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IMMUNE SYSTEM ASEPSIS

IMMUNE SYSTEM ASEPSIS. PRETEST. 1. Define Nosocomial infection 2. Identify what DTP stands for 3. Identify the most common Nsg . Intervention to prevent infection 4. Define sensory deprivation 5. Give one example of a Nsg. Procedure that uses surgical asepsis. PRETEST ANSWERS.

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IMMUNE SYSTEM ASEPSIS

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  1. IMMUNE SYSTEMASEPSIS

  2. PRETEST • 1. Define Nosocomial infection • 2. Identify what DTP stands for • 3. Identify the most common Nsg. Intervention to prevent infection • 4. Define sensory deprivation • 5. Give one example of a Nsg. Procedure that uses surgical asepsis.

  3. PRETEST ANSWERS • 1. Acute care or hospital acquired. • 2. Diptheria, Tetanus, Pertussis • 3. Handwashing • 4. Mental alteration resulting from severely decreased stimulation • 5. Invasive procedures: Starting an IV, injections, urinary catheterization

  4. IMMUNITY:DEFINITION • Specific resistance of the body to infectious agents

  5. SUSCEPTIBILITY:DEFINITION • Degree to which an individual can be affected • likelihood of an organism causing an infection in that person

  6. CHAIN OF INFECTION6 LINKS • 1. Etiologic agent (microorganism) • 2. Reservoir (source) • 3. Portal of exit from reservoir • 4. Method of transmission • 5. Portal of entry to the susceptible host • 6. Susceptible host

  7. ETIOLOGIC AGENT BODY SOURCES (6) • 1.Respiratory tract • 2.GI tract • 3.Urinary tract • 4.Reproductive tract (including genitals) • 5.Blood • 6.Tissue

  8. RESERVOIRS & PORTALS OF EXIT (5) • 1.Respiratory tract= nose/mouth, Endotracheal tubes or tracheostomies • 2.GI tract= Mouth per saliva, vomitus, anus/ostomies: feces, drainage tubes (eg, NG or T-tubes) • 3.Urinary tract= Urethral meatus & urinary diversion ostomies

  9. Con’t • 4. Reproductive tract= vagina: vaginal discharge; may be further transported by urine; urinary meatus: semen, urine • 5. Blood= open wound, needle puncture site, any disruption of intact skin or mucous membrane surfaces

  10. Direct Transmission= 1. Immediate & direct contact 2. Droplet spread if source & host within 3 ft of each other Indirect Transmission= 1. Vehicle borne = fomites 2. Vector-borne=animal, flying or crawling insect that serves as an intermediate means of transporting agent METHODS OF TRANSMISSION (3)

  11. (con’t) • Airborne Transmission= droplet nuclei • or residue of evaporated droplets that may remain in air for long periods of time emitted by infected host or dust particles containing the infectious agent are transmitted by air currents to a suitable portal of entry

  12. BREAKING THE CHAIN OF INFECTION • First link broken by use of antiseptics, disinfectants and sterilization • Aim of most isolation precautions & many hospital practices for infection prevention & control is breaking chain during transmission phase of cycle

  13. Antiseptics= agents that inhibit growth of some microorganisms chemical preparation used on skin or tissue Disinfectants= agents that destroy pathogens other than spores chemical preparation used to treat inanimate objects more concentrated solution=can be toxic & caustic to tissue ANTISEPTIC AGENTS VS DISINFECTANTS

  14. Bacteriostatic= prevents growth & reproduction of some bacteria BACTERICIDAL VS BACTERIOSATIC • Bactericidal= destroys bacteria

  15. ANTISEPTICS & DISINFECTANTS • “Commonly Used Antiseptics and Disinfectants, Effectiveness, and Use

  16. STERILIZATION • Process that destroys all micro org. including spores & viruses • METHODS (4): • 1. Moist heat (steam) • 2. Boiling water • 3. Gas • 4. Radiation

  17. INFECTION RISK FACTORS • HOST SUSCEPTIBILITY: age, heredity, stress level, nutritional status, immunization status, current medical therapy, pre existing disease processes, & some past or recent surgical interventions

