Infection Control and Asepsis

Infection Control and Asepsis

• Healthcare-associated infections (HAIs) are a significant concern, causing an estimated 1.7 million infections and 99,000 deaths annually in American hospitals.

• Body's natural defenses against infection include normal flora, inflammation, skin barrier, respiratory cilia and mucus, and gastrointestinal flora and pH.

• Untreated infections can lead to serious consequences, such as hypovolemia, vasoconstriction, renal failure, hypoxia, mental status changes, and potentially death.

• The chain of infection includes an infectious agent, source, portal of exit, mode of transmission, portal of entry, and susceptible host.

• HAIs (nosocomial infections) occur during a patient's hospital stay.

• Factors contributing to drug-resistant organisms include overuse/inappropriate use, and incomplete antibiotic courses.

• Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium resistant to some antibiotics, categorized as HA-MRSA or CA-MRSA, differentiated by infection sites.

• Hand hygiene is crucial; alcohol-based sanitizers and soap-and-water washing are essential preventive measures.

• Medical asepsis (clean technique) aims to reduce organisms, involving handwashing and gloves. Surgical asepsis excludes all organisms from sterile fields.

• Standard precautions treat all blood and body fluids as potentially infectious, utilizing PPE and infection control practices.

• Personal Protective Equipment (PPE) includes gloves, gowns, masks, respirators, goggles, and face shields. Gloves are changed after patient contact or soiling. Gowns are removed inside-out. Masks cover nose and mouth. Respirators filter inhaled aerosols. PPE donning sequence: gown, mask/respirator, goggles/shield, gloves. Removal sequence: gloves, goggles/shield, gown, mask/respirator.

• Respiratory hygiene/cough etiquette involves coughing into elbows, using tissues, and hand hygiene.

• Isolation separates and restricts movement of contagious individuals.

• Isolation environments require privacy, signage, hand hygiene facilities, and proper contaminated material disposal. Specific isolation precautions include contact, droplet, and airborne.

• Contact precautions are for infections spread via direct contact (e.g., MRSA, VRE), requiring gowns and gloves.

• Droplet precautions are for infections spread by droplets (e.g., COVID-19, influenza), requiring surgical masks.

• Airborne precautions are for infections suspended in the air (e.g., tuberculosis, measles), requiring negative-pressure rooms and N95 respirators.

Assessment

• The nursing process begins with observation, gathering, analyzing, validating, organizing, and documenting data.
• Subjective data comes from patients; objective data is measurable.
• Assessment methods encompass observation, patient interviews, and physical assessments.
• Patient interviews have stages: orientation, working (health history, review of systems), and termination.
• Health history includes chief complaint, illness history, allergies, medications, medical history, family/social history, and health promotion activities.
• Review of systems collects subjective data on each body system.
• Physical assessments include collecting vital signs and using techniques like inspection, palpation, percussion, and auscultation.
• Types of assessments include comprehensive, focused, and emergency.

Skin, Hair, and Nails

• Skin is the body's largest organ, involved in protection, temperature regulation, and sensory input.
• Skin assessment involves inspection and palpation.
• Normal skin is even-colored, intact, and without lesions.
• Abnormal findings include rashes, albinism, erythema, pallor, cyanosis, jaundice.
• Lesions are categorized as primary (arising from normal tissue) or secondary (changes in primary lesions) and include vascular lesions, tumors, nodules, papules, pustules, cysts, wheals, and burrows.
• Hair should be smooth, firm, and scalp clean/dry.
• Nails should be clean, well-manicured, pink, and with a 160-degree angle at the base.
• Abnormal nail findings include pale/cyanotic nails (hypoxia/anemia) and yellowish discoloration (fungal infections/psoriasis).
• Palpation assesses skin temperature, texture, turgor, moisture, and edema.
• A capillary refill test assesses oxygenation.

Eyes, Ears, Nose, Mouth, and Throat

• Eye assessment includes evaluating eyebrows, eyelids, lashes, conjunctiva, and globe.

• Extraocular muscles (EOMs) are assessed via positional testing, corneal light reflex, and cover test.

• Pupil assessment includes equality, shape, reaction to light, and accommodation (PERRLA). Normal pupil size is 3-7mm.

• Vision testing includes far/near vision (Snellen/pocket charts).

• Ear assessment involves evaluating the external ear (size, shape, position) and using an otoscope for the auditory canal and tympanic membrane.

• Hearing assessments include whispered voice, Weber, and Rinne tests.

• Nose assessment involves evaluating color, shape, symmetry, swelling, and tenderness. Internal nose is assessed for color, lesions, discharge, swelling, and the septum.

