Asepsis and Infection Control PDF

**Six elements are necessary for the development of an infection, referred to as the chain of infection. The chain must be interrupted to prevent the transmission of an infection.\ ** 1. **Infectious agent: A pathogen\ ** 2. **Reservoir: Where the pathogen can grow\ ** 3. **Portal of e...

**Six elements are necessary for the development of an infection, referred to as the chain of infection. The chain must be interrupted to prevent the transmission of an infection.\ ** 1. **Infectious agent: A pathogen\ ** 2. **Reservoir: Where the pathogen can grow\ ** 3. **Portal of exit: Exit route from the reservoir\ ** 4. **Mode of transmission: Method or vehicle of transportation\ ** 5. **Portal of entry: Entrance through the skin, mucous lining, or mouth\ ** 6. **Host: Another person or animal that is susceptible to the pathogen\ ** **Mode of Transmission:\ ** 7. **A contaminated vehicle is the means by which microorganisms are carried about and transported to the next host, once they have left the reservoir. Contamination means a condition of being soiled, stained, touched by, or otherwise exposed to harmful agents, which makes an object potentially unsafe for use.\ ** a. **A living vehicle is called a vector.\ ** b. **An inanimate vehicle is called a fomite.\ ** 1. **Fomites in health care facilities include computers, medical records and charts, stethoscopes, thermometers, bandage scissors, used tissues, drinking glasses, needles, and soiled dressings.\ ** 8. **Transmission may be direct or indirect.\ ** c. **Indirect transmission is most common, occurring when the host comes into contact with a fomite or vector.\ ** d. **Direct transmission is also possible, such as when the nurse uses poor hand hygiene and then touches a patient while providing care.\ ** 2. **Pay special attention to how microorganisms may spread through the environment.\ ** a. **Do not shake linens when making a bed, as air currents can carry microorganisms.\ ** b. **Use a dampened or treated cloth when dusting to prevent circulation of dust particles.\ ** c. **Avoid touching anything other than feet and furniture to the floor, and do not use anything that has been dropped on the floor, to include linens and supplies.\ ** **Portal of Entry\ ** 9. **Once the microorganism has exited the reservoir and has been transmitted to a susceptible host, it has to find a way to enter the host. Many of the entrance and exit routes that microorganisms take are the same, and the methods used to prevent or control both processes are also similar.\ ** e. **Skin is the first line of defense against infection. It should be kept intact, lubricated, and clean. Observe, protect, and treat open areas.\ ** 3. **Any injury caused by a sharp piece of equipment, such as a used needle or scalpel, should be immediately reported so that procedure can be initiated to help prevent development of certain types of infections. Punctured skin provides a portal of entry for microorganisms into the bloodstream.\ ** d. **Appropriate waste containers should be readily available and are essential for safe disposal of sharp instruments.\ ** e. **Needles should never be recapped.\ ** f. **Indwelling urinary catheters and other drainage equipment also provide an entrance for microorganisms.\ ** 4. **Ensure tubes remain connected and intact.\ ** 5. **Take care when turning, positioning, or transferring a patient to prevent any tubes from becoming tangled or pulled apart.\ ** g. **Gloves should be worn when handling areas of open skin or mucous membranes. Ensure soiled dressings are disposed of in an appropriate waste container.\ ** **Host\ ** 10. **A host is an organism in which another organism is nourished and harbored.** h. **Susceptibility to infection is defined by the amount of resistance that the host can exhibit against the pathogen. As the pathogen's strength and numbers increase, the person becomes more susceptible. Factors that affect host immunologic resistance include:\ ** 6. **Chemotherapy\ ** 7. **Diagnostic procedures\ ** 8. **Disease processes\ ** 9. **Environmental factors\ ** 10. **Fatigue\ ** 11. **Hereditary factors\ ** 12. **Very young or old in age\ ** 13. **Lifestyle\ ** 14. **Medical therapy\ ** 15. **Nutritional status\ ** 16. **Occupation\ ** 17. **Radiation exposure\ ** 18. **Stress\ ** 19. **Trauma\ ** 20. **Travel\ ** i. **Immunizations, in addition to normal defense mechanisms, have proven effective in reducing susceptibility to some types of infectious diseases.\ ** 21. **Many health care facilities require staff to be current on their immunizations. Nurses serve as role models for patients by adhering to, providing teaching about, and encouraging these health practices.** a. **In addition to immunologic resistance, the body has various natural defense mechanisms that protect against infection.\ ** 1. **Skin\ ** a. **The skin is the first line of defense against infection due to an intact, multilayered surface that provides a barrier to microorganisms.\ ** 1. **Cuts, abrasions, puncture wounds, and areas of maceration may alter this defense.\ ** b. **Shedding of the outer layer of skin removes organisms that adhere to the skin's outer layers.\ ** 2. **Failure to bathe regularly may alter this defense.