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206 Cards in this Set

  • Front
  • Back

NURSES AND INFECTION
responisble for
-identifying
-preventing
-controlling
-teaching
INFECTION
a disease state that results from the presence of pathogens in or on the body
PATHOGENS
disease producing microorganisms
6 COMPONENTS OF INFECTION
1-infectious agent
2-reservoir
3-portal of exit
4-means of transmission
5-portal of entry
6-susceptible host
INFECTIOUS AGENT
bacteria
virus
fungi
BACTERIA
most significant and most commonly observed infection-causing agents in healthcare insitiutions

categorized in variety of ways
SHAPE CATERGORIZING OF BACTERIA
cocci-spherical
bacilli-rod shaped
spirochetes-cork screw shaped
GRAM POSITIVE BACTERIA
based off gram stain
thick cell wall that resists decolorization of the stain and stay violet
GRAM NEGATIVE BACTERIA
more chemically complex cell wall and are decolorized by alcohol and remain pink in gram stain- do not stain violet
AEROBIC BACTERIA
bacteria that require oxygen to live and grow
ANAEROBIC BACTERIA
bacteria that do not require oxygen to live and grow
VIRUS
smallest of all mircoorganisms, visible only with microscope
cause many infections- cold aids
antibiotics do not affect
some antiviral drugs can reduce viral infection
FUNGI
plant like organisms that also cause infection
molds, yeasts
present in air, soil, and water
athletes foot, ringworm, yeast infections
treat with antifungal meds- many are resistant
FACTORS THAT DETERMINE ORGANISMS ABILITY TO CAUSE DISEASE
-number of organisms
-virulence of the organism
-competence of the person's immune system
-length and intimacy of the contact between the person and the mircobe

not all microbes cause disease
VIRULENCE
an organisms ability to cause disease
ENDEMIC DISEASE
a disease that occurs with predictibilty in one specific region or population
it can appear in different geographical locations in time as well
NORMAL FLORA
microbes that commonly inhibit various body sites and are part of the body's natural defense system

do not cause disease normally but may if the opportunity is given
OPPURTUNIST MICROBES
microbes that normally do not cause a problem but will in certain conditions or certain factors arise

EColi- in intestines when migrates to urinary tract = UTI
RESERVOIR
the natural habitat of a microbe
where it grows and multiplies
POSSIBLE MICROBE RESERVOIRS
people
animals
soil
food
water
milk
inanimate objects
OTHER PEOPLE AS A RESERVOIR
some people exhibit signs and symptoms; some do not
CARRIERS
a person who is acting as a reservoir for an infectious microbe but is not exhibiting any signs or symptoms of disease or infection

asymptomatic but can transmit disease to another

-nurses can act as such through improper handwashing and nail care
ANIMALS AS RESERVOIRS
rabies in dogs, bats, squirrels, racoons
west nile in birds
SOIL AS A RESERVOIR
gas gangrene, tetanus
WATER AS A RESERVOIR
Giardia, Ecoli, shigella
drinking or swimming leads to exposure
FOOD AS A RESERVOIR
undercooked meats
uncleaned vegetables
laws now govern fruits and vegetables
suggest to cook meat to certain temps
MILK AS A RESERVOIR
listeria- unpastuerized milk
INANIMATE OBJECTS AS RESERVOIRS
influenza- touch contaminated object and then nose or eyes
PORTAL OF EXIT
the point of escape for the organism from the reservior
microbe must be removed from reservior to infect another
most have primary exit route
HUMAN PORTALS OF EXITS
respiratory
gastrointestinal
genitourinary tract
breaks in skin
blood and tissue
MEANS OF TRANSMISSION
how the mircobe is transmitted from its reservoir to the host
various means and routes ; can use more than one
DIRECT CONTACT
a route by which a microbe is transmitted involving proximity between the susceptible host and an infected person or carrier
-touching, kissing, sexual intercourse
INDIRECT CONTACT
a route of transmission of a microbe by which personal contact is made with an inanimate object
-contaminated object- kleenex, instrument
INANIMATE OBJECTS
fomites
VEHICLES OF TRANSMISSION
nonliving/nonhuman carriers that an individual must come into contact with
contaminated blood, food, water, inanimate objects (fomites)
VECTORS
nonhuman carriers that transmit organism from one host to another
-mosquitos, ticks, lice
-inject salivary fluid into human as they bite
AIRBORNE ROUTES OF TRANSMISSION
infected hosts cough, sneeze, talks
-dust particles