  18. POPULATIONS AT RISK FOR INFECTION • Elderly, the very young • poorly nourished individuals • individuals with deficiency of serum immunoglobulins • individuals with insufficient immunizations or existing disease process • Individuals with multiple stressors • Individuals with certain medical therapies

  19. MEASURES THAT REDUCE A PERSON’S SUSCEPTIBILITY • Adequate hygiene • Administration of immunizations on a timely basis • Nutrition that is balanced and adequate • Fluid intake that is adequate • Rest and sleep that are adequate • Reduce stress

  20. STAGES OF AN INFECTIOUS PROCESS (4) • 1. Incubation period=time between entry of microorg. Into body & onset of s/s • 2. Prodromal Period=time from onset of nonspecific s/s until specific symptoms of infection appear • 3. Illness Period=specific s/s develop & become evident: localized s/s & systemic s/s

  21. (Con’t) • 4. Convalescent Period=extends from time s/s start to abate until person returns to normal state of health

  22. Nonspecific= intact skin & mucuous membranes, nasal passage cilia, lung alveolar macrophages & phagocytes, oral cavity lactoferrin & shedding, tears, GI pH,vaginal pH, inflammation Specific= 1. Active: natural vs artificial 2. Passive: natural vs Artificial NORMAL BODY DEFENSES

  23. STAGES OF INFLAMMATION • 1. Vascular & cellular responses • 2. Exudate • a. Serous • b. Purulent • c. Hemorrhagic • d. Serosanguineous • 3. Reparative

  24. LEUCOCYTOSIS • Abnormally high levels of white blood cells (leukocytes)= inflammation • Normal WBC count can go from 4500-11,000 per cubic millimeter of blood to 20,000 or more

  25. IMMUNIZATIONS INITIAL • HBV=Hep B-1,Hep B-2=Hep B-3= Hepatitis B= birth • DTP= Diptheria, Tetanus, Pertussis=2,4,6 months • Hib= Haemophilus Influenzae type b=2,4, 6 months • OPV=Oral Poliovirus=2, 4, 6 months • MMR= Measles, mumps, rubella=12 mo.

  26. (Con’t) • Varicella Zoster Virus Vaccine= 12-18 months

  27. BOOSTER SHOTS • HBV= health care workers draw titer & immunize with each exposure • DTP= 12 months, 4-6 yrs; Tetanus toxoid every 10 years thereafter • Hib= 12-15 months (Depending on type used) • OPV= 4-6 yrs • MMR= 4-6 yrs or 11-12 yrs

  28. NOSOCOMIAL INFECTION:DEFINITION • Infections that are associated with the delivery of health care services in a health care facility

  29. Endogenous Source= from the clients themselves Exogenous sources= microorganisms originate from the hospital environment and personnel NOSOCOMIAL INFECTION ORIGINS

  30. IATROGENIC INFECTIONS • Nosocomial infections that are due to any aspect of medical therapy • Example: Bacteremia resulting from an IV line • Other contributing factors: Presence of compromised hosts, insufficient hand washing or poor healthcare provider compliance with asepsis

  31. MAJOR SITES FOR NOSOCOMIAL INFECTIONS (4) • 1. Respiratory tract • 2. Urinary tract • 3. Bloodstream • 4. Surgical or open wounds

  32. RISK FACTORS THAT CONTRIBUTE TO NOSOCOMIAL INFECTION • 1. Invasive procedures • 2. Medical therapies • 3. Existence of large number of susceptible persons • 4. Inappropriate use of antibiotics • 5. Insufficient hand washing after client contact & after contact with body substances

  33. Localized: Infectious Process in only the affected body organ or area Example: abscess of big toe of right foot Systemic: Infectious process in the entire body Example: bacteremia LOCALIZED vs SYSTEMIC INFECTIONS: DEFINITIONS

  34. Local infection= localized swelling, localized redness, pain or tenderness with palpation or movement, palpable heat of affected part, loss of function of affected body part, wound drainage Systemic infection= ^ TPR,lassitude, malaise, loss of energy anorexia & n/v enlargement & tenderness of lymph nodes that drain area of infection see Kozier pg. 641 S/S OF LOCAL VS SYSTEMIC INFECTION

