Chapter 31 ASEPSIS
•Infection - an invasion of body tissue by microorganisms and their growth can alter normal tissue function – disease
•Pathogenicity–ability to produce disease
•Virulence – the degree of pathogenicity
•Asepsis – freedom from disease-causing microorganisms.
•Sepsis – having infection which can take many forms, including septic shock.
•Medical asepsis
–Includes all practices intended to confine a specific microorganism to a specific area
–Limits the number, growth, and transmission of microorganisms
–Objects referred to as clean or dirty (soiled, contaminated)
•Surgical asepsis
–Sterile technique
–Practices that keep an area or object free of all microorganisms
–Practices that destroy all microorganisms and spores
–Used for all procedures involving sterile areas of the body
Types of infections
•Colonization – microorganism strains become resident flora.
•Local – limited to a specific body part
•Systemic – the spread of infection damaging different parts of the body.
•Bacteremia – infection in the blood
•Septicemia – when the bacteria results in systemic infection
•Acute – sudden onset, short-lasting
•Chronic – slow onset; long-lasting
Signs of Localized Infection: Inflammatory Response
•Localized swelling. Redness. Pain or tenderness with palpation or movement
•Palpable heat in the infected area
•Loss of function of the body part affected, depending on the site and extent of involvement
•Inflamatory Response
3 Stages
•1st stage – Vascular and celluar response
–Hyperemia – increase vascularity, release of histamines causing the redness and heat to the injured area
–Leukocytes leak into affected area causing edema
•2nd stage – exudate production
•Serous, purulent and sanguineous drainage
•3rd stage – Reparative phase
•Repair of injured tissue; granulation tissue, followed by scar formation
Signs of Systemic Infection
•Fever; pulse, respiratory rate if the fever high; Malaise and loss of energy
•Anorexia; nausea and vomiting may occur
•Enlargement and tenderness of lymph nodes that drain the area of infection
Signs of Infection
•Laboratory data:
–Elevated WBC count; Increase in specific WBC types; Elevated ESR (erythrocyte sedimentation rate) – which indicates inflammatory conditions
–Cultures of urine, blood, sputum, or other drainage
Risks for Nosocomial Infections
•Nosocomial infections – hospital acquired infections
–HAIs – Healthcare associated infections
–National Patient Safety Goals: mandates the reduction of risks related to healthcare associated infections
•The goals are to reduce UTIs, VAPs, central line infections
–Latrogenic infections – result from diagnostic or therapeutic procedures (ex: central lines)
•Compromised host and a port of entry
•Insufficient hand hygiene is the biggest culprit
The Chain of Infection: includes 6 Links
- microorganism’s ability & extent to produce an infection
- Source carrying the microorganisms
- Exit port for microorganism to exit the source are
- A means for transmission: direct or indirect contact
(vehicle/vector-borne)
- Compromised host at risk
Factors Influencing Microorganism’s Capability to Produce Infection
•Number of microorganisms present; the Virulence and potency of the microorganisms (pathogenicity); the Ability of microorganism to enter the body; Susceptibility of the host, and the ability of the microorganism to live in the host’s body
Body Defenses Against Infection pg. 675
•Intact skin and mucous membranes
•Moist mucous membranes and cilia of the nasal passages
•Lung alveolar macrophages
•Tears, saliva (natural microbial inhibitor)
•High acidity of the stomach
•Resident flora of the large intestine
•Peristalsis moves microbes out
•Low pH of the vagina (pH 3 - 5-4.5)
•Urine flow through the urethra
Active Immunity- is where the host produces antibodies in response to natural antigens or
artificial antigens
-Formation of antibodies in the presence of an active infection - Provides lifelong immunity
-Vaccine innauculations to stimulate antibody formation. May provide long-term immunity; May require booster shot
Passive Immunity – is where the host receives natural or artificial antibodies produced from
another source.
-Antibodies transferred naturally from an immune mother to baby through the placenta or in colostrums; may lasts 6 months to 1 year
-Occurs when immune serum (antibody) from an animal or another human is injected. Can Lasts 2 to 3 weeks
Who is Suspectible to Infections? What are the factors that increase susceptibility?
