shampoo – may need a physician’s order depending on institution

• Facial hair care

Combing and brushing

• Should do this daily if possible

• Redistributes the natural oils of the hair

  • Detangle

Facial Haircare

Shaving beards

• Always used electric shaver!

• Manual ones can cause cuts – pts on anticoagulants!

Nail Care

• Epidermal appendages or extensions

• No cutting but can file carefully

• Soak fingers before cleaning under nails

• Gently push cuticles back with a washcloth

• Assess shape, angle, color of nail beds, texture, markings, and condition of surrounding tissue

  • Nails can be a big indicator of a patient’s nutritional status and habits (nail biting)

Oral Care

The mouth is very important to keep clean, many microbes can enter and proliferate here

Candidates for Oral Care

• Everyone

  • Those with an NG tube

  • Altered mental status

  • Fever

  • Older adult (lack of saliva production)

  • Patients on O2 (can cause dry mouth)

Oral Care Equipment

Kidney basin, tooth brush, gloves, toothpaste, floss

Oral Care Methods

• Place patient in lateral position if they have an altered level of consciousness

  • This position helps with excreting mucous (gravity)

• NEVER put finger in patient’s mouth

  • They can bite you!

Maintaining Hygienic Environment

• Bedmaking

• Cleaning

• Using Barriers

Bedmaking

Make sure sheets are taught (wrinkles can irritate the skin – skin breakdown!)

• Unoccupied

• Occupied

Cleaning

• Use of disinfectant wipes

• Disposal of possible contaminants

  • Do not save food! (food can spoil!)

  • Keep food fresh – keep refrigerated

  • Get rid of excess debris (tissues, garbage, etc.)

Principles of Bathing

Privacy, Involvement of patient, 3 steps to bathing, control of heat loss

Privacy in bathing

SUPER IMPORTANT! – always maintain the patient’s dignity. Pull the curtain and drape the patient’s area that isn’t being washed

Involvement of Patient

Always explain the procedure and what it entails (converse). Maintain autonomy- have them help as much as possible.

Components of Bathing

Washing, rinsing, drying

Control of Heat Loss

• Prevent evaporation

• Radiation

• Conduction

• Convection

Evaporation

Prevent (don’t leave skin wet- pat dry)

Radiation

Cover all parts not being used to maintain body temperature

Conduction

Heat transfers from warm objects to a cooler object. Use ideal water temperature (around 105)

Convection

Control air movement by closing doors, windows, etc.

Ex; Covering a patient w/ both blanket limits heat loss

Peri-care for the Male

• Wash and dry the penis using firm strokes

• Start at glans and work in circular motion away from the glans and along the shaft of the penis toward the body away from the urinary meatus

• Wash and dry the scrotum

• For the uncircumcised males, the foreskin or prepuce needs to be retracted to clean the glands and then replaced

• Anus area last

Peri-care for the Female

• Clean labia majora, then spread labia to wash and rinse between the folds of the labia majora and minora

• Patient may find it embarrassing at first – but needs to be done properly

• Work efficiently to expose patient as little of possible (No harsh chemicals, mostly for older adults)

• Pat dry

Foley

Clean away from entry