Asepsis - NSC 232 Fall 2024 PDF

Asepsis JAN PINHEIRO, RNC-OB, MSN, BSN NSC 232 TRADITIONAL FALL 2024  Asepsis Medical asepsis Surgical asepsis ◦ Includes all practices intended ◦ Sterile technique to confine a specific ◦ Practices that keep an area or microorganism to a specific area...

Asepsis JAN PINHEIRO, RNC-OB, MSN, BSN NSC 232 TRADITIONAL FALL 2024  Asepsis Medical asepsis Surgical asepsis ◦ Includes all practices intended ◦ Sterile technique to confine a specific ◦ Practices that keep an area or microorganism to a specific area object free of all ◦ Limits the number, growth, and microorganisms transmission of microorganisms ◦ Practices that destroy all ◦ Objects referred to as clean or microorganisms and spores dirty (soiled, contaminated) ◦ Used for all procedures involving sterile areas of the body Infection Phases of an infection: ◦ Incubation period- time from exposure of the pathogen until onset of symptoms. ◦ Still can be contagious without feeling symptoms ◦ Each disease process has its own incubation duration. Ex- flu- 1-4 days, Hep B- 1.5-6 months. ◦ Prodromal phase- vague characteristics/ symptoms start to occur depending on the disease process. ◦ Ex- Fatigue, low-grade fever, mild aches, nausea. Depends on the organism and body system. ◦ Clinical Illness- shows the full symptoms of the disease process. ◦ Vomiting, diarrhea, high fever, productive cough, chills. Depending on the pathogen and body system ◦ Convalescence- symptoms start to resolve and the person returns to their ADL’s (activities of daily living) ◦ “Normal” ADL’s depend on each person’s original health. Health Care Systems Responsibility Over prescribing of antibiotics causing resistant strains of infectious diseases Poor hand washing technique Nosocomial Infections- hospital acquired infection ◦ Estimated that 1 million clients per year acquire an HAI leading to many preventable deaths. ◦ According to the Centers for Disease Control and Prevention (CDC), “On any given day, about one in 31 hospital patients has at least one healthcare-associated infection” (2024).  Risks for Nosocomial Infection Compromised host- patient Insufficient hand hygiene- health care provider, patient and family Diagnostic or therapeutic procedures- poor sterile technique Signs of Localized Infection Localized swelling Localized redness Pain or tenderness with palpation or movement Palpable heat in the infected area Loss of function of the body part affected, depending on the site and extent of involvement Signs of Systemic Infection Fever Increased pulse and respiratory rate if the fever 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  Defenses Against Infection Primary defenses: ◦ Skin and mucus membranes ◦ Eyes ◦ Respiratory system: moist mucous membranes, cilia of the nasal passages, alveolar macrophages ◦ Gastrointestinal system: High acidity of stomach, Resident flora of the large intestine, Peristalsis ◦ Reproductive System ◦ Urinary System Circulatory system Secondary defenses: -Inflammatory response -Immune response Active Immunity Host produces antibodies in response to natural antigens or artificial antigens Natural active immunity ◦ Antibodies are formed in presence of active infection in the body ◦ Duration lifelong Artificial active immunity ◦ Antigens administered to stimulate antibody formation ◦ Lasts for many years ◦ Reinforced by booster Passive Immunity Host receives natural or artificial antibodies produced from another source Natural passive immunity ◦ Antibodies transferred naturally from an immune mother to baby through the placenta or in colostrum ◦ Lasts 6 months to 1 year Artificial passive immunity ◦ Occurs when immune serum (antibody) from an animal or another human is injected ◦ Lasts 2 to 3 weeks Standard Precautions Used with all clients Decrease the risk of transmitting unidentified pathogens Obstruct the spread of blood borne pathogens (hepatitis B and C viruses and HIV) Used in conjunction with other possible precautions Standard Precautions Category-specific Isolation Precautions Strict isolation Respiratory isolation Contact isolation Tuberculosis isolation Enteric precautions Blood and body fluid  Chain of Infection 1. Etiologic agent 2. Reservoir 3. Portal of exit 4. Mode of transmission 5. Portal of entry 6. Susceptible host Breaking the Chain of Infection Etiologic agent ◦ Correctly