particles that are less than 5mcm
DROPLET TRANSMISSION
particles that are greater than 5mcm
PORTAL OF ENTRY
the point at which a microbe enters a new host
must find entry or it will die
often the same as the exit route of the prior reservoir
COMMON PORTALS OF ENTRY
respiratory
gastrointestinal tracts
skin
SUSCEPTIBLITY
the degree of resistance the potential host has to the pathogen
-hospital patients with weakend states of health are more susceptible to infection
SUSCEPTIBLE HOST
a microbe must be able to enter a host and overcome their defenses to survive
must find a host that they can overtake
STAPH AUREUS
reservoirs- skin, mouth, nose, throat
means of transmission- direct contact
disease produced- wound infection, abscess, cabuncle, boil
HEP B
reservoir- blood, feces, bodily fluids and excretions
means of transmission- indirect contact
diseases produces- hep b
HIV
reserviors- blood, semen, vaginal secretions, breast milk
means of transmission- direct contat/injestion
diseases produces- AIDS
MYOBACTERIUM-TB, BORRELIA BURGDORFERI
reservoirs- respiratory tract (sputum), ticks-sheep, cattle, deer, mice
means of transmission- airborne, vectors, direct contact
diseases produced- TB, Lyme disease, EColi
ECOLI
reservoirs- feces, undercooked meats, unpasteruized juices, vegetables
means of transmission- ingestion
diseases produced-
SALMONELLA
reservoirs- intestinal tract of humans and animals-birds also
means of transmission- ingestion
diseases produced- diarrhea
STAGES OF INFECTION
1-incubation period
2-prodromal stage
3-full stage of illness
4-convalescent period

person may only pass through these stages one time or they may have reoccuring phases-herpes
INCUBATION PERIOD
interval between the microbes invasion of the body and the appearance of symptoms of infection

-microbe is growing an multiplying in the body
length of time varies -cold 1-2 days; tb 2-21 days
PRODROMAL STAGE
when the person is most contagious but does not know they are so
early signs and symptoms develop-often vague and nonspecific
may last several days to hours
FULL STAGE OF ILLNESS
specific signs and symptoms
type of infections determines length and severity of illness
LOCALIZED SYMPTOMS
symptoms that occur only in one body area
SYSTEMIC SYMPTOMS
symptoms that are manifested throughout the entire body
CONVALESCENT PERIOD
recovery period from the infection
varies according to the severity of infection and the patient's general conditon
signs and symptoms disappear-person returns to healthy state
depending on type of infection one may have temporary or permanent change to their pervious health condition even after this period
BODY'S NORMAL FLORA
one of the first lines of defense against infection
helps keep microbes from entering the body
INFLAMMATORY RESPONSE
protective mechanism that eliminates the invading microbe and allows for tissue repair to occur
-also occurs during injury
INFLAMMATION
helps the body
-neutralize
-control
-eliminate

offending agents and prepares the site to repair
ACUTE INFECTION
redness
heat
swelling
pain
loss of function

