i asepsis and infection control

8/13/2019 i Asepsis and Infection Control

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I.ASEPSIS AND INFECTION CONTROLRLE 007 Lecture Notes in laboratory

MS. SUSAN LOIDA SANTIAGO-SORIANO, RN ,MSN

Medical Asepsis

Clean technique

- reduces number of pathogens

- Hand washing removes microorganism

Surgical asepsis

1. Sterile technique2. Practices that keep an area or object free of all microorganisms3. Practices that destroy all microorganisms and spores4. Used for all procedures involving sterile areas of the body

Principles of Aseptic Technique

1. Only sterile items are used within sterile field.2. Sterile objects become unsterile when touched by unsterile objects.3. Sterile items that are out of vision or below the waist level of the nurse are considered unsterile.4. Sterile objects can become unsterile by prolong exposure to airborne microorganisms.5. Fluids flow in the direction of gravity.6. Moisture that passes through a sterile object draws microorganism from unsterile surfaces

above or below to the surface by capillary reaction.

7. The edges of a sterile field are considered unsterile.8. The skin cannot be sterilized and is unsterile.9. Conscientiousness, alertness and honesty are essential qualities in maintaining surgical asepsis

Infection

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


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Enlargement and tenderness of lymph nodes that drain the area of infectionFactors Influencing Microorganisms Capability to Produce Infection

Number of microorganisms present Virulence and potency of the microorganisms (pathogenicity) Ability to enter the body Susceptibility of the host Ability to live in the hosts body

Anatomic and Physiologic Barriers Defend Against Infection

Intact skin and mucous membranes Moist mucous membranes and cilia of the nasal passages Alveolar macrophages Tears High acidity of the stomach Resident flora of the large intestine Peristalsis Low pH of the vagina Urine flow through the urethra

NANDA Diagnosis

Risk for Infectiono State in which an individual is at increased risk for being invaded by pathogenic

microorganisms

Risks factorso Inadequate primary defenseso Inadequate secondary defenses

Related Diagnoses

Potential Complication of Infection: Fever Imbalanced Nutrition: Less than Body Requirement Acute Pain Impaired Social Interaction or Social Isolation Anxiety

Interventions to Reduce Risk for Infection

Proper hand hygiene techniques Environmental controls Sterile technique when warranted Identification and management of clients at risk


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Chain of Infection

1. The chain of infection refers to those elements that must be present to cause an infection froma microorganism

2. Basic to the principle of infection is to interrupt this chain so that an infection from amicroorganism does not occur in client

3. Infectious agent; microorganisms capable of causing infections are referred to as an infectiousagent or pathogen

4. Modes of transmission: the microorganism must have a means of transmission to get from onelocation to another, called direct and indirect

5. Susceptible hostdescribes a host (human or animal) not possessing enough resistance against aparticular pathogen to prevent disease or infection from occurring when exposed to the

pathogen; in humans this may occur if the persons resistance is low because of poor nutrition,

lack of exercise of a coexisting illness that weakens the host.

6. Portal of entry: the means of a pathogen entering a host: the means of entry can be the same asone that is the portal of exit (gastrointestinal, respiratory, genitourinary tract).

7. Reservoir: the environment in which the microorganism lives to ensure survival; it can be aperson, animal, arthropod, plant, oil or a combination of these things; reservoirs that supportorganism that are pathogenic to humans are inanimate objects food and water, and other

humans.

8. Portal of exit: the means in which the pathogen escapes from the reservoir and can causedisease; there is usually a common escape route for each type of microorganism; on humans,

common escape routes are the gastrointestinal, respiratory and the genitourinary tract.

Breaking the Chain of Infection


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Etiologic agent

Correctly cleaning, disinfecting or sterilizing articles before use Educating clients and support persons about appropriate methods to clean, disinfect, and

sterilize article

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

Portal of exit

Avoiding talking, coughing, or sneezing over open wounds or sterile fields Covering the mouth and nose when coughing or sneezing

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 Placing discarded soiled materials in moisture-proof refuse bags Holding used bedpans steadily to prevent spillage

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 possiblePortal of entry

Using sterile technique for invasive procedures, when exposing open wounds or handlingdressings

Placing used disposable needles and syringes in puncture-resistant containers for disposal Providing all clients with own personal care items

Susceptible host

Maintaining the integrity of the clients skin and mucous membranes Ensuring that the client receives a balanced diet Educating the public about the importance of immunizations

Modes of Transmission


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1. Direct contact: describes the way in which microorganisms are transferred from person toperson through biting, touching, kissing, or sexual intercourse; droplet spread is also a form of

direct contact but can occur only if the source and the host are within 3 feet from each other;

transmission by droplet can occur when a person coughs, sneezes, spits, or talks.

