Medical Asepsis /

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Module 2
Medical Asepsis / Infection Control
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INFECTION

• Definition
• An infection is the result of an interaction
  between a susceptible hose and an infectious
  agent (bacteria, viruses, fungi, parasites) a
  clinical syndrome caused by the invasion and
  multiplication of a pathogen in the body.

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Infections are
Localized
Systemic
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Course of Infection

• The course of an infection can be
• divided into four major phases
• 1. Incubation
• 2. Prodromal
• 2. Period of Clinical illness
• 3. Convalescence

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Transmission of Infections

• Health Care institutions can present a danger in
  infectious disease transmission
• Nosocomial infection - a hospital-acquired
  infection
• Iatrogenic infection a direct result of
  treatments

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Transmission of Infections

• Goal 4 of the National Patient Safety Goals
  (NPSGs) is directed toward infection related
  sentinel events Preventing health-care
  associated infections.
• Health care-associated infections are a serious
  problem and health care workers need to strive
  toward preventing the occurrence.

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PrimaryDefenses Against Infection

• 1. Skin and mucous membrane
• 2. Respiratory system
• 3. Gastrointestinal system
• 4. Circulatory system

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Secondary Defenses Against Infection

• Inflammatory response
• Local reaction to an infectious agent
• Serves to localize, destroy, dilute, neutralize,
  remove a pathogen
• Signs redness, heat, swelling and pain
• 2. Immune response
• Immunity is a measure of a person s ability to
  fight disease by forming immunoglobulins (
  antibodies formed against invading antigens), or
  producing interferon.

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Chain of Infection
Source of infection Pathogenic microorganism
Host Susceptibility
Portal of Entry to susceptible host
Mode of transmission
Reservior
Portal of exit from Reservior
http//www.d.umn.edu/ehso/training/idp1.html
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Link 1 Source of Infection /Pathogenic Organism

• What is the type of organism virus, bacteria,
  fungi, parasites, etc.
• Level of virulence
• Number of organisms

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Link 2 Portal of entry to Host

• Eyes
• Mucous membranes
• Respiratory tract
• Placenta
• Breaks in the host barriers

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Link 3 - Reservoir

• Humans
• Animals
• Environmental surfaces

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Link 4 Portal of Exit

• Respiratory tract
• Genitourinary tract
• Gastrointestinal tract
• Skin / mucous membrane
• Placenta
• Blood and body fluids

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Link 5 Mode of Transmission

• Direct contact
• Droplets
• Vectors
• Airborne

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Link 6 Characteristics of the Host

• Lack of effective resistance
• Changes in host defense
• Tissue destruction

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What are some examples of a Nursing Diagnosis?

• Risk for Infection RT

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Planning / Goals

• The patient will
• 1.
• 2.
• 3.

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Intervention
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Infection Control

• Although it is impossible to ensure that the
  patients environment is free of microorganisms,
  there are many steps that a nurse can take to
  reduce the spread of microorganisms and thus
  promote safety for both the patient and the
  healthcare personnel.

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National Patient Safety Goal

• Goal 4
• Reduce the risk of health careassociated
  infections.
• According to the Centers for Disease Control and
  Prevention, each year, millions of people acquire
  an infection while receiving care, treatment, and
  services in a health care organization.
• Consequently, health care-associated infections
  (HAIs) are a patient safety issue affecting all
  types of health care organizations.

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Quality and Safety Education in Nursing (QSEN)

• The goal of QSEN is to address the challenge of
  preparing future nurses with the knowledge,
  skills and attitudes (KSA) necessary to
  continuously improve the quality and safety of
  the healthcare systems in which they work.
• They have 6 competencies and Safety is one of the
  main competencies.

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Safety Infection Control

• Infection control measures used in the hospital
  include
• Medical Asepsis
• Standard Precautions
• Isolation Precautions

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Infection Control -- Medical Asepsis
Definition

• Practices designed to reduce the numbers of
  pathogenic microorganisms and limit their growth
  and transmission in the patients environment

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Why Practice Medical Asepsis

• Helps the patient fight a current infection and
  prevent its spread.
• Prevents the patient from being re-infected by
  the same pathogen.
• Prevents the patient from being infected with a
  new pathogen.
• 4. Prevents health care professionals and
  visitors who come in contact with the patient
  from being infected.

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• Helps decrease the chance of the patient
  acquiring a nosocomial infection.
• The infections can be simple and uncomplicated,
  or major and life threatening. Patients are at
  risk for nosocomial infection because they often
  have weakened immune systems and because the
  health care facility contains patients and
  equipment that harbor infection.
• The desired result is
• to reduce the transmission of the microorganisms
  from one person to another.
• Or from one person to an object

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Medical Asepsis Hand-washing

• The first line of defense in
• medical asepsis is hand-washing.
• Proper hand-washing is considered the single most
  effective way to stop the spread of
  microorganisms and preventing infection.