appears at the site of injury or inflammation
CARDINAL SIGNS OF INFECTION
caused by vascular and cellular stages of the inflammation process
VASCULAR STAGE OF INFLAMMATION
blood vessels constrict in the area and vasodilation of arterioles and venules occurs
-increases blood flow and causes the redness and heat in the area
HISTAMINE
released during inflammation
increases permeability of blood vessels allowing protein rich fluid to enter
CELLULAR STAGE
white blood cells-leukocytes move into area
LEUKOCYTES; LYMPHOCYTES
white blood cells
NEUTROPHILS
primary phagocytes that engulf the microbe, cell debris and foreign materials
EXUDATE
fluid, cells, and inflammatory byproducts released from the wound
-amount depends on the size and location of the wound
SEROUS
clear exudate
SANGUINOUS
exudate containing red blood cells
PURULENT
exudate containing puss
REGENERATION
repairing of damaged cells by replacing them with identical cells
SCAR TISSUE
another way the damaged cells may be replaced
IMMUNE RESPONSE
involves specific body responses to an invading foreign protein such as bacteria or the body's own proteins
-complex mechanisms that constitute as the body attempts to protect itself
ANTIGEN
a foreign material within the body that the body is going to try to protect itself against
ANTIBODY
a product produced by the body as a means to protect itself against an antigen
HUMORAL IMMUNITY
antigen-antibody reaction within the body
CELLULAR IMMUNITY
cell-mediated defense
-increase in number of lymphocytes that destroy or react with cells the body recognizes as harmful
-helps the body fight off
-bacteria
-viruses
-fungi
-malignant cells-cancer
FACTORS AFFECTING SUSCEPTIBILITY
integrity of skin and mucous
pH levels in the GI and GU tracts and skin
integrity of one's white blood cells
age, sex, race, heredity- neonates and the elderly
immunizations-natural and aquired
level of fatigue, nutritional status, general health preexisting illness, previous illness, medications
stress
invasive or dwelling medical devices
EXTENT OF NURSING INTERVENTIONS
depends on susceptibility of the host
the virulence of the microbe
the patient's signs and symptoms
ASSESSING
ask about previous immunizations and illnesses
observe nonverbal cues
gather history of current disease
observe signs and symptoms of local or systemic nature
LOCALIZED INFECTION
redness, swelling, warmth in one involved area
pain, tenderness or loss of function of affected part
SYSTEMMIC INFECTION
fever, increased pulse, increased respiratory rate lethargy, anorexia, tenderness and enlargement of lymph nodes that drain the infected area
PULMONARY INFECTION
aged response

age related changes
-decreased cough reflex, elastic recoil of lungs, cilia activity; abnormal swallowing
-strategies; place patient in sitting to eat and drink, encourage fluid consumption, encourage cough and deep breathing-spirometer; recommend pneumococcal vaccine 1xlife and flu vaccine 1xyear
UTI
aged response
aged related changes
-incomplete bladder emptying, decreased sphincter control, bladder outlet obstruction-enlarged prostate, pelvic floor relaxation-estrogen depletion, reduced renal blood flow
-strategies; void at regular intervals, drink fluids, administer meds for large prostate and estrogen, change incontinence pad frequently-pericare; assess for atypical UTI signs, discuss need to void after sex
SKIN INFECTION
aged response
age related changes
-loss of elactisity, increased dryness, thinning of epidermis, slow cell replacement, decreased vasular supply
-strategies- drink fluids, good hygiene, lotion, assess frequently for breaks, rashes or changes
ELEVATED WHITE BLOOD CELL COUNT
normal range 5,000-10,000/mm3
NEUTROPHILS
normal 60-70% count
increased in acute infection with puss
if decreased increased risk for bacterial infection
stress can increase
LYMPHOCYTES
normal 20-40%
increased with chronic bacterial and viral infections
MONOCYTES
normal 2-8%
increased in severe infections
act as scavenger and phagocyte
EOSINOPHIL
normal 1-4%
increased in parasitic infection
may be increased in allergic reaction
BASOPHIL
normal .5-1%
usually not affected by infections
ERYTHROCYTE SEDIMENTATION RATE
red blood cells settle in the bottom of a test tube at increased rate when infection is present
NURSING DIAGNOSIS IN INFECTION
must accurately reflect the patient's condition to be able to provide appropriate focus of care
DEVELOP APPROPRIATE PATIENT OUTCOMES
must review assessment data, consider the cycle of events resulting in the infection, and incorporate the principles of infection control first
PATIENT OUTCOMES TO PREVENT INFECTION AND USE OF INFECTION CONTROL
use effective hygiene- hand and personal
identify signs of infection
adequate nutrition
properly dispose soiled articles
cleaning and disinfecting techniques
immunization awareness
stress reduction techniques
know health risks associated with latex allergies
ASEPSIS
all activities to prevent infection or break the chain of infection

stops the spread and minimizes the threat of infections
MEDICAL ASEPSIS
clean technique
involves procedures and practices that reduce the number and transfer of pathogens
-hand hygiene, wearing gloves
SURGICAL ASEPSIS
sterile technique
includes practices used to render and keep objects and areas free from microbes
-indwelling urinary cath, inserting IV cath
MEDICAL ASEPSIS TECHNIQUES
used within and outside health agencies
based on assumption that pathogens are likely present
-can be specific to specific microbes if known
-nurse assumes major responsibility of
BARRIERS
created in medical aspepsis to prevent the spread of microbes
hand hygiene, personal protective equipment,
HAND HYGIENE
most effective way to help prevent the spread of infectious agents

hand washing with plain soap and water
use of antiseptic handrubs
surgical hand antisepsis

