Skills: Exam 1 (VS, Infection prevention, Hygiene, Urinary, Bowel)

3 responsibilites of nurses for asepsis and infection control

1. understanding the role in preventing transmission of infection

2. recognizing the source of infection and apply protective measures

3. protecting ourselves by being knowledgabe abo

importance of asepsis and infection control

7 pt in high income & 15 pt in low-middle income / 100 pts will aqcuire at least 1 HAI during their hospital stay

WHO says 70% of infections can be prevented

infection

the invasion of a susceptible host by pathogens or microorganisms when they multiple and ALTER normal tissue function; results in disease

colonization

presence and growth of microorganisms within a host without tissue invasion or damage

communicable disease

the infectious process transmitted frm one person to another

• ex: Hep C transmitted through direct contact (passage of blood into skin from a percutaneous procedure

  • ex: needle sticks, sharing needles, sexual contact, blood to blood contact

  • can lay silent for years until virus damages liver to cause symptoms

symptomatic

clinical signs and symptoms are present

asymptomatic

clinical signs and symptoms are not present

Chain of Infection

• infectious agent/pathogen

• reservoir or source for pathogen growth

• portal of exit

• mode of transmission

• portal of entry

• susceptible host

to prevent infections involves breaking chain of infection → HH most effective

infection agent

part of chain of infection

includes bacteria, virus, parasite, fungus

reservoir

part of chain of infection

includes humans, animals, insects, inanimate objects

portal of exit

part of chain of infection

includes resp tract, GI tract, GU tract, blood skin, mucosal surface

mode of transmission

part of chain of infection

includes contact, airborne (fine particles), vehicle, droplet (bigger drops/globs), vector-borne

types of mode of transmission

• direct

  • person o person (oral, fecal)

  • pink eye

• indirect

  • contaminated inanimate objects; sharps linens (bed changes)

• droplet

  • resp come in contact with 6 feet (larger droplets)

• airborne

  • resp transported/suspended in the air (smaller droplets)

• vehicles

  • contmainated sharps, water, blood, food

• vector

  • external transfer: flies, ticks, mosquitos

direct transmission

• person to person (oral, fecal)

• pink eye

indirect transmission

• contaminated inanimate objects; sharps linens (bed changes)

droplet tranmission

• resp come in contact with 6 feet (larger droplets)

airborne transmission

• resp transported/suspended in the air (smaller droplets)

vehicle transmission

• contaminated sharps, water, blood, food

vector transmission

• external transfer: flies, ticks, mosquitos

portal of entry

part of chain of infection

includes GI, GU, resp tract, mucous membranes, non-intact skin

host

part of chain of infection

includes: older adult, immunosuppressed, trauma, surgery, chronically ill

infectious process

Stages:

• incubation period

• prodromal stage

• illness stage

• convalescence

incubation period

Stage in infectious process

when symptoms first appear (flu 1-4 days)

prodromal stage

Stage in infectious process

MOST CONTAGIOUS STAGE

non-specific symptoms (fever, malaise) to more specific symptoms

i.e herpes simplex begins with itching and tingling at the site before lesion appears

illness stage

Stage in infectious process

full blown symptoms related to type of infection

convalescence stage

Stage in infectious process

symtoms disappear (recovery stage)

localized specific to site

pain tenderness, warmth, and redness

systemic lethargic

swollen lymph nodes, fever

normal flora

first line of defense against infection

• are microorganisms that reside in our bodies, do not usually cause disease when residing in usual areas of the body, helps with maintaing health

  • found in moth (saliva + oral)

  • GI (intestinal walls + acidity)

  • Resp tract (cilia)

  • vagina (lower pH inhibit growth)

inflammation

second line of defense against infection

• local response to cellular injury or infection. a protective reaction that delivers fluid, blood products, and nutrients to area of injury

  • exudates:

    • serous (clear plasma)

    • sanguineous (RBC, pinky)

    • purulent (WBC, bacteria, white/pus)

• if chronic, tissue defect sometimes fill with fragile granulation tissue that eventually takes from fo scar at end of healing process

HAI

Healthcare Associated Infections

• results from delivery of health services in healthcare facility

• break in infection control

• pt with greater risk:

