NURS 300 Chapter 28: Infection Control

Chapter 28: Infection Prevention and Control (NURS 300)

• Objectives:
  • Explain the connection between the chain and transmission of infection.
  • Provide examples of infection prevention for each element of the infection chain.
  • Detail the signs/symptoms of localized and systemic infections.
  • Identify the body's natural defenses against infection.
  • Detail the inflammatory response.
  • Explain factors that promote healthcare-associated infections.
  • Identify patients at highest risk for infection.
  • Differentiate between medical and surgical asepsis.
  • Explain the rationale for standard precautions.
  • Explain hand hygiene procedures.
  • Explain procedures for each isolation category.
  • Compare infection control methods in the home versus the hospital.
  • Define occupational exposure.
  • Explain the postexposure process.

Scientific Knowledge Base

• Infection: Pathogens/microorganisms invade a susceptible host, resulting in disease if those pathogens multiply and alter normal tissue function.
• Colonization: A microorganism invades the host but doesn't cause damage or infection.
• Communicable Disease: Infectious processes transmitted from one person to another.
• Symptomatic Infection: If pathogens cause clinical symptoms.
• Asymptomatic Infection: When no clinical signs or symptoms are present.

Nature of Infection

• Hand Hygiene: The most critical technique for preventing and controlling infection transmission.
• CDC Recommendation: Use alcohol-based waterless antiseptics as a handwashing alternative unless hands are visibly soiled.

Chain of Infection

• Infectious Agent (Pathogen): The germ causing the infection.
• Reservoir: Where the pathogen lives and grows (e.g., person, animal, food, environment).
• Portal of Exit: How the pathogen leaves the reservoir (e.g., coughing, sneezing, wounds).
• Mode of Transmission: How the pathogen moves from the reservoir to the susceptible host (e.g., direct contact, air).
• Portal of Entry: How the pathogen enters the susceptible host (e.g., broken skin, respiratory tract).
• Susceptible Host: A person vulnerable to the infection (e.g., immunocompromised individuals).

Additional Terminology

• Immunocompromised: An impaired immune system.
• Virulence: The capability of a pathogen to produce disease.
• Aerobic Bacteria: Need oxygen to survive.
• Anaerobic Bacteria: Thrive in environments with little/no oxygen.
• Bacteriostasis: Prevents bacterial growth and reproduction.
• Bactericidal: Kills bacteria.

Infectious Process

• Incubation Period: Time between pathogen entry and first symptoms.
• Prodromal Stage: Interval when nonspecific signs and symptoms appear.
• Illness Stage: Interval where specific signs and symptoms arise for the infection type.
• Convalescence: When acute symptoms subside.
• Localized Infection: Infection limited to a specific area (e.g., wound infection).
• Systemic Infection: Infection affecting the whole body (e.g., sepsis).

Defenses Against Infection

• Normal Flora: Microorganisms in the body, aiding in resisting infection by releasing antibacterial substances.
• Body System Defenses: -Organs like airways with moist mucous membranes and cilia for expelling mucus.
• Inflammation (Tissue Damage): Protective response delivering fluids, nutrients to the injured area, neutralizing pathogens, and repairing cells.

Health Care-Associated Infection (HAI)

• Types of HAI:
  • Iatrogenic: HAI resulting from a diagnostic or therapeutic procedure.
  • Exogenous: HAI from microorganisms outside the individual.
  • Endogenous: HAI resulting from overgrowth of the patient’s normal flora.

Health Care-Associated Infection (HAI) - Risk Factors

• Number of health care workers with direct contact to patients.
• Types and numbers of invasive procedures.
• Therapy received.
• Length of hospitalization.
• Sites like surgical wounds, the urinary tract, respiratory tracts, bloodstream.

Nursing Knowledge Base

• Factors influencing infection prevention/control include age, sex, nutrition, stress, disease process, and treatments/conditions.