  35. LABORATORY DATA ^LEUCOCYTE COUNT • 1. ^Neutrophils=acute suppurative infection • 2. Neutrophils Decrease=acute bacterial infection in elderly • 3. Lymphocytes=^ in chronic bacterial & viral infection • 4. Monocytes ^ in some protozoal & rickettsial infections & TB

  36. (Con’t) • 5. Eosinophils= unaltered in infectious process • 6. Basophils= unaltered in fection process

  37. ^ ERYTHROCYTE SEDIMENTATION RATE (ESR) • Rate increases in presence of an inflammatory process

  38. CULTURE & SENSITIVITY STUDIES • Specimens of: urine, blood, sputum, or other body drainage= cultures microorganisms in special growth medium to indicate presence of pathogenic microorganisms and chemical substance they are susceptible to

  39. ASEPSISDEFINITION • Freedom from infection or infectious material • Example: handwashing

  40. All practices intended to confine a specificmicroorg. To a specific area, limiting the number, growth, & transmission of microorganisms Example: 2-minute handwashing Practices that keep an area or objects free of all microorg.; it includes practices that destroy all microorg and spores Example: Invasive procedures=IV starts, injections urinary cath. MEDICAL ASEPSIS vs SURGICAL ASEPSIS

  41. RELEVANT NANDA NURSING DIAGNOSES • High risk for infection • Altered oral mucous membranes • High risk for altered body temperature • Impaired skin integrity • Impaired tissue integrity • Impaired physical mobility • Altered nutrition: less than body requirements

  42. (Cont’) • Pain • Social isolation • Diversional Activity deficit • Self-esteem disturbance • Anxiety • Fear • Hopelessness

  43. NURSING INTERVENTIONS TO PREVENT INFECTION • Discuss risk factors which place pt. at risk for infection • Teach Pt.: purpose of meds, monitoring of health status, drsg. Chges., TCDB, frequent repositioning, isolation precautions • Monitor VS & skin color q shift for s/s of infection • Assess lab values for s/s of infection=CBC, cultures

  44. (Cont’d) • Ask Pt. About presence of subjective clinical s/s of infection (chills, malaise, lethargy) • Assess & document s/s of localized infection(auscultate lungs & inspect urine, sputum & other drainage for alterations in color & consistency) • Inspect skin for s/s inflammation & impaired tissue integrity

  45. (Cont’d) • Collect wound, sputum, urine & other specimens as ordered for C & S and report abnormalities • Assess Pt.’s immunization status & life-style practices • Develop & implement plan to teach Pt. About proper nutrition =high-protein, high-vitamin diet, adequate fluid intake, proper hygiene & importance of rest

  46. Medical asepsis METHODS OF KILLING OR REDUCING INFECTIOUS AGENTS • Medical asepsis • Surgical asepsis • Use of Medications: antibiotics, antivirals, antifungals

  47. ANTIBIOTIC:DEFINITION • Natural or synthetic substance that has the capacity to inhibit the growth of or kill other microorganisms • Synonyms: anti-infectives, antimicrobials antibacterials • Several different characteristics may be used to classify antibiotics

  48. RX CLASSIFICATION CHARACTERISTICS (3) • 1. Spectrum of activity=Broad vs narrow spectrum • 2. Antimicrobial activity= Bacteriostatic vs bacteriocidal • 3. Mechanism of action= (5)=inhibition of bacterial cell wall synthesis, alt. in cell membrane function,

  49. (con’t) • Inhibition of protein synthesis, inhibition of nucleic acid metabolism, interference with intermediate cell metabolism ( Malseed, et., al. Pharmacology Drug Therapy and Nursing Considerations, 1995 pg.583).

  50. LIPPINCOTT’S NSG. GUIDEANTIBIOTIC CLASSIFICATION (9) • 1. Penicillins • 2. Sulfonamides • 3. Tetracyclines • 4. Cephalosporins • 5. Aminoglycosides • 6. Fluoroquinolones • 7. Lincosamides

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