asepsis and infection control

asepsis

absence of disease-producing microorganisms called pathogens

Aseptic technique

refers to practices and procedures implemented before, during, or after a clinical procedure to prevent the transmission of pathogens and reduce the risk for patient infections.

two types of aseptic technique

medical

surgical

medical asepsis

aka clean technique - implemented for all patients to prevent the transmission of microorganisms.

when do nurses utilize medical asepsis?

employs medical asepsis in daily activities when washing hands after toileting or when donning clean gloves before changing a basic dressing.

what is the purpose of medical asepsis?

break the chain of infection and protect the susceptible host

what are some medical aseptic interventions?

hand hygiene

PPE (personal protective equipment)

Surgical asepsis

aka sterile technique

what is the purpose of sterile technique/surgical asepsis?

prevents the introduction of microorganisms from the environment into the patient’s incision or body cavities during specialized procedures

what are two ways to practice hand hygiene?

Alcohol-based hand sanitizers - reduces but does not eliminate all types of pathogens

Washing hands with soap and water - best way to reduce number of hand microorganisms

When should you wash hands over hand sanitizing?

when hands are visibly dirty

after exposure to C-Diff or norovirus

before/after eating

after toileting

examples of PPE

Gowns, masks, gogggles, gloves, shoe/head covers

sequence of donning PPE

hand hygiene —> don gown —> mask —> goggles —> gloves

sequence of doffing PPE

gloves —> goggles —>gown —> mask

standard precautions

hand hygiene

Use of PPE

safe injection practices

respiratory hygiene and cough etiquette

when are standard precautions used?

For all patients

during contact or potential contact with: blood/bodily secretions

non-intact skin

mucous membranes

other potientally infectious material

when to use PPE for standard precautions?

gloves when blood and bodily fluid are present

if splashing is possible, use judgement to determine if other PPE is needed

when is hand hygiene used?

it is part of standard precautions

before/after working with an individual patient

before/after any procedure involving patient contact

before applying and removing gloves

What to do when using sharps? (safe injection practices)

Discard needles in sharps containers, including discontinued IV cannulas

use safety needles

use needleless systems when possible

NEVER RECAP USED NEEDLES

Respiratory hygiene/etiquette

covering mouth w/ tissue if available when coughing/sneezing

discard of tissue immediately after use

perform hand hygiene after contact wth respiratory secretions

wearing a mask if infected

documenting standard precautions

standard precautions alone do not require documentation

patient and family education regarding standard precautions needs to be documented

what are transmission based precautions?

second type of precautions for patients who are infected or colonized with certain highly contagious infectious agents

what are the three major types of transmission based precautions

airborne

droplet

contact

why are contact precautions implemented?

to prevent transmission of known or suspected infectious agents directly or indirectly from one patient or person to another

How can contact transmission of pathogens occur?

direct contact with the patient

indirect contact with equipment or items in the patients environment

what do contact precautions include?

single patient room or sharing room with patients with similar risk factors (if room is not available)

PPE use upon entry into room and discarding upon exit to contain pathogens

gloves/gown for nurses/caregivers/visitors when touching the patient/patients immediate environment/belongings

dedicated equipment (usually disposable) when possible

examples of diseases that need contact precautions

MRSA

Scabies

Herpes simplex virus (HSV)

Excessive wound drainage

fecal incontinence

MRSA

Methicillin resistant staphylococcus aureus

a type of staph (skin) bacteria that is resistant to many commin antibiotics

can live harmlessly on skin, but can cause serious infections if they enter through a cut/scrape

what does MRSA look like? signs/symptoms

may resemble a spider bite/pimples

affected areas may be red, swollen and painful

warm to touch

full of pus/other drainage

accompanied by a fever

when are droplet precautions implemented?

for patients who are known/suspected to be infected with an infectious pathogen that can be transmitted by respiratory droplets

protect agaibst droplets larger than 5mcg and travel 3 to 6ft from the client

How can droplet transmission occur?

can occur through coughing, sneezing, talking, suctioning, and endotracheal intubation. cardiopulmonary resuscitation (CPR), or chest physiotherapy

what do droplet precautions include?

private/single room with closed door or with other patients with same disease (patient is provided face mask (surgical) and placed in separate area as from other patients as possible)

PPE includes masks, gowns/gloves can also be used

patient wears face mask when exiting the room and follows respiratory/cough etiquette

examples of diseases that require droplet precautions?

mumps/rubella/pertussis

Streptococcal pharyngitis or pneumonia

scarlet fever

pneumonias (meningococcal, streptococcal, mycoplama)

Haemophilus influenzae type b

how does airborne transmission occur?

may occur through small droplets or particles that are suspended in the air for prolonged periods of time, traveling over a greater distance and for a longer time than larger droplets

for droplets smaller than 5mcg

what do airborne precautions include?

patients are put into a private/negative pressure room

Must use a N95 when caring for the patient

Negative pressure room

if splashing or spraying is possibility, wear gown/goggles/faceshield/gloves

examples of airborne diseases?

