Asepsis and Infection Control - Fall 2024 - NURSG200

Asepsis and Infection Control Fall 2024 Jinger Roy, DNP, APRN, FNP-C adapted from content by Wolters Kluwer and ATI (copyright 2023 and 2022...

Asepsis and Infection Control Fall 2024 Jinger Roy, DNP, APRN, FNP-C adapted from content by Wolters Kluwer and ATI (copyright 2023 and 2022 respectively) Learning Objectives  Students will be able to:  Explain the infection cycle.  List the stages of an infection.  Identify patients at risk for developing an infection.  Describe nursing interventions used to break the chain of infection.  Identify situations in which hand hygiene is indicated.  Identify multi-drug resistant organisms that are prevalent in hospitalized patients and community settings.  List actual and potential problems and needs for a patient who has or is at risk for infection.  Describe strategies for implementing CDC guidelines for standard and transmission-based precautions when caring for patients.  Implement recommended techniques for medical and surgical asepsis. The Infection Cycle  Infection: a disease state that results from the presence of pathogens in or on the body  Cyclic process with six components:  Infectious agent  Reservoir  Portal of exit  Means of transmission  Portal of entry  Susceptible host Classification of Bacteria  Categorized by shape:  Cocci  Bacilli  Spirochetes  Categorized by gram staining:  Gram-positive  Gram-negative  Categorized by need for oxygen:  Aerobic  Anaerobic What Impacts Susceptibility?  Number of organisms  Virulence  Competence of person’s immune system  Length and intimacy of contact between person and microorganism Examples! Means of Disease Organism Type Reservoir Transmission Transmitted Nose, mouth, Airborne/droplet, SARS-CoV-2 Virus throat, and contaminated COVID-19 respiratory tract surfaces Mouth, throat, Droplet, Neisseria Bacterial Bacteria and respiratory close/prolonged meningitidis meningitis tract oral contact Penile and Treponema Reproductive Bacteria vaginal Syphilis pallidum tract secretions Blood-to-blood Bloodstream, contact, penile HCV Virus reproductive Hepatitis C and vaginal tract secretions Stages of Infection  Incubation period: organisms growing and multiplying  Prodromal stage: person is most infectious, vague and nonspecific signs of disease  Full/acute stage of illness: presence of specific signs and symptoms of disease  Convalescent period: recovery from the infection Inflammatory Response  Helps the body neutralize, control, or eliminate the offending agent, and prepare the site for repair  Vascular phase:  Vasodilation increases blood flow  Histamine released causes permeability of vessels and protein-rich fluid to get to the site of injury  Cellular stage:  Leukocytes/neutrophils consume debris  Damaged cells are repaired Immune Response  Body attempts to protect and defend itself  Humoral (antibody-mediated/specific) immunity:  Involving B-cells  Antigen: foreign material  Antibody: produced by the body in response to antigen  Cell-mediated (nonspecific) immunity:  Involving T-cells  Increase in lymphocytes that destroy or react with cells that the body recognizes as Factors that Affect Risk for Infection  Intact skin and mucous  Fatigue, nutritional and general membranes health status, pre-existing illnesses/conditions,  pH levels of the skin, GI, and previous/current treatments, GU tracts certain medications   Stress level Integrity and number of WBCs   Use of invasive or indwelling Age, assigned sex at birth, and hereditary factors medical devices  Immunity, natural or acquired Laboratory Data  Leukocyte (WBC) count: 5000-10,000/mm3  Differential:  Neutrophils: 60-70%  Lymphocytes: 20-40%  Monocytes: 2-8%  Eosinophils: 1-4%  Basophils: 0.5-1%  ESR: 0-15 mm/hr AMAB, 0-20 mm/hr AFAB  Positive blood, wound, or body fluid cultures Nursing Process  Assessment examples  Diagnosis/Analysis examples  Planning examples  Implementation examples  Evaluation examples Outcome Identification and Planning for  Infection Control Demonstrate effective hand hygiene and good personal hygiene practices  Identify the signs of an infection  Maintain adequate nutritional intake  Demonstrate proper disposal of soiled articles  Use appropriate cleansing and disinfecting techniques  Demonstrate an awareness of the necessity of proper immunizations  Demonstrate stress-reduction techniques Asepsis  Includes all activities to prevent infection or break the chain of infection  Medical asepsis:  Clean technique to reduce number of pathogens  Hand hygiene and wearing gloves when appropriate  Surgical asepsis:  Sterile technique to keep area free from microorganisms  Examples: inserting indwelling urinary catheter, inserting IV or central line, suctioning tracheostomy, obtaining sample from peritoneal dialysis catheter, drawing blood cultures from a central line Practicing Medical Asepsis  Good hand hygiene  Do not shake linens  Carry soiled linens/items so  Clean the least soiled areas that they do not touch your first, move to most soiled clothing areas  Do not place items on the floor,  Dispose of soiled items into including soiled