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27 Cards in this Set
- Front
- Back
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nosocomial infections |
infection acquired in the hospitals |
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health care acquired infections (HAIs) |
infections that were not present at the time of admission result from delivery of health services in a health care setting |
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hospital infections |
healthcare workers transmit HAIs by direct contact during the delivery of care and nurses play a critical role in preventing infection |
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element of infection chain: infectious agent (pathogenic organism capable of causing disease) |
medical asepsis practices: clean contaminated objects clean, disinfect, and sterilize |
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element of infection chain: reservoir (site or source of microorganism growth) |
Perform hand hygiene before and after patient contact with appropriate antiseptic (e.g., chlorhexidine), or soap and water.Control and contain sources of body fluids and drainage.Bathe patient with soap and water, chlorhexidine, or disposable bath.Change soiled dressings.Dispose of soiled tissues, dressings, or linen in moisture-resistant bags.Place syringes, uncapped hypodermic needles, and intravenous needles in designated puncture-proof containers.Keep table surfaces clean and dry.Do not leave bottled solutions open for prolonged periods.Keep reusable solutions tightly capped.Keep surgical wound drainage tubes and collection bags patent.Empty and dispose of drainage suction bottles according to agency policy and keep wounds covered |
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element of infection chain: Portal of exit (means by which microorganisms leave a site) |
medical asepsis practices: Respiratory• Avoid talking, sneezing, or coughing directly over wound or sterile dressing field.• Cover nose and mouth when sneezing or coughing.• Wear mask if experiencing respiratory tract infection.Urine, feces, emesis, and blood• Wear clean gloves when handling blood and body fluids.• Wear gowns and eyewear if there is a chance of splashing fluids.• Handle all laboratory specimens as if infectious |
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element of infection chain: Transmission (means of spread) |
medical asepsis practices: Reduce microorganism spread:• Perform hand hygiene.• Use personal set of care items for each patient.• Avoid shaking bed linen or clothes; dust with damp cloth.• Avoid contact of soiled item with uniform.• Discard any item that touches the floor.• Follow Standard Precautions or select transmission-based isolation precautions |
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element of infection chain: Portal of entry (site through which microorganism enters a host) |
medical asepsis practices: Skin and mucosa• Maintain skin and mucous membrane integrity; lubricate skin, offer frequent hygiene, turn and position.• Cover wounds as needed.• Clean wound sites thoroughly.• Dispose of used needles in puncture-proof container.Urinary• Keep all drainage systems closed and intact, maintaining downward flow |
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element of infection chain: host (patient) |
medical asepsis practices: Reduce susceptibility to infection.Provide adequate nutrition.Ensure adequate rest.Promote body defenses against infection.Provide immunizations |
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patient centered care |
nurses are responsible for educating patients, family, care givers about infection control, signs and symptoms of infection, modes of transmission, methods of prevention, knowledge of infectious process, disease transmission, aseptic techniques and barrier protection isolation causes loneliness or changes in self-concept (think about cultures and what isolation can mean in that culture) know cultural views and preferences of your patients (alternative health care practices) |
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importance of hand hygiene |
correct hand hygiene before and after patient encounters prevents infections |
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isolation: standard precautions |
Standard Precautions apply to blood, blood products, all body fluids, secretions, excretions (except sweat), nonintact skin, and mucous membranes.• Perform hand hygiene before direct contact with patients; between patient contacts; after touching blood, body fluids, secretions, excretions, or contaminated items; and immediately after removing gloves.• Personal Protective Equipment: Wear gloves for touching blood, body fluids, secretions, excretions, and contaminated items; and for touching mucous membranes and nonintact skin.• Personal Protective Equipment: Wear a gown during procedures and patient-care activities when contact of clothing/exposed skin with blood/body fluids, secretions, and excretions is anticipated.• Personal Protective Equipment: Wear a mask, eye protection (goggles), face shield during procedures and patient-care activities likely to generate splashes or sprays of blood, body fluids, secretions, especially suctioning and endotracheal intubation. During aerosol-generating procedures on patients with suspected or proven infections transmitted by respiratory aerosols (e.g. tuberculosis, COVID-19), wear a fit-tested N95 or higher respirator in addition to gloves, gown, and face/eye protection.• Soiled Patient Care Environment: Handle in a manner that prevents transfer of microorganisms to others and to the environment; wear gloves if visibly contaminated; and perform hand hygiene.• Environmental Control: Develop procedures for routine care, cleaning, and disinfection of environmental surfaces, especially frequently touched surfaces in patient-care areas.