Assessment

• Review of systems, travel history
• Immunizations and vaccinations
• Status of defense mechanisms
• Patient susceptibility
• Medical therapy
• Clinical appearance (signs, symptoms)
• Laboratory data (e.g., increased WBCs)

Goals of Care

• Preventing exposure to infectious organisms.
• Controlling/reducing the extent of infection.
• Maintaining resistance to infection.
• Verbalizing understanding of infection prevention methods (e.g., hand hygiene).

Asepsis

• Asepsis: Absence of pathogenic microorganisms.
• Aseptic Technique: Practices/procedures to reduce infection risk.
• Medical Asepsis (Clean Technique): Procedures to reduce the number of organisms and prevent transfer.
• Surgical Asepsis (Sterile Technique): Isolates infected areas to maintain a sterile field.

Disinfection versus Sterilization

• Disinfection: Eliminates most microorganisms except bacterial spores.
• Sterilization: Eliminates all microorganisms, including bacterial spores.

Infection Prevention and Control

• Patient safety
• Separate personal care items
• Handling solid and fluid waste
• Wound cleaning
• Patient education
• Cough etiquette
• Isolation AND isolation precautions
• Surgical asepsis

Cough Etiquette

• Cover nose/mouth when coughing/sneezing with a tissue, dispose immediately.
• Place surgical mask on patients (if appropriate).
• Practice hand hygiene after contact with respiratory secretions.
• Maintain appropriate spatial separation.

Standard Precautions

• Standard Precautions: Procedures to prevent infection spread.
• Contact with blood, body fluids, non-intact skin, and mucous membranes: from all patients
• Hand hygiene: using alcohol antiseptic, washing with soap and water (when visibly soiled), and surgical scrub.
• Handwashing: proper technique for 15 seconds

Isolation and Barrier Precautions

• Isolation: separating individuals with communicable diseases.
• Isolation precautions:
  • Airborne, droplet, contact, and protective environment, appropriate PPE use.
  • Thorough hand hygiene, disposing properly of contaminated materials.
  • Understanding the transmission mode of the organism.

Isolation

• Psychological implications: loneliness potential.
• Isolation environment: Private rooms, negative pressure to prevent infection spread.
• Personal protective equipment (PPE).
• Specimen collection (sterile technique).
• Trash and linen bagging.
• Patient transport procedures.

Droplet Precautions

• Transmission via large droplets, traveling 3-6 feet.
• Mask-wearing protocols when within 3 feet.
• Practice hand hygiene and use of dedicated equipment.

Airborne Precautions

• Transmission via smaller droplets suspended in the air.
• Airborne infection isolation rooms (negative pressure).
• Using high-efficiency particulate air (HEPA) filters.
• Respiratory TB patient precautions.

Surgical Asepsis

• Surgical asepsis: Procedures to eliminate microorganisms in areas undergoing intentional procedures.
• Intended for procedures requiring skin perforation.
• Proper patient preparation and sterile field setup.

Principles of Surgical Asepsis

• Sterile objects remain sterile only when touched by another sterile object.
• Only sterile objects can be on the sterile field.
• Objects below waist level or not visible are considered contaminated.
• Prolonged exposure to air contaminates sterile objects/fields.
• Contact with wet, contaminated surfaces contaminates sterile objects.
• Fluid flows with gravity; edges of sterile fields are considered contaminated.

Infectious Disease and IDD

• People with IDD at higher risk of infectious diseases, possibly due to lower immunization rates, increased risk factors, or difficulties reporting symptoms.

COVID-19 and IDD

• Individuals with IDD may be at higher risk of severe COVID-19 outcomes due to limited mobility, difficulties communicating, or complying with preventative measures (e.g., handwashing).

Infectious Disease and IDD - Recommendations

• Incorporating the screening of patients with IDD into routine immunization programs.
• Risk factors of individuals for screening purposes.
• Reducing factors like infections, risky practices, and poor sanitation.
• Observing symptoms.

Explore the critical concepts of infection prevention and control detailed in Chapter 28 of NURS 300. This quiz addresses the transmission of infections, preventative measures, and the body's defense mechanisms. Delve into the differences between medical and surgical asepsis and understand the importance of standard precautions.