2. Indirect contact: can occur through fomites (inanimate objects or materials) or through vectors(animal or insect, flying or crawling); the fomites or vectors act as vehicle for transmission

3. Air: airborne transmission involves droplets or dust; droplet nuclei can remain in the air for longperiods and dust particles containing infectious agents can become airborne infecting a

susceptible host generally through the respiratory tract

Course of Infection

1. Incubation: the time between initial contact with an infectious agent until the first signs ofsymptoms the incubation period varies from different pathogens; microorganisms are growing

and multiplying during this stage

2. Prodromal Stage: the time period from the onset of nonspecific symptoms to the appearance ofspecific symptoms related to the causative pathogen symptoms range from being fatigued to

having a low-grade fever with malaise; during this phase it is still possible to transmit the

pathogen to another host3. Full Stage: manifestations of specific signs & symptoms of infectious agent; referred to as the

acute stage; during this stage, it may be possible to transmit the infectious agent to another,

depending on the virulence of the infectious agent

4. Convalescence: time period that the host takes to return to the pre-illness stage; also called therecovery period; the host defense mechanisms have responded to the infectious agent and the

signs and symptoms of the disease disappear; the host, however, is more vulnerable to other

pathogens at this time; an appropriate nursing diagnostic label related to this process would be

Risk for Infection

Standard precautions: previously called as universal precautions, are a set of basic infection preventionpractices that tend to prevent the transmission of infectious diseases from one person to another and

should always be practiced when exposure to any blood or body fluids is possible.

Hand Hygiene

This is considered as the most important hygiene measure when it comes to preventing the transmission

and spread of infection. It is done through washing hands using water and soap or alcohol-based arm

rubs.

It should be done before and after each clinical contact with a patient, before and after eating, after

using the toilet, before and after using gloves, after contact with used equipment and immediately

following contact with body substances such as blood and any body fluid.

However, it is best to wash with water and soap instead of alcohol-based rubs when the hands are

visibly dirty, contaminated, or soiled, after using the restroom and before eating or preparing food.


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Personal Protective Equipment

These are certain types of clothing or equipment used as a barrier to protect his/her body from injury

and infection.

Gloves must be worn if there is a possibility of contact with blood and body fluids, whenperforming venipuncture, touching mucous membranes, touching non-intact skin, handling

contaminated sharps, performing invasive procedures, cleaning body substances spills or any

equipment or any contaminated substances.

Face mask/ face shield/ eye protection must be worn when performing procedures such assuctioning, intubation and any procedures that require contact with blood or body fluids, or if there

is potential for splashing, splattering or spraying of blood or other body substances.

Gownworn to protect clothing and skin from contamination with blood and body substances. Footwearmust be enclosed and worn to protect feet from injury and contact with sharp objects.Isolation precautions create barriers between people and germs.

They are taken to help prevent the spread of germs in the hospital. The types of transmission-based

precaution are: contact precautions which are for diseases spread by direct or indirect contact, droplet

precautions practiced for diseases spread by large particles in the air, andairborne precautionsused for

diseases spread by small particles in the air.

Contact Precautions

These are practiced for patients/residents infections that can be transmitted by contact with from skin-

to-skin, from mucous membranes, feces, vomit, urine, wound drainage, or other body fluids, or by

contact with any contaminated equipment.

Diseases requiring this type of precaution are: MDRO organisms (MRSA, VRE, resistant Acinetobacter,ESBL), Rotavirus, RSV, Scabies, Wounds or abscesses with uncontained drainage.

Aside from practicing standard precautions, the nurse must:

Wear a gown and gloves upon room entry of a patient on contact precautions. Use disposable single-use noncritical care equipment such as blood pressure cuffs and stethoscopes.Droplet Precautions

Used for patients with infection that can be transmitted through droplet, close respiratory and mucous

membrane contact with respiratory secretions.

Diseases requiring this type of precaution are: Bacterial meningitis, Seasonal influenza, Pertussis

(whooping cough) and Mumps.

In addition to standard precautions, the nurse must:

Wear a mask upon entering the room of a patient. Must provide spatial separation of more than 3 feet and draw the curtain between beds. A private

room is preferable.

Airborne Precautions

Used for patients with infections that can be transmitted over long distances through suspended air.

Diseases that require this type of precaution are: Pulmonary or laryngeal Tuberculosis, Chickenpox,

Disseminated herpes zoster (shingles), Measles (rubeola) and Pandemic influenza.

Aside from practicing standard precautions, the nurse must also:

Wear a mask or respirator prior to room entry.
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Place patient/resident in an airborne infection isolation roomEven if with each type of isolation precautions come some unique prevention practices that must be

observed, still standard precautions must be the foundation of each of them.

