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NUR 104

NUR 104 . Asepsis Infection Control. Standard Precautions. Good health depends in part on a safe environment. Practice or techniques that control or prevent transmission of infection help to protect clients and health care workers from disease. Standard Precautions.

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NUR 104

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  1. NUR 104 Asepsis Infection Control

  2. Standard Precautions • Good health depends in part on a safe environment. • Practice or techniques that control or prevent transmission of infection help to protect clients and health care workers from disease

  3. Standard Precautions • Employees are to follow precautions to prevent contact with blood or other infectious materials during the routine care of clients • Personal protective equipment (PPE) must be provided at no cost to the employees who are at risk for exposure and must be used by the employee

  4. .Standard Precautions • Principles/procedures to prevent and control infection and its spread. • Break the chain of infection • Applies to all blood and body fluid except sweat • Nonintact skin and mucous membranes • Protect patient and healthcare worked

  5. Asepsis • Asepsis—absence of pathogenic microorganisms • The nurse’s efforts to minimize the onset and spread of infection based on principles of aseptic technique • Aseptic technique refers to practices that keep a client as free from microorganisms as possible • Two types: medical and surgical

  6. Surgical Asepsis • Sterile technique • To eliminate all microorganisms, including pathogens and spores from an object or area • If an area or object is touched by any object that is not sterile it is considered contaminated

  7. Medical Asepsis • Clean technique • Reduce number of organisms present and prevent the transfer of organisms • Hand Hygiene • Clean Gloves • Contaminated objects • Bedpans/Urinals • Overbed tables • Dirty Dressings

  8. Infection • Entry and multiplication of an infectious agent in the tissues of a host. • Infectious agent—pathogen • asymptomatic • symptomatic

  9. Health-Care Associated Infection • HAI result from delivery of health services in a health care facility • High population of virulent strains of microorganisms that may be resistant to antibiotics • Increased hospital stays • Surgical or traumatic wounds • Urinary and Respiratory tracts • Bloodstream

  10. Healthcare Acquired Infection • Clients in hospital are at risk for acquiring • Low resistance to infectious microorganisms • Increased exposure to the number and types of disease causing microorganisms • Invasive procedures • NON PAYMENT ISSUES

  11. Infection • Iatrogenic • HAI from a diagnostic or therapeutic procedure

  12. Infection • Exogenous infection—from organisms external to the person that do not exist as normal flora • Endogenous infection—when person’s flora becomes altered and an overgrowth results—yeasts, streptococci

  13. Risk factors • Inadequate secondary defenses • Reduced hemoglobin level • Suppression of WBCs • Suppressed inflammatory response • Low WBC count (leukopenia)

  14. Patient Susceptibility • Age—infant, child, older adults • Nutritional status—protein, carbohydrates, fats • Stress • Heredity • Disease process—immune system, chronic diseases, burn patients • Medical therapy—some drug and medical therapies compromise immunity to infection

  15. Patients at Risk Inadequate primary defenses • Broken skin or mucosa • Traumatized tissue • Decreased ciliary action • Obstructed urine outflow • Altered peristalsis • Change in pH of secretions • Decreased mobility

  16. Chain of Infection CAUSATIVE AGENT SUSCEPTIBLE HOST Reservoir PORTAL OF ENTRY PORTAL OF EXIT MODE OF TRANSMISSION

  17. CAUSATIVE AGENT Chain of Infection • Infection occurs in a cycle that depends on the presence of all of the following: • An infectious agent or pathogen • Bacteria, fungi, virus, parasite • Dose, Virulence, Enter/ survive, Host resistance

  18. A reservoir or source for pathogen growth Human beings, animals, inanimate objects Portal of exit from the reservoir Sputum, emesis, stool, blood Sneeze/Cough UTI Drainage Saliva Exchange PORTAL OF EXIT Chain of infection Reservoir

  19. Mode of transmission Contact Airborne Vectorborne Vehicle Portal of entry to a host Mucous membranes Nonintact skin GI tract GU tract Respiratory tract Chain of Infection MODE OF TRANSMISSION PORTAL OF ENTRY

  20. Chain of Infection • Susceptible Host • Immunosuppressed • Elderly • Chronically ill • Trauma • Surgery SUSCEPTIBLE HOST

  21. Infectious Process • Severity of illness depends on: • Extent of infection • Pathogenicity of microorganism • Susceptibility of host • Localized • Systemic—affects entire body

  22. Sepsis • The spread of an infection from its initial site to the blood stream, initiating a systemic response that adversely affects blood flow to vital organs • Bacterial infections are the most common source of initial infection • When organisms overwhelm local defenses and enters the bloodstream the resulting condition is called septicemia

  23. Inflammatory response • Body’s cellular response to injury or infection = inflammation • Inflammation = (1) protective vascular and cellular reaction that • Delivers fluid, blood products, and nutrients to interstitial tissues in the area of injury • Neutralizes and eliminates pathogens or dead (necrotic tissues) • Establishes means of repairing body cells and tissues