\ ** c. **Sebum contains fatty acid that kills some bacteria.\ ** 3. Bathing excessively may alter this defense. 2. Gastrointestinal tract d. The intact multilayered mucosa of the mouth provides a mechanical barrier to microorganisms. 4. Lacerations, trauma, and extracted teeth may alter this defense. e. Saliva contains microbial inhibitors and washes away particles that contain microorganisms. 5. Poor oral hygiene and dehydration may alter this defense. f. The acidity of gastric secretions chemically destroys microorganisms incapable of surviving low pH. 6. Use of antacids may alter this defense. g. Rapid peristalsis in the small intestine prevents the retention of bacterial contents. 7. Delayed motility resulting from impaction of fecal contents in the large bowel or mechanical obstruction by masses may alter this defense. 3. Eyes h. Tearing and blinking provide mechanisms to reduce entry or to assist in washing away particles that contain pathogens, thus reducing the number of organisms. 8. Injury or exposure, such as a splash of blood or other potentially infectious material into the eye may alter this defense. 4. Respiratory tract i. Cilia lining the upper airway, coated by mucus, trap inhaled microbes and sweep them outward in mucus to be expectorated or swallowed. They are also able to engulf and destroy microorganisms that reach the lungs' alveoli. 9. Smoking, high concentrations of oxygen and carbon dioxide, decreased humidity, and cold air may alter these defenses. 5. Genitourinary tract j. The flushing action of urine flow washes away microorganisms on the lining of the bladder and urethra. 10. Introduction of a urinary catheter, continuous movement of a urinary catheter in the urethra, delayed micturition, and obstruction of normal urinary flow may alter this defense. k. At puberty, normal vaginal flora causes vaginal secretions to achieve a low pH, inhibiting the growth of many microorganisms. 11. Antibiotics, excessive douching, and oral contraceptives disrupt normal vaginal flora and may alter this defense. a. **The infectious process describes the progression of stages that an infection, whether localized or systemic, courses through.\ ** 1. **Stages of the infectious process include:\ ** a. **Incubation period\ ** 1. **Interval between the entrance of a pathogen into the body and the appearance of first symptoms. The host may be infectious during this period.\ ** b. **Prodromal stage\ ** 2. **Interval from the onset of nonspecific signs and symptoms to more specific symptoms. During this time, microorganisms grow and multiply, and the patient is more capable of spreading the disease to others.\ ** c. **Acute stage\ ** 3. **Interval when the patient manifests signs and symptoms specific to the type of infection. This is often the period in which the individual is most contagious.\ ** d. **Convalescence\ ** 4. **Interval when acute symptoms of infection disappear. The length of recovery depends on the severity of the infection and the patient's general state of health, ranging from several days to months.\ ** 2. **The severity of a patient's illness depends on the extent of the infection, the virulence (disease-causing power) of the microorganisms, and susceptibility of the host.\ ** e. **A systemic infection that affects the entire body has the potential to be fatal. Localized infections require proper care to control spread and minimize illness.\ ** 3. **The course of an infection influences the level of nursing care that must be provided. The complexity of that care further depends on what body systems are affected by the infection. Nursing care for an infection may include:\ ** f. **Administration of prescribed antimicrobial agents\ ** g. **Monitoring patient response to therapies\ ** 5. **Vital signs\ ** 6. **Laboratory values\ ** 7. **Subjective data from the patient\ ** h. **Providing adequate nutrition\ ** i. **Allow for rest\ ** j. **Minimize spread\ ** b. **Inflammation is the body's response to injury or infection at the cellular level. The inflammatory process is a protective vascular reaction that delivers fluid, blood products, and nutrients to interstitial tissues in the area of injury. This process neutralizes and eliminates pathogens or necrotic tissues and establishes a means of repairing body cells and tissues.\ ** 4. **Signs of localized inflammation include:\ ** k. **Edema\ ** l. **Erythema\ ** m. **Heat\ ** n. **Pain or tenderness\ ** o. **Loss of function in the affected part\ ** 5. **Signs of systemic inflammation include:\ ** p. **Fever\ ** q. **Leukocytosis\ ** r. **Malaise\ ** s. **Anorexia\ ** t. **Nausea\ ** u. **Vomiting\ ** v. **Lymph node enlargement\ ** 6. **The inflammatory response is triggered by physical agents, chemical agents, or microorganisms. It may occur in the absence of an infectious process.