Kozier Ch 31

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Kozier Ch 31
2011-09-05 23:13:06
Kozier 31 Asepsis

Powerpoint & notes from Kozier Ch 31 on Asepsis
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  1. Infection
    •Infection- invasion of body tissue by MO

    •Disease- MO produces alteration in normal body tissue function

    •Asepsis- freedom from disease-producing MO (medical & surgical)
  2. Medical Asepsis
    –Includes all practices intended to confine a specific microorganism to a specific area

    –Limits the number, growth, and transmission of microorganisms

    –Objects referred to as clean (absence of almost all MO) or dirty (soiled, contaminated)
  3. Surgical Asepsis
    –Sterile technique

    –Practices that keep an area or object free of all microorganism

    –Practices that destroy all microorganisms and spores

    –Used for all procedures involving sterile areas of the body
  4. •Colonization
    MO become resident flora, grow and multiply but does not cause disease unless it succeeds in invading part of the body where host defenses are ineffective and causes tissue damage
  5. Local infection
    Systemic infection
    •Local- one area of body

    •Systemic- spreads throughout body - septicemia

    Bacteremia - MO present in blood cultures
  6. Acute Infection
    Chronic Infection
    •Acute- quick onset, short duration

    •Chronic- occurs slow, lasts a long time
  7. Nosocomial Infecitons
    Risk factors for Nosocomial Infections
    Iatrogenic infections
    • •Nosocomial- infections occurring from a healthcare delivery & facility
    • –“Hospital-acquired infection”

    • •Risk for nosocomial infections:
    • Iatrogenic infections (caused by diagnostic test or
    • therapeutic procedure)
    • –Compromised host- increased risk for infection
    • –Insufficient hand hygiene
  8. Sign & Symptoms of Local Infection
    • •Localized swelling (edema)
    • •Localized redness (erythema)
    • •Pain or tenderness with palpation or movement
    • •Palpable heat in the infected area
    • •Loss of function of the body part affected
    • •May be exudate coming from area
  9. 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
    • Enlargement and tenderness of lymph nodes that drain the area
    • of infection
  10. Laboratory signs of Infection
    • •Laboratory data
    • –Elevated WBC count (4,500 - 11,000/mL is normal)
    • –Increase in specific WBC types
    • –Elevated ESR (Erythrocyte Sedimentation Rate “Sed rate”) Red blood cells normally settle slowly, but rate increases in presence of inflammatory process
    • –Cultures of urine, blood, sputum, or other drainage - can indicate presence of MO
  11. Chain of Infection
    • •1. Etiologic agent (Microorganism)
    • –Ability to produce infection based on:
    • - - Number
    • - - Potency
    • - - Virulence- ability to produce disease (strength)
    • - -Types of MO- bacteria, viruses, fungi, parasites

    • •2. Reservoir (source)- respiratory tract, blood etc.
    • - -Carrier = reservoir does not manifest any clinical signs of infection

    •3. Portal of exit from source- nose, mouth etc

    • •4. Transmission- how it reaches other person
    • - - Direct Transmission - touching or droplets
    • - - Indirect Transmission -
    • - - - Vehicle-borne - objects
    • - - - Vector-borne - animal or insect
    • - - Airborne transmission - droplets or dust with droplet nuclei (residue of evaporated droplets)

    •5. Portal of entry to host

    • •6. Susceptible host- person at risk for infection, lacks resistance to infection
    • –Compromised host
    • Impairment of body’s defenses
  12. Reservoirs & Portals of Exit from Host
    1. Respiratory tract = nose or mouth through sneezing, coughing, breathing, or talking

    • 2. Gastrointestinal tract = Mouth- saliva, vomitus
    • Anus - feces, ostomies (surgical opening for waste products to leave body)

    3. Urinary Tract = Urethral meatus and urinary diversion (surgical procedure to reroute urine)

    • 4. Reproductive tract = Vagina: discharge
    • Urinary meatus: semen, urine

    5. Blood = Open wound, needle puncture site, any disruption of intact skin or mucous membrane surfaces

    6. Tissue = Drainage or cut from a wound
  13. Body Defences against infection
    •Anatomic & Physiologic Barriers

    •Inflammatory response

    •Immunity (Antibodies)
  14. Anatomic & Physiologic Barriers to infection
    (nonspecific defenses)
    •Intact skin and mucous membranes- first line of defense against MO

    •Moist mucous membranes and cilia of the nasal passages

    •Alveolar macrophages (lungs)


    •High acidity of the stomach

    •Resident flora of the large intestine


    •Low pH of the vagina

    •Urine flow through the urethra
  15. Inflammatory Response & Immunity
    • •Inflammatory response: (nonspecific defenses)
    • –5 signs:
    • Pain
    • Swelling (edema)
    • Redness (erythema)
    • Heat
    • Impaired function
    • –Other: elevated WBCs & exudate

    • •Immunity (specific immunity)
    • –Antibodies
    • Immunocompromised persons are at risk (cell mediated immunity does not work)
  16. NANDA Diagnosis: Risk for Infection
    • –State in which an individual is at increased risk
    • for being invaded by pathogenic microorganisms