50% compliance rates in healthcare settings
FACTORS OF POOR COMPLIANCE OF HAND HYGIENE
lack of access to sinks
lack of time
skin irritation
ignorance about the importance of
individual preference and habits
insufficient institutional commitment
SPEAK UP PROGRAM
Joint Commission
consumers should insist on hand hygiene of their healthcare providers
TRANSIENT BACTERIA
found on the hands, easily removed through washing
have the porential to adjust to the environment of the skin when present in large numbers over a long period of time and become resident bacteria
RESIDENT BACTERIA
derived from transient bacteria
found on the hands and the skin then becomes their carrier for transmission to others
NONANTIMICROBIAL AGENTS
soaps and detergents- emulsifying agents
used for routine mechanical cleansing of transient bacteria on hands
ANTIMICROBIAL/ANTIBACTERIAL INGREDIENTS
preferred when risk for infection is high
able to kill or suppress bateria growth
ALCOHOL BASED HANDRUBS
more effectively reduce bacterial counts than antimicrobial soaps
60-95% alcohol concentration

-recommended when hands are not soiled; saves time, no sink, easy to use
WHEN TO USE ALCOHOL BASED HANDRUBS
before and after direct contact with patients
before and after glove use
before inserting caths or invasive devices
when changing sites during patient care
after contact with objects
CDIFFICILE
controversy in using only alcohol based handrubs
gram positive spore forming bateria present in normal flora
antibiotic uses makes opportunistic
use of alcohol will not kill when in spore state
healthcare workers most common transporters and should use soap and water when in known contact with infected patient
NAIL CARE
artificial nails are banned from the OR- Joint Commision is a citable offense
natural nails less than 1/4 in long
SOILED HANDS
must use soap and water to clean
EFFECTIVE HAND WASHING
15second scrub with soap and warm water
visibly soiled needs longer scrub
SURGICAL HAND SCRUB
more lengthy scrub to reduce transient and resident flora of hands and forearms
surgical asepsis
HEALTHCARE ASSOCIATED INFECTIONS (HAI)S
certain patients in health agencies develop during the course of treatment for other infections
-condition was not noted upon their admission
prevention is a major challenge
occurences must be repoted as a sentinel event
NOSOCOMIAL
something originating of taking place in the hospital
EXOGENOUS
causative organism is acquired from other people
ENDOGENOUS
causative organism comes from microbial lifw harbored in the person
IATROGENIC
infection that results from a treatment or diagnostiv procedure
-not all nosocomial infections are
PREVENATBLE HAIS THAT MEDICAID WILL NO LONGER REIMBURSE FOR
UTIs from improper catherter use
vascular catheter associated infections
certain surgical site infections
8 on list 9 more being considered
MEASURES TO PREVENT HAIS
instituting constant surveillance by infection control committees and nurse epidemiologists- agressive control measures initiated upon their findings

having written infection prevention practices for all agency personnel-adherence to hand hygiene and infection control precaution techniques

using practices to promote and keep patients in the best possible physical conditions-meet patient's needs for nutrtion, fluids, rest, oxygen, and physcial and psychological confort and security
STAFF RATES AND HAIS
studies show that overworked nurses are more likely to not use proper hand hygiene- too many patients or working too many hours both contribute to this
MANDATORY PUBLIC REPORTING OF HAIS
difficult to unify but gives consumers that opportunity to be educated on facilities before they go in for care
COMMON HAI BACTERIAS
Ecoli
Staph Aureus
Streptococcus
Pseudo aeruginosa
Klebsiella
INVASIVE DEVICES & COMMON INFECTIONS
most HAIs can be traced to
-urinary catheter, venous access catheter
UTIs 32%
followed by surgical site infections, pneumonia, blood stream infections
Pneumonia and blood stream infections have highest mortality rate
OTHER BIOMEDICAL DEVICES CAUSING HAIS
hemodynamic monotoring lines
hemodialysis equipment
respiratory equipment
-mechanical ventilation increases risk for pneumonia
MEANS OF TRANSMISSION FOR HAIS
the health care workers hands using the equipment and insturments
ANTIBIOTIC RESISTANT BACTERIA
Methicillin resistant staph aureus MRSA
vancomycin resistant staph aureus VRSA
vancomycin intermediate resistant staph aureus VISA
vancomycin resistant enterococci VRE
MRSA
broad spectrum antibiotic used to treat staph aureus in the 1960s
org became resistant to it
STAPH
normally found in the nasal mucous membranes, skin, and in respiratory and GI tract
1/3 population is colonized with- org is present but they do not get sick
CA-MRSA
community assocaited MRSA
1980s
common cause of skin infections
VANCOMYCIN
powerful antibiotic used to treat MRSA in the health care setting
PEOPLE AT RISK FOR MRSA
young children
older adults
HIV and AIDS patients
playing contact sports
sharing personal items
TREATEMENT FOR CA-MRSA
incision and drainage of abscesses in patients with mild to moderate infections
-may not require antimicrobial theraoy

