Fundamentals 3a
Infection Control
Importance of Infection Control
Safety and hygiene care are critical for patient welfare.
Relevant chapters include Chapters 10, 17, 18, 19, 22, 23, 24, 25, 26, 28.
Medical and Surgical Asepsis
Definition of Asepsis:
The practice of making the environment and objects free of microorganisms.
Medical Asepsis: Also known as clean technique.
Surgical Asepsis: Also known as sterile technique.
Involves strategies and practices to prepare and handle materials, preventing client exposure to microorganisms.
Maintains objects and areas free from microorganisms.
Use of sterile gloves for procedures involving contact with sterile areas or materials.
Chain of Infection
Components of the Chain of Infection:
Causative Agent or Organism: The pathogen causing the infection.
Reservoir: A place where the organism grows.
Portal of Exit: The route by which the pathogen leaves the reservoir (e.g., body orifices, breaks in the skin, discharges).
Method of Transmission: Can be either direct (e.g., from person to person) or indirect (e.g., through contaminated objects).
Port of Entry: The path the pathogen takes to enter a new host (e.g., openings or breaks in skin).
Susceptible Host: Individual who is at risk for infection.
Types of Infections
Primary Infection: Initial infection caused by a specific pathogen.
Secondary Infection: Infection that occurs due to a second pathogen, often following a primary infection.
Localized Infection: Infection confined to a specific area of the body (e.g., lungs).
Systemic Infection: Infection that spreads to other organs through the bloodstream.
Septicemia: Presence and multiplication of bacteria in the blood.
Healthcare-Associated Infection (HAI): Also known as nosocomial infection; infections acquired in healthcare settings.
Risk Factors for Healthcare Workers
Exposure Factors to Bloodborne Pathogens:
Puncture wounds (e.g., needle sticks).
Breaks in the skin (e.g., cuts).
Mucous membranes of eyes, nose, or mouth (e.g., splashes of blood).
Wearing heavy or ornate jewelry that impedes hand hygiene.
Engaging in activities like eating, drinking, or applying cosmetics in work areas.
Protective Precautions & Infection Control
Guidelines from CDC:
Aimed at reducing risk of transmission of pathogens from body fluids.
Standard Precautions:
Measures to prevent microorganism transmission from recognized and unrecognized sources.
Applies to blood, all body fluids, secretions, excretions (excluding sweat), non-intact skin, mucous membranes, and items that might contain transmissible infectious agents.
Includes:
Handwashing
Body substance isolation
Use of personal protective equipment (PPE)
Proper disposal of used articles.
Standard Precautions
Key Practices:
Hand Washing:
Wash hands properly between patient contact and contact with body fluids or soiled equipment.
Wearing Gloves:
Wear gloves when handling blood, body fluids, non-intact skin, or soiled items; change gloves between patients.
Mask and Eye Protection:
Use when there's a potential for splashes.
Gowns:
Wear during procedures where splashes may occur.
Sharps Disposal:
Dispose of sharps in designated closed containers; do not bend or recap needles.
Patient Placement:
Follow protocols for patient placement, environmental controls, and care equipment.
Occupational Safety and Health Administration (OSHA)
Role of OSHA:
Develops and enforces standards for workplace safety and health.
Recommendations include:
Compliance with Standard Precautions & CDC Guidelines.
HBV vaccination before exposure is mandated.
Mandates that personal protective equipment must be supplied by employers.
Post Exposure Procedure
Steps after Exposure to Contaminated Material:
Wash the exposed area with water or soap and water immediately.
Notify a supervisor.
File an incident report.
Consult a medical professional.
Undergo baseline blood tests and follow-up assessments.
Seek counseling as needed.
When to Wear Gloves
Indications:
Anticipation of contact with blood or potentially infectious materials.
Handling non-intact skin.
During vascular access procedures.
Guidelines:
Change gloves for each task; do not wash or decontaminate disposable gloves.
Perform hand hygiene before donning and after removing gloves.
If allergic to latex, alternative glove types (e.g., vinyl) must be provided.
Hand Hygiene Guidelines
Handwashing Techniques:
Remove all jewelry before washing.
Use comfortably warm water, wet hands from wrists towards fingers.
Work soap into a lather for at least 20 seconds, scrubbing all surfaces, including under nails and between fingers.
Rinse hands thoroughly from wrists toward fingers, avoiding splash back on clothing.
Dry with paper towels and turn off the faucet using another towel.
Hand Sanitizers
Use of Hand Sanitizers:
When soap and water are unavailable, use a sanitizer with a minimum of 60% alcohol.
Rub hands together until dry (approx. 20 seconds).
Not as effective on visibly dirty hands or for removing harmful chemicals.
Personal Protective Equipment (PPE)
Definition: Equipment used for protection against exposure to blood, body fluids, and other infectious materials.
