Foundations exam 1 - Hygiene and Infection Control

Mucous Membranes

Block pathogens from entering the tissues and blood; mucus entraps
pathogens
• Line the respiratory, digestive and urinary tracts

Teeth

• Bacteria can build up in mouth and dissolve enamel on teeth leading to
infection and loss of teeth

Nails

• Layers of keratin to prevent injury to the fingers and toes
• Nails need to be kept clean and dry to prevent bacteria growth from
building up underneath

Skin

• first line of defense against pathogens
• Dermis layer made up of connective tissue that provides the skin with
its strength and elasticity; also contains nerves

What are the steps of the inflammatory response?

1. Injury occurs

2. Chemical mediators released

3. Vasodilation

4. Increased capillary permeability

5. WBC migration

6. Phagocytosis

7. Healing and Repair

What are the chemical mediators and what do they do?

• Histamine → causes blood vessels to widen and become leaky (vasodilation + increased permeability)

• Prostaglandins → cause pain and fever

• Cytokines → control and coordinate the immune response

What is vasodilation?

When blood vessels widening to increase blood flow which causes redness & heat

What is increased capillary permeability?

It is when fluid and proteins leak out causing swelling

Explain white blood cell migration

How immune cells move from the bloodstream into infected tissue to fight infection. Neutrophils arrive first to help fight off the infection then other WBC follow to continue the immune response and help with healing

Explain phagocytosis

is when white blood cells surround, swallow, and destroy germs or debris.

• WBCs “eat” pathogens (like bacteria) to kill them

• Macrophages help by cleaning up leftover dead cells and tissue damage

• This helps clear the infection and supports healing

What do hygiene needs vary by

• Health status
  • Assess ability to tolerate
  • Alert and oriented, sleeping, recent pain medication
  • Any aspiration risks?

• Daily routines
  • Oral hygiene, face and hands in morning
  • Maybe full bath in evening before bed?

• Cultural & social norms

How can we prep for hygiene care?

• Assess what the patient can do themselves

• Offer choices for timing, ask about home routine to support independence

• PUT SAFETY FIRST (bed height, two people, patient never alone, watch positioning, and risk for injury)

What is hygiene practices for stroke patients?

• Oral care ; showering is preferred method for bathing

• Dressing: the unaffected arm is used first to place clothing on the affected side (weak first, strong second)

• Undressing: clothing is removed from the unaffected side first, then the affected side (strong first, weak second)

What is hemiparesis?

minor loss of strength in face, upper or lower extremity on one side of the body
• Trouble grabbing objects, muscle weakness and
decreased coordination

What is hemiplegia?

paralysis affecting one side of the body
• Motor disability caused by a stroke usually affects the opposite side from which the stroke occurred in the brain (left brain stroke, right side body impairment)

What are older patients hygiene considerations?

• skin tends to be thin and dry

• bathing may be less frequent

• use WARM, not hot water

• do not use harsh soaps or cleansers

What is the nursing considerations for oral care?

• Check mouth daily (dryness, sores, redness, bleeding)

• Be gentle if bleeding risk (blood thinners/low platelets)

• Use oral swabs if patient can’t brush

• Perform hand hygiene before and after care

• Teach patient/family importance of oral care

• Report any mouth changes to the provider promptly

Denture care

• Remove dentures carefully

• Clean daily with soft brush + denture cleaner (no toothpaste)

• Soak overnight in water + denture tablet

• Rinse well before placing back in mouth

• Dry gently before storing

• Store in labeled container with water when not in use

What is the correct nail care?

• Never cut unless order present or outlined in facility policy

What is the correct foot care?

• Pts with DM (Diabetes Mellitus) require specialized foot care
• Dry the feet, especially between the toes to prevent moisture from building up when socks are placed back on
• Do not cut nails, instead use a nail file and file a straight edge not a round edge
• Do not apply lotion between toes but can put on feet
• Inspect both skin and sensation during foot care
• Use lukewarm water

What cues can you recognize while washing a patient’s feet?

• Skin color (can show vascular and perfusion issues)
• Skin temperature (can show vascular and perfusion issues)
• Lesions (skin cancer, open skin, injury)
• Ecchymosis (bruising, are they falling at home?)
• Nails (infection, vascular or perfusion issues)
• Heels (moist, dry, cracked)
• Mobility (can they walk okay)
• Sensation (vascular and perfusion issues, DM type 2)

What is vascular and perfusion issues?

involve blocked blood vessels or inadequate oxygen and nutrient delivery to bodily tissues

What is gait?

the specific pattern or manner in which a person walks or runs

What is perineal care?

Cleaning the genital and anal areas to maintain hygiene and prevent
infection.

Why is pericare important?

• Prevents urinary tract infections (especially CAUTI)
• Prevents skin irritation and breakdown
• Promotes patient comfort and dignity

How to perform pericare:

• Use warm water and mild soap or perineal wipes

• Clean from front to back to avoid spreading bacteria

• Use a clean part of the washcloth or wipe for each stroke

• Wear gloves and practice hand hygiene before and after

• Provide privacy and explain the procedure to the patient

What are the parts in the chain of infection?

1. Infectious agent

2. Reservoir

3. Portal of exit

4. Mode of transmission

5. Portal of entry

6. Susceptible host

What is an infectious agent in the chain of infection?

pathogen that causes disease (bacteria, virus, fungi, parasite)

What is a reservoir in the chain of infection?

where the organism lies and multiples (patients, environment)

What is the portal of exit in the chain of infection?

how the pathogen leaves the reservoir (coughing, sneezing, blood, urine, wound drainage)

What is the mode of transmission in the chain of infection?

direct contact, indirect contact, droplet (sneezing & coughing), airborne (tiny particles in the air), and vector-borne (mosquitoes, ticks)

What is the portal of entry in the chain of infection?

broken skin, respiratory tract, mucous membranes, urinary tract

What is a susceptible host in the chain of infection?

person at risk for infection; age, chronic illness, weakened immune system, poor nutrition, stress or fatigue

How does NPSGs connect to Infection Prevention?