• Mouth assessment includes color, odor, and abnormalities.

• Throat assessment involves evaluating uvula, soft palate, and tonsils for color, size, and exudate/lesions.

Hygiene

• Hygiene promotes comfort, relaxation, positive self-image, healthy skin, and infection prevention.
• Hygiene practices include bathing, oral care, hair washing, and nail care.
• Factors influencing hygiene include social practices, personal preferences, body image, socioeconomic status, culture, health beliefs, and physical condition.
• Nursing diagnoses related to hygiene include self-care deficit and impaired health maintenance.
• Hygiene care is gentle, considering pain, and teaching proper techniques. Bathing options include bed baths, partial baths, tub baths, bag baths, sitz baths, and tepid baths.

Vital Signs

• Vital signs include temperature, pulse, respiration, blood pressure, and pain assessment.

• Normal oral temperature ranges are 96.3°F-99.3°F (35.7°C-37.4°C); axillary temperature is 1°F lower; rectal temperature is 1°F higher.

• Normal pulse rate is 60-100 bpm; tachycardia is above 100 bpm; bradycardia is below 60 bpm.

• Pulse sites include radial, brachial, apical, carotid, femoral, temporal, popliteal, posterior tibial, and dorsalis pedis.

• Respiration is assessed for rate, depth, and rhythm.

• Pulse oximetry (SpO2) measures oxygen saturation (95-100%).

• Blood pressure measures force in arteries; systolic is the maximum pressure; diastolic is the minimum pressure.

• Korotkoff sounds indicate systolic (Phase 1) and diastolic (Phase 5).

• Normal blood pressure is around 120/80 mmHg; elevated BP is 120-129 systolic or less than 80 diastolic, Stage 1 Hypertension is 130-139 systolic or 80-89 diastolic, and Stage 2 Hypertension is 140 or greater systolic or 90 or greater diastolic.

• Hypotension is systolic BP 90 mm Hg or below; orthostatic hypotension is low BP upon standing.

• Pain is assessed using scales (e.g., Likert scale, Wong-Baker faces scale) and the COLDSPA mnemonic (Character, Onset, Location, Duration, Severity, Pattern, and Associated factors).

Wound Care and Skin Integrity

• Tissue integrity is the structural/physiological function of epithelial tissues. Wounds disrupt skin integrity, classified by cause, skin integrity, depth, and infection presence.

• Wound types include superficial, partial-thickness, and full-thickness (skin to subcutaneous), acute (healing timely) and chronic (not healing timely).

• Healing intentions include primary (acute wounds), secondary (chronic wounds), and tertiary (delayed closure).

• Healing phases include inflammatory, proliferative, and maturation. Factors affecting wound healing include vascular disease, diabetes, malnutrition, medications, moisture, external forces, aging, and infection.

• Wound drainage types include serous (clear), serosanguineous (pink), sanguineous (red), and purulent (yellow/green/beige). Drains are closed (e.g., Jackson-Pratt, Hemovac) or open (e.g., Penrose).

• Wound complications include dehiscence, evisceration, and fistulas. Pressure ulcers are localized injuries from pressure/pressure with shear.

• Factors contributing to pressure ulcers include friction and shear. Risk factors include inability to feel pain, respond, or move independently.

• The Braden Scale assesses pressure ulcer risk; scores range from minimal risk (above 18) to very high risk (9 or below).

• Pressure ulcer stages include I (non-blanchable erythema), II (partial-thickness loss), III (full-thickness to subcutaneous), IV (full-thickness with muscle/bone involvement), and unstageable (necrotic tissue).

• Nursing diagnoses related to skin integrity include impaired skin integrity, impaired physical mobility, and impaired tissue integrity.

• Debridement removes necrotic tissue using mechanical, enzymatic, biologic, autolytic, or sharp methods.

• Dressings prevent contamination, absorb drainage, protect periwound tissue, treat infection, and aid debridement.

• Negative-pressure wound therapy (Wound VAC) removes excess fluid and stimulates granulation tissue via negative pressure. Skin care involves avoiding hot water and drying soaps. Interventions for preventing pressure ulcers include regular turning, positioning, keeping skin clean, avoiding friction and shear, utilizing pressure-reducing items, and suspending heels.

This quiz covers essential concepts of infection control and asepsis, focusing on healthcare-associated infections (HAIs) and the body's defenses against infections. Understand the chain of infection, the impact of untreated infections, and factors contributing to drug-resistant organisms. Test your knowledge on important topics such as MRSA and infection prevention measures.