  24. Signs of inflammation • Localized • Swelling • Redness • Heat • Pain or tenderness • Loss of function • Systemic: • Fever, leukocytosis, malaise, anorexia, nausea, vomiting, lymph node enlargement

  25. Vascular response • Injury/infection: • Arterioles supplying the area dilate, allowing more blood into the local area. This causes redness, localized warmth is from greater blood volume. Vasodilation delivers blood and WBCs to injured tissues • Injury causes tissue necrosis. Fluid, protein, and cells enter interstitial spaces, accumulated fluid appears as localized swelling (edema) • Pain is caused by the swelling of inflamed tissues increasing pressure on nerve endings

  26. Cellular response • WBCs arrive at the site • WBC pass thru blood vessels into the tissues • Phagocytosis—specialized WBCs called neutrophils and monocytes ingest and destroy microorganisms or other small particles • Leukocytosis—increased # of circulating WBCs in response to WBCs leaving the blood vessels

  27. 2. Inflammatory exudate • Accumulation of fluid and dead tissue cells and WBCs form an exudate at the site of inflammation • Serous—clear, like plasma • Sanguineous—containing RBCs • Purulent—containing WBCs and bacteria • Cleared away by the lymphatic drainage

  28. 3. Tissue Repair • Healing involves the defensive, reconstructive, and maturative stages • Damaged cells replaced with healthy new cells • New cells undergo gradual maturation until they have the same structural and appearance as previous cells • Chronic inflammation—tissue defects may fill with fragile granulation tissue—not as strong as tissue collagen--scar

  29. Nursing Assessment • Review of disease history, exposure to CD • Review of clinical condition—signs and symptoms of actual infection or risk for infection • Analysis of lab findings

  30. Nursing Diagnosis • Risk for infection • Risk for injury • Imbalanced nutrition • Impaired skin integrity • Impaired oral mucus membrane

  31. Plan • Prevent exposure to infectious organisms • Controlling or reducing the extent of infection • Maintain resistance to infection • Education of client and family about infection control techniques

  32. Management of Infection • Asepsis • Handwashing is the MOST EFFECTIVE means for preventing the spread of organisms • Basic Practices:- Wash hands before and after each patient- Cleans from clean to dirty- Do not hold soiled items close to body- Wear gloves when exposure is expected • UCSF dress code includes:- Clean uniforms- Short nails, non-acrylic- No rings with grooves or stones that may harbor organisms

  33. Blood Borne pathogens • Hepatitis B • HIV

  34. Transmission of pathogens • Control or elimination of infectious agents • Cleaning • Disinfection and sterilization • Control or elimination of reservoirs • Control of portal of exit • Control of transmission • Handwashing, sharing of equipment, carrying dirty linen out from the body • Control of portals of entry

  35. Protection of susceptible hosts • Isolation precautions • Protective environment • PPE • Gloves, gowns, masks, eye protection • Specimen collection • Bagging trash/linen • Transporting clients

  36. Isolation Precautions • Standard Precautions • Universal precautions • Neutropenia • Respiratory • Contact • Hand hygiene • Most important and most basic in controlling transmission of infection • Use alcohol hand antiseptic before and after providing care • Handwashing is a vigorous, brief rubbing together of the surface of the hands lather with soap, followed by rinsing under a stream of water

  37. Isolation Precautions • Standard Precautions (Tier One)- Assumes that all patients are potentially infectious- Sometimes referred to as Body Substance or Universal Precautions (body fluids, secretions, excretions, blood) • Transmission-Based (Tier Two)- Airborne - Droplet - Direct

  38. Isolation Precautions • Personal protective equipment • Gloves • Goggles • Gown • Mask • Shoe covers • Isolation/protective environments • Client and family education

  39. What’s Wrong With This Picture?

  40. Isolation Precautions (cont.) • Airborne (measles, varicella, TB)- Private, negative pressure room- Wear fit-tested (N 95 respirators) masks- Stop Sign at Door • Droplet (diphtheria, rubella, mumps, (p663) etc.)- Private room- Mask (regular) when within 3 feet of patient- Stop Sign at Door

  41. Isolation Precautions • Contact (C-diff, E-coli, hepatitis, HSV, VRE, MRSA, etc.) • Private room • Gowns, gloves, masks (regular) - Stop Sign at Door • Protective (Reverse Isolation)

  42. Isolation Signage

  43. Respirator Equipment

  44. Isolation Precautions • Psychological implications • Environment • Equipment • Specimen collection • Bagging of trash and linen • Transporting clients

  45. Disposal Techniques • Bagging - Contaminated materials (i.e. blood, feces etc.) in Biohazard Bag- Slightly soiled and disposable equipment go in regular trash • Soiled linen in linen hampers- Bring hamper to bedside, do not carry soiled linens down the hall

  46. Disposal Techniques • Sharps- Needles, syringes, scalpels etc. in puncture resistant Sharps containers- Do NOT recap used needles • Isolation Rooms- May require special disposable equipment (i.e. food trays, blood pressure cuffs, thermometers etc.) that remain in room until patient leaves

  47. Handwashing • Is important because __________________

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