  • multiple illnesses

  • older adults (>susceptibility due to chronic and aging)

  • poorly nourished

  • compromised immune system (diabetics, cancer pt, pt with IVs and cath, surgery)

Iatrogenic

type of HAI

• from a procedure

• caused by an invasive diagnostic procedure such as bronchoscopy or treatment with broad spectrum antibiotics (upset normal flora)

Exogenous

types of HAI infection

• comes from microorganisms found outside the individual such as salmonella

Endogenous

type of HAI infection

• when part of pt’s flora becomes altered and overgrowth results

Sites and causes for HAI

UT - improper perineal care, unsterile insertion of cath

surgical or traumatic wounds - improper skin prep

resp tract - suctioning

blood stream - using aseptic tech with inserting IV

Factors that influence infection prevention and control

• age: infant immature immunity

• older adults: alt in skin decrease production of lymphocytes

• sex: changing levels of sex steroids hormones can affect immune system

• nutritional status: need protein, carbo, fats to fight infection

• stress: increase cortisone levels result in decreased resistance to infection

• disease process: disease that alters immune system: leukemia, AIDS

  • chronic disease: DM, MS PVD and emphysema

Assessment for Infection

• obtain med history (vaccines illnesses, surgeries, nutrition)

  • look for meds that increase pt’s suceptibility to infection (steroid/chemo)

• look at pt labs (WBC, sed. rate, cultures blood and urine)

  • sed rate (ESR): degree of inflammation in the body measure the level of contain proteins in the blood

• risk factors

• clinical appearance: notable signs/symptoms VS? localized systemic infections

• status of defense mechanisms

• medical therapy (steroid treatment/chemo)

• travel history

Diagnosis for inflection

gathering both objective and subjective data look for cues that create a pattern

explain the reasons for isolation procedures and provide meaning stimulation

A patient is placed on airborne precaustions for TB. The nurse notes that the patient seems to be angry, but the nurse recognizes that this is a normal response to isolation. Which is the nurse’s best intervention?

• proved a dark, quiet room to calm the patient

• reduce the level of precautions to keep the patient form getting angry

• explain the reasons for isolation procedures and provide meaning stimulation

• limit family and other caregiver visits to reduce the risk of spreading the infection

Planning of Infection

viewed by NCLEX as the stage when one begins to prioritize hypotheses

• developing a care plan that sets realistic outcomes so interventions are purposeful, direct, and measurable

• setting priorities for each diagnosis and for related goals of care

• teamwork and collab (include pt and other disciplines if necessary)

Planning of Infection

Health promotion: preventing an infection from developing or spreading

• looks at the pt’s nutrition, rest, hygiene, immunizations, and exercise patterns

Acute care: treating an infectious process includes eliminating the infectious organisms and supporting the pt’s defenses

medical asepsis

• “clean technique”

• asepsis is the absence of pathogenic microorganisms

standard precautions

PPE

gowns, gloves, masks, eyewear and other protective devices of clothing, the choice of barrier depends on the task at hand

hand hygiene

using soap and water, alcohol-based hand sanitizers

wash when:

• visibly dirty

• hand soiled with blood and/or body fluids

• before eating, after eating, after toileting

• exposed to spore-forming organisms such as C. difficile, bacillus anthracis, or Norovirus

  • only soap and water for C. diff

five moments for HH

1. before touching a patient

2. before clean aseptic procedures

3. after body fluid exposure risk

4. after touching a patients

5. after touching patient environment

sterile technique

prevents contamination of an open wound, serves to isolate the operative area from the unsterile environment, and maintains a sterile field for surgery

• includes procedures used to eliminate all microorganisms, including pathogens and spores from an object or area

• used in inserting foley cath and inserting central lines

effective prevention and control

requires you to remain aware of transmission of infection and ways to control infection

• fluid intake - means increase urine output and flushing

• deep breathing - opens airway

• comfort and sleep - increased energy

• reduction of stress decreases cortisone levels in the body boostin immune system

• dressing changes - bacteria likes wet/soiled/moist environ

• contaminated articles - needles sharp box, place tissues, or soiled linen in a fluid resistant bag