• Bedclothes/Linen: Handle in a manner that prevents transfer of microorganisms to others and to the environment (e.g., hold dirty linen away from uniform/gown).• Handling of Needles and Other Sharps: Do not recap, bend, break, or hand-manipulate used needles; if recapping is required, use a one-handed scoop technique only; use safety features when available; place all used sharps in puncture-resistant container.• Patient Resuscitation: Use disposable (when possible) mouthpiece, resuscitation bag, other ventilation devices to prevent contact with mouth and oral secretions.• Patient Placement: Prioritize for single-patient room if patient is at increased risk of transmission, is likely to contaminate the environment, does not maintain appropriate hygiene, or is at increased risk of acquiring infection or developing adverse outcome following infection.• Respiratory Hygiene and Cough Etiquette: Have patients cover the nose or mouth when sneezing or coughing; use tissues to contain respiratory secretions and dispose in nearest waste container; perform hand hygiene after contact with respiratory secretions and contaminated objects or materials; contain respiratory secretions with procedure or surgical mask; sit at least 3 feet away from others if coughing.• Safe Injection Practices: Use a sterile, single-use, disposable needle and syringe for each injection given, and prevent contamination of injection equipment and medication. Whenever possible, use of single-dose vials is preferred over multiple-dose vials, especially when medications will be administered to multiple patients. |
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Airborne Precautions (droplet nuclei smaller than 5 microns) |
Measles, chickenpox (varicella), disseminated varicella zoster, pulmonary or laryngeal tuberculosis protection: Private-room, negative-pressure airflow of at least 6 to 12 exchanges per hour via HEPA filtration; mask or respiratory protection device, N95 respirator (depending on condition) |
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Droplet Precautions (droplets larger than 5 microns; being within 3 feet of patient) |
Diphtheria (pharyngeal), rubella, streptococcal pharyngitis, pneumonia or scarlet fever in infants and young children, pertussis, mumps, Mycoplasma pneumonia, meningococcal pneumonia or sepsis, pneumonic plague protection: Private-room or cohort patients; mask or respirator (refer to agency policy) |
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Contact Precautions (direct patient or environmental contact) |
Colonization or infection with multidrug-resistant organisms such as VRE and MRSA, Clostridium difficile , Shigella , and other enteric pathogens; major wound infections; herpes simplex; scabies; varicella zoster (disseminated); respiratory syncytial virus in infants, young children or immunocompromised adults
protection: Private-room or cohort patients (see agency policy), gloves, gowns; patients may leave their room for procedures or therapy if infectious material is contained or covered and placed in a clean gown and hands cleaned |
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Protective environment |
Allogeneic hematopoietic stem cell transplants protection: Private room; positive airflow with ≥12 air exchanges per hour; HEPA filtration for incoming air; mask to be worn by patient when out of room during times of construction in area |
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hand hygiene step1: Inspect surface of hands for breaks or cuts in skin or cuticles. Cover any skin lesions with a dressing before providing care. If lesions are too large to cover, you may be restricted from direct patient care |
rationale: Open cuts or wounds can harbor high concentrations of microorganisms. |
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hand hygiene step 2: Inspect hands for visible soiling. |
rationale: Visible soiling requires handwashing with soap and water. |
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hand hygiene step3: Inspect condition of nails. Natural tips should be no longer than 0.625 cm (¼ inch) long. Be sure that fingernails are short, filed, and smooth |
rationale: Subungual areas of hand harbor high concentrations of bacteria. Long nails and chipped or old polish increase the number of bacteria residing on hands ( CDC, 2020b ). |
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hand hygiene planning 1: Expected outcomes following completion of procedure:• Hands and areas under fingernails are clean and free of debris.• Skin of hands is without irritation or breakdown.• Patient and/or family caregiver perform hand hygiene appropriately in health care or home setting |
rationale: Transient bacteria have been removed.Proper hand hygiene technique used.Reduces infection transmission. Family caregivers often have primary responsibility for adherence to recommended infection control practices |
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hand hygiene implementation 1: Push wristwatch and long uniform sleeves above wrists. Avoid wearing rings. If worn, remove during hand hygiene |
rationale: Provides complete access to fingers, hands, and wrists. The skin underneath rings carries higher bacterial count; bacteria include gram-negative bacilli, enterobacteria, and Staphylococcus aureus |
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hand hygiene implementation 2: Antiseptic hand rub a. According to manufacturer directions, dispense ample amount of product into palm of one dry hand (see illustration).Use enough product to cover hands thoroughly.b. Rub hands together, covering all surfaces of hands and fingers with antiseptic (see illustration).Ensures complete antimicrobial action.c. Rub hands together until alcohol is dry. Allow hands to dry completely before applying gloves. |