Inflammation

The protective response of the tissues of the body to injury or infection; the physiologicalreaction to injury or infection is the inflammatory response; it may be acute or chronic

Bodys response

1. The inflammatory response begins with vasoconstriction that is followed by a brief increase invascular permeability; the blood vessels dilate allowing plasma to escape into the injured tissue

2. WBCs (neutrophils, monocytes, and macrophages) migrate to the area of injury and attack andingest the invaders (phagocytosis); this process is responsible for the signs of inflammation

3. Redness occurs when blood accumulates in the dilated capillaries; warmth occurs as a result ofthe heat from the increased blood in the area, swelling occurs from fluid accumulation; the pain

occurs from pressure or injury to the local nerves.

Immune Response

1. The immune response involves specific reactions in the body to antigens or foreign material2. This specific response is the bodys attempt to protect itself, the body protects itself by

activating 2 types of lymphocytes, the T-lymphocytes and B-lymphocytes

3. Cell mediated immunity: T-lymphocytes are responsible for cellular immunityo When fungi , protozoa, bacteria and some viruses activate T-lymphocytes, they enter

the circulation from lymph tissue and seek out the antigen

o Once the antigen is found they produce proteins (lymphokines) that increase themigration of phagocytes to the area and keep them there to kill the antigen

o After the antigen is gone, the lymphokines disappearo Some T-lymphocytes remain and keep a memory of the antigen and are reactivated ifthe antigen appears again.

4. Humoral response: the ability of the body to develop a specific antibody to a specific antigen(antigen-antibody response)

o B-lymphocytes provide humoral immunity by producing antibodies that convey specificresistance to many bacterial and viral infections

o Active immunity is produced when the immune system is activated either naturally orartificially.

Natural immunity involves acquisition of immunity through developing thedisease

Active immunity can also be produced through vaccination by introducing intothe body a weakened or killed antigen (artificially acquired immunity)

Passive immunity does not require a host to develop antibodies, rather it istransferred to the individual, passive immunity occurs when a mother passes

antibodies to a newborn or when a person is given antibodies from an animal or

person who has had the disease in the form of immune globulins; this type of

immunity only offers temporary protection from the antigen.

Types of Immunity


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Active Immunity

Host produces antibodies in response to natural antigens or artificial antigens Natural active immunity

o Antibodies are formed in presence of active infection in the bodyo Duration lifelong

Artificial active immunityo Antigens administered to stimulate antibody formationo Lasts for many yearso Reinforced by booster

Passive Immunity

Host receives natural or artificial antibodies produced from another source Natural passive immunity

o Antibodies transferred naturally from an immune mother to baby through the placentaor in colostrum

o Lasts 6 months to 1 year Artificial passive immunity

o Occurs when immune serum (antibody) from an animal or another human is injectedo Lasts 2 to 3 weeks

Nosocomial Infection

1. Nosocomial Infections: are those that are acquired as a result of a healthcare delivery system2. Iatrogenic infection: these nosocomial infections are directly related to the clients treatment or

diagnostic procedures; an example of an iatrogenic infection would be a bacterial infection that

results from an intravascular line or Pseudomonas aeruginosa pneumonia as a result of

respiratory suctioning

3.

Exogenous Infection: are a result of the healthcare facility environment or personnel; anexample would be an upper respiratory infection resulting from contact with a caregiver who

has an upper respiratory infection

4. Endogenous Infection: can occur from clients themselves or as a reactivation of a previousdormant organism such as tuberculosis; an example of endogenous infection would be a yeast

infection arising in a woman receiving antibiotic therapy; the yeast organisms are always

present in the vagina, but with the elimination of the normal bacterial flora, the yeast flourish.

Risks for Nosocomial Infections

Diagnostic or therapeutic procedureso Iatrogenic infections

Compromised host Insufficient hand hygiene

Factors Increasing Susceptibility to Infection

1. Age: young infants & older adults are at greater risk of infection because of reduced defensemechanisms

o Young infants have reduced defenses related to immature immune systemso In elderly people, physiological changes occur in the body that make them more

susceptible to infectious disease; some of these changes are:


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Altered immune function (specifically, decreased phagocytosis by theneutrophils and by the macrophages)

Decreased bladder muscle tone resulting in urinary retention Diminished cough reflex, loss of elastic recoil by the lungs leading to inability to

evacuate normal secretions

Gastrointestinal changes resulting in decreased swallowing ability and delayedgastric emptying.