if incision and drainage are not effective and systemic or serious infection results
-use antimicrobial therapy
ANTIMICROBIAL THERAPY FOR MRSA INFECTIONS
7-10 days depending on the severity of the infection
trimethoprim-sulfamethoxazole- batrim
minocycline- minocin
doxycycline- vibramycin
clindamycin- cleocin
TETRACYCLINE HYDROCHLORIDE- ACHROMYCIN
*not recommened for pregnant women or children under 8yo
-yellows teeth
HAI OF MRSA
more serious implications
60% of infections that occur in the hospital
= blood stream infections, wound infections, ventilatior associated pneumonia, multidrug resistant
INTRAVENOUS VANCOMYCIN
drug of choice for HAI MRSA
if resistant to use synthetic antibiotic- linexolid-zyvox
MODE OF TRANSMISSION FOR HAI MRSA
contaminated hands of healthcare personnel or contact with equipment
-basic infection control pracitices are key to prevention and control of MRSA
DRUG RESISTANT BACTERIA
progress from being sensitive to an antibiotic to an intermediate resistance to complete resistance
VISA=VRSA
DRUGS USED TO REPLACE VANCOMYCIN
linezolid-zyvox- some resistance has been reported
quinupristin-dalfopristin- synercid
-very expensive
PEOPLE AT RISK FOR VISA & VRSA
history of renal failure requiring hemodialyssi or peritoneal dialysis
previous MRSA infection
history of prior and prolonged use of vancomycin
DECREASING VISA & VRSA
effective infection control measures
prudent use of vancomycin
VRE
streptococcus
found in normal intestinal and female genital tracts
high mortality rate if vancomycin resistant org
-resistant to penicillin, ampiciliin, and gentamicin which were used to treat it in the past as well as now vancomycin
DRUGS USED TO TREAT VRE
only linezolid and quinupristin-dalfopristin
RISK FACTORS FOR VRE
compromised immune system
recent abdominal or chest surgery
presence of urinary of central IV catheter
prolonged antibiotic use- especially vancomycin
lengthy hospital stay ; especially in the ICU
MODE OF TRANSMISSION FOR VRE
contact with feces, urine, blood of infected or colonized person
contact of contaminated healthcare personnel hands

must use proper hand hygiene precautions and careful assessment, intervention, and evaluation of high risk patients and situations to minimize spread of
DISINFECTION
destroys all pathogenic organisms except spores
-used when preparing the skin for a procedure or cleaning a piece of equipment that does not enter a sterile bosy part
STERILIZATION
destroys all microorganisms including spores
-used on equipment that is entering a sterile portion of the body
FACTORS THAT INFLUENCE THE CHOICE OF STERILIZATION AND DISINFECTION METHODS
-nature of organism
- number of organisms present
- intended use of equipment
- available means for sterilization or disinfection
- time
NATURE OF ORGANISMS PRESENT
all supplies, linens, and equipment in a health care setting should be treated as if the patient were infectious
- some orgs easily destroyed; some are not
NUMBER OR ORGANISMS PRESENT
the more orgs present on an item the longer it will take to destroy them
TYPE OF EQUIPMENT
small luments, crevices, or joints require special care
articles that may be damaged by methods require special handling
INTENDED USE OF EQUIPMENT
need of medical or surgical asepsis influences preparation and cleaning of equipment