Varicella (chickenpox)

Rubeola (measles)

Mycobacterium tuberculosis (TB) - pulmonary and laryngeal

pulmonary vs laryngeal TB

Pulmonary affects the lungs, most common form TB

Laryngeal affects larynx (voicebox), rarer form of TB

When are negative pressure rooms used?

for patients on airborne precautions

Immunizations

process by which an individual develops active acquired immunity against a specific agent

most common immunizations are vaccines but can be acquired through many techniques

what is another term for Neutropenic precautions?

protective isolation

Neutropenic precautions/protective isolation

used to protect patients who have compromised immune systems

patients may or may not already be sick

positive pressure room - nothing from the outside comes inside

protects patients from (infectious) microorganisms in the environment

what types of precautions are used for patients on neutropenic precautions?

filters, masks

meticulous handwashing

no live items (flowers,etc) can be broyght into room

limited or no contact with kids/visitors

raw veggies/uncooked foods are restricted

examples of diseases/conditions that may need protective isolation/neutropenic precautions

cystic fibrosis

people waiting for organ transplants

people undergoing chemotherapy

Quarantine

separates and restricts movement of people/buldings/animals that have been exposed to a contagious disease, but not yet ill, to see if they develop the disease

communicable diseases that isolation and quarartine is authorized

cholera

diphtheria

infectious TB

plague

smallpox

yellow fever

viral hemorrhagic fevers

severe acute respiratory symptoms

influenze that causes a pandemic

what are some environmental safeguards for medical asepsis?

discard disposable items in proper respectables

clean from less soiled to more soiled areas to avoid increasing contamination

avoid shaking linens to decrease the chance of infectious particles becoming airborne

avoid allowing soiled items to touch clothing

pour liquids directly into the drain to avoid splashing

nurses role in medial asepsis

maintaining personal hygiene

keeping fingernails short to avoid scratching patients

avoiding artificial nails bc they harbor microorganisms

keeping hair short/pulled back

avoid wearing rings with groves/stones which can harbor microorganisms

avoid working when ill to prevent spreading infections to susceptible patients/staff members

donning protective eyewear and gloves before cleaning equipment contaminated with infectious organic material

how to set up a sterile field?

don a facemask if required

perform hand hygiene before beginning sterile procedures, a surgical brush with an antimicrobial agent and disposable brush may be required

establish a sterile field on a flat, clean, dry work surface that is above waist

check packages for sterility, intactness, and expiration date before opening

open sterile packages away from body to avoid contamination

How to maintain a sterile field?

keep sterile surfaces dry

to pour liquids into a sterile container, pour liquids slowly within close proximity with a short steady stream to avoid splashing

nonsterile items should not be places on sterile field

to add a packaged item to sterile field, peel the packaging away from the item while maintaining the sterility of the item. do not touch the field with the outside of the packaging

how to avoid contaminating the sterile field?

avoid spilling liquids on cloth/paper that is used as a sterile field because fluids give organisms a means of transport onton the field by capillary actions

do not reach across sterile field

keep all sterile equipment and sterile gloves above waist level

do not sneeze/cough/laugh or talk over sterile field

never turn away from sterile field, it is no longer considered sterile if out of sight

Patient education for transmission based precautions

must educate family if a patient is diagnosed with a transmission based illness and requires precautions

provide fact sheets on illness

provide rationales for the new precautions

explain any risk to family members

explain PPE being used and provide directions for its use by the family

be available to explain and ask questions if necessary

cohorting

assigning patients with the same infectious organism to the same room or care area

used when private rooms are limited

only cohort patients with the same organism

do not cohort immunocompromised patients with infected patients

Nursing care: documentation

document when isolation has begun and when it is discontinued

document patient and family education concerning the proper procedures

Mark isolation precautions required on the chart

place signs in clear view on the door

if isolation is broken, refer to institutional policy and procedures

disinfection

the use of specialized cleaning techniques/agents to destroy or remove all pathogenic microorganisms except spores from inanimate objects

what are some disinfecting agents include:

germicidal agents including bleach, ammonium, formalehyde, chlorhexidine

antiseptic agents include alcohol, hydrogen peroxide, iodine, and benxzalkonium chloride

sterilization

process used to destroy all microorganisms, including spores

many items are purchased as sterile or can be sterilized through physical or chemical means

is used on equipment that is entering a sterile body cavity

physical sterilization

use of steam, boiling water, dry heat or radiation

chemical sterilization

through the use of gases, or solutions

dependent intervention

require a written or oral prescription from a health care provider and include the administration of a medication

independent intervention

do not require a prescription from a health care provider, supervision, or direction from others

aka a nurse-initiated intervention

interdependent intervention

require nursing expertise and knowledge and also require collaboration with other health care professionals

