Taylor - Fundamentals Of Nursing - Adn 1 Exam #1 Chapter 27 Asepsis & Infection Control

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afebrile

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without fever

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antibiotic

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a natural or synthetic substance that destroys or inhibits the growth of microorgnisms

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antibody

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a substance produced by B lymphocytes in response to a unique antigen

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antigen

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any substance capable of eliciting an immune response or of binding to an antibody.

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antimicrobial

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destructive to or preventing the development of microorganisms.

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antipyretic

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an agent that reduces fever.

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asepsis

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a condition free from microorganisms

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medical asepsis

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practices designed to reduce the number and transfer of of pathogens

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surgical asepsis

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practices that render and keep objects and areas free from microorganisms.

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biohazardous

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anything that is harmful or potentially harmful to humans, other species and the environment.

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debridement

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the removal of foreign material and dead or damaged tissue.

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exudate

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any fluid released from the body with a high concentration of protein, cells or solid debris

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drainage

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the flow or withdrawal of fluids such as blood,infused saline, pus and collected debris from a cavity, organ, surgical site or wound.

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purulent

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forming or containing pus

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pus

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protein rich fluid containing white blood cells, especially neutrophils, and cell debris produced during inflammation.

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sanguineous

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bloody

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serosanguineous

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containing serum and blood

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serous

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having the nature of serum, thin and watery.

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erythema

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reddening of the skin.

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intention

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a natural process of healing
primary &
secondary

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infection

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a disease stat that results from the presence of pathogens i or on the body.

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An infection occurs as a result of a cyclic process consisting of six components:

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infectious agent
reservoir
portal of exit
means of transmission
portal of entry
susceptible host

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bacteria are categorized by:

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shape:cocci-spherical
bacilli- rod shaped
spirochete-corkscrew
gram stain: gram positive, thick cell wall of peptidoglycans which retain the gram stain and appears violet.
gram negative, do not retain gram stain
aerobic: require oxygen to live
anaerobic: do not need oxygen to live.

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a pathogen's potential to produce didease in its host depends on:

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the # of pathogens present.
the virulence of the pathogen.
the competence of the host's immune system.
length & intimacy of contact with the host.

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virulence

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the power of an organism's ability to cause disease.

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endemic

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a continuous occurrence of a disease within a locale or specific group of people.

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reservoir

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a person,animal, arthropod, soil or substance in which an infectious agent normally lives and multiplies and depends for survival in a way that allows transmission to a susceptible host.

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portal of exit

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the pathway by which pathogens leave the body of its host.
e.g. respiratory droplets
feces
urine
blood.

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portal of entry

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the pathway by which pathogens gain access to the host.

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the means of transmission are:

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direct contact: via proximity to an infected individual through touch.
indirect contact: contact with an inanimate object - fomite.
airborne: when a cough or sneeze or dustborne pathogen affects a host- < 5 micrometers in size.
droplets: same as airborne- > 5 micrometers in size.
vector: non-human carriers that transmit a pathogen from one host to another.

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susceptibility

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the degree of resistance the potential host has to the pathogen.

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the stages of an infection cycle:

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incubation period
prodromal stage
full stage of illness
convalescence period.

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incubation period

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the time from the moment a host is infected to the appearance of the first symptoms.

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prodromal stage

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the initial stage of a disease where the earliest symptoms of a disease appear leading to a rash or fever.
this period is when the host is the most contagious.

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full stage of illness

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where full symptoms are present.

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localized symptoms

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limited to a particular body area.

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systemic symptoms

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when symptoms are manifested throughout the entire body.

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convalescent period

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the recovery period from the infection.

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the cardinal signs of inflammation are:

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redness
heat
swelling
pain
immobility/loss of function.

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the two types of immune responses are:

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humoral immunity- the antibody-antigen reaction
T cell mediated immunity: leukocyte related activity.

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assessment

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the appraisal or evaluation of a patient's condition.

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diagnosis

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a scientific or clinical determination of the cause & nature of an illness or condition.

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Two types of bacterial flora:

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resident flora: bacteria normally found on or within a host.
transient flora:bacteria that have the potential to set up residence on or within a host if not removed or if their #'s increase.

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HAI's

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Healthcare Associated Infections aka nosocomial infection
an infection, not present upon admission, which develops during the course of treatment.

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nosocomial

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aka HAI's
an infection or condition which originates within a hospital setting.

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exogenous infection

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an infection where the causative organism is acquired from another person or object.

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endogenous infection

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an infection which occurs when the pathogen comes from organisms harbored by that person

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Iatrogenic infection

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an infection resulting from a treatment or diagnostic procedure.

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antibiotic resistant bacteria

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organisms able to survive and continue to cause infection in the presence of antibiotics resulting from the indiscriminate use of broad spectrum antibiotics.

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MRSA

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methicillin resistant Staphylococcus aureus.

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VISA

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vancomycin intermediate Staphylococcus aureus.

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VRSA

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vancomycin resistant Staphylococcus aureus.

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VRE

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vancomycin resistant Enterococci.

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disinfection

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the killing of all pathogens except for spores.

