Asepsis By Dr. Seham Mohamed PDF

Asepsis By Dr. Seham Mohamed Outlines: Introduction. Definitions. Nosocomial infections. Factors contribute to nosocomial infections. Chain of infection. Body defenses against infections. Factors increasing susceptibility to infection. Nursing manage...

Asepsis By Dr. Seham Mohamed Outlines: Introduction. Definitions. Nosocomial infections. Factors contribute to nosocomial infections. Chain of infection. Body defenses against infections. Factors increasing susceptibility to infection. Nursing management  Nursing interventions that break the chain of infection.  Preventing nosocomial infections.  Disinfecting and sterilizing.  Three categories for sterilization, disinfection, and cleaning  Isolation precautions.  Infection control for health care workers.  Role of the Infection Control Department.  Role of the nurse. 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). 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.  Some microorganisms capable of causing disease referred to as 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 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 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. 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. A chronic infection: occurs slowly, over a very long period, and may last months or years. 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. Your immune system protects you from many illnesses and infections, but it’s also possible for it to go into overdrive in response to an infection. Asepsis: is a condition in which no living disease- causing microorganisms are present. Asepsis covers all those procedures designed to reduce the risk of bacterial, fungal or viral contamination, using sterile instruments, sterile draping and the gloved ‘no touch’ technique. There are two types of asepsis; medical and surgical asepsis. Infection Prevention and Control (IPC): is a public health issue that is fundamental in patient safety and health system strengthening. 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. The microorganisms that cause nosocomial infections can originate from: 1. The clients themselves (an endogenous source) 2. The hospital environment and hospital personnel (an exogenous sources). Most nosocomial infections appear to have endogenous source. Escherichia coli, staphylococcus aureus, and enterococci are the most common infecting microorganisms. 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 factors contributing to the spread of nosocomial 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, transmission of enterococci, normally found in fecal material, from the hands to the skin is a cause of wound infections. Major sites for nosocomial infection include the urinary tract, surgical wounds, the respiratory tract, and the bloodstream. Modes or routes of infection transmission :Body defenses mechanisms Factors increasing susceptibility to infection Host susceptibility is considered one of the most important factors for occurring the infection after invasion of the body by pathogenic microorganism and affected by various factors as age, hereditary, level of stress, nutritional status, Age Infections are a major cause of death of newborns, who have immature immune systems and are protected only for the first 2 or 3 months by immunoglobulin passively received from the mother. With 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. The nature and duration of physical and emotional stressors Stressors elevate blood cortisone. Prolonged elevation of blood cortisol decreases anti-inflammatory responses, depletes energy stores, leads to a state of exhaustion, and decreases resistance to infection. For example, a person recovering from a major operation or injury is more likely to develop an infection than a healthy person. 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 more vulnerable to infection. Some diagnostic procedures may also predispose the client to an infection, especially when the skin is broken or sterile body cavities are penetrated during the procedure. 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 Any disease That lowers the body’s defenses against infection places the client at risk. Examples are chronic pulmonary disease, which impairs cilliary action and weakens  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. Nursing history: The nurse assess:  The clients at risk of developing an infection through collecting data regarding the factors influencing the development of infection, especially existing disease process.  History of recurrent infections.  Current medications and therapeutic measures. Current emotional stressors.  Nutritional status, and history of immunizations.  Any client complaints suggesting the presence of an infection. 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. 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, depending on the site and extent of involvement  Open wound may exude drainage of various colors. 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, in some situations, nausea and vomiting  Enlargement and tenderness of lymph nodes that drain the area of infection C. Laboratory data Laboratory data that indicate the presence of an infection include the following: Elevated leukocyte (white blood cell or WBC) count (4,500 to 11,000 /ml is normal). Increased in specific types of leukocytes. 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  Potential Complication of Infection: Fever  Imbalanced Nutrition: Less Than Body Requirements  Acute Pain if the client is experiencing tissue damage and discomfort  Impaired Social Interaction or Social Isolation  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. Preventing nosocomial infections  Strict use of medical and surgical asepsis is necessary to prevent transport of potentially infectious microorganisms.  