1. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Asepsis/ Infection Prevention & Management Stephanie Stevens, MSN, RN, CNE

2. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Chain of Infection Infectious Agent Source or Reservoir Portal of Exit

3. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Chain of Infection Mode of Transmission –Contact Direct Indirect

4. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Chain of Infection Mode of Transmission –Droplet Transmission –Airborne Transmission

5. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Chain of Infection Mode of Transmission –Vehicle Transmission –Vectorborne Transmission

6. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Chain of Infection Portal of Entry Susceptible Host

7. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Chain of Infection Swine Flu –Infectious agent –Source –Portal of exit –Mode of transmission –Portal of entry –Susceptible host

8. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Normal Resistance to Infection Nonspecific Natural Defenses –Individual factors –Anatomical –Mechanical –Chemical See Table 30-1 p. 981

9. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Normal Resistance to Infection Nonspecific Natural Defenses –White Blood Cells (WBCs) –Fever –Normal flora

10. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Normal Resistance to Infection Nonspecific Natural Defenses –Inflammatory Response Cellular response; protective vascular reaction Localized Inflammation Systemic Inflammation

11. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Normal Resistance to Infection Specific-Acquired Defenses –Immunity Cellular immunity Humoral immunity

12. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Normal Resistance to Infection Specific-Acquired Defenses –Immunity Active Immunity Passive Immunity

13. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Factors Affecting Normal Resistance Infectious Agents Compromised Host

14. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Altered Resistance to Infection Types of Infections –Superinfection –Colonized –Bacteremia or Septicemia

15. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Altered Resistance to Infection Types of Infections –Opportunistic –Sepsis

16. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Altered Resistance to Infection Progress of an Infection –Incubation Period –Prodromal Period –Illness Period –Convalescent Period

17. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Altered Resistance to Infection Progress of Varicella –Incubation period –Prodromal period –Illness period –Convalescent period

18. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Altered Resistance to Infection Healthcare-associated infections (HAIs) Nosocomial infection Iatrogenic infection

19. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Altered Resistance to Infection Risk Factors in Development of HAIs –See Box- 30-1: “Factors Predisposing to Common Infections” p. 989 Urinary Tract Infection Wound Infection Respiratory Infection Gastrointestinal Infection

20. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Infection Control Prevention and control of infections are important concerns for all types of healthcare agencies –Regulatory agencies –Local agencies –Centers for Disease Control –Joint Commission –Occupational Safety & Health Administration

21. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Infection Control

22. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Aseptic Practices Categories of Aseptic Practice –Medical asepsis –Surgical asepsis

23. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Aseptic Practices Medical Asepsis –Hand Hygiene Most effective medical aseptic practice Soap and water OR waterless ETOH-based antiseptic cleanser Hand washing with soap and water when hands are visibly soiled Hand hygiene compliance among HCPs is poor Refer to p. 370 in the text regarding situations in which hand hygiene should be performed.

24. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Aseptic Practices Medical Asepsis –Disinfection Used for items that come in contact with intact skin Sterilization Used for items that enter sterile tissue or the vascular system

25. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Aseptic Practices Medical Asepsis –Use of Personal Protective Equipment (PPE) Mask and Respirators Protects from inhaling both large and small particle droplets Gowns Used when soiling of clothing is likely.

26. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Aseptic Practices Medical Asepsis –Use of Personal Protective Equipment Caps and Shoe Coverings Gloves Used when direct contact with moist body substances is anticipated Hand hygiene before and after gloving

27. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Aseptic Practices Medical Asepsis –Use of Personal Protective Equipment Goggles or Face Shields Used when splashing is likely, contamination from respiratory secretions or blood splatter is possible

28. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Aseptic Practices Medical Asepsis –Isolation Systems Practices either prevents organisms from leaving the room of the infected person or prevents organisms from entering the room of the susceptible person. Two-Tiered System of Isolation Standard Precautions Transmission Categories

29. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Aseptic Practices Tier I - Standard Precautions –Used in the care of all patients regardless of their diagnosis or possible infection status. –Applies to blood, all body fluids, secretions, and excretions, except sweat –Refer to Box 18-3: “Standard Precautions” on p. 373 for recommended practices

30. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Aseptic Practices Tier II - Transmission-Based Precautions –Always used in conjunction with Standard Precautions –Designed to be utilized with clients who have a diagnosed OR suspected infection –Extent of isolation based on how it is transmitted

31. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Aseptic Practices Categories of Transmission-Based Precautions –Airborne Precautions Transmission of small particle droplets –Droplet Precautions Transmission of large droplets –Contact Precautions Transmitted through direct contact –See Table 18-2: “Transmission-Based Precautions” on p. 373

32. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Aseptic Practices Protective Isolation –Used in high-risk situations for those patients whose body defenses are known to be compromised –May not be allowed to have dried or fresh flowers, potted plants, or fruit.

33. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Aseptic Practices Regardless of type of isolation system: –Hand hygiene –Proper disposal of contaminated supplies and equipment –Use protective barriers appropriately –Protection of individuals during transport of an isolated patient outside the isolation room

34. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Aseptic Practices Surgical Asepsis –Used in the following situations: Surgical and vascular procedures Procedures that involve a break in skin or mucous membranes Procedures involving insertion of catheters into sterile body cavities Care for selected high-risk people or group

35. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Aseptic Practices Surgical Asepsis –Principles of Surgical Asepsis See Table 18-3: “Principles of Surgical Asepsis” on p. 378 –Skin Preparation Soap and water Friction of scrubbing Antiseptic agents

36. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Aseptic Practices Surgical Asepsis –Surgical Hand Washing –Sterile Field –Sterile Gloves

37. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment Status of Defense Mechanisms –Any reduction in the body’s defenses against infection increases risk of infection Client Susceptibility

38. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment Clinical Appearance/Physical Assessment Diagnostic Tests and Procedures

39. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Diagnosis Risk for Infection Impaired Skin Integrity Impaired Oral Mucous Membranes Social Isolation

40. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Planning Controlling the spread of infection Providing education Supporting normal defense mechanisms Reducing or eliminating adverse effects of infection on functional abilities Detecting behaviors that increase the potential for infection Participating in community planning and activities for infection prevention

41. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation Control/Elimination of the Infectious Agent –Ensure that articles are cleaned properly according to use by: Disinfection Sterilization

42. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation Control/Elimination of the Source –Assist client in appropriate skin/oral hygiene. –Dressing changes when soiled/wet –Dispose of damp. Soiled linens –Empty drainage or suction bottles at end of shift. –Dispose of urine/feces appropriately

43. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation Control/Elimination of Portals of Exit –Cough/sneeze etiquette. –Avoid coughing, sneezing, talking over open wounds/sterile fields. –Handle body fluids cautiously.

44. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation Control of Transmission –Hand hygiene –Standard Precautions –Use of PPE –Isolation and barrier protection –Sterile technique

45. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation Control/Elimination of Portals of Entry –Skin/mucous membranes integrity –Urinary tract hygiene –Invasive tubes and lines closed/intact –Open wounds covered –Sterile technique for invasive procedures –Proper needle disposal

46. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation Protection of Susceptible Host –Skin/mucous membrane integrity –Balanced nutrition –Immunizations –Stress management

47. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Evaluation Patient will have adequate knowledge to recognize and report signs of infection. Patient will demonstrate use of good health practices to prevent the occurrence and spread of infection. Patient will participate in treatment regimens to prevent and minimize possible complications.