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sterilization

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the killing of all pathogens, including their spores.

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PPE

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Personal Protective Equipment:
gloves
gown face mask
cap
protective eye gear.

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OPIM

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Other Potentially Infective Material.

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isolation

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a protective procedure that limits the spread of infectious diseases among hospitalized patients, staff and visitors.

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The two levels of precautions set forth by the current CDC guidelines:

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Standard precautions & Transmission Based precautions.

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Standard Precautions

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CDC precautions used in the care of all patients regardless of their diagnosis or possible infection status in order to prevent the spread of infection.This always includes handwashing and the use of PPE's when possible contact with bodily fluids and excretions is a possibility.

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Transmission Based Precautions:

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CDC precautions used in addition to Standard Precautions when in contact with patients known or suspected to be infected with pathogens that can be transmitted by:
airborne
droplet or
contact routes.

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MDRO

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Multi- Drug Resistant Organism.

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Neutropenic Precautions

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Precautions used for patients who are immunocompromised.

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Neutropenia

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having an abnormally low neutrophil count/ usually less than 1500 to 2000 per microliter.

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CDC

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Center for Disease Control Prevention.

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RAST

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Radioallergosorbent test
a blood test for allergy that measures minute quantities of immunoglobulin E(IgE) in the blood.
Often used to test for latex allergies.

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Emerging Infectious Disease

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any previously unknown communicable illness or any previously controlled contagion whose incidence and prevalence are suddenly rising.

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Culture

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the propagation of a microorganism in special media that are conducive to their growth.

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Vector

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a carrier, usually an insect or other arthropod, that transmits the causative organism of a disease from infected to noninfected individuals. Usually the causative organism goes through one or more stages of its life cycle within the vector.

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CMS

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Centers for Medicare and Medicaid Services.

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The underlying cause for an infection with Clostridium difficile is usually attributed to:

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Antibiotic therapy, because it changes the normal flora of the large intestine. It is usually transmitted via the feces of an infected individual.

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According to the CDC, alcohol based hand rubs are considered ineffective against which organism?

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C. difficile. Largely due to its spore forming abilities. Hand washing with soap,a minimum scrub of 15 seconds, is still the best defense.

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Colonization

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the growth and increase of #'s of microorganisms, especially bacteria, in a particular body site such as a wound. Symptoms of an infection are not necessarily evident during this stage.

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Requirements for an organism to survive are:

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food,water
presence or absence of oxygen
temperature
Ph.
light

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The most common causative organism in a urinary infection is:

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E. coli

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The most common resistant organism fond in a hospital setting is:

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MRSA

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the infectious agents are:

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bacteria
viruses
fungi

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The greatest reservoir of organisms in a hospital setting has been found to be the

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telephone!

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Breaking the chain of infection:
how should spills be treated?

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wet the affected area with a wet bleach solution for at least one minute.

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Breaking the chain of infection:
supplies

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treat all supplies as possibly being infectious.

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Breaking the chain of infection:
terminal cleaning

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thorough cleaning after a patient leaves
environment.

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Breaking the chain of infection:
Biohazard materials

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a RED BAG is the universal identifier for a biohazard disposal receptacle.

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The Portal of Exits are:

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skin and mucous membranes
respiratory tract
urinary tract
GI tract
Reproductive tract
blood

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Breaking the chain of infection:
Hand hygiene rules

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A thorough hand washing is required after every 10th. use of an alcohol based hand rub.
Hand washing is required before and after gloving.

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Breaking the chain of infection:
respiratory masks

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used primarily to prevent the spread of tuberculosis.

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Breaking the chain of infection:
disinfection/sterilization

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proper time and exposure is required.
Medical asepsis-Clean technique
Surgical asepsis- Surgical technique.

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Latex allergy
people commonly at risk are:

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healthcare workers
people with allergic tendencies

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Latex allergy
most common symptoms

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contact dermatitis-redness and itching of the skin.
rhinitis-a runny nose.
may lead to anaphylaxis and respiratory difficulties.
vinyl, powder-free equipment is the norm in medical settings.
a Patch Test is commonly used to identify such allergies.

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Breaking the chain of infection:
Sterile Asepsis rules:

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Sterile can only touch sterile!
Keep hands and equipment ABOVE waistline.
ALWAYS keep sterile equipment in vision- do not turn back on a sterile field.
Check expiration date on sterilized equipment. Sterility is not indefinite. Monitor equipment and record dates.
Do not re-use disposable equipment in a clinical area- the only exception is in a patients home because they normally will not infect themselves.

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Breaking the chain of infection:
Dressings

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draining wounds must be covered.
Splatter shields and equipment barriers and PPE's must be used.
Patient education is important.

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Breaking the chain of infection:
Mode of transmission-contact

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direct contact with an infected individual.
indirect- contact with a fomite.

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Breaking the chain of infection:
Mode of transmission-droplet

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a person's sneeze in your vicinity-direct or indirect contact.

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Breaking the chain of infection:
Mode of transmission-airborne

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contracting tuberculosis, for instance- must use a individually fitted HEPA or N95 style respirator in a room of a suspected tuberculosis patient in isolation.

