Chapter 26: Asepsis and Infection Control

Introduction

  • Nurses' Responsibilities: Understanding their role in preventing transmission of infectious agents. Infection control practices are essential for safe health care environments for both patients and health care teams.

  • Health Care-Associated Infections (HAIs): The past years have seen a significant increase in the number of HAIs, posing a danger to everyone in health care settings.

  • Objective of the Chapter: Explores the basic aseptic techniques and infection control measures necessary to protect patients and communities from harmful microorganisms.

LO 26.1 Normal Structure And Function of The Body’s Defense System

  • Asepsis: Refers to freedom from and prevention of disease-causing contamination.

  • Infection: Establishment of a pathogen in a susceptible host; a disease state is caused by the infectious agent.

  • Contagious Microorganisms: Some microorganisms can cause serious illness. Nurses must be familiar with how to prevent the spread of infection through aseptic interventions.

  • The Body’s Defenses Against Microorganisms:

    • Normal flora

    • The inflammatory response

    • The immune response

Normal Flora

  • Definition: A group of microorganisms (bacteria, fungi, protozoa) that live in or on the body without causing disease.

  • Locations: Found on skin, eyes, nose, mouth, upper throat, lower urethra, small intestine, and large intestine.

  • Role: Constitutes the body’s first defense against infection by inhibiting the colonization of pathogenic microorganisms.

  • Reference: (Huether, McCance, & Brasher, 2020)

Inflammatory Response

  • Definition: A local response to cellular injury or infection.

  • Mechanism: Includes capillary dilation and leukocyte infiltration, producing redness, heat, pain, and swelling.

  • Function: Allows for neutralization, control, and elimination of invading pathogens. If systemic, can cause fever, chills, malaise, and altered mental status.

  • Fever: Caused by prostaglandins acting on the hypothalamus increases metabolic rate to fight pathogens.

Immune Response

  • Activation: Triggered by recognition of antigens, which are substances that provoke an immune response. These include proteins on pathogens or substances like toxins.

  • Innate Immunity: Non-specific immune response providing immediate defense against antigens (e.g., skin, mucus, enzymes, and acidity).

    • Barrier function: Chemical mediators combat infection, remove foreign substances, and trigger the adaptive immune system.

  • Adaptive Immunity: Provides long-term immunity through exposure to antigens, involving two types:

    • Humoral Immunity: Involves B lymphocytes that produce antibodies in response to pathogens. Antibodies recognize foreign invaders, initiating protective responses (e.g., inflammation).

    • Cellular Immunity: Involves T lymphocytes (e.g., cytotoxic T cells) attacking nonself antigens, with helper T cells stimulating B cell response and macrophage actions.

Immunologic Memory

  • Nature: Adaptive immunity is antigen-specific with long-term immunologic memory.

  • Memory Cells: Formed after exposure to specific antigens, they ensure a quicker, stronger response upon re-exposure.

  • Immunity Types:

    • Active Immunity: Developed through infection or vaccination (long-term).

    • Passive Immunity: Short-term, acquired naturally (e.g., maternal antibodies) or artificially (e.g., injection of antibodies).

Other Body Defenses

  • Integumentary System: Skin prevents infections, but breaches offer portals for pathogens.

  • Respiratory System: Contains cilia and mucus to trap foreign bodies, reducing infection risk.

  • Gastrointestinal System: Flora and low pH prevent pathogen colonization by secretions and nutrient competition.

LO 26.2 Altered Structure And Function of The Body’s Defense System

  • Chain of Infection: Critical to understand for preventing infectious spread. Composed of six links:

    1. Infectious agent

    2. Source of infection

    3. Portal of exit

    4. Mode of transmission

    5. Portal of entry

    6. Susceptible host

Infectious Agents

  • Definition: Pathogens that cause diseases (bacteria, viruses, fungi, parasites).

  • Bacteria: Single-cell organisms, capable of causing disease if their growth exceeds the immune response or if they invade non-natural habitats.

    • Reproduction: Divides through binary fission; identified via culture sensitivity tests.

  • Viruses: The smallest pathogens, requiring host cells for reproduction (e.g., the common cold to AIDS).

  • Fungi: Examples include molds and yeasts that cause conditions like athlete’s foot and candidiasis.

  • Parasites: Living organisms on/in hosts, e.g., protozoans, helminths (worms), arthropods.

Source of Infection

  • Definition: Also called a reservoir where pathogens can survive.

  • Types: Inanimate objects (surfaces, equipment) or human sources (healthcare personnel, patients), and nonhuman sources (animals).

Portal of Exit

  • Definition: Means by which pathogens escape the reservoir (e.g., sneezing, coughing, blood).

Mode of Transmission

  • Definition: Pathways for microorganisms’ transmission to a susceptible host.

  • Types include:

    • Contact Transmission: Physical transfer between the infected and the host (direct or indirect).

    • Airborne Transmission: Microorganisms dispersed through air currents.

    • Droplet Transmission: Occurs when droplets from an infected person reach another's mucous membranes.

    • Vector-Borne Transmission: Carried by vectors (e.g., insects).

Portal of Entry

  • Definition: Ways for pathogens to enter susceptible hosts (e.g., gastrointestinal tract, respiratory tract, skin breaches).

Susceptible Host

  • Definition: An individual at risk of developing an infection after exposure to pathogens.

  • Increased susceptibility in individuals with age extremes, malnutrition, and weakened immunity (e.g., chronic diseases, chemotherapy).

Health Care–Associated Infections (HAIs)

  • Definition: Infections occurring during healthcare treatment.

  • Impact: Significant health and financial costs; result in prolonged recovery, increased disability, and possible death.

