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NUR 104 . Asepsis Infection Control. Standard Precautions. Good health depends in part on a safe environment. Practice or techniques that control or prevent transmission of infection help to protect clients and health care workers from disease. Standard Precautions.

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nur 104

NUR 104

Asepsis

Infection Control

standard precautions
Standard Precautions
  • Good health depends in part on a safe environment.
  • Practice or techniques that control or prevent transmission of infection help to protect clients and health care workers from disease
standard precautions3
Standard Precautions
  • Employees are to follow precautions to prevent contact with blood or other infectious materials during the routine care of clients
  • Personal protective equipment (PPE) must be provided at no cost to the employees who are at risk for exposure and must be used by the employee
standard precautions4
.Standard Precautions
  • Principles/procedures to prevent and control infection and its spread.
  • Break the chain of infection
  • Applies to all blood and body fluid except sweat
  • Nonintact skin and mucous membranes
  • Protect patient and healthcare worked
asepsis
Asepsis
  • Asepsis—absence of pathogenic microorganisms
  • The nurse’s efforts to minimize the onset and spread of infection based on principles of aseptic technique
  • Aseptic technique refers to practices that keep a client as free from microorganisms as possible
  • Two types: medical and surgical
surgical asepsis
Surgical Asepsis
  • Sterile technique
  • To eliminate all microorganisms, including pathogens and spores from an object or area
  • If an area or object is touched by any object that is not sterile it is considered contaminated
medical asepsis
Medical Asepsis
  • Clean technique
  • Reduce number of organisms present and prevent the transfer of organisms
    • Hand Hygiene
    • Clean Gloves
  • Contaminated objects
    • Bedpans/Urinals
    • Overbed tables
    • Dirty Dressings
infection
Infection
  • Entry and multiplication of an infectious agent in the tissues of a host.
  • Infectious agent—pathogen
  • asymptomatic
  • symptomatic
health care associated infection
Health-Care Associated Infection
  • HAI result from delivery of health services in a health care facility
    • High population of virulent strains of microorganisms that may be resistant to antibiotics
    • Increased hospital stays
    • Surgical or traumatic wounds
    • Urinary and Respiratory tracts
    • Bloodstream
healthcare acquired infection
Healthcare Acquired Infection
  • Clients in hospital are at risk for acquiring
    • Low resistance to infectious microorganisms
    • Increased exposure to the number and types of disease causing microorganisms
    • Invasive procedures
    • NON PAYMENT ISSUES
infection11
Infection
  • Iatrogenic
    • HAI from a diagnostic or therapeutic procedure
infection12
Infection
  • Exogenous infection—from organisms external to the person that do not exist as normal flora
  • Endogenous infection—when person’s flora becomes altered and an overgrowth results—yeasts, streptococci
risk factors
Risk factors
  • Inadequate secondary defenses
    • Reduced hemoglobin level
    • Suppression of WBCs
    • Suppressed inflammatory response
    • Low WBC count (leukopenia)
patient susceptibility
Patient Susceptibility
  • Age—infant, child, older adults
  • Nutritional status—protein, carbohydrates, fats
  • Stress
  • Heredity
  • Disease process—immune system, chronic diseases, burn patients
  • Medical therapy—some drug and medical therapies compromise immunity to infection
patients at risk
Patients at Risk

Inadequate primary defenses

  • Broken skin or mucosa
  • Traumatized tissue
  • Decreased ciliary action
  • Obstructed urine outflow
  • Altered peristalsis
  • Change in pH of secretions
  • Decreased mobility
chain of infection
Chain of Infection

CAUSATIVE

AGENT

SUSCEPTIBLE

HOST

Reservoir

PORTAL OF

ENTRY

PORTAL OF EXIT

MODE OF

TRANSMISSION

chain of infection17

CAUSATIVE

AGENT

Chain of Infection
  • Infection occurs in a cycle

that depends on the presence

of all of the following:

    • An infectious agent or pathogen
      • Bacteria, fungi, virus, parasite
    • Dose, Virulence, Enter/ survive, Host resistance
chain of infection18
A reservoir or source for pathogen growth

Human beings, animals, inanimate objects

Portal of exit from the reservoir

Sputum, emesis, stool, blood

Sneeze/Cough

UTI

Drainage

Saliva Exchange

PORTAL OF EXIT

Chain of infection

Reservoir

chain of infection19
Mode of transmission

Contact

Airborne

Vectorborne

Vehicle

Portal of entry to a host

Mucous membranes

Nonintact skin

GI tract

GU tract

Respiratory tract

Chain of Infection

MODE OF

TRANSMISSION

PORTAL OF

ENTRY

chain of infection20
Chain of Infection
  • Susceptible Host
    • Immunosuppressed
    • Elderly
    • Chronically ill
    • Trauma
    • Surgery

