Chapter 17: Infection Prevention Control in the Hospital and Home

Incubation Period

Begins when the organism firsts enters the body and lasts until the onset of symptoms

Prodromal Period

The short time from the onset of vague, nonspecific symptoms to the beginning of specific symptoms of infection

Malaise

a general feeling of discomfort or illness

What period is the highly infectious stage?

Prodromal Period

Illness Period

localized and systemic signs and symptoms appear

Which period does an individual start to get a fever, headache, and malaise?

Illness Period

The severity of the symptoms and duration of the illness depends on what?

Virulence of the pathogen and the person's susceptibility to the microorganism

Convalescent Period

When the symptoms begin to subside and it extends until the patient has returned to a normal state of health

What period is also known as the recovery stage?

Convalescent Period

Health Care-associated Infections (HAI)

Infections transmitted to a person while receiving/giving health care services;

What lab studies indicate possible infection?

Increased white blood cell count

Which patients are at greater risk of HAIs?

Patients with invasive diagnostic and therapeutic devices (IVs, tubes) and weak immune system

Isolation

Used to prevent contact between patient and others

What precautions can you take to prevent and control infection?

Surgical and Medical Asepsis

Standard Precautions

Transmission Based Precautions

When are strict aseptic techniques used?

In invasive diagnostic and therapeutic procedures (IV, catheters, surgical procedure )

Infection preventions and control involves

Monitoring infection diagnostic reports

Check patient for signs of infection

Implementing procedures to contain microorganism

Properly handling, sterilizing, or disposing of contaminated items

Use approved sanitation

Recognize individuals at high risk of infection and implement protections

Standard Precautions

describe methods for avoiding direct contact with body secretions except sweat

Which precaution can be used alone or in combo but always in addition to Standard Precautions?

Transmission-Based Precautions

Transmission-Based Precautions

Interrupting mode of transmission by identifying specific secretions that might be effective

Which tier is Standard Precaution?

Tier 1

Which tier is Transmission-Based Precaution?

Tier 2

CDC guidelines state that PPE should be put on in the following order:

Gown

Mask

Goggles

Gloves

PPE should be removed in the following order

Gloves

Goggles

Gown

Mask

For whom should Standard Precautions be used?

For all patients

Airborne Precautions

Measles

Varicella

Pulmonary tuberculosis

Droplet Precautions

Meningitis

Pneumonia

Diphtheria

Contact Precautions

GI,

Skin or wound infections

RSV

Herpes simplex virus

Why is wearing disposable gloves a Transmission-Based Precaution when handling body secretions infected with hepatitis B?

It's an airborne transmitted disease

When is the only time a nurse is not required to wear gloves?

For patients with intact skin or unsoiled articles

What action should the nurse take if uniform is contaminated with infectious body secretions or blood?

Change into disposable scrubs and bring soiled clothes to appropriate department to be cleaned

How can uniform contamination be prevented when handling infectious body secretions?

Wear gown

When first encountering a patient, a baseline assessment should include:

Assess for signs of infection that may require Transmission-Based Precautions,

Asses wounds each shift for signs of infection,

Monitor the patient's temp,

Admission lab studies may indicate infection

What symptoms may indicate infection?

Patient has a decrease in overall urine output and/or fever

What's the nurse's next step after cultures are preformed on bodily fluids?

Check the reports to see if any microorganism have been identified

What lab studies may indicate a possible infection?

Admission lab studies

What results from an Admission lab study indicate a possible infection?

An increase n white blood cell count

What's the nursing diagnosis?

Risk of infection related to surgical wound, open wound, or weakened condition

How can you ensure yourself that you will have everything necessary when you don your protective clothing before entering the room?

Speaking to the patient in advance via the intercom

What's the planning process?

Expected outcomes would include "No HAIs is evident"

When using Transmission-Based Precautions equipment, the nurse must prepare before each entry into the patient's room

How should the nurse implement precautions?

Teach a patient who is at risk for an infection about disease process, modes of transmission, and precautions necessary to prevent spread of the infection

When should the Transmission Based Precaution be implemented?

Based on patient's infection status

Hand hygiene

Most important in preventing infection transmission

Used before and after contact with patient, wound care, or invasive procedure

Before donning gloves and after removing them

When the patient has known or suspected pulmonary tuberculosis, what type of mask must be worn?

N95 mask

What's the general guidelines for Isolation Precautions concerning specimen removal ?

Label specimen container before entering room;

Collect specimen and place it in a leak-proof container without contaminating the outside

What's the general guidelines for Isolation Precautions concerning linens?