• bottles solutions - need to have date and time of when to discrad

• draining bags - protect yourself from splashing when emptying

isolation

separation and restriction of movement of ill persons with contagious diseases

• 2 tiers

  • standard precautions

  • transmission based

standard precautions

Tier 1 of isolation

• precautions we take with every patient. blood/body fluid exposure risk

transmission based

Tier 2 of isolation

• contact: direct patient or environment contact (gloves and gown)

• airborne: droplets <5 microns; measles, chickenpox, TB (N95), private room and negative pressure

• droplet: within 3 ft; influenza, rhinovirus, rubella, mumps (private room or cohort, mask or respirator)

• protective environment - positive airflow, private room (mask, gown, gloves), stem cell transplant, kidney transplant, leukemia, lymphoma

physiological implications of isolation

• pts feel loneliness

  • best to explain reason for isolation and steps to follow for isolation precautions

• private rooms airborne - negative pressure rooms keeps infections pparticles from flowing out fo room HEPA

• PPE usually located outside dorr to room

sterile field

an area free of microorganisms and prepared to receive items

Principles:

• sterile object remains sterile only when touched by another sterile object

• only sterile objects may be placed on a sterile field

• sterile object or field out of the range of vision or an object held below a person’s waist is contaminated

• sterile object or field becomes contaminated by prolonged exposure to air

• never turn back on sterile field

• sterile surface comes in contact with a wet, contaminated surface

• fluid flows in direction of gravity

• edges of sterile field or container are considered to be contaminated

evaluation

• patient outcomes

  • measure the success of the infection control techniques

  • compare the pts actual response with expected outcomes

  • if goals are not achieved, determine what steps must be taken

• exposure issues

personal hygiene

• influecnes patients comfort, safety, and well being

• variety of personal, social, financial and cultural factors influence hygiene practices

• use communication skills

• integrate other nursing activities alongside hygeine (i.e assessment)

• ensure privacy, respect, for pt’s independence, safety, and comfort

skin functions

• protects from micro-organisms, helps regulate body temp

• sensation - touch, pain, heat, cold

• excretion/sweating

• relfect physical condition

• feet, hands, nails → prevent infection, odor, injury

• hair (hormonal changes, stress, aging

• oral cavity

• eyes

factors influencing hygiene

• social practices - influenced by social groups and can affect patient hygiene practices

• personal preferences - frequency AM/PM, bath, shower, preferences fro grooming products

• body image affects the way a person maintain personal hygiene

• socio-economic status - lact of resources can affect a person’s ability to affor basic supplies for hygiene care

• health benefits and motivation - influences

• cultural variables cultural beliefs, religious practices, and personal values

helathy feet

key for ambulation. A body in motion stays in motion, older adults do not have strength, ability, visual acuity to care for their feet and nails

glossitis

inflamed tongue

chelitis

cracked lips

bathing guidelines

• provide privacy, maintain safety, mainatin warmth

• promote independence

• long firm strokes

• extremities start distal to proximal => improves circulation

completed bed bath

pts totally dependent and delivered in patients bed

partial bed bath

face, hands, axillary perineal area, cause discomfort if left unbathed

sponge bath at sink

at sink, sitting in a chair, pt can help with this

tub bath

mainly long term care facilities on assigned days, full immersion in tub. some facilities have lifts to assist patients into the tub

travel bath

bag bath contains several soft, non woven cotton cloths that are premoistened in a solutions of no-rinse surfactant cleaner

CHG bath

chlorohexhidine gluconate antimicrobial wipes to help reduce healthcare associated infections on skin, invasive lines and caths

perineal care

• should not be overlooked

• let pt participate if able (allows independency and autonomy)

• be sure to allow for gender congruent care if pt request

• FRONT TO BACK ALWAYS

• rinse and DRY area thoroughly

Nasal cannula

check skin at nares and on top fo ears for irritation to the skin from pressure or rubbing from device

NG/nasotracheal tube

check nasal cavity skin for irritation to the skin from pressure or rubbing from device esp. SHORT term

• G-tube = long term

dysphagia

difficulty swallowing

don’t stand over them, sit with them

Main thing to remember when assisting meals and cutting up patients food for them in smaller bites?