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Promoting Asepsis and Infection Control. Teresa V. Hurley, MSN, RN. Nosocomial Infections. Worldwide Problem Acquired in health care facilities USA: Cost is in the billions for extended care and treatment A Leading cause of death

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nosocomial infections
Nosocomial Infections
  • Worldwide Problem
  • Acquired in health care facilities
  • USA: Cost is in the billions for extended care and treatment
  • A Leading cause of death
  • Spread by health care workers who fail to wash hands or change gloves
asepsis
Asepsis
  • The absence of contamination by disease causing microorganisms
  • Needed to prevent nosocomial infections, limit transmission of infection and to protect clients and healthcare workers from infection
infection
Infection
  • Pathogen is an organism capable of causing disease
    • Bacteria
    • Viruses
    • Fungi includes yeast and molds
    • Helminths (worms)
current research studies
Current Research Studies

Intensive Investigations into the:

  • Role of bacteria in producing heart disease
  • Role of viruses in the development of cancer
  • Mutation of microorganisms and their ability to resist antimicrobial drugs
center of disease control and prevention reports
Center of Disease Control and Prevention Reports
  • HIV
    • Global HIV AIDS Pandemic 2006
    • Since 1981 65 million infections and 25 million deaths
    • Identified at risk populations in the USA
      • High school students engaged in unprotected sex
      • High school students using injectable drugs

(CDC, 8/11/2006)

cdc reports
CDC Reports
  • HIV testing, counseling and treatment recommendations for all people accessing health care: adolescents, adults and pregnant women as part of routine health care in order to prevent spread (CDC, 9/22/06)

Antibiotic Resistance is WORLD’S MOST PRESSING PROBLEM (CDC, 4/21/06)

cdc reports8
CDC Reports
  • MRSA Resistance to methicillin, oxacillin, amoxicillin
    • Surgical wounds -Bacteremia
    • Catheters -UTI
    • Hospitals -Pneumonia
    • Nursing Homes
    • Dialysis Units where there exits clients with weakened immune systems
cdc reports9
CDC Reports
  • Emergence of CA-MRSA
    • Community Associated MRSA now occurring in people who have not been hospitalized within 1 year or even had a medical procedure (dialysis, catheter or surgery)
    • s/s skin infections, pimples, boils,
    • Clusters: crowded living conditions and poor hygiene practices
cdc reports10
CDC Reports
  • Athletes
  • Military Recruits
  • Children
  • Male to male sexual contact
  • Prisoners
  • Pacific Islanders
  • Alaskan Natives
  • Native Americans
  • Spread skin to skin, cuts, abrasions, contaminated items and surfaces (CDC, 2/3/2005)
cdc reports11
CDC Reports
  • CA-MRSA Tattoo recipients (6/22/06)
  • Streptococcus Pneumoniae Disease
    • Leading cause of morbidity and mortality in the USA
    • Emergence and widespread Drug Resistant Strains (penicillin and multi-drug resistance) (CDC, 1/26/2001)
cdc reports12
CDC Reports
  • Streptococcus Pneumoniae
    • Transmission person to person
      • Otitis media
      • Pneumonia
      • Bacteremia
      • Sinusistis
      • Peritonitis
      • Arthritis

Populations at risk: HIV infected, Sickle Cell Disease,

Elderly, Children under 2 y/o and children attending group day

care centers (CDC, 10/24/2005)

cdc reports13
CDC Reports
  • Drug Resistant Tuberculois Emergence
    • TB resistant to a least one MDRTB (multi-drug resistant TB) INH and Rifampin (CDC, 10/6/2004)

June 2006 hc/Pro Briefings on Infection Control

HIPPA regulations and infection control practices must protect privacy of patients. Door signs on patient doors with TB could lead to potential legal problems due to posting of a sign linked to patient

cdc reports14
CDC Reports
  • VRE Vancomycin Resistant Enterocci

-SPREAD BY DIRECT CONTACT, stool, urine and hands of health care workers

-Normally present in intestines and female genital tract

    • UTI
    • Wound Infections
    • Bacteremia

Risk: long term antibiotic treatment; previous treatment with vancomycin and gentamycin; ICU, CA and Transplant Units; abdominal and chest surgeries; catheters (IV or urinary) (CDC, 11/2005)

cdc reports15
CDC Reports
  • Clostridium Difficile
    • Increased reports of outbreaks in USA
    • Emergence of new and more virulent strains
    • Resistant to antibiotic group: floroquinolones

