Fundamental Nursing Skills and Concepts

1
Fundamental Nursing Skills and Concepts

• Chapter 22
• Page 464

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Infection Control

• Interferes with the infectious process cycle to
  gain control over the spread of infectious or
  contagious disease.

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INFECTIOUS DISEASES

• INFECTIOUS DISEASES are diseases spread from one
  person to another. They are also known as
  contagious or communicable diseases, and
  community acquired infections.
• Infectious diseases were once the leading cause
  of death.
• The threat of infectious diseases decreased
  because of vaccines, public health measures, and
  drug therapy.
• But, infectious diseases have not been
  eliminated. There are new, drug-resistant
  strains of TB, gonorrhea, and organisms which
  cause wound and respiratory infections.

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INFECTIOUS DISEASES

• AIDS and SARS present grave threats to public
  health.
• Box 22-1. page 465 Facts and myths about the
  transmission of HIV

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COLONIZATION DIFFERS FROM INFECTION

• COLONIZATION A CONDITION IN WHICH
  MICROORGANISMS ARE PRESENT, BUT THE HOST DOES NOT
  MANIFEST ANY SIGNS OR SYMPTOMS OF INFECTION.
• INFECTION A CONDITION THAT RESULTS WHEN
  MICROORGANISMS CAUSE INJURY TO A HOST.
• Whether infected or colonized, the host can
  transmit infectious diseases to others.

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INFECTIOUS DISEASES

• Table 22.1 The course of infectious disease
  through distinct stages. Page 465
• Incubation for a cold maybe 2-4 days, for HIV
  maybe months to years, before symptoms of AIDS
  appears.

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INFECTION CONTROL PRECAUTIONS

• INFECTION CONTROL PRECAUTIONS are physical
  measures designed to curtail the spread of
  infectious diseases.
• INFECTION CONTROL PRECAUTIONS interfere with the
  chain of infection and require knowledge of the
  mechanism by which an infectious disease is
  transmitted.
• Two major categories of infection control
  precautions are standard precautions and
  transmission-based precautions.
• Centers of Disease Control and Prevention
  established guidelines for 2 major categories of
  infection control precautions.

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STANDARD PRECAUTIONS Box 22-2 pg466

• MEASURES FOR REDUCING THE RISK OF MICROORGANISM
  TRANSMISSION FROM BOTH RECOGNIZED AND
  UNRECOGNIZED SOURCES OF INFECTION.
• FOLLOW WHEN CARING FOR ALL CLIENTS, REGARDLESS OF
  DIAGNOSIS OR INFECTION STATUS.
• REDUCES THE POTENTIAL FOR TRANSMITTING BLOODBORNE
  PATHOGENS AND PATHOGENS FROM BODY FLUIDS.
• Follow whenever there is potential for contact
  with blood, body fluids, nonintact skin, or
  mucous membranes.

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STANDARD PRECAUTIONS

• Examples of moist body substances feces, urine,
  sputum, saliva, wound drainage, and other body
  fluids.
• Remember if it is wet it has the ability to
  transmit microorganisms.

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TRANSMISSION-BASED PRECAUTIONS Table 22.2 page
467

• Also called ISOLATION PRECAUTIONS.
• Three types CONTACT PRECAUTIONS, DROPLET
  PRECAUTIONS, and AIRBORNE PRECAUTIONS.
• Used based on the mechanism of transmission of
  the pathogen.
• Used in combination if pathogen has multiple
  routes of transmission.
• Standard precautions are used with every patient,
  but transmission-based precautions may be
  discontinued depending on the pathogen.

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TRANSMISSION-BASED PRECAUTIONS

• Depending on culture testing showing negative.
• Drainage stops from wound or lesion.
• Antibiotic therapy being initiated.

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CONTACT PRECAUTIONS

• MEASURES USED TO BLOCK THE TRANSMISSION OF
  PATHOGENS BY DIRECT OR INDIRECT CONTACT.
• Direct contact is skin-to-skin contact with an
  infected person. Indirect contact is contact
  with a contaminated object in the clients
  environment.
• CONTACT PRECAUTIONS Private room or room with a
  similarly infected client. Gloves. Gowns if
  drainage not contained by dressings or if
  excessive drainage like diarrhea. Equipment for
  clients exclusive use.
• Used with drug resistant infections (whether
  skin, wound, respiratory, or GI), acute diarrhea,
  draining wounds or abscesses, and acute viral
  conjunctivitis.

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DROPLET PRECAUTIONS

• MEASURES THAT BLOCK PATHOGENS WITHIN MOIST
  DROPLETS LARGER THAN 5 MICRONS.
• Pathogens carried on droplets exit the body
  during coughing, sneezing, or suctioning.
  Droplets do not remain suspended in the air and
  are encountered by close contact with the client
  (within 3 feet of the client).
• DROPLET PRECAUTIONS Private room or room with
  similarly infected client. Standard precautions.
  Mask if within 3 feet of the client. Door may
  be open.
• Used with influenza, rubella, streptococcal
  pneumonia, and meningococcal meningitis.

