1. CONCEPT: INFECTION Chapter 28

2. Objectives The student will be able to: Define the concept of infection Explain the relationship between the chain and transmission of infection. Identify the normal defenses of the body against infection. Discuss the events in the inflammatory response. Identify patients most at risk for infection.

3. Objectives The student will be able to: Described the signs/symptoms of a localized infection and those of a systemic infection. Explain the difference between medical and surgical asepsis. Explain the rationale for standard precautions. Discuss the principles of surgical asepsis Develop a nursing care plan for a patient with an infection.

4. Definition Infection is the invasion and multiplication of microorganisms in body tissues, which may be unapparent or the result of local cellular injury caused by competitive metabolism, toxins, intracellular replication, or antigen-antibody response. An infection is the invasion of a susceptible host by pathogens or microorganisms, resulting in disease.

5. Collaborative learning With your neighbor, discuss the elements in the chain of infection.

6. Case study Mrs. Eldredge is a 63-year-old woman who underwent a total hip replacement. Kathy Jackson is a nursing student caring for Mrs. Eldredge on her home health clinical rotation. Two weeks after surgery, Mrs. Eldredge complains to Kathy that she has increased pain in her hip and low-grade fever. Kathy observes the incision and notes that it is red, swollen, and warm.

7. The infectious process www.youtube.com/watch?v=_bNN95sA6-8

8. Case Study Mrs. Eldredge was admitted to the hospital for treatment. When Sally Brown, the student nurse caring for Mrs. Eldredge, changed the dressing, she observed that the incision had dehisced, had serous sanginous drainage, peri-wound was swollen and indurated and Mrs. Eldredge complained of pain when the tissue was touch. Sally’s clinical assignment is to write a care plan for Mrs. Eldredge.

9. Nursing Knowledge Asepsis is the absence of pathogenic (disease- producing) microorganisms. Aseptic technique refers to practices/procedures that help reduce the risk for infection. Medical asepsis, or clean technique, includes procedures for reducing the number of organisms present and preventing the transfer of organisms, Handwashing is the most important action to prevent infection.

10. Standard Precautions Standard precautions are used to prevent and control infections and its spread. Standard precautions: Wear gloves when there is an opportunity to come in contact with blood, body fluid, nonintact skin, and mucous membranes from all patients.

11. Disinfection and Sterilization Disinfection describes a process that eliminates many or all microorganisms, with the exception of bacterial spores, from inanimate objects. Sterilization is the complete elimination or destruction of all microorganisms, including spores. What items need to be disinfected???

12. Infection Prevention and control to reduce reservoirs of infection Bathing Use soap and water to remove drainage, dried secretions, or excess perspiration. Dressing changes Change dressings that become wet and/or soiled Contaminated Articles Place tissues, soiled dressings, or soiled linen in fluid-resistant bags for proper disposal. Contaminated Sharps Place all needles, safety needles, and needleless systems into puncture-proof containers, which should be located at the site of use. Bedside Unit Keep table surfaces clean and dry

13. Infection Prevention and control to reduce reservoirs of infection Bottled Solutions Do not leave bottled solutions open. Keep solutions tightly capped. Date bottles when opened and discard in 24 hours. Surgical Wounds Keep drainage tubes and collection bags patent to prevent accumulation of serous fluid under the skin surface.

14. Infection Prevention and control to reduce reservoirs of infection Drainage Bottles and Bags Wear gloves and protective eyewear if splashing or spraying with contaminated blood or body fluids is anticipated. Empty and dispose of drainage suction bottles according to facility policy. Empty all drainage systems on each shift unless otherwise ordered by physician. Never raise a drainage system (urinary drainage bag) above the level of the site being drained unless it is clamped off.

15. Isolation precautions Two Tier Approach Tier One Standard precautions: Wear gloves when there is an opportunity to come in contact with blood, body fluid, nonintact skin, and mucous membranes from all patients. Tier two Contact precautions Droplet precautions Airborne Protective environment

16. Contact Precautions Used for patients with a known or suspected to be infected with microorganisms that can be transmitted by direct contact with the patient; and indirect contact with surfaces or items in the patient’s environment. Examples: MRSA & C. Difficule Precautions: Private room, Gown and Gloves, Wash hands, Masks: as needed for standard precautions Transporting instructions: Cover cart or wheelchair with clean sheet. Clean with approved disinfectant after transporting patient. Reusable items: Items (stethoscope, BP cuff, tourniquet) must be cleaned and disinfected before being used on another patient.

17. Droplet Precautions Used for patients with transmission of large droplets during coughing, sneezing, talking, suctioning, etc, and deposited on mucous membrane of nurse’s nose, mouth, eyes. Examples: Meningococcal meningitis, Rubella, Influenza, Pertussis Precautions: Private room, Masks, Gown & gloves, Wash hand Transporting instructions: Place surgical mask on patient prior to patient leaving room. Transporter: no mask

18. Airborne Precautions Airborne must be used for patients known or suspected to be infected with pathogens that can be transmitted by the airborne route via micro particle droplets that can remain suspended in the air for long periods of time, be dispersed by air currents, and be inhaled by a susceptible host. Examples: TB, Chickenpox (varicella virus), SARS, Measles Precautions: Private room: Private negative-pressure room. Room door shall be kept closed Mask: respirator (N95 mask) for TB or a surgical mask for measles Gown: if patient has chickenpox (varicella virus) Gloves Transporting instructions: a surgical mask and yellow gown must be placed on patient. If patient has chickenpox (varicella virus) cover all draining lesions.

19. Protective environment Used in limited populations Examples: stem cell transplants Precautions: mask to be worn by patient when out of room, patient can not have dried or fresh flowers or potted plants in their rooms.

20. Surgical Asepsis Patient preparation Sterile field: an area free of microorganisms and prepared to receive sterile items Principles Performing sterile procedures

21. Sterile technique What are the principles for sterile technique?

22. Principles of Surgical Asepsis 1. A sterile object remains sterile only when touched by another sterile object. 2. Only sterile objects may be placed on a sterile field. 3. A sterile object or field out of the range of vision or an object held below a person’s waist is contaminated. 4. A sterile object or field becomes contaminated by prolonged exposure to air.

23. Principles of Surgical Asepsis (cont’d) 5. When a sterile surface comes in contact with a wet, contaminated surface, the sterile object or field becomes contaminated by capillary action. 6. Fluid flows in the direction of gravity. 7. The edges of a sterile field or container are considered to be contaminated.

24. Sterile area