home may be safe to use disinfected items but in a health care setting may be better to use sterile items
AVAILABLE MEANS FOR STERILIZATION OR DISINFECTION
choice of chemical or physical means of sterilization or disinfection depends on the nature and number of orgs, the type and inteded use of the equipment and the availability and practicality of the means
TIME
a key factor
failure to follow the recommended time periods is grossly negligent
PHYSICAL METHODS OF STERILIZATION AND DISINFECTION
steam
boiling water
dry heat
radiation
STEAM/ AUTOCLAVING
higher temperature caused by higher pressure kills orgs
most plastic and rubber devices would be damaged
BOILING WATER
frequently used in the home; simple and inexpensive; boil for at least 10 min
spores and some viruses will not be killed
DRY HEAT
alternative sterilization for the home; used for metal; oven to 350 for 2 + hours
will not destroy all
*not used in the health care setting
RADIATION
pharmaceuticals, foods, plastics, and heat sensitive items
objectmust be directly exposed to ultraviolet radiation on all surfaces to work
*risk to personnel
CHEMICAL METHODS OF STERILIZATION AND DISINFECTION
ethylene oxide gas
chemical solutions
ETHYLENE OXIDE GAS
destroys microbes and spores; interferes with metabolic processes in cells
gas is released while item is in autoclave
-items- oxygen and suction gauges, blood pressure equipment
gas is toxic to humans- requires precautions
CHEMICAL SOLUTIONS
instrument and equipment disinfection; housekeeping disinfection
-chlorines-disinfecting water and housekeeping
-sodium hypochlorite-household bleach-1:100 dilution inactivates HIV
-betadine; alcohol
does not destroy all spores
may cause corrosion on metal items
TECHNIQUES FOR CLEANING EQUIPMENT
wear waterproof gloves at all times
rinse articles with cold water first to remove organic material-heat may coagulate organic material and make it difficult to be removed

wash the article after rinsing it in warm water that contains detergent or soap-warm water and soap will emulsify and remove dirt and debris

use a brush with stiff bristles to clean article-friction aids to the removal of orgs and debris from difficult to reach areas

rinse and dry well
prepare the clean article for sterilization of disinfection
consider the sink, brush, gloves and anything used to clean the article as contaminated and treat or discard of
PERSONAL PROTECTIVE EQUIPMENT PPE
mandated in 1992 by OSHA that all healthcare agencies provide their employees with

gloves, gowns, masks, protective eye gear
GLOVES
not a substitute for good hand hygiene
worn once and discarded
hands must be washed before and after use
use new pair for each patient interaction and when changing sites of care on a patient

always changed when moving from contaminated task to clean one
not necessary when care tasks do not involve possibility of soiled hand with body fluids
- turning a patient, feeding a patient, taking vital signs, changing IV fluid
ACTIVITIES NEVER TO DO WHILE WEARING GLOVES
-leave the patient's room- unless transporting a contaminated item or following transmission based procedures
- write in the patient's chart
- use the computer keyboard or telephone
- touch cell phone, pager
DOUBLE GLOVING
barrier of gloves is not impenetrable
glove barrier failure goes undetected by heatlhcare workers
recommened to double glove whn in contact with blood or body fluids
GLOVE FAILURE
surgery longer than 3 hours = 50% glove failure rate
- handling of surgical instruments, exposure to body fluids and blood
electronic glove monitoring devices, education, double gloving with colored glove under non colored glove
GOWNS
worn to prevent soiling of the health care worker's clothing by patient's blood and body fluids

provide barrier protection
put on before entering patient'r room
individual gown technique-only worn once and discarded
if becomes soiled must remove, wash hands, and put one new one
MASKS
prevent the wearer from inhaling large particle aerosols that travel short distances -3ft and small particel nuclei that stay in the air and travel farther

discourage the wearer from touching their eyes, nose and mouth

various situations and uses are possible
only worn once and never lowered around the neck then brought back up to the mouth
should be discarded before it becomes damp from the wearers exhalation
HIGH EFFICIENCY PARTICULATE AIR HEPA- N95 B RESPIRATOR USES
mulitdrug resistant tuberculosis cases increased the use of these
must be worn when entering the room of a patient with TB or suspected of having TB

HEPA- more difficult to wear for extended periods of time
N95- designed to filter out very small particles and fits more comfortably; also is cheaper
RESPIRATORS
filter inspired air
surgical masks only filter expired air
PROTECTIVE EYE WEAR
goggles or face shields
must be available whenever there is a risk for contaminating the mucous membranes of the eyes
-suctioning a trach, assisting in an invasive procedure that may result in blood splatter
-plain glasses not acceptable
BIHAZARDS
bags used to dispose of trash that contains liquid or semiliquid blood or other potentially infective material OPIM