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, Disinfecting and sterilizing The first links in the chain of infection, the etiologic agent and reservoir are interrupted by antiseptics, disinfectant and by sterilization. Disinfection: is a process that eliminates almost all pathogen organisms on objects, with the exception of bacterial spores. Disinfectant: is a chemical agent that destroys pathogens other than spores, such as phenol and used on Antiseptic: is a chemical preparation that inhibits the growth of some microorganism and used on skin and tissue. Both antiseptic and disinfectant are bactericidal (destroy bacteria) or bacteriostatic (prevent the growth and reproduction of some bacteria). Sterilization: is a process that destroys all microorganisms, including spores and viruses. Four commonly used method of Moist heat. To sterilize with moist heat (such as with autoclave), steam under pressure is used because it attains temperatures higher than the boiling point. Gas. Ethylene oxide gas destroys microorganisms by interfering with their metabolic processes. It is also effective against spores. Its advantages are good penetration and effectiveness for heat-sensitive items. Its major disadvantage is its toxicity to humans. Boiling water. This is the most practical and inexpensive method for sterilizing in the home. The main disadvantage is that spores and some viruses are not killed by this method. Boiling a minimum of 15 minutes is advised for disinfection of articles in the home. Radiation Both ionizing (such as alpha, beta, and x-rays) and non-ionizing (ultraviolet light) radiation are used for disinfection and sterilization. The main drawback to ultraviolet light is that the rays do not penetrate deeply. Ionizing radiation is used effectively in industry to sterilize foods, drugs, and other items that are sensitive to heat. Its main advantage is that it is effective for items difficult to 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 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:  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).  Follow standard precautions with all patients, based on the type of exposure expected.  Depending on the anticipated exposure, types of PPE that may be required include:  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. Transmission-based precautions are followed in addition to standard precautions. Some infections require more than one type of transmission- based precaution. Follow transmission-based precautions when an illness is first suspected. Stop following these precautions only when that illness has been treated or ruled out and the room has been cleaned. Patients should stay in their rooms as much as possible while these precautions are in place. They may need to wear a mask when they leave their rooms. (B-1) Airborne precautions  may be needed for germs that are so small they can float in the air and travel long distances.  Airborne precautions help keep staff, visitors, and other people from breathing in these germs and getting sick.  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-2) 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.  Some of the germs that contact precautions protect from are C difficile and nor virus. These germs can cause serious infection in the intestines.  Anyone entering the room that may touch the person or objects in the room should wear a gown and gloves. (B-3) Droplet precautions are used to prevent contact with mucus and other secretions from the nose and sinuses, throat, airways, and lungs.  When a person talks, sneezes, or coughs, droplets that contain germs can travel about 3 feet (90 centimeters).  Illnesses that require droplet precautions include influenza (flu), pertussis (whooping cough), mumps, and respiratory illnesses, such as those caused by Infection control for health care workers There are three major modes of transmission of infectious materials in clinical setting:  Puncture wounds from contaminated needles or other sharps  Skin contact, which allows infectious fluids to enter through wounds and broken or damaged skin  Mucous membrane contact, which Steps to follow after exposure to blood borne pathogens  Report the incident immediately to appropriate personnel within the agency.  Complete an injury report.  Seek appropriate evaluation and follow up. This include:  Identification and documentation of the source individual.  Testing of the source for hepatitis B, hepatitis C, and HIV when consent is given.  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 or risk 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:  Providing staff education on infection control.  Reviewing infection control policies and procedures.  Gathering statistics regarding the epidemiology of nosocomial infections.  Investigation of outbreaks of infection.  Providing input regarding selection of patient-care products.  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. Evaluating If outcomes have not been achieved, the nurse may need to consider questions such as the following:  Were appropriate measures implemented to prevent skin breakdown and lung infection?  Was strict aseptic technique implemented for invasive procedures?  Are prescribed medications affecting the immune system?  Is client placement appropriate to reduce the risk of transmission of microorganisms?  Did the client and family misunderstand or fail to comply with necessary instructions?