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Proper Hand washing Assures

• Reduction in the number of pathogens on the hands

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Safety Check Prior to Hand washing

• Assess that the fingernails are short
• Highest concentration of organisms on the
  
• hands are found UNDER THE NAILS.
• Jewelry should be removed, especially rings with
  stones. Wedding bands may be worn sometimes.
• Skin is free of lesions
• If the skin should have a small lesion, bandage
  the area then double glove.

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When Should You Wash Your Hands ?

• At the start of each shift
• After sneezing or coughing
• After using the bathroom
• After handling contaminated items
• Before and after giving patient care and between
  patients.
• After handling body excretions- even with gloves
  on

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• Before and after performing any treatments
• After removing gloves
• At the end of each shift before leaving the
  health facility

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WASH YOUR HANDS !
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Guidelines and Principles

• Hand-washing is one of the most effective methods
  of preventing the spread of bacteria.
• Usually 15 seconds should be allowed to wash the
  hands
• Clean from the cleanest
• area to the dirtiest area

wrist
Finger tips
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Guidelines and Principles
Medical Asepsis

• These 3 are necessary to remove microorganisms
• Do not touch the sink when washing hands stand
  away
• Keep clean items separate from dirty ones.
• Turn off water with a dry paper
• towel wet acts as a wick.

1. Friction
3. Cleansing Agent
2. Running Water
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Guidelines and Principles
Medical Asepsis

1. Jewelry makes it difficult to adequately cleanse
   the hands. It is best to not wear jewelry in the
   clinical setting. Wedding bands are acceptable
   sometimes.
2. If using hand lotionallow hands to dry about 30
   minutes before applying. Do NOT apply hand
   lotion immediately after washing hands.

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Alcohol Based Handrubs

• Alcohol-based hand rubs (foam or gel) kill more
  effectively and more quickly than handwashing
  with soap and water.
• They are less damaging to skin than soap and
  water, resulting in less dryness and irritation.
• They require less time than handwashing with soap
  and water.
• Bottles/dispensers can be placed at the point of
  care so they are more accessible.

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How to use Handrubs

• HAND RUB (foam and gel)
• Apply to palm of one hand (the amount used
  depends on specific hand rub product).
• Rub hands together, covering all surfaces,
  focusing in particular on the fingertips and
  fingernails, until dry. Use enough rub to require
  at least 15 seconds to dry.

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Alcohol based handwash
ALCOHOL-BASED HAND RUBS ARE MORE EFFECTIVE IN
KILLING BACTERIA THAN SOAP AND WATER.
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Modifying Hand-washing in Home
Care Situations

• Bring bacterial soap and paper towels with you to
  the patients home
• If no running water is available in the home, use
  disposable wipes or alcohol-based rubs.

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Infection Control Standard
Precautions

• Standard Precautions are
• Those precautions designed for the care of all
  patients in hospitals regardless of their
  diagnosis or presumed infection status.

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Standard Precautions

• Set of guidelines developed by the Centers for
  Disease Control and Prevention (CDC) for
  preventing contact with potentially infectious
  blood or body fluids that may harbor diseases
  regardless of whether or not they contain visible
  blood

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Standard Precautions are used for

• All body fluids, secretions and excretions
  regardless of whether or not they contain visible
  blood
• Sputum, saliva
• Urine
• Feces
• Nasal secretions, tears
• Vomitus
• Spinal fluid/ cerebrospinal fluid
• Synovial, pleural, peritoneal , pericardial,
  amniotic fluid
• All moist body surfaces, mucus membranes
• Blood

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Standard Precautions

• Used for all patients, not just those with known
  infections
• These precautions should be implemented whenever
  contact with potentially infectious material is
  anticipated.
• Used to protect the caregiver.

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Components of Standard Precautions

• Hand-Washing
• Personal Protective Devices
• Gloves
• Mask, Eye Protection, Face Shield, Gown
• Patient-care equipment
• Environment
• Linen
• Sharp Objects

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Hand-Washing

• Hands must be washed after patient contact
  regardless of the use of gloves. Even if you
  wear gloves, wash your hands
• Gloved hands cannot be effectively washed.

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Gloves

• Gloves can be used to avoid direct contact with
  infectious material
• Wear gloves to handle
• Blood
• Body fluids
• Secretions, Excretions
• Contaminated items
• Change gloves before preceding to the next task,
  or touching non-contaminated items even on the
  same patient.
• Made of vinyl or latex -- vinyl are used
• if allergy to latex is
  present.