2. Heredity: some people have a genetic predisposition or susceptibility to some infectiousdiseases

3. Cultural practices: healthcare beliefs and practices, as well as nutritional and hygiene practices,can influence a persons susceptibility to infectious diseases

4. Nutrition: inadequate nutrition can make a person more susceptible to infectious diseases;nutritional practices that do not supply the body with the basic components necessary to

synthesized proteins affect the way the bodys immune system can respond to pathogens

5. Stress: stressors, both physical and emotional, affect the bodys ability to protect againstinvading pathogens; stressors affect the body by elevating blood cortisone levels; if elevation of

serum cortisone is prolonged, it decreases the anti-inflammatory response and depletes energy

stores, thus increasing the risk of infection6. Rest, exercise and personal health habits: altered rest and exercise patterns decrease the

bodys protective, mechanisms and may cause physical stress to the body resulting in an

increased risk of infection; personal health habits such as poor nutrition and unhealthy lifestyle

habits increase the risk of infectious over time by altering the bodys response to pathogens

7. Inadequate defenses: any physiological abnormality or lifestyle habit can influence normaldefense mechanisms in the body, making the client more susceptible to infection; the immune

system functions throughout the body and depends on the following:

o Intact skin and mucous membraneso Adequate blood cell production and differentiationo A functional lymphatic system and spleeno

An ability to differentiate foreign tissue and pathogens from normal body tissue andflora; in autoimmune disease, the body has a problem with recognizing its own tissue

and cells; people with autoimmune disease are at increased risk of infection related to

their immune system deficiencies.

8. Environmental: an environment that exposes individuals to an increased number of toxins orpathogens also increases the risk of infection; pathogens grow well in warm moist areas with

oxygen (aerobic) or without oxygen (anaerobic) depending on the microorganism, an

environment that increases exposure to toxic substances also increases risk

9. Immunization history: inadequately immunized people have an increased risk of infectionspecifically for those diseases for which vaccines have been developed.

10.Medications and medical therapies: examples of therapies and medications that increaseclients risk for infection includes radiation treatment, anti-neo-plastic drugs, anti-inflammatory

drugs and surgery

Diagnostic Tests Used to Screen for Infection

1. Signs and symptoms related to infections are associated with the area infected; forinstance, symptoms of a local infectionon the skin or mucous membranes are localized swelling,

redness, pain and warmth

2. Symptoms related to systemic infectionsinclude fever, increased pulse & respirations, lethargy,anorexia, and enlarged lymph nodes


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3. Certain diagnostic tests are ordered to confirm the presence of an infection.

Category-specific Isolation Precautions

Strict isolation Contact isolation Respiratory isolation Tuberculosis isolation Enteric precautions Drainage/secretions precautions Blood/body fluid precautions

Disease-specific Isolation Precautions

Delineate practices for control of specific diseaseso Use of private rooms with special ventilationo Cohorting clients infected with the same organismo Gowning to prevent gross soilage of clothes

Universal Precautions (UP)

Used with all clients Decrease the risk of transmitting unidentified pathogens Obstruct the spread of bloodborne pathogens (hepatitis B and C viruses and HIV) Used in conjunction with disease-specific or category-specific precautions

Body Substance Isolation (BSI)

Employs generic infection control precautions for all clients Body substances include:

o

Bloodo Urineo Feceso Wound drainageo Oral secretionso Any other body product or tissue

Standard Precautions

Used in the care of all hospitalized persons regardless of their diagnosis or possible infectionstatus

Apply to:o Bloodo All body fluids, secretions, and excretions except sweat (whether or not blood is present

or visible)

o Non-intact skin and mucous membranes Combine the major features of UP and BSI

Transmission-based Precautions

Used in addition to standard precautions For known or suspected infections that are spread in one of three ways:


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o Airborneo Dropleto Contact

May be used alone or in combination but always in addition to standard precautionsManaging Equipment Used for Isolation Clients

Many supplied for single use only Disposed of after use Agencies have specific policies and procedures for handling soiled reusable equipment Nurses need to become familiar with these practices

Blood borne Pathogen Exposure

Report the incident immediately Complete injury report Seek appropriate evaluation and follow-up Identification and documentation of the source individual when feasible and legal Testing of the source for hepatitis B, C and HIV when feasible and consent is given Making results of the test available to the source individuals health care provider Testing of blood exposed nurse (with consent) for hepatitis B, C, and HIVplease check these to

match style used in bookfairly certain it should be caped antibodies

Post exposure prophylaxis if medically indicated Medical and psychological counseling

Puncture/Laceration

Encourage bleeding Wash/clean the area with soap and water Initiate first aid and seek treatment if indicated Mucous membrane exposure (eyes, nose, mouth)

Flush with saline or water flush for 5 to 10 minutes

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