In the absence of visible soiling of hands, approved alcohol-based products for hand disinfection are preferred over antimicrobial or plain soap and water because of their superior microbiocidal activity, reduced drying of the skin, and convenience ( CDC, 2019c )a. According to manufacturer directions, dispense ample amount of product into palm of one dry hand (see illustration).Use enough product to cover hands thoroughly.b. Rub hands together, covering all surfaces of hands and fingers with antiseptic (see illustration).Ensures complete antimicrobial action.c. Rub hands together until alcohol is dry. Allow hands to dry completely before applying gloves.Provides enough time for product to work. |
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hand hygiene implementation 3: Handwashing using regular or antimicrobial soap:a. Stand in front of sink, keeping hands and uniform away from sink surface. (If hands touch sink during handwashing, repeat sequence.) b. Turn on water (see illustration) or push knee pedals laterally or press pedals with foot to regulate flow and temperature. c. Avoid splashing water against uniform. d. Regulate flow of water so temperature is warm. e. Wet hands and wrists thoroughly under running water. Keep hands and forearms lower than elbows during washing f. Apply 3 to 5 mL of antiseptic soap and rub g. Perform hand hygiene using plenty of lather and friction for at least 20 seconds. Interlace fingers and rub palms and back of hands with circular motion at least 5 times each. Keep fingertips down to facilitate removal of microorganisms. hands together (see illustration). h. Areas underlying fingernails are often soiled. Clean them with fingernails of other hand and additional soap or with disposable nail cleaner. i. Rinse hands and wrists thoroughly, keeping hands down and elbows up (see illustration). j. Dry hands thoroughly from fingers to wrists with paper towel or single-use cloth. k. If used, discard paper towel in proper receptacle. l. To turn off hand faucet, use clean, dry paper towel; avoid touching handles with hands (see illustration). m. If hands are dry or chapped, use small amount of lotion or barrier cream dispensed from individual-use container. |
rationale: a. Inside of sink is contaminated area. Reaching over sink increases risk of touching edge, which is contaminated. b. Knee pads within operating room and treatment areas are preferred to prevent hand contact with faucet. Faucet handles are likely to be contaminated with organic debris and microorganisms ( AORN, 2019 ). c. Microorganisms travel and grow in moisture. d. Warm water removes less of protective oils on hands than hot water. e. Hands are the most contaminated parts to wash. Water flows from least to most contaminated area, rinsing microorganisms into sink. Ensure that all surfaces of hands and fingers are cleaned. f. Ensure that all surfaces of hands and fingers are cleaned. Soap cleans by emulsifying fat and oil and lowering surface tension. Friction and rubbing mechanically loosen and remove dirt and transient bacteria. Interlacing fingers and thumbs ensures that all surfaces are cleaned. Adequate time is needed to expose skin surfaces to antimicrobial agent. g. Hands should be washed with soap and water for at least 20 seconds when visibly soiled, before eating, and after using the restroom ( CDC, 2020c ). h. Area under nails can be highly contaminated, which increases risk for transmission of infection from nurse to patient. i. Rinsing mechanically washes away dirt and microorganisms. j. Drying from cleanest (fingertips) to least clean (wrist) avoids contamination. Drying hands prevents chapping and roughened skin. Do not tear or cut skin under or around nail k. Wet towel and hands allow transfer of pathogens from faucet by capillary action. l. Turn off water with foot or knee pedals (if applicable). m. Helps to minimize skin dryness. There is risk of organism growth in lotion; therefore only apply after patient care activities are complete. |
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Airborne Precautions (droplet nuclei smaller than 5 microns) |
Measles, chickenpox (varicella), disseminated varicella zoster, pulmonary or laryngeal tuberculosis:: Private-room, negative-pressure airflow of at least 6 to 12 exchanges per hour via HEPA filtration; mask or respiratory protection device, N95 respirator (depending on condition) |
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Droplet Precautions (droplets larger than 5 microns; being within 3 feet of patient) |
Diphtheria (pharyngeal), rubella, streptococcal pharyngitis, pneumonia or scarlet fever in infants and young children, pertussis, mumps, Mycoplasma pneumonia, meningococcal pneumonia or sepsis, pneumonic plague:: Private-room or cohort patients; mask or respirator (refer to agency policy) |
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Contact Precautions (direct patient or environmental contact) |
Colonization or infection with multidrug-resistant organisms such as VRE and MRSA, Clostridium difficile , Shigella , and other enteric pathogens; major wound infections; herpes simplex; scabies; varicella zoster (disseminated); respiratory syncytial virus in infants, young children or immunocompromised adults: :Private-room or cohort patients (see agency policy), gloves, gowns; patients may leave their room for procedures or therapy if infectious material is contained or covered and placed in a clean gown and hands cleaned |
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Protective environment |
Allogeneic hematopoietic stem cell transplants:: Private room; positive airflow with ≥12 air exchanges per hour; HEPA filtration for incoming air; mask to be worn by patient when out of room during times of construction in area |