    • When using this label, the nurse must identify risk factors
    • •Risks factors
    • Inadequate primary defenses- skin, mucosa, tramaitzed tissue, decreased ciliary action, stasis of body fluids, change in pH of secretions, altered peristalsis

    Inadequate secondary defenses- decreased hemoglobin, immunosupression, suppressed inflammatory response
  17. Other Diagnoses related to Infection or Risk for Infection
    • •Potential Complication of Infection: Fever
    • •Imbalanced Nutrition: Less than Body Requirement
    • •Acute Pain
    • •Impaired Social Interaction or Social Isolation
    • •Anxiety
  18. Breaking the Chain of Infection;
    Etiolgic agent (MO)
    • •Etiologic agent
    • –Clean, disinfect or sterlize articles before use
    • –Educate clients, support persons, and heathcare workers about methods to clean, disinfect, and sterilize article
  19. Breaking the Chain of Infection:
    • •Reservoir
    • –Change dressings when soiled or wet
    • –Assist client to carry out skin and oral hygiene
    • –Dispose of damp & soiled linens
    • –Dispose of feces and urine in appropriate receptacles
    • –Keep all fluid containers covered or capped (bedside water jug, suction & drainage bottles)
    • –Empty suction and drainage bottles at end of each shift or before full or according to agency policy
  20. Breaking the Chain of Infection:
    Portals of Exit
    • •Portal of exit
    • –Avoid talking, coughing, or sneezing over open
    • wounds or sterile fields
    • –Cover the mouth and nose when coughing or sneezing
  21. Breaking the chain of Infection:
    Method of Transmission
    • •Method of transmission
    • –Use hand hygiene (hands most frequent cause of spread of infection) between client contacts, after touching body substances, before performing invasive procedures or touching open wounds
    • –Teach hand hygiene before handling food, eating, after eliminating and after touching infectious material
    • –Wear gloves when handling secretions and excretions
    • –Wear gowns if there is danger of soiling clothing with body substances
    • –Place discarded soiled materials in moisture-proof refuse bags
    • –Dispose of urine and feces in appropriate receptacles
    • –Wear masks and eye protection when in close contact with clients who have infections
    • transmitted by droplets from the respiratory tract
    • –Wear masks and eye protection when
    • in close contact with clients who have infections transmitted by droplets by resp track
    • --Wear masks and eye protection when
    • sprays of body fluid are possible
  22. Hand Hygiene & Hand Sanitizers
    • –Most likely cause of spread of infection in healthcare facility
    • –Single most important measure to break chain of
    • infection

    • Hand Sanitizers:
    • – Contain 60-70 % alcohol.
    • –Kills 99.9% of most common MO in less than 30 sec.
    • –Cannot be used for MO that are bacterial spores
    • (Clostridium Difficile “C-diff”)
    • –Apply & rub hands until alcohol dries.
    • –Doesn’t remove debris. May still need to wash hands
    • –CDC says hands should be washed with soap &
    • water every 10 uses of alcohol sanitizers
  23. Breaking the Chain of Infection:
    Portal of Entry
    • –Use sterile technique for invasive procedures, when
    • exposing open wounds or handling dressings

    • –Place used disposable needles and syringes in
    • puncture-resistant containers for disposal

    - Provide clients with their own personal care items
  24. Breaking the chain of infection:
    Susceptible Host
    • •Susceptible host
    • –Identify clients at risk
    • –Maintain the intact skin & mucous membranes
    • –Provide a balanced diet and fluid
    • –Promote enough sleep
    • –Decrease stress
    • –Educate the public about the importance of
    • immunizations
  25. Breaking the chain of infection:
    • –Appropriate barrier- glowns, gloves etc
    • –Don PPE (Personal Protective Equipment) before
    • entering room and remove PPE before exiting
    • –Sterilization & disinfection of patient equipment
    • –Sterile technique when warranted
    • –Isolation of communicable patients
  26. Isolation Precautions
    • •Isolation- measures designed to prevent the spread of infection
    • •Many supplied for single use only
    • •Disposed of after use
    • •Agencies have specific policies and procedures for handling soiled reusable equipment
  27. 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 transmission- based precautions
  28. Standard Precautions
    •Used in the care of all hospitalized persons regardless of their diagnosis or possible infection status

    • •Apply to
    • –Blood
    • –All body fluids, secretions, and excretions except
    • sweat (whether or not blood is present or visible)
    • –Nonintact skin and mucous membranes
  29. Transmission-based precautions
    •Used in addition to standard precautions

    • •For known or suspected infections that are spread in one of three ways:
    • –Airborne (Tuberculosis)
    • –Droplet (respiratory droplets- meningococcal
    • meningitis)
    • -Contact (C-diff, scabies herpes or MRSA skin
    • infections
  30. Bloodborne Pathogen Exposure
    • •Wash the area
    • •Report the incident immediately
    • •Complete injury report
    • •Seek appropriate evaluation and follow-up
  31. Bloodborne pathogen exposure - 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 for 5 to 10 minutes