-items that would release the substance if compressed or during handling
ISOLATION
a protective procedure that limits the spread of infectious diseases among hospitalized patients, hospital personnel, and visitors

used in addition to barriers to prevent transmission of infections
OSHA
1991 issued regulations for use of universal precautions in all situations and settings in which occupational exposures to blood and OPIM were possible

mandated that all hospital workers receive HEPB vaccinations
HEPATITIS B
pses the greatest bloodborne risk to healthcare workers
CDC GUIDELINES
2007 updated previous recommendations from 1996
reflects emergence of new pathogens, methods to prevent resistant orgs, and concern of biological terrorism
-nosocomial infection replaced with HAI
CDC 2 TIERS OF PRECAUTIONS
1-standard precautions
2- transmission based precautions
STANDARD PRECAUTIONS
used in the care of all hospitalized individuals regardless of diagnosis or possible infection status
-applys to blood, body fluids, sevretions, excretions- except sweat, non intact skin, mucous membranes
TRANSMISSION BASED PRECAUTIONS
used in addition to standard procedures for patients in hospitals with suspected infections of pathogens that can be transmitted airborne, droplet, or contact routes

-must wear PPE when entering the room of a patient on contact or droplet precaution-previously was only necessary when within 3ft of the patient
-recognizes that the disease may have multiple routes of transmission
3 TYPES OF TRANSMISSION BASED PRECAUTIONS
1- airborne
2- droplet
3- contact
all must be used with standard precautions as well
NEEDLESTICK INJURIES
most occur when recapping the needle
*never recap a needle
CDC recommends use of puncture resistant containers for disposal of
-most serious risk is exposure to bloodborne pathogens
STANDARD PRECAUTION GUIDELINES
-follow hand hygiene
- wear clean nonsterile gloves when touching blood, body fluids, excretions, and non intact skin & change gloves between tasks on the same patient; remove promptly after use
- wear PPE such as mask, eye protection, face shield, or gown during procedures and care activities that are likely to generate splashes or sprays of blood or body fluids
- follow respiratory hygiene/cough etiguette- education on covering mouth and nose with a tissue when coughing, promptly dispose of tissue, offer surgical mask to coughing patients, encouage 3ft distance from other persons
- avoid recapping of used needles, if must recap never use 2 hands, place needles in appropriate containers
- wear face mask when placing a catheter or injecting materinal into spinal or epidural space
- handle used patient care equipment that is soiled carefully to prevent transfer of microbes; clean and process appropriately
- use adequate environmental controls to ensure that routine care, cleaning, and disinfecting procedures are being followed
- review room assignements carefully; place patients who may contaminate the environment in private rooms- incontinent patients
TRANSMISSION BASED PRECAUTIONS GUIDELINES/AIRBORNE
used for patients with infections that spread through the air
-TB, varicella, rubeola, SARS

-place patient in private room, monitored with negative air pressure; 6-12 air changes/hour; appropriate discharge of air outside or monitored filtration if air is recirculated ; keep door closed
-wear madk or respirator when entering room
- transport the patient out of the room only when necessary and place surgical mask on them when doing so
- consult CDC guidelines for TB precautions
TRANSMISSION BASED PRECAUTIONS/ DROPLET
used for patients with infections that are spread by large particle droplets
-rubella, mumps, diphtheria, adenovirus-infants/young children

