PERSEPHONE GEE, RN, MSN CITY COLLEGE OF SAN FRANCISCO INSTRUCTOR

Asepsis and Infection Control

introduction The nurse’s major focus is wellness. In the hospital setting, prevention of infection is primary. The nurse identifies, prevents, control infection, and teach the patient and other healthcare providers asepsis and infection control. Prevent spread of microorganism from person to person and from place to place.

Start with definition of terms Asepsis-a condition free from germs, infection, and any form of life Sterile-free from living microorganisms, i.e. bacteria, fungi, protozoa, viruses, spores, or other living organisms

If sterile means: -free from living microorganisms, i.e. bacteria, fungi, protozoa, viruses, spores, or other living organisms-

What is sterility? It is a state-of freedom from contamination or colonization by living microorganisms.

activity Student draws from the box, a term written on a piece of paper to define (instructor explains the rules) Student draws a term to define. After giving his comments, takes the term to another student or has the other student choose another term to define.

DEFINE THE TERM DRAWN FROM BOX

HANDWASHING AND FRICTION (HOW DO THE TERMS RELATE?) ISOLATION TECHNIQUES: RESPIRATORY, CONTACT AND REVERSE ISOLATION

Next terms to define Nosocomial infection- an infection acquired from a healthcare setting e.g. hospital, nursing home, SNF Standard precaution- guidelines recommended by the Centers for Disease Control and Prevention to reduce the risk of spread of infection in the hospitals. What are the precautions ? Handwashing and use of personal protective equipment such as gloves, mask, gown, and eye protection.

Current CDC Guidelines Standard precautions—used in care of all hospitalized patients –Apply to blood, body fluids, secretions, excretions, non-intact skin, mucous membranes Transmission-based precautions—used in addition to standard precautions for patients with suspected infection –Include airborne, droplet, or contact precautions

Targeted body fluids in standard precaution: Blood All body fluids: BLOOD, URINE, SPUTUM, EMESIS, VAGINAL SECRETIONS, AMNIOTIC FLUID, PERITONEAL FLUID, THORACENTESIS FLUID, SPINAL FLUID Secretions Excretions (except sweat) Non-intact skin Non-intact mucous membranes

Personal Protective Equipment and Supplies Gloves Gowns Masks Protective eye gear

Components of the Infection Cycle Infectious agent—bacteria, viruses, fungi Reservoir—natural habitat of the organism Portal of exit—point of escape for the organism Means of transmission—direct contact, indirect contact, airborne route Portal of entry—point at which organisms enter a new host Susceptible host—must overcome resistance mounted by host’s defenses

The Infection Cycle

Infectious Agents Bacteria—most significant and most prevalent in hospital settings Virus—smallest of all microorganisms Fungi—plantlike organisms present in air, soil, and water

Bacterial Flora Transient—attached loosely on skin, removed with relative ease Resident—found in creases in skin, requires friction with brush to remove

Classification of Bacteria Spherical (cocci), rod shaped (bacilli), corkscrew shaped (spirochetes) Gram positive or gram negative—based on reaction to Gram stain Aerobic or anaerobic—based on need for oxygen

Factors Affecting an Organism’s Potential to Produce Disease Number of organisms Virulence (ability to cause disease) Competence of person’s immune system Length and intimacy of contact between person and microorganism

Possible Reservoirs for Microorganisms Other humans Animals Soil Food, water, milk Inanimate objects

Common Portals of Exit Respiratory Gastrointestinal Genitourinary tracts Breaks in skin Blood and tissue

METHODS OF TRANSMISSION INFECTED WATER RAW VEGETABLES VECTORS DIRECT CONTACT SEXUAL CONTACT AIRBORNE DROPLET SPREAD

Play-acting instruction Trace the path of the Hepatitis B virus Prevent the infection. Break the chain of infection

Play-acting: The chain of infection: Hepatitis B pathogen (blood and body fluid transmission Actors: host, what will make you susceptible? the organism, where do you go? Portals? Susceptible individual, how can you diminish your risk

Transmission barriers Hand washing Barrier techniques (sterilization, decontamination, dispose waste properly) Personal protective equipment (gloves, mask, gown, protective eye gear)

The Infection Cycle

Laboratory Data Indicating Infection Elevated white blood cell count—normal is 5000 to 10,000/mm3 Increase in specific types of white blood cells (neutrophils-bacterial, eosinophils-allergic, parasitic, basophils-parasitic, allergic, lymphocytes-viral (measles, rubella,chicken pox, infectious mono), monocytes-severe infection by phagocytosis Elevated erythrocyte sedimentation rate Presence of pathogen in urine, blood, sputum, or draining cultures

Questions/comments What are Nursing interventions used to break the chain of infection? Let’s have a look---

Aseptic Technique Includes all activities to prevent or break the chain of infection Two categories –Medical asepsis—clean technique –Surgical asepsis—sterile technique

USE OF GLOVES, EYE PROTECTORS & APRONS SURGICAL PROCEDURES GENERATION OF DROPLETS SPLASHING BLOOD, AND/OR BODY FLUIDS

SITUATIONS REQUIRING GLOVES ADMINISTRATION OF INJECTIONS APPLICATION OF TOPICAL PREPARATIONS EMPTYING DRAINAGE BAGS (BILE, URINE, ETC.) PERINEAL CARE HANDLING SOILED LNEN

Proper handling of linen & soiled articles Keep soiled linen from touching clothing Do not put soiled linen on the floor Avoid raising dust Place soiled linen in plastic bag, dispose in appropriate containers

Practice good hygiene and grooming Shampoo hair regularly Pin hair up or have it cut short Keep fingernails short and free of broken cuticles and ragged nails Avoid artificial nails Avoid wearing rings with grooves Follow institutional guidelines re infection control

Any questions or comment?

