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Sepsis and Infection Control: Chapters 1-10 Flashcards

Learning outcomes

  • Perform hand hygiene using an alcohol-based hand sanitizer.
  • Perform hand hygiene using soap and water (hand washing).
  • Put on and remove personal protective equipment (PPE) safely.
  • Prepare a sterile field.
  • Add sterile items to a sterile field.
  • Put on sterile gloves and remove soiled gloves.
  • Nursing concepts: clinical decision making, clinical judgment, infection, inflammation, and safety.

Introduction to Sepsis and Infection Control

  • Nurses and other health care workers play a key role in preventing and controlling infection, minimizing complications, and reducing adverse outcomes for patients.
  • Prevention of health care-associated infections (HAIs) is a major challenge for health care providers.
  • In the United States, more than a million HAIs occur every year, accounting for tens of thousands of deaths and billions of dollars in health care costs. (AHRQ, 2019)
  • Limiting the spread of microorganisms is accomplished by breaking the chain of infection.
  • The practice of asepsis includes all activities to prevent infection or break the chain of infection.

Asepsis: Medical vs Surgical

  • Medical asepsis (clean technique): procedures and practices that reduce the number and transfer of pathogens.
    • Examples: hand hygiene, wearing gloves.
  • Surgical asepsis (sterile technique): practices used to render and keep objects free of microorganisms.
    • Examples: procedures like inserting an indwelling urinary catheter or an intravenous catheter.

Hand Hygiene and Moments for Action

  • Hand hygiene is the most effective way to reduce the spread of potentially infectious agents and the risk of provider colonization or infection.
  • Hand hygiene means cleaning hands by:
    • Soap and water (hand washing),
    • Aseptic hand wash,
    • Aseptic hand rub (alcohol-based hand sanitizer), or
    • Surgical hand antisepsis.
  • The Joint Commission recommends using CDC and WHO guidelines for hand hygiene as part of patient safety goals.
  • WHO’s Five Moments for Hand Hygiene (key moments for performing hand hygiene):
    • Before touching a patient
    • Before clean or aseptic procedure
    • After body fluid exposure risk or risk of exposure
    • After touching the patient
    • After touching the patient’s surroundings

Standard and Transmission-Based Precautions (CDC/WHO references)

  • Fundamentals Review 1.3 and 1.4 summarize CDC-recommended practices for standard and transmission-based precautions.
  • Standard precautions apply to all patients regardless of diagnosis or presumed infection status and cover:
    • Blood, all body fluids, secretions, and excretions (except sweat), nonintact skin, and mucous membranes.
    • The extent of exposure determines the specific application.
  • The topic emphasizes nursing skills to prevent the spread of infection:
    • Hand hygiene, PPE use, preparing a sterile field, adding sterile items to a sterile field, and sterile glove use/removal.

Basic Principles of Medical Asepsis (Fundamentals Review 1-1)

  • Practice good hand hygiene.
  • Carry soiled items away from the body to prevent contamination of clothing.
  • Do not place soiled linen or items on the floor (floor is grossly contaminated).
  • Avoid allowing patients to cough, sneeze, or breathe directly on others; provide disposable tissues and instruct patients to cover their mouth/nose when indicated.
  • Move equipment away from you when brushing, dusting, or scrubbing to prevent contamination of face, hair, and uniform.
  • Use a dampened cloth to reduce dust; dust and lint can transport organisms.
  • Clean least soiled areas first, then move to more soiled areas to avoid contaminating clean areas.
  • Handle used textiles/fabrics with minimal agitation to avoid contaminating air, surfaces, and people.
  • Dispose of soiled/used items directly into appropriate containers; wrap moist items in waterproof containers before discarding.
  • Pour liquids (e.g., bath water, mouth rinse) directly into the drain to avoid splattering.
  • Sterilize items suspected of containing pathogens; after sterilization, they can be managed as clean items if appropriate.
  • Use personal grooming habits to prevent spread: shampoo hair regularly; keep nails short and free of broken cuticles; avoid artificial nails in high-risk care; avoid rings with grooves and stones that harbor organisms.
  • Follow facility infection-control guidelines for barrier techniques.

Basic Principles of Surgical Asepsis and Patient Care (Fundamentals Review 1-2)

  • Only a sterile object can touch another sterile object; touching sterile with unsterile causes contamination.
  • Open sterile packages so the first edge of the wrapper is directed away from you to avoid contact between the sterile surface and unsterile clothing.
  • The outside of a sterile package is considered contaminated.
  • Avoid spilling liquids on cloth/paper used as a sterile field; moisture can penetrate and carry organisms via capillary action.
  • A wet field is contaminated if the surface below is not sterile.
  • Hold sterile objects above waste level.
  • Do not talk, cough, sneeze, or reach over a sterile field or object.
  • Never walk away from or turn your back on a sterile field.
  • All items that contact broken skin or penetrate skin or enter sterile body cavities must be sterile (e.g., dressings, needles, catheters).
  • Consider the outer 1 inch edge of a sterile field contaminated.
  • Be cautious: an object is contaminated if there is any doubt about sterility.