\ ** w. **Examples of physical agents include:\ ** 8. **Mechanical trauma\ ** 9. **Temperature extremes\ ** 10. **Radiation\ ** x. **Examples of chemical agents include:\ ** 11. Harsh poisons (external irritant) 12. Gastric acid (internal irritant) **\ ** a. **Administration of prescribed antimicrobial agents\ ** b. **Monitoring patient response to therapies\ ** 1. **Vital signs\ ** 2. **Laboratory values\ ** 3. **Subjective data from the patient\ ** c. **Providing adequate nutrition\ ** d. **Allow for rest\ ** e. **Minimize spread\ ** a. **Previously referred to as nosocomial infections, health care-associated infections (HAI) are those that are acquired by patients when undergoing medical treatment in a health care facility, to include:\ ** 1. **Central-line associated bloodstream infection (CLABSI)\ ** 2. **Catheter-associated urinary tract infection (CAUTI)\ ** 3. **Surgical site infection (SSI)\ ** 4. **Ventilator-associated pneumonia (VAP)\ ** b. **Hospitals harbor microorganisms that are often highly virulent, making them more likely places for infection. The hospitalized patient's immune system is probably already weakened from disease or invasive procedures, making them more susceptible to these pathogens.\ ** c. **Much attention has been given to the prevention of HAIs, including monitoring and surveillance by the Centers for Disease Control and Prevention (CDC) and the Joint Commission.** 5. **Detrimental effects of HAIs include:\ ** a. **Longer hospital stays for the patient\ ** b. **Increased cost for the patient, hospital, and funding bodies\ ** c. **Possibility of disability or death. The Centers for Medicare and Medicaid Services (CMSS) require hospitals to collect and report data regarding the incidence of HAIs to receive funding. This position encourages facilities to focus on activities that prevent HAIs to avoid financial penalties.\ ** d. **HAIs are most commonly transmitted via direct contact between health care workers and patients or from patient to patient. Exogenous infections are caused by microorganisms from another person. Endogenous infections are caused by the patient's own normal microorganisms, which become altered and overgrow or are transferred from one body site to another.\ ** 6. **Strong emphasis must be placed on the prevention of transmission with measures such as hand hygiene and environmental cleaning. Conscientious and thorough practice while performing clean and aseptic procedures is critical in reducing the transmission of infection.\ ** 1. Standard precautions aim to interrupt the chain of infection and reduce transmission of bloodborne pathogens and other potentially infectious materials, to include blood, body fluids, secretions, excretions except sweat, nonintact skin, and mucous membranes. Standard precautions include the following, as applicable to the patient situation: 1. **Masks\ ** 2. **Eye protection\ ** 3. **Gowns\ ** 4. **Hand hygiene\ ** a. **Hand hygiene is the single most important and basic preventive technique that health care workers can use to interrupt the infectious process.\ ** 1. **Standard cleansing practice requires handwashing for a minimum of 20 seconds with facility-approved soap, running hands under water (See Foundations and Adult Health Nursing, 8^th^ Ed., Skill 7.1 Performing Hand Hygiene with Soap and Water, pg. 129-130).\ ** b. **Hand washing is required (regardless of whether gloves are worn):\ ** 2. **Before and after patient care\ ** 3. **After touching blood, body fluids, secretions, excretions, and contaminated items\ ** 4. **At the beginning and end of each shift\ ** 5. **Immediately after gloves are removed\ ** 6. **Between patient contacts\ ** 7. **Before and after eating\ ** 8. **Before and after using the toilet\ ** 9. **Before changing and dressing or having contact with open wounds\ ** 10. **Before preparing and administering medications\ ** 11. **In preparation for an invasive procedure\ ** 12. **When hands are visible soiled\ ** 13. **Between tasks or procedures on the same patient to prevent cross-contamination of different body sites** 14. **When caring for a patient with *Clostridium difficile* or exposed to *Bacillus anthracis* (spores are not killed by alcohol-based hand sanitizer)\ ** 15. **When otherwise indicated to prevent transfer of microorganism to other patients or environments\ ** c. **The use of alcohol-based hand sanitizer has proven more effective in reducing HAIs than plain hand washing and therefore should be used (See Foundations and Adult Health Nursing, 8^th^ Ed., Box 7.8 Using an Alcohol-Based Waterless Antiseptic for Routine Hand Hygiene):\ ** 16. **Before and after patient contact\ ** 17. **Before donning sterile gloves when inserting central intravascular catheters\ ** 18. **Before performing nonsurgical invasive procedures\ ** 19. **After contact with body fluids, excretions, mucous membranes, nonintact skin, and wound dressings\ ** 20. **If moving from a contaminated body site to a clean body site during patient care\ ** 21. **After contact with inanimate objects in the immediate vicinity of the patient\ ** 22. **After removing gloves\ ** d. **Note: Only natural nails, no longer than ¼ inch, should be worn in the health care setting\ ** 5. **Gloves\ ** e. Nurses and other health care personnel should don gloves if any possibility exists of contact with infectious material with their hands (See **Foundations and Adult Health Nursing, 8^th^ Ed., Skill 7.2 Gloving, pg. 132-133)**. 