Patient Care 1 - Exam 2 - chp. 17-23

Define Chain of Infection

A precise series of events for microorganisms from infected person to be transmitted to an uninfected person.

1. Host

2. Infectious organism

3. Mode of transportation

4. Reservoir

Categorize the four basic infectious agents along with their unique characteristics

Bacteria: microscopic, single-celled, simple internal organization, prokaryotic (lack nucleus), may reside in a group/luster (colony), can be spheres/cocci, rods/bacilli, or spirals

Viruses: neither prokaryotic nor eukaryotic, obligate intracellular parasites, cannot live outside of a living cell, dependent on host, carries own genetic material DNA OR RNA, size 20-250nanometers (microscopic), uses organelles and metabolic functions of host to make new viruses

Fungi: macroscopic (mushrooms) or microscopic (mold/yeast), eukaryotic, intracellular organelles can be visualized, much larger than bacteria, mold resembles a tree with branches

Protozoan parasites: unicellular, neither plants nor animals, greater size, do not posses a cell wall, motile, eukaryotic, able to ingest food particles, some have rudimentary digestive systems, some can form cysts so they can survive outside of the host

Explain the steps involved in the establishment of an infectious disease

1. Encounter: infectious organism coming into contact with host, initially takes place during the normal birthing process

2. Entry: via ingression (microorganisms adhere to the surface of the cell and excrete toxins) or penetration (using flagella, vectors, or wounds/cuts)

3. Spread: the propagation of the infectious organism, can take place before or after multiplication, site of microbial entry and human anatomy of the site determine the spread

4. Multiplication: incubation period

5. Damage: direct (cell death) or indirect (altering the metabolism of the host)

6. Outcome: 1. Host gains control and eliminates infectious agent, 2. Infectious agents overcomes host’s immunities and causes disease, 3. Both host and infectious agent are present together

Discuss the four factors involved in the spread of disease and the chain of infection

1. Host: humans are a favorable host bc of the abundance of nutrients and metabolites

2. Infectious organism: bacteria, fungi, viruses, and Protozoa

3. Mode of transportation: exogenous (externally, can be direct or indirect) or endogenous (inside, encounters with organisms already present in/on body)

4. Reservoir: site where an infectious organism can stay alive and where transmission can occur, carrier

Describe the various sources of healthcare-associated infection

• medical personnel

• Patient flora

• Contaminated healthcare environment

• Blood-borne pathogens

• Invasive procedures

Contrast medical and surgical asepsis

Medical asepsis: reduction in numbers of infectious agents

Surgical asepsis: procedure used to prevent contamination before, during, or after surgery using sterile technique

Explain the constituents of microbial control within the host

Internal

Mechanical and chemical barrier is skin and mucous membranes

Mechanical: skin

Chemical: sebaceous glands, sweat glands, mucus, tears, and urine

Cellular: phagocytosis

External

Normal microbial flora

Physical methods: handwashing

Chemotherapy

Immunizations: vaccines

List the chemical and physical methods of asepsis

Chemical

Disinfectants: alter environment but do not remove bacterial endospores. Chlorine and iodine, alcohol, and hydrogen peroxide

Physical

Sterilization: moist heat (autoclave), dry heat (oven)

pasteurization: heating followed by rapid cooling

UV light

Barriers: gloves, gowns, masks, face shield, protective eyewear

Demonstrate the medically aseptic handwashing technique

1. Approach sink and consider it to be contaminated. Avoid contact with any clothing. Use foot or knee levers when available. If unavailable, use toweling to handle all controls. Adjust water flow to avoid splashing.

2. Wet hands throughly with water. Keep hands lower the elbow.

3. Apply soap.

4. Use a firm, vigorous, rotary motion. Begin at wrist and work toward fingertips. Rub palms, back of hands, between fingers, and under nails.

5. Rinse and allow water to run down over the hands.

6. Repeat the entire process to cleanse from the elbow to the fingertips.

7. Turn off the water. Use toweling on handles if foot or knee levers not available.

8. Dry from elbow to fingertips, never returning to an area.

Describe the basic premises of standard precautions

Both body fluid precautions and body substance isolation. Should be used when coming into contact with blood, body fluids, secretions, excretions, mucus membranes, and nonintact skin, also soiled/contaminated items of these. All patients should be regarded as potentially infectious.

• handwashing: hand MUST be washed before and after

• Gloving: gloves MUST be worn

• PPE: MUST be used when coming into contact is possible

• Needle recapping: used needles MUST be put into sharps container and it is strongly advised not to recap

• Biohazard spill: gloves and PPE must be worn to clean

Relate types of transmission-based precautions with appropriate clinical situations

Airborne: patients with TB, chickenpox (varicella), measles should be placed in a negative pressure isolation room with door closed. When entering, wear respiratory protection. If patient needs to leave they need to wear a surgical mask.

Droplet: patients with rubella, mumps, flu, and adenovirus should be placed in a private room or with another patient with the same disease, the door can remain open. Both patient and healthcare worker should wear surgical masks.

Contact: patients with hepatitis A, impetigo, varicella, and varicella zoster should be placed in a private room or with a patient with the same disease. Healthcare workers should wear gloves and gown and take them off before leaving. Patient should wear mask and gown when leaving.

Demonstrate the contact precautions technique

1. Determine the correct number of cassettes needed for examination. Place each cassette into protective bag.

2. Move the portable machine to the isolated room.

3. Locate the isolation supplies for the room.

4. Remove all ornamentation and place them in pocket

5. Put on lead apron

6. Wash hands

7. Booties?

8. Put on clean gown, making sure it is sufficiently long. Pick up the gown from the inside near the armhole openings and gently shake it open. Put one arm in and then the other. First tie the neck strings and then tie the waist strings.

9. Put on a mask, tying it securely, and then a cap. Goggles may also be worn.

10. Put on gloves

11. Have the assistant put on gown, gloves, and cap

12. Enter the isolate area and explain to the patient who you are and what you are doing. You will appear intimidating, so a gentle word would go far.

13. Position the patient and the cassette

14. Have your assistant manipulate the machine and make the exposure

15. Remove the cassette from behind the patient. Fold the edge of the protective bag back, never touching the inside. Have your assistant remove the cassette, never touching the outside. Place the covering into an appropriate container. Have your assistant remove the portable equipment from the room

16. Untie the waist strings of the gown

17. Untie the neck strings of the gown and pull the gown forward and down from the shoulders. Pull the gown off so that the sleeves are inside out and the front of the gown is folded inward. Avoid touching the front of the gown. Discard it into an appropriate container.

18. Remove the cap and the mask, touching only the mask’s stings or elastic. Discard the cap and mask into an appropriate container.

19. Wash your hands

20. Have your assistant follow the same protocol. Clean the portable equipment with an antiseptic.

21. Wash your hands one last time.