ones appropriate containers  Avoid allowing patients to  Pour liquids directly into drain cough, sneeze, or breathe to avoid splashing directly on others  Keep nails short and well- groomed Hand Hygiene  The most effective way to help prevent the spread of infectious agents  WHO’s Five Moments for Hand Hygiene:  Before touching a patient  Before a clean or aseptic procedure  After a body fluid exposure risk  After touching a patient  After touching patient surroundings Bacterial Flora  Transient:  Resident:  Attached loosely on skin  Found in skin creases  Occur on hands with ADLs  Usually stable in number and type  Greatest number under the fingernails  Cling to skin by adhesion and absorption  Can be pathogenic or nonpathogenic  Require friction with brush to remove, less susceptible to  Removed relatively easily with antiseptics handwashing Health Care-Associated Infections (HAIs)  Catheter-associated urinary  Invasive health care-associated tract infection (CAUTI) methicillin-resistant S. aureus (MRSA) infections  Surgical site infection (SSI)  Hospital-onset MRSA infections  Central-line-associated bloodstream infection (CLABSI)  Clostridioides difficile (C. diff) infections (CDI)  Ventilator-assisted pneumonia (VAP)  CDI hospitalizations Multidrug-Resistant Organisms  Methicillin-resistant S. aureus (MRSA)  Vancomycin intermediate-resistant S. aureus (VISA)  Vancomycin-resistant S. aureus (VRSA)  Vancomycin-resistant Enterococci (VRE)  Carbapenem-resistant Enterobacteriaceae (CRE)  Carbapenem-resistant Acinetobacter baumannii (CRAB)  Clostridioides difficile (CDI) Sterilizing and Disinfecting  Disinfection: destroys all pathogenic organisms, except spores  Preparing the skin for a procedure or cleansing equipment that does not enter a sterile body part  Sterilizing: destroys all microorganisms  Cleansing equipment that can enter sterile body parts  How do you choose?  Nature of organisms present  Intended use of equipment  Number of organisms present  Available means for sterilization  and disinfection Type of equipment  Time Personal Protective Equipment  Gloves  Gowns  Masks  Protective eyewear (face shields, goggles) Standard Precautions  Used in the care of all hospitalized patients, regardless of their diagnosis or possible infection status  Apply to blood, all body fluids, secretions, and excretions except sweat, nonintact skin, and mucous membranes  New recent additions:  Respiratory hygiene/cough etiquette  Safe injection practices  Masking with high-risk prolonged procedures involving spinal canal punctures Transmission-Based Precautions  Used in addition to standard precautions for patients in hospitals with suspected infection with pathogens  Don PPE when entering the room of a patient on isolation precautions, and remove only when leaving the room, before leaving the room  With one exception!  Three types: airborne, droplet, and contact  Can be used alone or in combinations Preventing Needlestick Injuries  Avoid using needles whenever safe alternatives are available  Use needles with safety devices  Never recap a need that might be contaminated  Never bend a needle that might be contaminated  Use sharps containers for disposal immediately after use Accidental Exposure  Performed immediately after needlestick injury or exposure to blood or body fluids:  Immediately wash the exposure site with warm water and soap (flush mucous membranes and eyes with water or irrigation)  Immediate, detailed incident report to facility  Baseline testing of patient first, with permission  Postexposure prophylaxis (PEP), if recommended  Follow-up testing as recommended, depends on exposure  Counseling sessions regarding safe practices to protect self and others Surgical Asepsis Techniques  Open sterile kits only on a flat, disinfectable surface  Only sterile objects can touch other sterile objects  Always open with first flap going away from you, to prevent contaminating the sterile wrapper  A wet field is not sterile  All sterile objects should be held above waist level Surgical Asepsis Techniques  Avoid reaching over a sterile field  Never turn your back on a sterile field  Consider the outer 1” edge of a sterile field to be contaminated  If pouring liquids, the outside bottle and cap are not sterile, hold with label facing palm of hand and never pour over a field Teaching Medical Asepsis at Home  Wash hands before preparing or  Wash raw fruits and vegetables eating food  Use pasteurized milk and fruit  Prepare foods at high enough juices temperatures  Wash hands after using  Wash hands, cutting boards, bathroom and utensils before and after handling raw poultry or meat  Use individual care items rather than sharing  Keep food refrigerated Evaluation of Patient Goals  Correctly use techniques of medical asepsis  Identify health habits and lifestyle patterns promoting health  State signs and symptoms of an infection  Identify unsafe situations in the home environment References  Assessment Technologies Institute. (2023). Fundamentals for Nursing (Edition 11.0).  Taylor, C. et al. (2022). Taylor’s Fundamentals of Nursing (10th ed.). Wolters Kluwer Health.