Standard Precautions (Overview and Practices)

  • Standard precautions apply to all patients in all settings, regardless of infection status.
  • Apply to blood, all body fluids, secretions, excretions (except sweat), nonintact skin, and mucous membranes.
  • Application depends on the interaction and anticipated exposure.
  • Goals: reduce transmission of infectious agents among patients and healthcare workers.
  • Tier One actions:
    • Follow hand hygiene recommendations.
    • Wear clean, non-sterile gloves when touching blood, body fluids, excretions, secretions, contaminated items, mucous membranes, nonintact skin, or potentially contaminated skin.
    • Change clothes between tasks on the same patient when moving from a contaminated body site to a clean body site.
    • Remove gloves promptly after use.
    • Wear PPE (mask, eye protection, goggles, face shield, or fluid-repellent gown) during procedures that involve contact with blood, body fluids, secretions, contaminated items, mucous membranes, nonintact skin, or when splashes are likely.
    • Use a gown to protect skin and prevent soiling of clothing.
    • Avoid recapping used needles; if recapping is necessary, never use two hands—use a needle recapping device or one-handed scoop technique.
    • Place needles, sharps, and scalpels in appropriate puncture-resistant containers after use.
    • Wear gloves to handle used equipment or items soiled with blood or body fluids.
    • Clean and reprocess items appropriately if used for another patient.
    • Follow respiratory hygiene and cough etiquette; educate patients and visitors.
  • Respiratory hygiene and cough etiquette are part of standard precautions and apply to all entering individuals with signs of illness; educate and post appropriate multilingual signs; advise mask use for coughing individuals when possible; maintain spatial separation when feasible (
    • Spatial separation ideally greater than 3\,\text{feet} between individuals with respiratory infections in common waiting areas).
  • Healthcare personnel with respiratory infections should avoid direct patient contact, especially with high-risk patients; if unavoidable, wear a mask.

Transmission-Based Precautions (Standard + Transmission-Based; CDC 2007 reference and updates)

  • Transmission-based precautions are used in addition to standard precautions for patients with documented or suspected infection or colonization with pathogens transmitted by airborne, droplet, or contact routes.
  • The three categories can be used in combination as needed.
  • Equipment should be disposable when possible; keep patient-care equipment in the room and do not reuse for other patients.
  • In 2007 CDC guidelines, PPE should be worn when entering a room of a patient with transmission-based precautions and removed when leaving the room.
  • Categories recognize multiple transmission routes and may require multiple precautions.

Airborne Precautions (Tier Two)

  • For infections that spread via the air (e.g., tuberculosis, varicella/chickenpox, rubella/measles, possibly SARS, SARS-CoV-2/COVID-19 during aerosol-generating procedures).
  • Place the patient in a private room with monitored negative air pressure relative to surrounding areas; ensure 6–12 air changes per hour and appropriate air discharge outside or monitored filtration if air is recirculated.
  • Keep the door closed; wear a mask or respirator appropriate to the disease before entry.
  • If possible, non-immune healthcare personnel should not care for patients with vaccine-preventable airborne diseases.
  • Transport the patient out of the room only when necessary; place a surgical mask on the patient if possible and ensure respiratory hygiene and cough etiquette.
  • Consult CDC guidelines for disease-specific precautions and additional prevention strategies (e.g., tuberculosis).

Droplet Precautions (Tier Two)

  • For infections spread by large particle droplets generated when a patient coughs, sneezes, or talks (e.g., influenza, coronavirus, rubella, mumps, diphtheria, certain adenovirus infections in infants/young children).
  • Use a private room if possible; door may remain open.
  • Wear PPE upon entry for all interactions that may involve contact with the patient or potentially contaminated surfaces.
  • Transport the patient out of the room only when necessary; place a surgical mask on the patient if possible.
  • Keep visitors at least three feet away from the infected person.

Contact Precautions (Tier Two)

  • Intended to prevent transmission from direct or indirect contact with the patient or the patient’s environment (e.g., C. difficile, RSV, MRSA, impetigo, norovirus, MDROs).
  • Place the patient in a private room if available; wear a gown and gloves for all interactions that may involve contact with the patient or potentially contaminated surfaces.
  • Remove PPE before leaving the patient’s environment and wash hands with an antimicrobial or waterless antiseptic
  • Limit movement of the patient out of the room and avoid sharing patient-care equipment.
  • Special note: observe increased environmental contamination risk with excessive wound drainage or fecal incontinence; take extra precautions in such cases.

Safe Injection Practices and Additional Precautions

  • Use basic principles of aseptic technique for preparation and administration of parenteral medications.
  • Use a sterile, single-use disposable needle and syringe for each injection.
  • Prevent contamination of injection equipment and medications.
  • Whenever possible, use a single-dose vial (preferred) over multiple-dose vials, especially when medications will be administered to multiple patients.
  • Wear a face mask for placement of a central venous catheter and during replacement of a catheter or injection into the spinal/epidural space.
  • Implement respiratory hygiene and cough etiquette for all staff, patients, and visitors; educate, post multilingual signs, and encourage tissues for coughing individuals.

Respiratory Hygiene and Etiquette (Practical Implementation)

  • Respiratory hygiene and cough etiquette apply broadly to all persons entering a health care setting (staff, patients, visitors).
  • Provide education about respiratory hygiene and cough etiquette; post signs in appropriate languages.
  • Cover mouth and nose with a tissue when coughing; dispose of tissues promptly after use.
  • Use surgical masks on coughing individuals when tolerated and appropriate.
  • Perform hand hygiene after contact with respiratory secretions.
  • Provide spatial separation (ideally > 3\,\text{feet}) in waiting areas when possible.

Notes on Real-World Practice and Policy

  • Follow facility-specific infection control policies and the CDC/WHO guidelines for ongoing updates.
  • The above precautions are designed to protect patients, health care workers, and visitors from infection and transmission risks in health care settings.