Handle as little as possible; roll up and hold linens arm's length away from the body;

place inside linen hamper (isolation container) inside patient's room

What's the general guidelines for Isolation Precautions concerning trash?

Disposable soiled equipment should be placed in plastic bags lining the waste receptacle; a biohazard (red) bag may be needed

What type of wounds do not bleed freely and are difficult to clean and infection usually occur?

Puncture

What's the general guidelines for Isolation Precautions concerning sharps?

Never recap a needle before disposal; all sharps are dropped into sharps containers, never put your fingers or hands inside the opening of the sharps container; which are replaced when 2/3 full

What's the general guidelines for Isolation Precautions concerning other equipment?

Reusable equipment cleaned if visibly soiled, then sent to central supply to be disinfected

What's the general guidelines for Isolation Precautions concerning natural defenses?

Institute measures to enhance the patient's natural body defenses, such as protect intact skin; promote a balanced diet; provide opportunity for sleep; decrease stress

What part of a sterilized room is contaminated?

Floors

Patients with communicable diseases should be grouped according to epidemiology of transmission

Contact through respiratory spread

Transmission by the GI tract

Direct contact with wound/skin infection

Can objects in the "clean zone" be used by patients in isolation?

No

Is it true that anything brought into isolation area may not be removed except in special container?

Yes

General Principle Regarding Isolation

Minimize dust, never shake linen, never rub eyes or nose while in unit, change gloves after handling contaminated items, use paper towels when sitting down sterile items, keep water and glass in room, turn on/off faucets with paper towels, use room clock when taking vitals or watch in plastic bag, monitor yourself for infections

How do you handle the blood pressure cuff used on patients with an infectious disease?

Use disposable cuffs

Name the reusable equipment in the isolation room

Dishes

What's the general guidelines for Isolation Precautions concerning Patient placement?

Patients who need Transmission Precautions should be placed in a private room or with another patient infected with the same organism

What's the general guidelines for Isolation Precautions concerning Transporting the patient?

Avoid unless absolutely necessary; patient is given standard mask to wear outside the room

How to prevent and control Infection at home concerning clothing and linen?

Keep clothing and linen away from others until washed

How to prevent and control Infection at home concerning hand hygiene?

Teach patient and family proper hand hygiene techniques, each patient and family proper hand hygiene techniques

How to prevent and control Infection at home concerning bathroom?

disinfect bathroom with 1:10 bleach water

How to prevent and control Infection at home concerning dishes?

wash dishes in scalding water and let air dry

How to prevent and control Infection at home concerning sharp objects?

Use heavy plastic jug with secure top to hold needles

How to prevent and control Infection at home concerning gloves?

Use clean gloves for wound care or dressing changes, and teach family how to remove soiled gloves

How to prevent and control Infection at home concerning room cleanliness?

Clean patient's room frequently

What's the nurse's goal when a patient is immunocompromised?

Protect him from exposure to potential pathogens

Immunocompromised patients should be placed in special isolation room with it's own what?

Ventilation system

Who should not be able to enter protective environments such as isolation?

Anyone with an active infection including health care workers

What can the nurse do to help the patient overcome sensory deprivation?

Having visitors, learning about patient's interest/hobbies, provide age appropriate games/puzzles/crafts, encourage connecting to wifi to listen to music or watch TV

Signs of sensory deprivation

boredom, slowness of thought, disorganized thoughts, excessive sleeping during day, anxiety, hallucinations or panic attacks

What regulations protect health care workers from exposure to blood-borne pathogens in the workplace?

OSHA

What are the three main modes of occupational exposure to blood-borne pathogens?

Puncture wounds from contaminated sharps,

Skin contact with bodily fluids/blood,

Mucous membrane contact (eyes, mouth, nose)

What actions decrease the nurse's risk for infection include:

Good hand hygiene and other medical asepsis techniques, wearing PPE, using needless IV equipment and needles with guards, and avoiding carelessness in the clinical area.

What are the four rules of surgical asepsis?

Know what is sterile

Know what is not sterile

Separate sterile from unsterile

Remedy contamination immediately

Where is surgical asepsis practiced?

Operating room, obstetric areas, special diagnostic areas, and for procedures (administering injections, change wound dressings, urinary catheterization and IV therapy)

How are breaks in sterile technique caught and rectified?

Being careful to know what is sterile, what is clean, and what becomes contaminated

Who's responsible for infection prevention?

Nurse

How long does a surgical scrub take?

2-4 minutes

Standard precautions

All patients; to avoid body secretions except sweat

Airborne precautions

MTV (measles, TB, varicella); special mask N97

Droplet precautions

Meningitis, pneumonia, diphtheria

Contact precautions

GI, skin, wound infections, RSV, herpes simplex