Chapter 31 Asepsis

Asepsis Medical asepsis “Clean technique” 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 or dirty (soiled, contaminated)

Asepsis (cont'd) Surgical asepsis Sterile technique Practices that keep an area or object free of all microorganisms Practices that destroy all microorganisms and spores Used for all procedures involving sterile areas of the body

Type of Infections Local infection Systemic infection Bacteremia Septicemia Acute infections Chronic infections

Nosocomial Infections Originate in the health care facility Health care associated infections (HAIs) Common HAIs Factors What is the impact of HAIs on clients?

Figure 31-1 The chain of infection 6

Etiologic Agent Microorganisms Number of microorganisms present Virulence and potency of the microorganisms (pathogenicity) Ability to enter the body Susceptibility of the host

Reservoir Where the microorganism lives Common sources Carrier

Portal of Exit Must leave reservoir Coughing Sneezing Saliva & mucous membranes Feces & urine Drainage Open wound

Method of Transmission Direct Transmission Indirect Transmission Vehicle borne Formite Vector borne Airborne Transmission

Portal of Entry & Host Portal of entry (5th link of chain of infection) Any opening in the body Non-intact skin Susceptible host (6th link of chain) Person who is at risk for infection

First line of defenses against infection Intact skin & mucous membranes Mouth Cilia of the nasal passages Tears GI Vagina Urine flow

Second line of defense against infection Inflammatory Response Signs Suffix –itis

Stages of Inflammatory Response First Stage- vascular & cellular response Vessel constriction quickly followed by dilation Increase in vascular permeability Production & release of leukocytes (type of WBC) into bloodstream

Stages of Inflammatory Response Second Stage Exudate production Fibrinogen, thromboplastin & platelets clump together Form a barrier to prevent additional harm/injury

Stages of Inflammatory Response Third Stage Reparative phase Regeneration Granulation tissue Fibrous tissue formation (scar)

Third line of defense against infection- Specific Defenses Active immunity Host produces antibodies in response to natural antigens or artificial antigens Natural From active infection Artificial Administered

Passive Immunity Passive immunity Host receives natural or artificial antibodies Natural passive immunity Ex. from mother to baby through breastmilk Artificial passive immunity injection of antibodies

Factors Influencing Susceptibility to Infection Age Heredity Stress Nutrition Medications/procedures Disease Other

Consider your current lifestyle Consider your current lifestyle. Identify the risk factors that increase your risk for infection. How would you evaluate your ability to support your body’s defenses? Is there anything you can do to decrease your risk for infection?

Nursing Nursing history Physical assessment S/S localized infection S/S systemic infection Laboratory data Elevated WBC count Increase in specific WBC types Elevated erythrocyte sedimentation rate (ESR) Cultures of urine, blood, sputum, or other drainage

Nursing Nursing goals focus on: Maintaining/restoring defenses Avoiding spread of infection Reduce/alleviate complications

CDC Guidelines to Prevent Infection Two tiered approach Standard precautions (SP) Transmission based precautions Hand hygiene Personal protective equipment Environmental controls Respiratory hygiene (cough etiquette)

Standard Precautions (Box 31-1 pg. 694) Designed for all clients Apply to: Blood All body fluids, excretions, secretions, except sweat Nonintact skin Mucous membranes

Transmission-Based Precautions Used in addition to standard precautions For known or suspected infections that are spread in one of three ways: Contact Airborne Droplet May be used alone or in combination but always in addition to standard precautions

General Guidelines for Isolation Precautions Limit supplies taken into room Limit client transport outside of room Use disposable supplies if possible Keep precaution supplies just outside the client’s room Removal of items from room Private room if possible (or place with client with same infection)

Contact Precautions Transmitted by direct or indirect contact Includes drug resistant bacteria Methicillin-resistant Staphylococcus Aureus (MRSA) Vancomycin-resistant Enterococcus (VRE) Extended spectrum beta-lactamase-producing (ESBL) Clostridium difficile (C-diff) Spore which requires soap and water, not alcohol based hand sanitizer

Contact Precautions (cont.) Surfaces in room are contaminated PPE

Airborne Precautions Transmitted by small droplets TB, measles, varicella Airborne infection isolation room Negative air pressure room PPE

Droplet Precautions Transmitted by larger droplets 3 ft. diameter PPE Pertussis, mumps, influenza (flu), strep throat 3 ft. diameter PPE

Personal Protective Equipment (pg. 695-700) As discussed in learning lab: Indications, donning and removal of: Gloves Gowns Face masks Eyewear

Psychosocial Needs of Isolation Clients Sensory deprivation Environment lacks normal stimuli Lack of interaction Feeling of Inferiority Nursing interventions

Sterile Technique (pg. 700-710) As discussed in learning lab: Sterile field Sterile gloves Sterile gowns

Infection Control for Health Care Workers Regulations Common hazards Contaminated needles/sharps injury Skin contact Mucous membrane contact Medical asepsis, PPE, and avoiding carelessness behavior

Practice Guidelines Steps to follow After Exposure to Bloodborne Pathogen Provide immediate care to exposed area Report the incident immediately Complete injury report Seek appropriate evaluation and follow-up

Group Work You are working as a nurse on a medical-surgical unit. How do nurses help break the chain of infection at each link? What education is necessary to help control infection?