SUSCEPTIBLE

HOST

infectious process
Infectious Process
  • Severity of illness depends on:
    • Extent of infection
    • Pathogenicity of microorganism
    • Susceptibility of host
  • Localized
  • Systemic—affects entire body
sepsis
Sepsis
  • The spread of an infection from its initial site to the blood stream, initiating a systemic response that adversely affects blood flow to vital organs
  • Bacterial infections are the most common source of initial infection
  • When organisms overwhelm local defenses and enters the bloodstream the resulting condition is called septicemia
inflammatory response
Inflammatory response
  • Body’s cellular response to injury or infection = inflammation
  • Inflammation = (1) protective vascular and cellular reaction that
    • Delivers fluid, blood products, and nutrients to interstitial tissues in the area of injury
    • Neutralizes and eliminates pathogens or dead (necrotic tissues)
    • Establishes means of repairing body cells and tissues
signs of inflammation
Signs of inflammation
  • Localized
    • Swelling
    • Redness
    • Heat
    • Pain or tenderness
    • Loss of function
  • Systemic:
    • Fever, leukocytosis, malaise, anorexia, nausea, vomiting, lymph node enlargement
vascular response
Vascular response
  • Injury/infection:
    • Arterioles supplying the area dilate, allowing more blood into the local area. This causes redness, localized warmth is from greater blood volume. Vasodilation delivers blood and WBCs to injured tissues
    • Injury causes tissue necrosis. Fluid, protein, and cells enter interstitial spaces, accumulated fluid appears as localized swelling (edema)
    • Pain is caused by the swelling of inflamed tissues increasing pressure on nerve endings
cellular response
Cellular response
  • WBCs arrive at the site
  • WBC pass thru blood vessels into the tissues
  • Phagocytosis—specialized WBCs called neutrophils and monocytes ingest and destroy microorganisms or other small particles
  • Leukocytosis—increased # of circulating WBCs in response to WBCs leaving the blood vessels
2 inflammatory exudate
2. Inflammatory exudate
  • Accumulation of fluid and dead tissue cells and WBCs form an exudate at the site of inflammation
    • Serous—clear, like plasma
    • Sanguineous—containing RBCs
    • Purulent—containing WBCs and bacteria
  • Cleared away by the lymphatic drainage
3 tissue repair
3. Tissue Repair
  • Healing involves the defensive, reconstructive, and maturative stages
    • Damaged cells replaced with healthy new cells
    • New cells undergo gradual maturation until they have the same structural and appearance as previous cells
    • Chronic inflammation—tissue defects may fill with fragile granulation tissue—not as strong as tissue collagen--scar
nursing assessment
Nursing Assessment
  • Review of disease history, exposure to CD
  • Review of clinical condition—signs and symptoms of actual infection or risk for infection
  • Analysis of lab findings
nursing diagnosis
Nursing Diagnosis
  • Risk for infection
  • Risk for injury
  • Imbalanced nutrition
  • Impaired skin integrity
  • Impaired oral mucus membrane
slide31
Plan
  • Prevent exposure to infectious organisms
  • Controlling or reducing the extent of infection
  • Maintain resistance to infection
  • Education of client and family about infection control techniques
management of infection
Management of Infection
  • Asepsis
  • Handwashing is the MOST EFFECTIVE means for preventing the spread of organisms
  • Basic Practices:- Wash hands before and after each patient- Cleans from clean to dirty- Do not hold soiled items close to body- Wear gloves when exposure is expected
  • UCSF dress code includes:- Clean uniforms- Short nails, non-acrylic- No rings with grooves or stones that may harbor organisms
blood borne pathogens
Blood Borne pathogens
  • Hepatitis B
  • HIV
transmission of pathogens
Transmission of pathogens
  • Control or elimination of infectious agents
    • Cleaning
    • Disinfection and sterilization
  • Control or elimination of reservoirs
  • Control of portal of exit
  • Control of transmission
    • Handwashing, sharing of equipment, carrying dirty linen out from the body
  • Control of portals of entry
protection of susceptible hosts
Protection of susceptible hosts
  • Isolation precautions
  • Protective environment
  • PPE
    • Gloves, gowns, masks, eye protection
  • Specimen collection
  • Bagging trash/linen
  • Transporting clients
isolation precautions
Isolation Precautions
  • Standard Precautions
    • Universal precautions
    • Neutropenia
    • Respiratory
    • Contact
  • Hand hygiene
    • Most important and most basic in controlling transmission of infection
    • Use alcohol hand antiseptic before and after providing care
    • Handwashing is a vigorous, brief rubbing together of the surface of the hands lather with soap, followed by rinsing under a stream of water
isolation precautions37
Isolation Precautions
  • Standard Precautions (Tier One)- Assumes that all patients are potentially infectious- Sometimes referred to as Body Substance or Universal Precautions (body fluids, secretions, excretions, blood)
  • Transmission-Based (Tier Two)- Airborne - Droplet - Direct
isolation precautions39
Isolation Precautions
  • Personal protective equipment
    • Gloves
    • Goggles
    • Gown
    • Mask
    • Shoe covers
  • Isolation/protective environments
  • Client and family education
isolation precautions cont
Isolation Precautions (cont.)
  • Airborne (measles, varicella, TB)- Private, negative pressure room- Wear fit-tested (N 95 respirators) masks- Stop Sign at Door
  • Droplet (diphtheria, rubella, mumps, (p663) etc.)- Private room- Mask (regular) when within 3 feet of patient- Stop Sign at Door
isolation precautions42
Isolation Precautions
  • Contact (C-diff, E-coli, hepatitis, HSV, VRE, MRSA, etc.)
    • Private room
    • Gowns, gloves, masks (regular)

- Stop Sign at Door

  • Protective (Reverse Isolation)
isolation precautions45
Isolation Precautions
  • Psychological implications
  • Environment
  • Equipment
  • Specimen collection
  • Bagging of trash and linen
  • Transporting clients
disposal techniques
Disposal Techniques
  • Bagging

- Contaminated materials (i.e. blood, feces etc.) in Biohazard Bag- Slightly soiled and disposable equipment go in regular trash

  • Soiled linen in linen hampers- Bring hamper to bedside, do not carry soiled linens down the hall
disposal techniques47
Disposal Techniques
  • Sharps- Needles, syringes, scalpels etc. in puncture resistant Sharps containers- Do NOT recap used needles
  • Isolation Rooms- May require special disposable equipment (i.e. food trays, blood pressure cuffs, thermometers etc.) that remain in room until patient leaves
handwashing
Handwashing
  • Is important because

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