(CDC, July 2005)

Acinertobacter Normally present in soil and water and skin of people---especially in health care workers

Outbreaks reported in ICUs and in settings where very ill are housed

Risk: people with weakenedd immune systems;chronic lung disease, ventilator patients, diabetics, open wounds and prolonged hospital stays (CDC, 9/24/2004)

airborne transmission
Airborne Transmission

Agent Transferred by droplet nuclei (moisture) or dust particles

  • coughing , talking, sneezing
vehicle transmission
Vehicle Transmission
  • Agent transferred to host by contaminated inanimate objects
  • Food, milk, water, drugs, blood, urine
  • Cholera by water
  • Salmonellosis by meat
  • E-coli by spinach
vectorborne
Vectorborne
  • Agent transferred to host by animate means
  • Mosquitoes, fleas, ticks, lice, and other animals
  • Lyme Disease, malaria, West Nile virus
chain of infection
Chain of Infection
  • Agent, Host and Environmental Interaction
  • The links symbolize essential elements needed by microorganisms to invade and cause cellular injury
portal of entry
Portal of Entry
  • Agent enters the Host by:
    • Integumentary system (skin breaks, mucous membranes as in surgical wounds)
    • Respiratory tract (inhale droplets as colds, measles, influenza)
    • Genitourinary (infected vaginal secretions, semen, as in STDs)
    • Gastrointestinal (ingestion food, water contaminates, as typhoid and Hepatitis A)
    • Circulatory (insect bites as malaria from mosquito bite
    • Transplacental (mother to fetus as HIV and Hepatitis B)
slide21
Host
  • Human being is a susceptible host that can be affected by an agent

If you have not received measles vaccine more likely to get it because you lack immunity.

host characteristics
Host Characteristics
  • Age (immunity declines as age increases)
  • Illness and Injury
  • Stress (decreases immune response)
  • Immunization/Vaccination Status
  • Lifestyle (sharing needles, multiple sex partners, smoking, alcohol and drug abuse)
  • Occupation (chemical agents,needle sticks
  • Skin breaks which is the first line of defense (surgical, pressure ulcer, IV)
host characteristics23
Host Characteristics
  • Nutritional Status (overweight, underweight)
  • Heredity
  • Medications (steroids, non-steroidal anti-inflammatory agents NSAIDs (ibuprofen, aspirin), chemotherapy, antibiotics lead to vaginal yeast infections
  • Nursing and Medical Procedures (urinary catheters, IV’s)
breaking chain of infection
Breaking Chain of Infection
  • Infection Control is the First Line of Defense
  • HAND HYGIENE IS THE SINGLE MOST PRACTICE IN PREVENTING THE SPREAD OF INFECTION
  • JCAHO June 2006: Hand washing is the top priority
  • National Patient Safety Goal (USA Government)
breaking the chain of infection
Breaking the Chain of Infection
  • Wear gloves, masks, gowns and goggles
  • Client Hygiene
  • Dressing Changes using aseptic technique
  • Clean linens
  • Clean Equipment
  • Educate on covering mouth and nose when coughing and sneezing; throwing tissues into garbage bag
breaking chain of infection26
Breaking Chain of Infection
  • Nutrition (protein needed to maintain and repair tissues, production of antibodies, and acid-base balance
  • Exercise
  • Immunizations (measles, mumps, rubella, tetanus every 10 years and flu every year
  • MUMPS reported by CDC (8/6/2006) as being beyond historical limits. Cummulative for 2006 in selected states 5,482
body defenses
Body Defenses
  • Immune system recognizes its self
  • Antigen is non-self “pathogen” and the immune system will attack it
  • Non-Specific Immune Responses are
    • Skin and its normal flora
    • Mucous membranes (as cilia in respiratory tract keep from entering lungs)
non specific immune responses
Non-Specific Immune Responses
  • Coughing, sneezing, tearing reflexes
  • Elimination and acid environment
    • Flora in the large intestine prevent growth of pathogens and peristalsis removes them with feces
    • Natural urine acidity prevents growth and urination rids bladder neck and urethra of microorganisms
non specific immune responses29
Non-Specific Immune Responses
  • Vaginal Flora is acidic; puberty lactobacilli ferment and produce sugars lowering the pH preventing growth of microorganisms
  • Inflammation is cellular response to tissue injury by bacteria, trauma, chemicals, heat etc….
    • Erythema (redness) increased blood flow to area
    • Heat (increased blood flow and metabolism)
    • Pain (pressure on pain receptors)
    • Edema (swelling) fluid and leukocytes
    • Function Loss (pain, swelling)
    • Purulent Exudate (WBCs, dead cells, bacteria, debris)
specific immune response
Specific Immune Response
  • Response to invading antigen
    • Phagocytes do not destroy antigen completely
    • T-cells (T lymphocytes) produce and release lymphokines thus attracting phagocytes and lymphocytes to destroy the antigens;
    • T-cells stimulate B-cell production which leads to antibody production against antigen
medical asepesis
Medical Asepesis

