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What are the factors involved in the chain of infection? Be prepared to give examples of each.
- a. Infectious agent/Pathogen: bacteria, viruses, fungi, protozoa
- b. Reservoir: humans, animals, food, water, inanimate objects (fomites)
- c. Port of exit: blood, skin, mucus membrane, respiratory tract, genitourinary tract, gastrointestinal tract and transplacental (mother to fetus)
- d. Mode of transportation: unwashed hands, equipment used like stethoscope, airborne, droplet
- e. Port of entry: pierced skin, mucus membrane, respiratory tract, etc (like mode of exit)
- f. Susceptible host: depends on persons degree of resistance to pathogens and their risk factors like age, nutritional status, presence of chronic disease, smoking, etc
Describe the different routes and means regarding modes of transmission and provide examples of each.
- Direct: person to person
- Indirect: personal contact of susceptible host with contaminated inanimate object (eg needles, dressings, evironment)
- Droplet: large particles that travel up to 3 fet during coughing, sneezing or talking and come in contact with susceptible host
- Airborne: Droplet nuclei or residue or evaporated droplets suspended in air during coughing or sneezing or carried on dust prticles
- Vehicles: contaminated items, water, drugs (solutions), blood, food (improperly handled stored or cooked, fresh or thawed meats)
- Vector: external mechanical transfer (flies), internal transmission (parasitic conditions between vector and host like mosquito, louse, flea, tick
What determines how severe a clients illness may become?
Severity of infection and patients host resistance.
What are the bodys normal defense mechanisms against infection? Know the action they provide and the factors that may alter the defense mechanism and how the nurse would protect the susceptible host. Table 28-2 pg 402
- a. Skin
- b. Mouth
- c. Eye
- d Respiratory tract
- e. Urinary tract
- f. Gastrointestinal tract
- g. vagina
What are health care-associated infections (iatrogenic, exogenic, & endogenic) and what are the sites and causes of these infections?
- Results from delivery of health services in a health care facility
- Iatrogenic: from a procedure
- Exogenous: from microorganisms outside the individual
- Endogenous: when the patients flora becomes altered and an overgrowth results
- Sites for and causes of health-care associated infections Box 28-3 page 404
- Urinary tract
- Surgial or Traumatic wounds
- Respiratry tract
What factors increase a clients susceptibility to infection?
- Nutritional status
- Disease process
- Treatments or conditions that compromise the immune response
How can the nurse minimize the spread of infection?
- Standard precautions
- 1) Frequent and effective handwashing
- 2) Educating the patient on required and recommended immunizations
- 3) Educating patient on good oral hygiene
- 4) Encourage patient to consume adequate amounts of fluids
- 5) Use of aseptic technique and proper personal protective equipment
In what ways can the nurse practice asepsis?
- Medical asepsis: Hand hygiene, barrier techniques and routine environmental cleaning
- Standard precautions: when in contact with blood, body fluids, non-intact skin and mucous membranes of pts
- Hand hygiene: includes instant alcohol hand antiseptic before and after pt care, washing hands with soap and water when visiby soiled, surgical scrub.
What are examples of disinfection and sterilization and when would they be used?
- Disinfection: process that eliminates many or all microorganisms, with exception of bacterial spores, from inanimate objects. Eg: alcohols, chlorines, glutaraldehydes, hydrogen peroxide and phenols
- Sterilization: complete elimination or destruction of all microorganisms, including spores. Eg steam under pressure, ethylene oxide (ETO) gas, hydrogen peroxide plasma
How would the nurse utilize infection prevention and control to ensure client safety?
- Nurses need to remain aware of the modes of transmission and ways to control them.
- Always be careful when handling exudate such as urine, feces, emesis and blood
What are standard precautions and when would it be appropriate for the nurse to use them?
Precautions used to prevent and control infection and its spread. Used on all patients; apply to all blood and blood type products; all body fluids (except sweat), nonintact skin and mucous membrane.
What are the categories of isolation precautions? When would they be utilized and what barrier protection would be needed?
- Airborne precaution: droplet nuclei smaller than 5 microns; measles, chickenpox (varicella); disseminated varicella-zozter; pulmonary or laryngeal TB; requires a specially equipped room with a negative air flo (airborne infection isolation room). Health care personnel wear N95 mask.
- Droplet precaution: droplet larger than 5 microns; being within 3 feet of patient; influenza; diphtheria (pharyngeal); rubella; streptococal pharyngitis, pneumonia, or scarlet fever in infants and young children; pertussis; mumps; mycoplasma pneumonia; meningococcal pneumonia or sepsis; pneumonia plague; surgical mask, proper hand hygiene, gloves and gown.
- Protective environment: for pts who had transplants or gene therapy. Requires specialize room with positive airflow. Airflow rate set at greater than 12 air exchanges per hour and all air is filtered through HEPA filter. No dried or fresh flowers or potted plants in room
What are some of the psychological implications of isolation and how might the nurse assist the client in dealing with them?
- Loneliness: encourage visiting family to avoid expressions or actions that convey revulsion or disgust r/t infection prevention or control practices
- Body image:
- Rejection: do not rush care
Name the different types of personal protective equipment for the nurse and when it would be appropriate to use each one?
- Gowns: protect from contact w/infected material and blood and body fluids
- Masks: droplet
- N95 masks: respiratory protection
- Eye protection (special glasses and goggles): protect from splash
- Gloves: direct and indirect contact
How would the nurse obtain and transport various specimens?
- All specimen are collected using clean gloves and sterile equipment
- Seal specimen containers tightly
What would the nurse teach the client regarding infection prevention and control?
- Clean equipment w/soap and water and disinfect
- Good hand hygiene
- S&S of infection
- For tube feedings, only prepare formula for 8 hrs. since feeding bags and tubing w/mild soap and water daily and dry
- Place contaminated dressings and other disposable items with infectious body fluids in impervious plastic or brown paper bags and needles in metal or hard plastic containers
- Clean noticeably soiled linen separate from other laundry in warm water
How would the nurse transport a client with a communicable disease?
- Put pt in clean gown
- Mask (if pt has airborne infection)
- Extra layer of sheets between pt and wheelchair or stretcher
- (clean equipment with an approved germicide after pt use and before another pt uses it)
What are the principles of Surgical Asepsis?
- Principles of Surgical Asepsis #1: A sterile object remains sterile only when touched by another sterile object
- Principles of Surgical Asepsis #2: Only sterile objects may be placed on a sterile field
- Principles of Surgical Asepsis #3: A sterile object or field out of the range of vision or an object held below a person's waist is considered contaminated
- Principles of Surgical Asepsis #4: A sterile object or field becomes contaminated by prolonged exposure to air
- Principles of Surgical Asepsis #5: When a sterile surface comes in contact with a wet, contaminated surface, the sterile object or field becomes contaminated by capillary action
- Principles of Surgical Asepsis #6: Fluid flows in the direction of gravity
- Principles of Surgical Asepsis #7: The edges of a sterile field or container are considered to be contaminated
What follow up should be done following exposure to blood or other potentially infectious materials (OPIM)?
- Report any contaminated needlesticks or blood or OPIM in direct contact w/ open skin, or splashed in eyes, mouth or nose or cuts w/object covered in blood or OPIM immediately
- Source patient testing
- Need for tx linked to results of risk assessment and testing of pt.
- Test pt for HIV, hepatitis B & C
What vaccines are recommended for health care workers by the CDC?
- Hepatitis B
- TB testing
- Annual influenza vaccine
- Measles, mumps & rubella (MMR)
- Chickenpox vaccine
- Tetanus, diphtheria and pertussis (Tdap)