Types of PPE:
Respirators, gloves, gowns, masks, protective eyewear.
Usage: Involves wearing them when caring for clients, regardless of their infection status.
Removing Personal Protective Equipment (PPE)
Steps for Safe Removal:
Follow an orderly sequence to prevent contamination.
Remove the most contaminated items first without touching the outside surfaces.
Dispose of items appropriately; wash hands after removal.
Handle eyewear and masks by their straps to avoid contamination.
Disposal of Contaminated Linens, Equipment, and Supplies
Procedures Include:
Proper cleaning and reprocessing of client care equipment.
Single-use items disposed of appropriately.
Soiled linens placed in leak-proof bags, possibly double-bagged to prevent contamination.
Sharps must be disposed of in puncture-resistant containers.
Blood/Body Fluid Spills
Clean Up Procedure:
Wear gloves and clean spills with a bleach solution (1 part bleach to 9 parts water).
All equipment and surfaces must be cleaned daily or when visibly soiled.
Transmission-Based Precautions (Isolation Precautions)
Definition: Specific precautions used to control the spread of highly contagious pathogens.
Types:
Airborne Precautions: Used for diseases that can be suspended in air (e.g., TB, measles).
Requires private rooms with negative pressure airflow.
Use of high filtration masks (e.g., N95 respirator).
Droplet Precautions: For infections spread via larger droplets (e.g., flu, meningitis).
Maintain a certain distance from the patient.
Contact Precautions: For infections requiring direct/indirect contact (e.g., MRSA, C-diff).
Client Safety
Overview of Client Safety Practices:
Aims to maintain a safe environment and prevent injuries like falls, electrical incidents, and poisoning.
Educating clients on safety practices and monitoring environmental safety.
Fire Safety Protocols:
Familiarize with exits, alarms, extinguishers.
Remember RACE (Rescue, Alarm, Contain, Extinguish/Evacuate).
Fall Prevention in Clients
Assessing Fall Risk: Perform assessments and implement interventions to prevent falls.
Important Considerations:
Ensure patient orientation, maintain call lights within reach, keep beds low, lock wheelchairs and beds, ensure appropriate footwear.
Report all incidents to the responsible personnel.
Hygiene & Care of Client Environment
Room Environment: Must be comfortable and safe, maintain appropriate temperature, ventilation, noise levels, and lighting.
Bed Requirements: Should feature a firm mattress, no rips, side rails, and proper controls.
Hygiene Practices in Client Care
Personal Hygiene Care Plan: Regularly scheduled care, including early morning, morning, afternoon, and bedtime care.
Bathing Practices: Effective bathing is essential, especially for vulnerable populations (i.e., older adults). Warm water is recommended (around 105 degrees F).
Oral Hygiene and Denture Care: Important for maintaining mouth health.
Skin and Hair Care
Importance of skin care in preventing infections; decubitus ulcers must be assessed regularly.
Use tools like the Braden Scale for risk assessment of pressure ulcers.
Pressure Ulcers
Stages:
Stage I: Erythema without blanching, warm area, sensitive to touch.
Stage II: Partial-thickness skin loss with exposed dermis, blistering.
Stage III: Full-thickness loss extending through subcutaneous tissue, potential for infection.
Stage IV: Deep tissue necrosis involving muscle/bone, high risk for infection (e.g., osteomyelitis).
Unstageable: Wound depth obscured by necrotic tissue (eschar).
Effects and Complications of Immobility
Body Systems Impacted by Immobility:
Musculoskeletal: Muscle atrophy, contractures, osteoporosis.
Cardiovascular: Orthostatic hypotension, blood clots.
Respiratory: Atelectasis, pneumonia.
Gastrointestinal: Constipation, decreased appetite.
Urinary: Urinary tract infections, renal calculi.
Integumentary: Pressure ulcers from pressure on skin.
Neurological: Compression neuropathy, confusion.
Positioning, Moving & Lifting Clients
Common Positions: Different methods of supporting patients during assessment and procedures (supine, prone, Fowler’s, etc.).
Body Mechanics: Proper posture and movements to prevent injury and maintain care quality.
Moving Aids: Use of draw sheets, trapeze bars, and transfer belts for safe patient mobility.
Range of Motion (ROM) Exercises
Types of ROM: Active exercises performed by clients versus passive exercises assisted by caregivers.
CPM Machines: Continuous passive motion devices assist patients with mobility recovery.
Comfort, Rest & Sleep
Understanding Pain: Subjective experience; assessed through various scales (Wong Baker, Numerical).
Techniques for pain management include both non-invasive (e.g., TENS, heat application) and invasive (medications like analgesics).
Importance of Sleep: Awareness that hospitalization and other factors can disrupt normal sleep patterns; nurses support rest.