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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


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—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
  • 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
  • Iatrogenic
    • HAI from a diagnostic or therapeutic procedure
  • 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











chain of infection17



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




Saliva Exchange


Chain of infection


chain of infection19
Mode of transmission





Portal of entry to a host

Mucous membranes

Nonintact skin

GI tract

GU tract

Respiratory tract

Chain of Infection





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



infectious process
Infectious Process
  • Severity of illness depends on:
    • Extent of infection
    • Pathogenicity of microorganism
    • Susceptibility of host
  • Localized
  • Systemic—affects entire body
  • 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
  • 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
  • Is important because