cleaning, disinfecting or sterilizing articles before use ◦ Educating clients and support persons about appropriate methods to clean, disinfect, and sterilize article Breaking the Chain of Infection Reservoir (source) ◦ Changing dressings and bandages when soiled or wet ◦ Appropriate skin and oral hygiene ◦ Disposing of damp, soiled linens appropriately ◦ Disposing of feces and urine in appropriate receptacles ◦ Ensuring that all fluid containers are covered or capped ◦ Emptying suction and drainage bottles at end of each shift or before full or according to agency policy Breaking the Chain of Infection Portal of exit ◦ Avoiding talking, coughing, or sneezing over open wounds or sterile fields ◦ Covering the mouth and nose when coughing or sneezing Breaking the Chain of Infection Method of transmission ◦ Proper hand hygiene ◦ Instructing clients and support persons to perform hand hygiene before handling food, eating, after eliminating and after touching infectious material ◦ Wearing gloves when handling secretions and excretions ◦ Wearing gowns if there is danger of soiling clothing with body substances Breaking the Chain of Infection Method of transmission (continued) ◦ Placing discarded soiled materials in moisture-proof refuse bags ◦ Disposing of urine and feces in appropriate receptacles ◦ Initiating and implementing aseptic precautions for all clients ◦ Wearing masks and eye protection when in close contact with clients who have infections transmitted by droplets from the respiratory tract ◦ Wearing masks and eye protection when sprays of body fluid are possible Breaking the Chain of Infection Portal of entry ◦ Using sterile technique for invasive procedures, when exposing open wounds or handling dressings ◦ Placing used disposable needles and syringes in puncture- resistant containers for disposal ◦ Providing all clients with own personal care items Breaking the Chain of Infection Susceptible host ◦ Maintaining the integrity of the client’s skin and mucous membranes ◦ Ensuring that the client receives a balanced diet ◦ Educating the public about the importance of immunizations Hand washing technique Applying sterile gloves Removal of Gloves Establishing and Maintaining a Sterile Field Establishing and Maintaining a Sterile Field (cont.) Establishing and Maintaining a Sterile Field (cont.) Cleaning- closed wound Sterile Dressing Change- Open Wound  10 Basic principles of Sterile Technique 1. Only sterile items are used within the sterile field. 2. Sterile persons are gowned and gloved. 3. Tables are sterile only at table level/waist high. 4. Sterile persons touch only sterile items or areas. Unsterile persons touch only unsterile items or areas. 5. Unsterile persons avoid reaching over sterile field. Sterile persons avoid leaning over unsterile areas. 6. Unsterile persons avoid sterile areas. 10 Basic principles of Sterile Technique 7. Sterile field is created as close as possible to the time of use. 8. Sterile areas are continuously kept in view. “Don’t turn your back on your sterile field.” 9. Destruction of integrity of microbial barriers results in contamination- keep sterile area free from moisture. 10. Date, time and initial all opened containers if they are to be reused- “if in doubt, throw it out.” Question 1 The client is a chronic carrier of infection. To prevent the spread of the infection to other clients or health care providers, the nurse emphasizes interventions that do which of the following? 1. Eliminate the reservoir 2. Block the portal of exit from the reservoir 3. Block the portal of entry into the host 4. Decrease the susceptibility of the host Answer: 2. Correct. Blocking the movement of the organism from the reservoir will succeed in preventing the infection of any other persons. Question 2 The most effective nursing action for controlling the spread of infection includes which of the following? 1. Thorough hand cleansing 2. Wearing gloves and masks when providing direct client care 3. Implementing appropriate isolation precautions 4. Administering broad-spectrum prophylactic antibiotics Answer: 1. Correct- handwashing is one of the best ways to help prevent spread of germs. Questions? Berman, A., Snyder, S.J., & Frandsen, G. (2021). Kozier & Erb’s fundamentals of nursing: Concepts, process, and practice (11th ed.). Boston, MA: Pearson. ISBN#10:0-13-668103-4