antigens

non-self, harmful and foreign substances

could be both living and non-living

not all antigens are pathogens

immune response is initiated any time immune system recognizes a antigen

pathogen

a disease causing microorganism

infection

establishment of a pathogen in a susceptible host

adaptive immunity

the process by which the immune system is programmed to recognize and destroy non-self (antigen) cells

two types of immune response

innate (nonspecific)

adaptive (specific or acquired)

innate immunity

nonspecific short term defense against foreign antigens (usually immediate/short term response)

first line of defense against pathogens

no memory of the event for future immunity. The same antigen will cause the same reaction in the future

innate immunity defenses include

physical (skin) and chemical (tears, stomach acid) barriers

normal flora

inflammatory response

adaptive immunity

specific, active, long-term defense against foreign antigens

is acquired by exposure to specific antigens

if a pathogen gets past the innate response, this ______ immunity is activated, eliminating the pathogen and providing the memory for future immunity from the same specific antigen

adaptive immunity includes

antigen specific antibodies (humoral immunity)

Lymphocytes (cellular immunity)

virulent

the degree of disease caused by a pathogen

invasive

the ability of any organism to gain entry into the host

normal flora

nonpathogenic microorganisms

could be bacteria, fungi, protozoa

found in various body systems that inhibit colonization in healthy individuals

does normal flora have the potential to be pathogenic

True - it becomes pathogenic when introduced to areas where it does not belong

inflammation

local response to cellular injury/infection

includes capillary dilation and leukocyte infiltration

protective response that helps the body to neutralize control and eliminate invading pathogens.

what are the physical signs of inflammation?

redness, heat, pain, swelling at injured/affected area

where can physical and chemical barriers to pathogens be found?

integumentary, respiratory, and gastrointestinal system

integumentary system (skin)

a barrier that impermeable to most infectious microorganisms

can be a portal of entry or portal of exit for organisms

contains squamous epithelial cells that help remove microorganisms and other infectious agents

sweat decreases the likelihood of infection bc its low pH inhibits bacterial growth

where is normal floral found?

skin/eyes/nose/mouth/upper throat

lower urethra

small intestine

large intestine

normal flora is not present in

sterile body sites such as

heart

kidney/bladder

lungs

blood

what is important when introducing urinary catheters into patients?

maintaining sterile technique

normal flora can become pathogenic in the bladder bc the urinary bladder is sterile

can cause UTIs

white blood cells (WBC)

defend the body from pathogens/foreign substances and promote wound healing

what triggers inflammation?

antigen exposure, cellular and tissue damage, infection

inflammation is generally ______, but too much can _______

protective

can damage tissue and cells, producing disease

five symptoms of imflammation

redness, swelling, heat, pain and loss of function

first stage of inflammation

capillary dilation - increased blood flow, causing the area to feel warm and appear reddened

second stage of inflammation

increased capillary permeability results from body’s release of chemical mediators

chemical mediators allow fluid, cells and protein to leak from surrounding blood vessels into the injured tissue, which results in swelling and pain.

third stage of inflammation

involves leukocyte migration to injury sire. they perform phagocytosis

primary intention - healing occurs at the surface (little injury to tissues)

secondary intention - healing from the bottom up (deep tissue injury)

no memory occurs from the injury or healing for future immunity

what are some signs/symptoms that inflammation and infection share?

Patients with infection can have inflammation, but patients can experience inflammation without having an infection

when do you begin to recognize inflammation as a symptom of infection instead of healing?

patient reports more pain, heat and redness begin o increase, the patient develops a fever greater than 100.4 degrees

purulent drainage

patient may feel nauseated or excessively fatigued

confusion/altered mental status in older adults

gastrointestinal system

normal flora inhibits growth of harmful microorganisms

the low pH of stomach acid acts a chemical barrier that destroys certain types of harmful microorganisms

respiratory system

cilia and mucus move and trap foreign bodies, thereby decreasing the risk for infection

proteins have antimicrobial properties and promote phagocytosis

second line of immune protection

adaptive immunity

what does adaptive immunity begin

at birth and is acquired over a person’s lifetime

humoral immunity

involves specialized WBC that produce antibodies using B-cells

antibody-secreting cells convert into memory cells which provide immunity to the specific antigen upon future encounters

antibodies

immunoglobulin molecules that recognize foreign invaders (antigen)

specific to antigen

cellular immunity

mediated by T cells, occurs at the same time as a humoral response

defend against all pathogen/antigen including fungi and protozoa

also creates memory cells for antigens

types of adaptive immunity

active immunity (includes natural and artificial)

passive immunity (includes natural and artificial)

active immunity

involves the production of antibodies in response to exposure to an antigen

provides long-term immunologic protection

naturally acquired active immunity

occurs by being naturally exposed to a pathogen or contracting disease and becoming immune by developing antibodies