Infection Control and Asepsis Overview

Asepsis

• Asepsis is a condition where no disease-causing microorganisms are present
• Asepsis covers procedures designed to reduce the risk of bacterial, fungal, or viral contamination
• Two types of asepsis are medical and surgical asepsis
• Infection Prevention and Control (IPC) is a fundamental public health issue for patient safety and health system strengthening

Nosocomial Infections

• Also called healthcare-associated or hospital-acquired infections
• Subset of infectious diseases acquired in a healthcare facility
• To be considered nosocomial, the infection must develop at least 48 hours after admission
• Microorganisms causing nosocomial infections can originate from the clients themselves (endogenous) or the hospital environment and personnel (exogenous)
• Most nosocomial infections have endogenous sources

Factors Contributing to Nosocomial Infections

• Iatrogenic infections result from diagnostic or therapeutic procedures
• Compromised host is a client whose normal defenses have been weakened by illness or surgery
• Insufficient hand cleansing among personnel is a significant contributing factor to the spread of nosocomial microorganisms

Types of Nosocomial Infections

• Iatrogenic: Resulting from a diagnostic or therapeutic procedure (e.g., urinary catheter insertion)
• Exogenous: The causative organism is acquired from other people (e.g., Tuberculosis)
• Endogenous: Sufficient numbers of microorganisms normally found in one body cavity, transferred to another body site, develop and become pathogens (e.g., transmission of enterococci)

Chain of Infection

• Includes the reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host
• Reservoirs and the etiologic agent are interrupted by antiseptics, disinfectants, and sterilization

Body Defenses Against Infections

• Nonspecific defenses include the skin, mucous membranes, and secretions from these areas
• Lysozyme, for example, is a protective protein found in the upper respiratory tract.
• With increased inflammation, there may be indicators such as redness, swelling, pain, or increased blood flow to the affected area(s)
• Specific defenses (immune system) include lymphocytes, antibodies and the inflammatory response
• Ex. Interferons are produced by virus-infected cells that affect the replication of other viruses

Factors Increasing Susceptibility to Infection

• Age: Newborns have immature immune systems; older adults have weakened immune systems
• Heredity: Some people inherit a genetic predisposition to certain infections
• Stress: Prolonged stress depletes energy stores and can decrease resistance to infection
• Nutritional status: Inadequate nutrition can impair the ability to synthesize antibodies
• Medical therapies: Certain treatments, like radiation therapy, can weaken the immune system
• Certain medications: Some medications, like anticancer medications or anti-inflammatory medications, depress bone marrow function causing reduced white blood cell production
• Certain diseases: Any disease that can lower the body's defenses against infection puts a patient at risk

Nursing Management (Assessment)

• Nursing history: Gathering client risk factors, history of recurrent infections, current medications, emotional stressors, nutritional status, and immunization history
• Physical assessment: Evaluating for signs and symptoms of infection like fever, elevated pulse/respiratory rates, malaise, anorexia, nausea, vomiting. Check for localized swelling, redness, tenderness, heat, loss of function and exudates from open wounds.
• Laboratory data: Assessing for leukocyte count, elevated erythrocyte sedimentation rate (ESR) and pathogen presence in specimens (urine, blood, etc.) using cultures

Nursing Management (Diagnosis)

• Potential complications such as fever, malnutrition, imbalanced nutrition less than body requirements, acute pain due to damage/discomfort, impaired social interaction, and anxiety related to changes in life activities

Nursing Management (Planning)

• Goals include maintaining or restoring client defenses, avoiding spread of infectious organisms, and reducing/alleviating problems associated with the infection

Nursing Management (Implementation)

• Strategies for preventing infection, halting spread of infection between individuals, and treating existing infections
• Activities that interfere with the chain of infection and transmission of infectious agents
• Breaking the chain of infection includes preventive measures like immunizations, treatment of underlying diseases, educational programs, and the prevention and control of transmissions using personal and health protective equipment
• Isolating patients with contagious diseases and implementing proper disinfection/sterilization practices

Infection Control for Health Care Workers

• Three main modes of transmission of infectious materials in clinical settings are puncture wounds, skin contact, and mucous membrane contact
• Steps to follow after exposure to blood-borne pathogens include reporting the incident, completing an injury report, seeking appropriate evaluation and treatment, documenting the source exposure, and testing the source for relevant pathogens. If medically appropriate, post-exposure prophylaxis should be administered

Isolation Precautions

• Isolation precautions create barriers between people and germs and help prevent the spread of germs in hospitals
• Standard precautions (e.g., hand hygiene, personal protective equipment)
• Transmission-based precautions (for specific germs, e.g., airborne, contact, droplet precautions) to prevent germ spreading.

Disinfecting and Sterilizing

• Disinfection is a process that eliminates most pathogens on objects, with the exception of bacterial spores
• Disinfectants are chemical agents that destroy most pathogens other than spores
• Antiseptics prevent microorganism growth on living tissue surfaces
• Sterilization destroys all microorganisms, including spores and viruses.
• Methods of sterilization/disinfection include moist heat (e.g., autoclave), gas (e.g., ethylene oxide), boiling water, and radiation

Role of the Infection Control Department

• Providing continuing staff education on infection control principles and policies
• Review infection control policies and procedures
• Monitor the epidemiology/statistics of nosocomial infections
• Investigating outbreaks of infection
• Providing input on patient-care products selection
• Conducting research related to infection control

Role of the Nurse

• Responsible for providing a safe environment for clients using effective aseptic techniques
• Monitoring healthcare team members when they enter the client's environment
• Educate healthcare workers and clients regarding isolation status and preventive measures
• Uses appropriate precautions for all clients, even if an infection has not been diagnosed

Evaluation of Outcomes

• If outcomes of infection prevention and control are not achieved, the nurse may need to identify gaps and evaluate factors such as implementation of appropriate measures to prevent skin breakdown and infection, use of aseptic techniques during invasive procedures, and possible effects of prescribed medications on the client’s immune system. Additional considerations could be about the client's placement and compliance with infection prevention and control instructions from the healthcare team.