Asepsis (Infection Prevention and Control) PDF

Asepsis (Infection Prevention and Control)  Outline  Introduction  Definitions of terminology  Definitions of Nosocomial infections  The microorganisms that cause nosocomial infections can originate from  Factors contribute to nosocomial infections...

Asepsis (Infection Prevention and Control)  Outline  Introduction  Definitions of terminology  Definitions of Nosocomial infections  The microorganisms that cause nosocomial infections can originate from  Factors contribute to nosocomial infections  Cycle or Chain of infection  Modes or routes of infection transmission  Body defenses mechanisms  Factor increase suscbitability to infection  Nursing management  Outline  Break the chain of infection: Preventing nosocomial infections  Three categories for preventing nosocomial infection  Isolation precautions  Infection control for health care workers  Introduction Nurses are directly involved in providing a biologically safe environment. Microorganisms exist everywhere: in water, in soil, and on body surfaces such as the skin, intestinal tract, and other areas open to the outside (e.g., mouth, upper respiratory tract, vagina, and lower urinary tract). No one should catch an infection while receiving health care;. WHO is working with numerous partners to support Member States to deliver clean, quality care for all, through Infection Prevention and Control (IPC) best practices.  Definitions: Microorganisms: comes from Micro = small and organism = body Cannot be seen with the naked eye, only under the microscope. Are found everywhere, both inside and outside the body. Within the body found in the mouth, in various body systems and on the skin. Live in communities called colonies.  Microorganisms: Some microorganisms capable of causing disease referred to as pathogens. Some microorganisms essential for maintaining health or have no harmful effect on the body referred to as non-pathogens. Colonies of non-pathogens in the body constitute what is known as normal body flora.  Microorganisms: Flora not the same in all body areas, e.g. normal flora in the intestines is different from the normal flora of the skin, when it misplaced to another part of the body can become pathogens, e.g. intestinal flora entering the urinary bladder can cause a urinary tract infection.  Definitions: Contamination: the process of making something dirty, polluted, or poisonous by adding a chemical, waste, or infection Infection: it is defined as the successful transmission of pathogenic microorganisms, such as bacteria, viruses, parasites or fungi that are spread.  Definitions: Local infection: is the infection that limited to the specific part of the body where the microorganisms remain. Systemic infection: the microorganisms spread and damage different parts of the body Acute infection: Appears suddenly or last a short time. Chronic infection: occurs slowly, over a very long period, and may last months or years.  Definitions: A carrier: is a person or animal reservoir of a specific infectious agent that usually does not manifest any signs of disease. Bacteremia: When a culture of the person’s blood reveals microorganisms. Septicemia: When bacteremia results in systemic infection. Sepsis: is a life-threatening illness caused by your body’s response to an infection.  Definitions: Asepsis: is a condition in which no living disease-causing microorganisms are present. Infection Prevention and Control (IPC): is a public health issue that is fundamental in patient safety and health system strengthening  Definitions: Nosocomial infections: also called health-care- associated or hospital-acquired infections, are a subset of infectious diseases acquired in a health-care facility. To be considered nosocomial, the infection cannot be present at admission; rather, it must develop at least 48 hours after admission. These infections can lead to serious problems like sepsis and even death..  The microorganisms that cause nosocomial infections can originate from: The clients themselves (an endogenous source) The hospital environment and hospital personnel (exogenous sources). Most nosocomial infections appear to have endogenous source. Escherichia coli, staphylococcus aureus, and enterococci are the most common infecting microorganisms  Types of nosocomial infection Iatrogenic infection: resulting from a diagnostic or therapeutic procedure. (Urinary catheter insertion). An exogenous infection: the causative organism is acquired from other people, such as Tuberculosis. Endogenous infections: when sufficient numbers of microorganisms normally found in one body cavity or lining are transferred to another body site, an endogenous infection develops. For example, Major sites for nosocomial infection include the urinary tract, surgical wounds, the respiratory tract, and the bloodstream.  