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Mask, Eye Protection, Face
Shield, Gown

• Masks provide barrier protection against splashes
  and sprays, and airborne droplets
• Masks come in various types depending on their
  permeability to airborne particles.
• Eye goggles or glasses and face shields provide
  barrier protection against splashes and sprays.
• Gown should be water
• impermeable to provide barrier
• protection

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Infection Control Patient-Care Equipment

• Handle equipment in a manner that prevents
  personal skin and mucous membrane exposure and
  cross contamination to other patients.
• Reusable equipment must be cleaned/ disinfected
  and reprocessed before using it in the care of
  another patient.

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Environment

• Each hospital, clinic has procedures for care,
  cleaning, and disinfection of environmental
  surfaces.
• Spills of blood or body fluids need to be handled
  with special procedures.

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Linen

• Handled in a way to prevent contamination of
  skin, mucous membranes, and clothing.
• Fold soiled linen with contaminated area to the
  inside. Do not shake.
• Hold away from body and place in appropriate bag
  and dispose
• of properly.

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Sharp Objects

• Place all sharp objects in a
• puncture-proof container.
• Do not re-cap needles
• Immediately discard after use. Do not attempt to
  bend or break a needle before discarding. Throw
  away the whole thing.

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Infection Control -Isolation Precautions

• Isolation precautions are utilized when
• patients have a greater susceptibility to
  infection than others
• A patient or patients body fluids are a carrier
  of microorganisms that can easily be transmitted
  to other patients, family members, or health care
  workers.

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Isolation Precaution Categories

• In addition to standard precautions, the CDC
  recommends three categories of transmission-based
  precautions. They include
• 1. Airborne precautions
• 2. Droplet precautions
• 3. Contact precautions
• The fourth type of isolation is protective
  isolation.

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Airborne Precautions

• Used when the organism is capable of remaining in
  the air for prolonged periods of time and can be
  transported in the air for distances greater than
  3 feet.
• Most common organisms are
• Tuberculosis
• Chicken pox
• Measles
• Must wear a special particulate filter mask

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• A private negative air pressure room is used for
  patients needing airborne precautions.
• Negative air pressure rooms are used for patients
  needing airborne precautions
• Bring air into the room from the hallway and have
  a separate exhaust system.
• Outside the room is isolation cart that contains
  supplies needed to care for the patient and
  protects persons entering the room.

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• Caring for the patient in isolation
• Personal Care - Remember it is the disease that
  is being isolated, not the patient.
  Place linens in proper contaminated waste
  container, and soiled paper towels in an
  isolation waste container.
• Food Service disposable paper trays and
  disposable dishes that are discarded in proper
  isolation waste container. Do not put tray back
  on the food cart.
• Contaminated articles according
• to agency policy, usually double
• bagged or color-coded waste
• bags to indicate contaminated waste.

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Airborne Isolation

• All patients on airborne precautions should
  wear surgical
• masks when leaving
• the negative air
• pressure room for
• x-rays, tests, or
• procedures.

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Droplet Precautions

• Organisms that can be spread by large airborne
  droplets through the air but are unable to remain
  in the air further than 3 feet.
• Examples of organisms include
• Influenza
• Cold
• Meningitis
• Mumps
• Pertussis

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Droplet Precautions

• Single rooms are preferable
• Patients with same disease can share the same
  room
• Standard surgical masks without a filter must be
  worn for anyone coming within 5 feet of the
  patient.
• Gowns should be worn if clothing or uniforms are
  likely to become contaminated with respiratory
  secretions.
• Gloves should be worn anytime handling tissues or
  items contaminated with the respiratory secretions

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Contact Precautions

• Purpose is to prevent the transmission of disease
  by direct or indirect contact
• Direct contact involves
• Touching
• Bathing
• Skin-to-skin contact
• Indirect contact involves
• Contact with inanimate objects doorknobs, light
  switches, tabletops, telephones
• Examples of diseases are staph, herpes,
  diphtheria, and many others

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Contact Precautions

• Contact precautions include use of barrier
  precautions such as gloves and impermeable gowns
  to prevent direct contact with infectious
  organism
• Used
• For patient with diarrhea
• When coming into contact with draining wounds
• Patients with acquired antibiotic resistance
  infections

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Critical Thinking - Ask Yourself

• You have gone in Mr. A.s room to perform a
  dressing change.
• What type of isolation is he in?
• What equipment would you use?
• A. Gloves only
• B. Gloves and gown
• C. Gloves, gown, and mask

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Protective / Strict Isolation

• Used with patients who are immunocompromised such
  as
• Chemotherapy
• AIDS
• Organ transplants

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Review Match the Following

• __ Influenza
• __ Diarrhea
• __ Tuberculosis
• __ AIDS
• __ Chicken pox
• __ Draining wound
• __ Chemotherapy pts

• A. Airborne
• B. Droplet
• C. Contact
• D. Protective / Strict

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Review

• Mrs. B. is on airborne isolation.
• What specific equipment is used in airborne
  isolation that is not used in other types of
  isolation?

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Review

• When would the nurse apply goggles
• or a face mask?