23. CDC guidance for gloving includes: a. Wear gloves only once, then place them into the appropriate waste containers for safe disposal b. If you have not completed patient care but have come into contact with infectious material, change the gloves before continuing the patient's care c. Because of the risk of perforating the gloves during use, perform hand hygiene after removing gloves 24. Latex allergies result from a reaction to certain proteins found in natural rubber latex. These proteins can enter the body through the skin, mucous membranes, intravascularly, and by inhalation. d. A latex allergy should be suspected and evaluated when anyone develops red, watery, itchy eyes; sinus or nasal congestion; tachycardia; or hypotension after exposure to latex. Anaphylaxis is possible. e. Synthetic versions of many products are available. Even though an individual product is "latex free," an environment is "latex safe" only when all items of latex that have potential to come in contact with the allergic individual are removed. f. To avoid developing a latex allergy: 1. Whenever possible, wear powder-free gloves since they are lower in protein allergies 2. Wear gloves that appropriate for the task 3. Wash with a pH-balanced soap immediately after removing gloves 4. Apply only non-oil-based hand care products (oil-based products break down latex) 5. If a reaction or dermatitis occurs, seek medical treatment immediately a. In addition to standard precautions, the CDC condensed disease-specific approaches to isolation into transmission categories: airborne, droplet, and contact precautions. These precautions are designed to be used in the care of patients with a specific type of confirmed or suspected infection. Isolation precautions are implemented *in addition to* standard precautions. 6. Regardless of which technique is used, the nurse should follow some basic principles in all scenarios: f. Perform thorough hand hygiene before and after caring for a patient g. Have an adequate understanding of the disease process and method of transmission of the infectious microorganism to help determine which protective barriers to use h. Dispose of contaminated equipment and articles in a safe and effective manner to prevent transmission of pathogens to other individuals i. If the patient is to be transported to other areas in the agency (away from the isolation room), take necessary measures to protect those who potentially will be exposed. The patient should be transported in accordance with hospital protocol. 7. Airborne Precautions j. **Some examples of illnesses requiring airborne precautions include:\ ** 25. **Measles\ ** 26. **Varicella zoster virus\ ** 27. **Tuberculosis\ ** k. Private patient room l. Negative-pressure airflow with 6-12 air exchanges per hour, vented to the outside 28. Door should remain closed to maintain negative pressure m. Health care workers are required to wear an N-95 or higher particulate respirator mask or a powered air purifying respiratory (PAPR) when entering an isolation room 29. Each health care worker must undergo fit-testing before using a respirator for the first time to ensure type and size are appropriate for the individual 30. A respirator fit-check should be performed before each use g. Respirators may be reused and stored according to manufacturer recommendations and agency policy n. Patient transport should be limited to medically necessary purposes 31. Patient must wear a surgical mask when out of isolation room and observe respiratory hygiene etiquette 8. Droplet Precautions o. **Some examples of illnesses requiring droplet precautions include:\ ** 32. ***Haemophilus influenzae*\ ** 33. ***Neisseria meningitidis\ *** 34. **Pertussis\ ** 35. **Rubella\ ** p. Private patient room, cohort, or maintain minimum of 3 feet from other patients and visitors q. Health care workers are required to wear a mask when entering an isolation room r. Patient transport should be limited to medically necessary purposes 36. Patient must wear a surgical mask when out of isolation room and observe respiratory hygiene etiquette 9. Contact Precautions s. **Some examples of illnesses requiring contact precautions include:\ ** 37. ***Clostridium difficile*\ ** 38. **Respiratory syncytial virus\ ** 39. **Impetigo\ ** 40. **Methicillin-resistant *Staphylococcus aureus* (MRSA)\ ** t. Private patient room u. Health care workers are required to wear gloves and a gown upon entering an isolation room v. Noncritical patient care equipment should be disposable or designated for patient-dedicated use only w. Patient transport should be limited to medically necessary purposes 41. Infected or colonized areas of the patient's body should be contained and covered 42. Remove contaminated personal protective equipment (PPE) and perform hand hygiene prior to transporting patients 43. Don clean PPE to handle the patient at the transport destination 10. Protective Precautions x. Protective precautions are used for patients with immunocompromising conditions. These patients are generally at increased risk for bacterial, fungal, parasitic, and viral infections from endogenous and exogenous sources. y. Immunocompromised patients may require additional protective measures, such as health care staff donning masks, even though the patient does not have an infection, or requiring a private room. These protective measures are identified on patient door signage, just as isolation precautions are.