Medical Asepsis is used to prevent the spread of microorganisms. Hand washing is the most effective means to prevent the spread of infection.

  • It is critical that Healthcare workers CLEAN HANDS with alcohol based solution or wash with soap and water as recommended by CDC 2002
  • Microorganisms like to harbor in cracks and crannies of jewelry, long nails, artificial nails/wraps and under nails. Wearing gloves also increases risk of growth from moisture and warmth.
basic principles of medical asepsis
Basic Principles of Medical Asepsis
  • Clean Technique used to prevent the spread of microorganisms
  • Hand washing AGAIN
  • Carry soiled items away from body
  • Do not place soiled items on floor
  • Client instructed not to cough, sneeze, breathe on anyone; expectorate into tissues; cover mouth and nose when coughing and sneezing; (Airborne)
medical aseptic principles
Medical Aseptic Principles
  • Do not shake linens.
  • Clean from least soiled to most soiled.
  • Dispose of soiled or used items directly into receptacles. Place bodily discharge and drainage into plastic bags or containers (e.g. briefs, diapers; linens; specimens).
  • Pour bath water, mouth wash directly into sink drain.
medical aseptic principles34
Medical Aseptic Principles
  • Personal Grooming
    • Shampoo hair
    • Fingernails short, free of broken cuticles, ragged edges
    • Do not wear false nails
    • Do not wear rings with grooves and stones
    • Keep hair off shoulder
handwashing
Handwashing
  • Five Key Factors
    • Time: 15 seconds
    • Water: warm
    • Soap: 1 teaspoon liquid
    • Friction: rub in circular motions from fingers to 1 inch above wrist if not visibly soiled (moving from dirtiest to cleanest) and 1 inch above area of contamination
    • Drying: begin with fingers and move upward

DRY HANDS FIRST THAN TURN OFF FAUCET WITH PAPER TOWEL

personnel protective equipment ppe
Personnel Protective Equipment (PPE)
  • Purpose is to lessen or prevent exposure to infectious material
  • OSHA (1992) mandated that health care agencies must provide its employees with equipment to protect against infection
gloves
Gloves
  • Wear once
  • Do not wear outside client’s room which includes and is not limited to:
    • Charting
    • Telephoning
    • Using the computer
    • Cell phones, pagers, blackberries

Double gloving is acceptable practice when working with blood and bodily fluids.

latex allergies
Latex Allergies
  • Is a critical concern in health care facilities

Clients and health care workers have developed latex allergies.