Measures to Reduce Incidence of Nosocomial Infections Constant surveillance by infection-control committees and nurse epidemiologists Written infection-prevention practices for all agency personnel Hand hygiene recommendations Infection control precaution techniques Keeping patient in best possible physical condition

Stages of Infection Incubation period—organisms growing and multiplying Prodromal stage—person is most infectious, vague and nonspecific signs of disease Full stage of illness—presence of specific signs and symptoms of disease Convalescent period—recovery from the infection

Body’s Defense Against Infection Body’s normal flora Inflammatory response Immune response

Factors Affecting Host Susceptibility Intact skin and mucous membranes Normal pH levels Body’s white blood cells Age, sex, race, hereditary factors Immunization, natural or acquired Fatigue, climate, nutritional and general health status Stress Use of invasive or indwelling medical devises

Ball toss Toss the ball to a student, the class will listen to student’s statement about who is at risk, your rationale.

Evolution of Specialized Infection Control Precautions Early CDC guidelines Specific isolation techniques Disease-specific isolation Universal precautions OSHA regulations for universal precautions Body substance precautions Current CDC guidelines

Type N95 Particulate Respirator

REVIEW

Infection Control Measures Identifying the infection Preventing infection –Breaking the chain of infection Controlling infection –Minimizing complications –Reducing adverse outcomes Teaching patient about infection

Aseptic Technique Includes all activities to prevent or break the chain of infection Two categories –Medical asepsis—clean technique –Surgical asepsis—sterile technique

Practice of Asepsis Medical asepsis (clean technique) –Involves procedures and practices that reduce the number and transfer of pathogens Surgical asepsis (sterile technique) –Includes practices used to render and keep objects and areas free from microorganisms

Basic Principles of Medical Asepsis Practicing good hand hygiene Carrying soiled items away from body Keeping soiled items off the floor Avoiding having patients cough, sneeze, or breeze on others Moving equipment away when cleaning articles Avoiding raising dust Cleaning least soiled areas first

Basic Principles of Medical Asepsis (cont.) Disposing of soiled or used items in appropriate containers Pouring discarded liquids directly into the drain Sterilizing items suspected of containing pathogens Using personal grooming habits that prevent spread of microorganisms Following guidelines for infection control or barrier technique

Basic Principles of Surgical Asepsis Only a sterile object can touch another sterile object Follow guidelines for opening sterile packages Avoid spilling solution on a sterile setup Hold sterile objects above waist level Avoid talking, coughing, reaching over sterile field Never turn your back on a sterile field

Basic Principles of Surgical Asepsis (cont.) Sterilize all items brought in contact with broken skin or sterile body cavities Use dry, sterile forceps when necessary Consider outer 1 inch of sterile field to be contaminated When in doubt, consider all suspect items contaminated

Use of Surgical Asepsis Operating room, labor and delivery areas Certain diagnostic testing areas Patient bedside –e.g., for procedures that involve insertion of urinary catheter, sterile dressing changes, or preparing and injecting medicine

HAND HYGIENE HANDWASHING TECHNIQUE

Criteria for Performing Hand Hygiene Before and after contact with each patient Before putting on sterile gloves Before performing invasive procedures After accidental contact with body fluids When moving from contaminated body site to clean one After contact with inanimate objects near the patient After removal of gloves

Lathering Hands With Soap and Rubbing With Firm Circular Motion

Washing Areas Between Fingers

Washing to 1 inch Above the Wrist

Using Fingernails to Clean Under Nails of Opposite Hand

Rinsing Hands Under Running Water With Water Flowing Toward Fingertips

Standard Precautions Follow hand hygiene techniques Wear clean nonsterile gloves when touching body fluids Wear personal protective equipment during care activities likely to generate splashes or sprays of blood Avoid recapping used needles Handle used patient care equipment appropriately Ensure routine care, cleaning, and disinfection procedures are followed Review room assignments carefully

Mask and Goggles

Glove Cuffs Covering Wrists of Gown

Transmission-Based Precautions: Airborne Use for patients who have infections spread through air Place patient in private room with monitored negative air pressure Use respiratory protection when entering room of patient Transport patient out of room only when necessary; place surgical mask on patient Consult CDC guidelines for prevention strategies for tuberculosis

Transmission-Based Precautions: Droplet Use for patient with infection spread through droplets Use a private room (door may remain open) Wear a mask when working within 3 feet of patient Transport patient out of room only if necessary; place surgical mask on patient Keep visitors 3 feet from patient

Transmission-Based Precautions: Contact Use for patients infected by a microorganism spread by direct or indirect contact Place patient in private room if available Wear gloves when entering the room; change as appropriate Wear a gown if contact with infection agent is likely Limit movement of patient out of room Avoid sharing patient care equipment

Guidelines for Effective Use of PPE Put on PPE before contact with patient Choose appropriate PPE based on type of exposure When wearing gloves work from clean to dirty areas Touch as few surfaces and items with PPE as possible Avoid touching or adjusting other PPE Keep gloved hands away from face Remove and replace torn or heavily soiled gloves Do not substitute goggles with personal glasses

Patient Teaching for Medical Asepsis at Home Wash hands before preparing or eating food Prepare foods at high enough temperatures Use care with cutting boards and utensils Keep food refrigerated Wash raw fruits and vegetables Use pasteurized milk and fruit juices Wash hands after using bathroom Use individual care items

homework Describe strategies for implementing CDC guidelines for standard and transmission-based precautions when caring for patients. Submit typed, 2-3 pages, include rationale. Due at the beginning of next class.