Factors contribute to nosocomial infections Iatrogenic infections are the direct result of diagnostic or therapeutic procedures, e.g. bacteremia that results from an intravascular line. Compromised host is a client whose normal defenses have been lowered by surgery or illness. The hands of personnel are a common vehicle for the spread of microorganisms. Insufficient hand cleansing is thus an important factor contributing to the spread of nosocomial microorganisms Cycle or Chain of infection Modes or routes of infection transmission Body defenses mechanisms  Factor increase suscbitability to infection Age: Infections are a major cause of death of newborns, who have immature immune. protected only for the first 2 or 3 months by immunoglobulin passively received from the mother. Advancing age, the immune responses again become weak. Heredity: Heredity influences the development of infection in that some people have a genetic susceptibility to certain infections. For example, some may be deficient in serum immunoglobulin, which play a significant role in the internal defense mechanism of the body. Factor increase suscbitability to infection The nature and duration of physical and emotional stressors :Stressors elevate blood cortisone. Prolonged elevation of blood cortisol decreases anti-inflammatory responses, and decreases resistance to infection, depletes energy stores, leads to a state of exhaustion, and decreases resistance to infection.  Factor increase suscbitability to infection Nutritional status Because antibodies are proteins, the ability to synthesize antibodies may be impaired by inadequate nutrition, especially when protein reserves are depleted (e.g., as a result of injury, surgery, or debilitating diseases such as cancer). Some medical therapies Predispose a person to infection. For example, radiation treatments for cancer destroy not only cancerous cells but also some normal cells, thereby rendering them Certain mediations Anticancer medications may depress bone marrow function, resulting in inadequate production of white blood cells. Anti-inflammatory medications, such as adrenal corticosteroids, inhibit the inflammatory response, an essential defense against infection. Antibiotics may kill resident flora, allowing the proliferation of strains that would not grow and multiply in the body under normal conditions. Any disease That lowers the body’s defenses against infection places the client at risk. Examples are chronic pulmonary disease, which impairs ciliary action and weakens the mucous barrier  Nursing management Nursing management Assessing During the assessment phase of the nursing process, the nurse obtains the client’s history, conducts the physical assessment, and gathers laboratory data. A. Nursing history: during nursing history, the nurse assess: history of recurrent infections, current medications and therapeutic measures, current emotional stressors, nutritional status, and history of immunizations. B- Physical assessment Signs and symptoms of an infection vary according to the body area involved. For example: Sneezing, watery or mucoid discharge from the nose and nasal stuffiness commonly occur with an infection of the nose and sinuses. Urinary frequency and cloudy or discolored urine often occur with a urinary infection.  B- Physical assessment Signs of local infection include the following: Localized swelling Localized redness Pain or tenderness with palpation or movement Palpable heat at the infected area Loss of function of the body part affected Open wound may exude drainage of various colors. B- Physical assessment Signs of systemic infection include the following: Fever Increased pulse and respiratory rate if the fever is high. Malaise and loss of energy Anorexia and, nausea and vomiting Enlargement and tenderness of lymph nodes that drain the area of infection  C- Laboratory data Elevated leukocyte (white blood cell or WBC) count Elevated erythrocyte sedimentation rate (ESR). Red blood cells normally settle slowly, but the rate increases in the presence of an inflammatory process. Urine, blood, sputum, or other drainage cultures that indicate the presence of pathogenic microorganisms.  Diagnosing (nursing diagnosis= patient problem) Examples of nursing diagnoses : Potential Complication of Infection: Fever Imbalanced Nutrition: Less Than Body Requirements Acute Pain if the client is experiencing tissue damage and discomfort Anxiety if the client is apprehensive regarding changes in life activities  Planning The major goals for clients susceptible to infection are to:  Maintain or restore defenses.  Avoid the spread of infectious organisms.  Reduce or alleviate problems associated with the infection. Implementing The nurse implements strategies to prevent infection. If infection cannot be prevented, the nurse’s goal is to prevent the spread of the infection within and between individuals and to treat the existing infection.  Break the chain of infection: Nursing activities that interfere with the chain of infection to prevent and control transmission of infectious organisms, and that promote care of the infected client are described in the following table  Preventing nosocomial infections Hand hygiene is considered one of the most effective infection control measures. Supporting defenses of a susceptible host through proper oral and skin hygiene, balanced nutrition, fluid intake to flush out the bladder and urethra, adequate sleep, stress- reduction techniques and immunization. Disinfecting and sterilizing: The first links in the chain of infection, the etiologic agent and reservoir are interrupted by antiseptics, disinfectant and by sterilization.  Preventing nosocomial infections Disinfection: is a process that eliminates almost all pathogen organisms on objects, except for bacterial spores. Disinfectant: is a chemical agent that destroys pathogens other than spores, such as phenol. Antiseptic: is a chemical preparation that inhibits the growth of some microorganism and used on skin and tissue. Sterilization: is a process that destroys all microorganisms, including spores and viruses. Four commonly used method of sterilization are moist heat, gas, boiling water, and radiation.  