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Breaking the chain of infection:
Mode of transmission-vehicle

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receiving a bite/saliva from an animal harboring rabies, for instance.

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Breaking the chain of infection:
Mode of transmission-vector

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malaria from a mosquito's sting, for instance.

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Breaking the chain of infection:
Mode of transmission-ingestion

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salmonella - food poisoning, for instance.

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Breaking the chain of infection:
Mode of transmission- Isolation techniques. Standard precautions.

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Treat all clients as if they are infected.
Wear PPE's where contact with bodily fluids is a possibility.

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Breaking the chain of infection:
Mode of transmission- Isolation techniques - Airborne

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Measles,Varicella
contracting tuberculosis, for instance- must use a HEPA or N95 style respirator in a room of a suspected tuberculosis patient in isolation.
Negative Pressure rooms.
Limit client transport-client must always wear a mask in transport.

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Breaking the chain of infection:
Mode of transmission- Isolation technique - droplet precautions.

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Meningitis/Influenza
client must be in a private room/ a cohort is allowable(one who shares the same disease).
PPE's-masks must be worn within 3 feet of the person.
dedicated equipment must remain in that room.
client must wear mask if transported.

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Breaking the chain of infection:
Mode of transmission- Isolation technique -contact precautions.

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MRSA, VRE, C.difficile
client must be in a private room/ a cohort is allowable(one who shares the same disease).
PPE"s if in contact with client or his environment.
dedicated equipment must remain in that room.
client must wear gown if transported.

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Breaking the chain of infection:
Neutropenic precautions

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Standard precautions a minimum with immunosuppressed patients.
Caregiver/visitor must be healthy.
no standing water/flowers,humidifiers.
neutropenic diet.

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Neutropenic diet

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all food must be fully cooked.

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Psychological Interventions for clients requiring isolation.

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Explain situation and all procedures to client, emphasizing that these precautions are temporary.
Express empathy.
Support coping mechanisms.

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Most common Portal of Entry is:

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broken skin.

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A urinary tract infection is classified as an:

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Ascending Infection.

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Breaking the chain of infection:
Portal of Entry- Sharps.

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minimize risks of exposure by:
avoid manipulation of sharps-do not re-cap needles!
properly dispose of sharps in a sharps container.
Avoid poor visualization when working with sharps-GOOD LIGHTING!
do not share blood monitoring devices.
consider all used injection supplies
as contaminated.
Immediately report if exposed via a needle stick!!

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Recapping needles- if necessary, you must..

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use a one-hand technique- keeping your other hand behind your back as you scoop up cap.

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Breaking the chain of infection:
Portal of Entry - Administering Medications.

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Perform Hand Hygiene!
Draw up medications in a clean area.
disinfect vial stopper before use.
discard expired vials.
DO NOT SHARE equipment or medications! Once in a room, equipment is considered used.

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Breaking the chain of infection:
Susceptible Host.

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immunosupressed client
avoid stress
get proper rest.
get proper nutrition.
Burn patients
Diabetics-injection sites, high blood glucose attracts organisms-food source.
Cardio-pulmonary disease-poor blood circulation hampers the immune system's effectiveness.

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What is the most important cause of hospital-acquired infections in the US?

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indwelling urinary catheters.

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Breaking the chain of infection:
Accidental Exposure Recording-especially with needle sticks.

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immediately wash area with soap and water.
report and file an incident report.
Blood tests:baseline
6 weeks
3 months
1 year.
receive post exposure prophylaxis(antivirals).
Testing of involved client- they must give consent-exception is when rape is involved.
education and counseling.

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Assessment of Infection Risks:
inadequate primary defenses

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poor saliva production as in the elderly.
compromised normal flora and mucous membranes.
compromised respiratory system-poor cough reflexes.
urinary tract - ph changes.
GI tract-
Vaginal- hormonal and ph changes

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Assessment of Infection Risks:inflammatory response

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stress
heredity
current diseases
age
medications used.

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Immunity
natural antibodies

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humans are naturally immune to diseases that other species aren't. distemper, for instance.

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Immunity
Natural Actively acquired

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when you have a disease and your immune system develops its own antibodies in response to it.

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Immunity
Artificial Actively acquired

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being immunized exposes you to an attenuated version of the pathogen and you develop antibodies in response to it.

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Immunity
Natural Passively acquired

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Temporary immunity conferred to fetus and neonate from mother's preformed antibodies in colostrum.

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Immunity
Artificial Passively acquired

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when you are administered gamma globulins to treat Hepatitis A, for instance. antibodies provide temporary
immunity.

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A Differential Blood Count looks at:

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neutrophils
lymphocytes
monocytes
eosinophils
basophils

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Most definitive method of identifying an infection is through a

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positive culture.

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An Infection Control Nurse is involved with:

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bioterrorism
mandatory reporting of diseases to the health department.
new product effectiveness evaluations.
policy development.
work under the auspices of OSHA and CDC.
epidemiology.
education.

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Epidemiology

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the study of the distribution and determinants of health related states and events in populations, and the application of this study to the control of health problems.