  • Sources: Often associated with medical devices, surgical complications, or antibiotic overuse.

    • Examples of resistant pathogens: MRSA, VRE, C. difficile.

Safe Practice Alert

  • Handwashing is the most effective way to prevent HAIs.

Resistant Organisms

  • Drug Resistance: Documented since the 1940s; occurs when microorganisms adapt to evade antibiotics.

  • Conditions with Resistance: Includes MRSA, VRSA, VRE, and certain community-acquired organisms.

  • Factors Contributing to Resistance: Over-prescribing antibiotics, use of inappropriate antibiotics, inadequate treatment courses.

Blood-Borne Pathogens

  • Types: Include hepatitis B, hepatitis C, and HIV, commonly transmitted through contaminated blood.

Signs and Symptoms of Infection

  • Localized Infections: Signs include redness, swelling, heat, and tenderness.

  • Systemic Symptoms: Fever, increased heart rate, and altered mental state may indicate sepsis or systemic infection.

Skill 26.1 Hand Hygiene

  • Purpose: Essential for preventing spread of microorganisms.

  • Resources Needed: Soap, water, paper towels, hand sanitizer.

  • Collaboration: Mandatory for all healthcare workers; cannot be delegated.

  • Evidence-Based Practice: Guidelines for when to wash hands and the effectiveness of hand sanitizers.

Special Circumstances

  1. Assess: Condition of skin (cut, sore).

    • Intervention: Cover and appropriate dressing.

  2. Assess: Nail condition (length, polish).

    • Intervention: Trim, file, or remove.

  3. Assess: Use of jewelry.

    • Intervention: Remove jewelry.

Procedure: Hand Hygiene

  1. Introduce self and educate patient about hand hygiene.

  2. Turn on water to medium flow, wet hands with fingers downward.

  3. Apply soap, lather and rub for 20 seconds (in specified order from less to more contaminated).

  4. Rinse thoroughly, keeping hands pointing downwards.

  5. Dry thoroughly with clean paper towels; avoid rubbing.

  6. Dispose of towels appropriately, turn off the tap with a paper towel.

Hand Hygiene: Sanitizer Method

  1. Apply sanitizer to palm and rub hands thoroughly until dry.

LO 26.3 Assessment

Health History

  • Importance of assessing patient’s susceptibility and defenses against infection.

Skill 26.2 Sterile Gloving

  • Use: Protects highly susceptible patients and sterile objects from microorganisms.

  • Resources Needed: Sterile gloves, flat clean surface.

  • Collaboration: Required of all providers; some tasks may be delegated.

Special Circumstances

  1. Assess: Skin integrity.

    • Intervention: Appropriate dressing or change of assignment.

  2. Assess: Fingernail condition.

    • Intervention: File nails or remove polish.

  3. Assess: Jewelry and glove damage.

Procedure: Applying Sterile Gloves

  1. Introduce self and explain need for sterile technique.

  2. Hand hygiene must be performed.

  3. Open package carefully to avoid contamination.

  4. Don non-dominant glove first, followed by dominant glove, keeping hands above waist.

  5. Adjust gloves as needed without contamination.

Removing Sterile Gloves

  1. Remove gloves in a manner that does not expose skin.

  2. Dispose of gloves correctly and perform hand hygiene afterward.

Effects of Infection on The Body’s Defense System

  • Infection Types: Acute vs. chronic.

  • Signs of Infection: Varies per individual.

  • Assessment of Vital Signs: Changes indicate infection risk (temperature, heart rate, etc.).

  • Nutritional Assessment: Nutrition essential for immune function.

Risk Assessment

  • Factors increasing infection risk include chronic diseases, malnutrition, and the use of indwelling devices.

Laboratory and Diagnostic Tests

  • CBC: Monitor WBC counts; elevated counts indicate infection.

  • Cultures: Identify causative agents and test for antibiotic sensitivity.

  • ESR: Indicates inflammation and response to therapy.

LO 26.4 Nursing Diagnosis

  • Examples of Nursing Diagnoses:

    • Risk for Infection: Based on surgical breaks in skin integrity and chronic disease conditions.

    • Lack of Knowledge: About causes and prevention of infection.

    • Impaired Skin Integrity: Due to prolonged bed rest or inadequate nutrition.

LO 26.5 Planning

  • Planning Stage: Prioritize nursing diagnoses, set goals, and develop care plans.

  • Goals: Patient-centered and measurable.

LO 26.6 Implementation and Evaluation

  • Nurse's Role: Critical in infection control through aseptic technique.

  • Intervention Examples: Regular hand washing, patient education, monitoring temperature and WBC counts, and maintaining strict aseptic technique.

  • Evidence-Based Guidelines: Important for infection prevention strategies across patient care.

LO 26.7 Hand Hygiene

  • Key practices keep infection transmission low among healthcare providers and patients.

  • Hand hygiene is a cornerstone of infection prevention.

LO 26.8 Personal Protective Equipment (PPE)

  • Use of PPE: Protection against infection spread.

  • Proper Application: Prevent contamination, especially in isolation situations.

Removing PPE

  1. Remove gloves first, followed by gown, eyewear, and mask in a specific order to minimize contamination.

Immunization

  • Process: Key for preventing communicable diseases through patient education and updated schedules.

  • Importance: To stay vigilant about vaccinations to reduce risks.

Medical Asepsis vs. Surgical Asepsis

  • Medical Asepsis: Clean techniques and practices to minimize infections.

  • Surgical Asepsis: Sterile techniques for invasive procedures to prevent introducing microorganisms.

Evaluation

  • Continuous assessment allows monitoring of effectiveness in infection control and prevention strategies, ensuring nurses and patients are educated about preventing infection transmission effectively.