•Age; hereditary; Level of stress; Altered nutritional status
•Current medical condition or medical therapy: like Anti-inflammatory drugs, Corticosteroids; Long-term or chronic invasive procedures; and Preexisting diseases or illnesses such as Diabetes, asthma, renal disease and imunocompromised diseases
Nursing Management. Utilizing the Nursing Process when caring for clients:
1Assessment - Nursing history, demographics – gather subjective & objective data, laboratory data. Includes findings from your physical assessment
2Nursing diagnosis with Nursing Outcomes
3Planning
4Implementation
5Evaluation
NANDA Diagnosisrelated to Risk for Infection
-Nursing diagnosis should be written in a statement in which an individual is at increased riskfor being invaded by pathogenic microorganisms. Example:
•Risk for infection related to current treatment with mechanical ventilator
•Client will not develop a respiratory infection
•Identify Risks factors
–Inadequate primary defenses and/or Inadequate secondary defenses
Related Diagnosis for Infections
•Potential Complication of Infection: Fever
•Imbalanced Nutrition: Less than Body Requirement
•Acute Pain; Anxiety
•Impaired Social Interaction or Social Isolation
Interventions Aimed to Reduce the Risk for Infection
•Prevent nosocomial infections; Proper hand hygiene techniques; maintaine environmental controls; utilize sterile techniques when warranted; Identify and manage clients at risk; and
•PRACTICE: STANDARD PRECAUTIONS
What is meant by Standard Precautions?
•Used in the care of all hospitalized persons regardless of their diagnosis or possible infection status
•Applies to hHandling of Blood and all body fluids, secretions; except the excretions of sweat (whether or not blood is present or visible). Handling of non-intact skin and mucous membranes, clients with known Infectious diseases and contaminated articles
Breaking the Chain of Infection
- Etiologic agent
–Correctly clean, disinfect or sterilize articles before use
–Educate clients and support persons about proper methods to clean, disinfect, and sterilize articles
- Reservoir (source)
–Provide appropriate skin and oral hygiene; Change dressings & bandages when soiled
–Remove damp, soiled linens appropriately and dispose of feces, urine and secretions in appropriate receptacles
–Ensure fluid containers are covered or capped
- Portal of exit
–Covering the mouth and nose when coughing or sneezing
–Avoiding talking, coughing, or sneezing over open wounds or sterile fields
–Avoid high traffic movement in clean or sterile area
- Method of transmission
–Practice proper hand hygiene; Wear gloves when handling secretions or contaminated items; utilize Isolation procedures; Wear PPE
- Portal of entry
–Use sterile technique for invasive procedures
–Disposable needles and syringes in puncture-resistant containers
–Clients should have their own personal care items - “No Sharing”
- Susceptible host
–Maintain integrity of skin and mucous membranes
–Ensure balanced nutritional diet;
–Educate about the importance of immunizations
Transmission-Based Precautions
Isolation Precautions – in addition to standard precautions
- Contact isolation
–Enteric precautions, used for drainage/secretions precautions
–Blood/body fluid precautions
- Droplet isolation
–Transmit particle droplets > 5 micron
–Respiratory isolation
- Airborn isolation
–Transmit particle droplets < 5 micron
–Tuberculosis isolation; SARS, measles
- Reverse isolation
–Immunocompromised clients
Isolation Precautions should delineate practices for the control of specific diseases in the use of private rooms with special ventilation; or when Cohorting clients infected with the same organism (same infection). Guidelines should include procedures for gowning to prevent gross soiling of clothes. Equipment for use of preventing and protecting from infections include:
•PPE – Personal Protective Equipment
–Gloves, face mask & shields, Gowns, Bagging of infectious waste and posting Biohazard Alert signs
Handwashing and Gloving - Review skills in Taylor’s
Managing Equipment Used for Isolation
•Much of the equipment and medical suppliescome for single use only and are disposed of them after use
•Agencies have specific policies and procedures for handling soiled reusable equipment
•Nurses need to become familiar with these practices
Bloodborne Pathogen Exposure – Read assignment in Taber’s
•Exposure to bloodbornepathoges are reported immediately as an incident
•Complete an injury report
•Seek follow-up evaluation
–Identifies and documents the source individual
–Test the source for hepatitis B, C and HIV when feasible and consent is given
–Make results of the test available to the source individual’s health care provider
–Test blood of exposed nurse (with consent)
–Post-exposure prophylaxis if medically indicated
–Puncture/Laceration
•Wash/clean the area with soap and water
•Encourage bleeding at the puncture site
•Initiate first aid and seek treatment if indicated
•When Mucous membrane are exposed (eyes, nose, mouth), flush with saline or water flush for 5 to 10 minutes