- use private room; door may be open
- wear PPE when entering the room for all interactions that may involve contact with the patient and contaminated areas in the room
- transport the patient out of the room only when necessary and place surgical mask on them
- keep visitors 3ft away from the patient
TRANSMISSION BASED PRECAUTIONS/CONTACT
used for patients infected or colonized by a mulitdrug resistant organism
-place patient in private room
-wear PPE whenever entering the room for all interactions that may involve contact with the patient or contaminated areas in the room; change gloves whenever in contact with infective material; remove PPE befoe leavng the patient environment and wash with antimicrobial or waterless antiseptic
-limit the patient's movement out of the room
- avoid sharing patient care equipment
NEUTROPENIC PRECAUTIONS
used on a patient whose immune system is compromised
-recovering from transplant surgery; chemotherapy
more likley to become infected by microbes within their own body than pathogens present in the environment or transmitted by another
must use standard precautions as well as additional measures
ADDITIONAL PRCEDURES TO USE WITH IMMUNOSUPRESSED PATIENTS
- ensure the caregiver is healthy
- restrict visitors from friends and family who have colds or contagious illnesses
- avoid standing water in the room- flowers; humidifiers to prevent bacteria from growing within it
PROTECTIVE MEASURES TO REDUCE THE RISK OF INFECTION TO PRACTICE AT HOME
wash hands frequently-before preparing food, before eating, after using the restroom
keep immunizations up to date
clean and disinfect kitchen surfaces-especially when preparing meat, chicken, fish
avoid sharing personal items
cook food to proper internal temperature
promptly refrigerate or freeze parishables, prepared foods, and left overs
SURGICAL ASEPSIS
used regularly in the OF, labor and delivery areas, and certain diagnostic testing areas; also at the patient's bedside
- inserting urinary catheter, sterile dressing changes, preparing an injectable medication
STERILE OBJECT
all microbes including pathogens and spores have been destroyed on it
MEDICAL ASEPSIS
areas are considered to be contaminated if they bear or are suspected of bearing pathogens
SURGICAL ASEPSIS
areas are considered contaminated if tehy are touched by any object that is not also sterile
-effectiveness lies on the faithful and conscientious practice of carrying out appropriate technique ; patient education is key to maintaining a sterile environment while working with them
OPENING A STERILE PACKAGE
may use a flat surface or both hands
should cover the item after opening if not using immediately
only touch the outside wrapper
POURING STERILE SOLUTIONS
outer surface of bottle and cap are unsterile
inside of the bottle and the solution is sterile
once open the outer bottle should be labled and dated if to be reused
most solutions sterile for 24 hours after opening
hold the bottle with the lable in your palm to prevent the solution from running down the label
avoid splashing- this would contaminate the sterile field you are working in
ADDING STERILE SUPPLIES TO THE STERILE FIELD
objects on a field may be handled only by using sterile forceps or with hands wearing sterile gloves
PUTTING ON STERILE GLOVES
only the inside of the glove must come into contact with your skin
after gloves are on only sterile items may be handled
careful removal to avoid contact with contaminated materials
must use good hand hygiene before and after putting them on
POSITIONING STERILE DRAPE
ideally will be waterproof
used to extend the sterile working area
use of sterile gloves allows nurse to handle entire drape surface
fold upper edge of the drape over gloved hands
when sterile gloves are not being worn nurse can only touch outer 1in of the drape
use caution when opening so it doesn't touch clothing or unsterile objects
*do not reach over the drape= contaminated field
PSYCHOLOGICAL IMPLICATIONS OF INFECTION CONTROL
standard precautions treat everyone the same
transmission based precautions may lead to self esteem loss and deprivation of sensory stimulation
-transmission based could lead to less checking of vital signs, irregular documentation, and less patient monitoring
- receive fewer visits from family, friends, and healthcare staff
-leads to depression,
TEACHING ABOUT INFECTION CONTROL
-can reduce the negative effects isolation may lead to
medical asepsis used common in the home for patient care
surgical asepsis used in the home for injections, catheter insertion
MEDICAL ASEPSIS PRACTICES IN THE HOME
wash hands before preparing food and eating
prepare foods at appropriate temperatures
wash hands, cutting boards, utensils in hot soapy water before and after handling poultry and meat
keep food refridgerated; especially ones containing mayonnaise
use pasteurized milk and juices
wash hands after using bathroom
do not share personal care items
TECHNIQUES TO PREVENT INFECTION FROM PUBLIC FACILITIES
wash hands after using bathrooms
use paper towels or air dryers
use individually wrapped straws
use tongs to lift food from service trays
COMMUNITY TECHNIQUES TO REINFORCE MEDICAL ASEPSIS
sterilized combs and brushes in barber shops
examinate food handlers for evidence of disease
encourage food handlers to receive HEPA vaccine
enforce frequent handwashing of food handlers
PATIENTS SHOULD ACCOMPLISH THE FOLLOWING WHEN THEY LEAVE THE NURSE'S CARE
be able to correctly use the techniques of medical asepsis
identify health habits and lifestyle patterns that promote health
state the signs and symptoms of infections
identify unsafe situations within their home environment