• Part of standard nursing practice

• Prevents infection, complications, and longer hospital stays

• Protects nurses from exposure and injury

• Helps meet hospital safety/accreditation rules

• Improves safe, professional nursing care

What are some Infection: Expected Assessment Cues

• Fever + vital sign changes

• Fatigue (malaise), loss of appetite

• Redness, swelling, warmth, pain

• Changes in drainage or mucus

• ↑ WBC (normal: 5,000–10,000/mm)

• ↑ ESR (inflammation marker)

• Positive cultures (urine, sputum, blood—collect before antibiotics)

• Older adults: confusion or restlessness

What is the most important factor when assessing a patient?

keep an eye out for ANY BASELINE CHANGES

How are HAIs preventable?

By effective hand hygiene

What are nosocomial infections?

infections that happen during the patient’s hospital stay but was not present upon admission

What are two types of nosocomial infections?

CAUTI and SSI

What is a CAUTI?

Catheter associated urinary tract infection, when pathogens enter the urinary system via a catheter in the urethra

What is a SSI?

Surgical site infection that occurs where a surgery happened

When is alcohol based handwashing appropriate?

before touching a patient, touching a device, after touching an object in their environment, after removing gloves

When is soap and water based handwashing appropriate?

hands are visibly soiled, after caring for a patient with infectious diarrhea (Clostridium difficile)

What is medical asepsis (Clean technique) ?

• used for all patients

• hand hygiene: soap and water > 15 seconds OR alcohol based hand gel till dry

• use CLEAN gloves

• clean equipment and environment routinely

what is the normal WBC range?

5,000–10,000

What is surgical asepsis (Sterile technique)?

• Gloves and equipment are sterile

• Hand hygiene will be done before putting on sterile gloves

• Use sterile supplies and equipment (opening and preparing a sterile field, adding sterile items to a sterile field)

• wear sterile gloves

• maintain sterility

  • between shoulders and waist: below waist is contaminated

  • in front of you: if you lose sight of it = contaminated

  • Do not reach over sterile field = contaminated

CAUTI prevention

• Insert catheter only if necessary; remove ASAP

• Keep system closed (don’t disconnect tubing)

• Clean insertion site daily

• Keep tubing unkinked and below bladder

• Perform hand hygiene before/after care

• Teach patient/family infection prevention

SSI Bundle

• Use sterile technique during surgery and wound care

• Give antibiotics on time (before/after surgery as ordered)

• Check incision daily (redness, swelling, pain, warmth, drainage)

• Teach patient how to care for incision at home

• Report signs of infection right away

What does bundle mean in this sense?

group of evidence-based care steps that are done together every time to prevent a problem

Surgical Site Infection (SSI) bundle is:

• A set of specific actions nurses and providers always follow

• Done consistently (not just sometimes)

• Proven to lower infection risk and improve outcomes

What are standard precautions?

• Hand hygiene

• Cough and sneeze etiquette

• PPE: Gloves, goggles, gown

• clean and disinfect surfaces and equipment

• handle laundry carefully

• sharps in sharps container

• nails: no artificial, gel or chipped polish

What are contact precautions?

• mode of transmission: direct or indirect contact

• infectious agents: MRSA, VRE, Scabies, C. Diff

• PPE: Gown and gloves

• special considerations: use disposable or dedicated patient care equipment, room cleaning for contact precautions,

**** C diff requires soap and water NO hand gel

**** C diff requires sporicidal disinfectant on objects and equipment

what are droplet precautions?

• mode of transmission: respiratory droplets traveling short distances (3-6 feet)

• coughing, sneezing, talking

• inhaled or enter through eye

• infectious agents: flu, meningitis, pertussis, RSV

• PPE: Mask

• Special considerations: place mask on patient when transporting, use disposable or dedicated patient care equipment, room cleaning for droplet precautions

what are airborne precautions ?

• mode of transmission: aerosolized smaller particles traveling longer distances (>6 feet)

• transmitted through airflow, remain in air for longer time

• infectious agents: TB, Varicella (chicken pox), Measles, Disseminated herpes zoster (shingles > 3 dermatomes)

• PPE: N95, gown, gloves, goggles

• special considerations: place airborne-infection isolation (AIIR) in private room with door closed, place mask on patient when transporting, use disposable or dedicated patient care equipment (stethoscope remains at bedside)

What does donning ppe mean ?

Putting on personal protective equipment

What are the steps for donning ppe?

1. Gown

2. Mask or respirator

3. Eye protection

4. Gloves

What is MRSA?

• Methicillin-resistant staphylococcus aureus

• Bacteria strain that is resistant to many antibiotics

• Vancomycin and linezolid are used to treat MRSA

What are the nursing actions for MRSA?

• obtain specimen for C & S before starting antibiotics

• monitor vitals, antibiotic count, kidney and liver function * watch for sepsis

• splash risks

• bath patients in water and CHG baths daily

• PPE: Gown, goggles, gloves

Breaking the Chain

• Hand hygiene → stops transmission

• PPE (gloves, masks, gown) → blocks entry/exit

• Cleaning & disinfecting → removes pathogens

• Isolation precautions → limits spread of agent

• Vaccination → protects host

• Proper wound care → closed entry points