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AIRBORNE PRECAUTIONS

• MEASURES THAT REDUCE THE RISK OF TRANSMITTING
  AIRBORNE INFECTIOUS AGENTS WHICH ARE SMALLER THAN
  5 MICRONS.
• Airborne pathogens are present in the residue of
  evaporated droplets and remain suspended in the
  air and attached to dust particles.
• AIRBORNE PRECAUTIONS Private room or room with
  a similarly infected client. Negative air
  pressure. Standard precautions. Mask. OSHA
  approved particulate air filter respirator if TB.
  Door closed.
• Used with pulmonary tuberculosis and measles
  (rubeola).

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INFECTION CONTROL MEASURES barriers to spread of
microorganisms

• PRIVATE ROOM- negative pressure room is
  suggested.
• SIGNS NOTIFYING VISITORS AND STAFF OF ISOLATION
• DISPOSABLE EQUIPMENT
• PERSONAL PROTECTIVE EQUIPMENT Garments that
  block the transfer of pathogens (gloves, cover
  gowns, masks, face shields, goggles).
• HOUSEKEEPING PRACTICES and DISPOSAL OF WASTE
  which serve to prevent the spread of the pathogen.

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INFECTION CONTROL MEASURES

• Disposing of contaminated items properly.
• Page 471 illustrates double bagging if one bag is
  not sturdy or a possibility of breaking or the
  outside of the first bag is contaminated.
• Using infection control measures properly to
  prevent spread is very important.
• A nosocomial infection is a hospital acquired
  infection.

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INFECTION CONTROL MEASURES

• Biodegradeable trash- flush what can be flushed.
• Moist items like soiled dressings should be
  wrapped so transfer of pathogens do not happen.
• If it is wet it is considered contaminated.

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PERSONAL PROTECTIVE EQUIPMENT

• EQUIPMENT IS USED ONCE.
• GLOVES, GOWNS, AND MASKS ARE DISPOSED OF AFTER
  USE. CLOTH GOWNS ARE PLACED WITH SOILED LINEN
  AND CLEANED.
• THE MOST CONTAMINATED GARMENT IS REMOVED FIRST.
• HANDS ARE THOROUGHLY WASHED AFTER REMOVING ALL
  PERSONAL PROTECTIVE EQUIPMENT AND BEFORE LEAVING
  THE CLIENTS ROOM.

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DISPOSAL OF CONTAMINATED ITEMS

• STURDY, LINED CONTAINERS FOR SOILED LINEN AND
  TRASH IN THE ROOM.
• EMPTIED AT THE END OF EACH SHIFT OR SOONER IF
  FULL.
• EMPTIED USING DOUBLE-BAGGING WHERE THE BAG
  CONTAINING THE CONTAMINATED ITEMS IS PLACED
  WITHIN AN OUTER, CLEAN BAG.
• DISPOSABLE EQUIPMENT IS PREFERRED. REUSABLE
  ITEMS MUST BE PROPERLY CLEANED BEFORE REUSE.
• LAB SPECIMENS ARE TAKEN TO THE LAB IN SEALED
  CONTAINERS IN PLASTIC BIOHAZARD BAGS.

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TRANSPORTING CLIENTS ON ISOLATION

• Client remains in private room unless absolutely
  necessary.
• Wheelchair or stretcher covered with sheet.
  Client also covered with sheet or blanket.
• CONTACT PRECAUTIONS Client wears gown. Areas
  of drainage well-covered (for example, extra
  dressing over draining wound).
• DROPLET OR AIRBORNE PRECAUTIONS Client wears
  mask. Nurse transporting should also wear mask
  and PPE
• Inform receiving department of isolation. Staff
  in receiving department wear personal protective
  equipment. Limit time in receiving department,
  for minimal exposure.

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Patients in isolation

• Feel very isolated.
• Encourage them to use phone, to stay in touch.
• Please make frequent contacts with them.
• Use the intercom to stay in touch.
• Converse about current events.
• Offer wide choice of foods, within their limits.
• Use touch, (back rubs), and assist to turn and
  reposition.
• Encourage deep breathing, spirometry.
• Wiggle toes, isometric exercises.

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NURSING CONSIDERATIONS

• Teach reasons for precautions to client and
  visitors. Assist visitors to follow precautions.
• Teach the client and significant others about the
  disease process, prevention of transmission, and
  any prescribed medications. Page 475a
• Provide appropriate interaction with the client
  to mitigate the effects of sensory deprivation
  and decrease feelings of social isolation.

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THE ELDERLY AND INFECTIOUS DISEASES

• Older adults have a decreased immune response.
• Chronic diseases make it harder to resist
  infections.
• Symptoms of infection will be more subtle.
• A change in behavior or mental status may
  indicate an infection.
• Older adults may have a lower baseline
  temperature. A normal temperature may actually
  indicate an infection.
• Early detection and prompt treatment can prevent
  hospitalization.
• Infection is major reason for transfer from
  nursing home to hospital.