Nursing Skills

first chain of infection

infectious agent

• bacteria, fungi, viruses, parasites

second chain of infection

reservoir

• dirty surfaces and equipment, people, water, animals/insects, soil

third chain of infection

portal of exit

• open wounds/skin, splatter of body fluids, aerosols

fourth chain of infection

mode of transmission

• contact (direct or indirect), ingestion, inhalation

fifth chain of infection

portal of entry

• broken skin/incisions, respiratory tract, mucous membranes, catheters and tubes

sixth chain of infection

Host

• any person, especially those receiving healthcare

chain of infection

infectious agent

reservoir

portal of exit

mode of transmission

portal of entry

host

Health Care Associated Infection

airborne precautions: measles, chickenpox (varicella), disseminated herpes zoster, mycobacterium tuberculosis, rubeola

droplet precautions: influenza, adenovirus, group A streptococcus, Neisseria meningities

contact precautions: C. Diff., MRSA, scabies

Health Care associated Urinary Tract infection

• unsterile insertion of urinary catheter

• improper positioning of drainage tubing

• open drainage system

• catheter and tube becoming disconnected

• drainage bag port touching contaminated surface

• improper specimen collection technique

• obstructing or interfering with urinary drainage

• Urine in catheter or drainage tube being allowed to reenter bladder (reflux)

• improper perinea hygiene

Health Care associated surgical or traumatic wound infection

• improper skin preparation before surgery (shaving versus clipping hair; not performing a preoperative bath or shower)

• failure to clean skin surface properly

• failure to use aseptic tech. during procedures and dressing changes

• use of contaminated antiseptic solutions

healthcare associated respiratory tract infection

• contaminated respiratory therapy equipment

• failure to use aseptic technique while suctioning airway

• use of contaminated antiseptic solutions

Health Care associated bloodstream infection

• contamination of IV fluids by tubing

• insertion of drug additives to IV fluid

• addition of connecting tube or stopcocks to IV system

• improper care of needle insertion site

• failure to change IV access at fist sign of infection or at recommended intervals

donning PPE

gown

mask or respirator

google or face shield

gloves

doffing PPE

gloves

googles or face shield

gown

mask or respirator

complete bed bath

bath administered to totally dependent patient in bed

partial bed bath

bed bath that consists of bathing only body parts that would cause discomfort if left unbathed, such as hands, face, axilla, and perineal area. partial bath also includes washing back and providing back rub. Dependent patients in need of partial hygiene or self sufficient bed ridden patients who are unable to reach all body parts receive a partial bed bath

sponge bath at the sink

involves bath from a basin or sink with patient sitting in a chair. patient can perform part of the bath independently. Nurse helps wit hard-to-reach areas

tub bath

involves immersion in a tub that allows more thorough washing and rinsing than a bed bath. Patients may require nurse’s help. Some agencies have tubs equipped with lifting devices that facilitate positioning dependent patients in the tub

shower

patient sits or stand under a continuous stream of water. the shower provides more thorough cleaning than a bed bath but can be tiring

disposable bed bath/ travel bath

the bag bath contain several soft, non-woven cotton cloths that are pre-moistened in a solution of no rinse surfactant cleaner and emollient. The bag bath offers an alternative because of the ease of use, reduced time bathing, and patient comfort

Chlorhexidine gluconate (CHG) bath

antimicrobial agent to reduce incidence of hospital acquired infections on skin, invasive lines, and catheters

CNA task

can only assist in ADL (activities of daily living)

fowler position

• use when eating

• promotes lung expansion

  • postion for nasogastric insertion

Semi-Fowler position

• promotes lung expansion

• when receiving oral care and gastric feeding

Trendelenburg

• use for postural drainage

• for venous return w/ patients w/ poor peripheral perfusion

reverse trendelenburg

• promotes gastric emptying

• prevents esophageal reflux

supine of flat

• used for patients w/ vertebral injuries & cervical traction

• for hypotensive patient

• use for patients who are sleeping

allergic reaction

adhesive tape, dental or face mask, golf club grip, ostomy bag, rubber band, balloon, bandage, elastic underwear, intravenous (IV) tubing, rubber gloves, condom.

higher risk of latex reaction

history of asthma, contact dermatitis, eczema, urticaria, rhinitis.

sterile objects become contaminated

• go below the waist

• reaching over sterile field

• leading sterile field unattended

• turning back on sterile field

sterile glove cuff

5 cm and dominant hand goes first

outer cuff touches hand or wrist

contaminated

after putting on sterile gloves

interlock hands together and hold away from body above waist level until beginning procedure

A patient is diagnosed with meningitis. Which type of isolation precaution is most appropriate for this patient?

Droplet Precautions