Three categories for preventing nosocomial infection First category: for Critical items by sterilization Items that enter sterile tissue or vascular system present a high risk of infection if the items are contaminated with any microorganisms and spores. Items must be sterile. Some of these items follow: Surgical instruments Cardiac catheters Urinary catheters Needles Implants Second category: for Semi critical items-by Disinfection Items that come in contact with skin that is not intact or mucous membranes also present risks. These objects must be free of all microorganisms (except bacterial spores). Some of these items follow: Respiratory therapy equipment Endotracheal tubes Gastrointestinal endoscopes Reusable mercury thermometers  Three categories for preventing nosocomial infection Third category: for Noncritical items – by cleaning Items that come in contact with intact skin but not mucous membranes must be clean. Some of these items follow: Bedpans Blood pressure cuffs Crutches Linens Food utensils  Isolation precautions Isolation precautions create barriers between people and germs. These types of precautions help prevent the spread of germs in the hospital. Isolation: refers to measures designed to prevent the spread of infections or potentially infectious microorganisms to health personnel, clients, and visitors. Two types of isolation precautions protect against different types of germs. A- Standard Precautions B-Transmission-based Precautions  Two types of isolation precautions protect against different types of germs. A- Standard Precautions: Follow standard precautions with all patients, based on the type of exposure expected. When you are close to or handling blood, bodily fluid, bodily tissues, mucous membranes, or areas of open skin, you must use personal protective equipment (PPE). Gloves Masks and goggles Aprons, gowns, and shoe covers  B- Transmission-based Precautions Transmission-based precautions are extra steps to follow for illnesses that are caused by certain germs (B-1) Airborne precautions may be needed for germs that are so small they can float in the air and travel long distances. Germs that warrant airborne precautions include chickenpox, measles, and tuberculosis (TB) bacteria infecting the lungs or larynx (voice box). People who have these germs should be in special rooms where the air is gently sucked out and not allowed to flow into the hallway. This is called a negative pressure room. Anyone who goes into the room should put on a well-fitted respirator mask before they enter.  B- Transmission-based Precautions (B-2) Droplet precautions are used to prevent contact with mucus and other secretions from the nose and sinuses, throat, airways, and lungs. Illnesses that require droplet precautions include influenza (flu), pertussis (whooping cough), mumps, and respiratory illnesses, such as those caused by coronavirus infections. Anyone who goes into the room should wear a surgical mask.  B- Transmission-based Precautions (B-3) Contact precautions may be needed for germs that are spread by touching. Contact precautions help keep staff and visitors from spreading the germs after touching a person or an object the person has touched. Anyone entering the room that may touch the person or objects in the room should wear a gown and gloves  Infection control for health care workers There are three major modes of transmission of infectious materials in clinical setting: 1.Puncture wounds from contaminated needles or other sharps 2.Skin contact, which allows infectious fluids to enter through wounds and broken or damaged skin 3.Mucous membrane contact, which allows infectious fluids to enter through mucous membranes of the eyes, mouth, or nose.  Steps to follow after exposure to blood borne pathogens. 1. Report the incident immediately to appropriate personnel within the agency. 2. Complete an injury report. 3. Seek appropriate evaluation and follow up. This includes: - Identification and documentation of the source individual. - Testing of the source for hepatitis B, hepatitis C, and HIV when consent isgiven. - Making results of the test available to source individual’s health care provider. - Testing of blood of exposed for hepatitis C, hepatitis B, and HIV antibodies. - Post exposure prophylaxis if medically indicated. - Medical and psychological counseling regarding personal risk of infection orrisk of infecting others.  For puncture/ laceration: - Allow some bleeding to drain the site but do not squeeze the tissues. - Wash/clean the area with soap and water. - Initiate first-aid and seek treatment if indicated. - For a mucous membrane exposure (eye, nose, mouth) saline or water flushes for 5 to 10 minutes. Role of the Infection Control Department 1. Providing staff education on infection control. 2. Reviewing infection control policies and procedures. 2. Gathering statistics regarding the epidemiology of nosocomial infections. 3. Investigation of outbreaks of infection. 4. Providing input regarding selection of patient-care products. 5. Research related to infection control activities Role of the nurse: The nurse is responsible for providing the client with the safe environment by using effective aseptic techniques. The nurse should also assume responsibility for monitoring other health care team members who enter the client's environment. Educate others regarding the client's isolation status. Aggressive preventive measures can be highly effective in reducing nosocomial infections. The nurse uses precautions for all clients, even when an infection has not been diagnosed.