handwashing39
Handwashing

CDC (2002) recommendations for hand hygiene

  • Use soap and water if visibly soiled
  • Alcohol based hand rub if not visibly soiled
slide40
PPE
  • Personal Protective Equipment (PPE) is any equipment or supplies used to protect clients and healthcare workers.
  • Clean and sterile gloves
  • Impervious gowns
  • Surgical and high-efficiency particulate air (HEPA) masks,
  • Face shields
slide41
PPE
  • Protective eye wear
  • Surgical caps
  • Shoe covers
  • Splash guards
  • Nursing Diagnosis : Risk for Infection
  • Goal: Transmission of microorganisms will be contained
risk for infection
Risk for Infection
  • Assessment: determine need for use
  • Diagnosed infection, communicable disease
  • Likelihood of contact with bodily fluids or blood
  • Check infection control manual
risk for infection43
Risk for Infection
  • Use of PPE interrupts chain of infection and protects client and nurse.
  • Implementation
    • Wash Hands
    • Don gown, gloves, mask, and eyewear
    • Remove gloves, mask, gown, protective eyewear and discard
    • Wash hands
risk for infection44
Risk for Infection
  • Outcomes:
  • Transmission of microorganisms contained
  • Client free of exposure to potentially infectious microorganisms
  • Client verbalizes rationale for use of PPE
surgical asepsis
Surgical Asepsis
  • Sterile means without life
  • Nurse creates an environment free from microorganisms
  • Sterile Technique is used to perform a variety of procedures as giving an injection, starting and IV, sterile dressing change, insertion of urinary catheter, suctioning)
basic principles of surgical asepsis
Basic Principles of Surgical Asepsis
  • Sterile Technique
  • Sterile objects can only touch sterile objects
  • If Un-sterile touches sterile = contaminated
  • Outside of sterile package is contaminated
  • Inside of sterile package is sterile
  • Open sterile package by making sure the first edge is away from you.
sterile principles
Sterile Principles
  • Spilling solution on paper or cloth used for a sterile field = contaminated
  • Sterile objects are held above waist level to keep object in sight
  • Limit talking, coughing, sneezing, or reaching over a sterile field or object.
  • Never turn your back or walk away from a sterile field.
sterile principles48
Sterile Principles
  • The outer 1 inch edge of the sterile filed is contaminated.
  • Use dry sterile forceps to place sterile items on the sterile field.
  • Every item that comes in contact with broken skin, to penetrate skin, inject into body, or enter sterile body cavities is to be sterile ( e.g. dressings, needles, tubes).
sterile technique
Sterile Technique
  • Wash your hands
  • Check expiration date on package labels
  • Check to make sure package is intact
  • Check for signs of wetness
  • Horizontal plane on a field is considered sterile
  • Anything dropping over the edges contaminated
  • One inch border around the sterile plane is considered not sterile
preparing a sterile field
Preparing a Sterile Field
  • Purpose: Maintain sterile asepsis
  • Explain procedure to client
  • Gather equipment
  • Perform hand hygiene
  • Work area flat and waist high
  • Prepare sterile field with drape
  • Place sterile objects on field
  • Check solution three times
  • Place cap on table with edges up
  • Pour with label facing palm from height 4-6 inches into sterile basin
unexpected outcomes
Unexpected Outcomes
  • What would you do if:
  • part of the sterile field becomes contaminated?
  • forgot something?
  • client touches your hand or sterile field?
donning and removing sterile gloves
Donning and Removing Sterile Gloves
  • Purpose: provide barrier against infection spread
  • Wash hands
  • Obtain correct size glove and bring to work area
  • Surface is clean and dry
  • Open outside package
  • Open inside package
  • Don gloves using non-dominant hand to put on dominant hand glove than later for non-dominant
  • Remove using dominant first
  • Discard gloves in hazardous waste container
  • Wash hands

Be careful that you do not touch your face when you have gloves on.

If you sneeze or cough and cover your nose or mouth you must re-glove.

risk for latex allergy response
Risk for Latex Allergy Response
  • Assess for Latex Allergy
  • Hx allergies etc.
  • Use latex-free gloves
  • Goal: Client will not exhibit signs and symptoms of latex allergy response