Presentation on theme: "Metropolitan Community College NURS 1510 Nancy Pares, RN, MSN."— Presentation transcript:
Metropolitan Community College NURS 1510 Nancy Pares, RN, MSN
Asepsis… ◦.absence of germs or micro organisms Medical asepsis…. ◦ technique or procedure which reduces the number of micro organisms and thus prevents the spread of disease Surgical asepsis…. ◦ Protection against infection before, during and after a surgical procedure. Infection ◦ Invasion of the body by pathogens
Bacteria ◦ One celled, multiply rapidly, classified by shape and how they cluster together Virus ◦ Smallest of all pathogens; replication within the host Fungi ◦ Organisms that exist by feeding on organic matter Protozoa ◦ Single celled organism; spread by feces,
Rickettsia ◦ Organisms multiply in animal hosts and transmit to humans through bites Helminths ◦ Parasitic worms found in soil; transmitted via hand to mouth Mycoplasmas ◦ No cell wall; multi shaped
Chemical agents ◦ Pesticides, food additives, medications, industrial Physical agents ◦ Heat, noise, radiation, and machines
Infectious agents Pathogens Normal flora that become pathogenic Reservoir Where pathogens live and multiply May be living Humans, animals, insects May be nonliving Food, floors, equipment, contaminated water
Portal of Exit: Via Bodily fluids Coughing, sneezing, diarrhea Seeping wounds Tubes, IV lines Mode of Transmission: Contact Direct – touching, kissing, sexual contact Indirect – contact with a fomite Droplet: Cough, sneeze Airborne: Via air conditioning, sweeping
Portal of Entry: Eye, nares, mouth, vagina, cuts, scrapes Wounds, surgical sites, IV or drainage tube sites Bite from a vector Susceptible Host: Person with inadequate defense Three determining factors: Virulence Number of organisms Host’s defenses
Incubation: From time of infection until manifestation of symptoms; can infect others Prodromal: Appearance of vague symptoms; not all diseases have this stage Illness: Signs and symptoms present Decline: Number of pathogens decline Convalescence: Tissue repair, return to health
By Location: Local Occurs in a limited region in the body (e.g., urinary tract infection) Systemic Spread via blood or lymph Affects many regions (e.g., septicemia)
Acute - Rapid onset of short duration e.g., Common cold Chronic - Slow development, long duration e.g., Hypertension, diabetes mellitus, osteomyelitis Latent - Infection present with no discernible symptoms e.g., HIV/AIDS
Presence of pathogen Reservoir (source) ◦ Pathogen survive and multiply Portal of exit from reservoir ◦ Direct, indirect, airborne Mode of transmission Portal of entry to host Susceptible host
Local ◦ Limited to a defined area; resembles inflammation ◦ Ex: redness, warmth, tenderness, swelling Systemic ◦ Affects the entire body and may involve multiple organs, goes through the stages of infection ◦ Ex: fever, anorexia, n/v, lymph node swelling
Vascular ◦ Aterioles dilate, blood and WBC go to area ◦ s/s= redness and warmth Inflammation ◦ Tissue dies causing release of chemicals (histamine and prostaglandins) which allow blood vessel permeability. Cells, proteins, fluids enter the tissue spaces blocking lymphatics to create a ‘wall’ against infection Phagocytosis ◦ WBC enter the tissues causing release of pyrogens (fever); exudates form discharge; healing occurs
An infection acquired in a health-care facility Cost to the health-care system = $4.5 billion/year Leading cause of death Preventable with use of aseptic principles/ techniques Exogenous Nosocomial Infection: Pathogen acquired from health-care environment Endogenous Nosocomial Infection: Normal flora multiply and cause infection as a result of treatment
Iatrogenic ▫ Infection from a procedure ex: UTI from foley insertion exogenous ▫ Infection from non-normal flora ex: clostridium Endogenous ▫ Infection when normal flora altered ex: yeast infection
UTI ◦ Insertion, contamination of drainage system, improper cleansing Surgical site ◦ Improper technique for handwashing or dressing change URI ◦ Improper handwashing or suctioning technique IV ◦ Improper handwashing or site care
Extended LOS in hospital Multiple care givers Antibiotic choices and over use Improper medical or surgical asepsis
Age ◦ Very young and very old Poor nutritional status Smoker, ETOH use Existing co-morbid conditions Chronic illnesses, chemo,radiation Clients with invasive procedures Clients with prolonged stress
Containing nosocomial infections CLEAN, DISINFECT, STERILIZE Controlling/eliminating reservoirs ▫ Bathing, dressing changes, patent drainage systems Controlling the portal of exit ▫ Cover mouth/nose, wear mask, client teaching Controlling transmission ▫ Do not share equipment, proper handling of linens, HANDWASHING Controlling portal of entry ▫ Maintain skin integrity, position changes, proper wiping techniques, maintain drainage integrity
Protecting susceptible host ◦ Protect natural defenses-skin, mucous membranes, fluid intake ◦ Encourage cough and deep breathing ◦ Change position ◦ Oral hygiene ◦ Promote rest and sleep ◦ Reduce client stress
Primary Defenses: Anatomical features, limit pathogen entry Intact skin Mucous membranes Tears Normal flora in GI tract Normal flora in urinary tract
Secondary Defenses: Biochemical processes activated by chemicals released by pathogens Phagocytosis Complement cascade Inflammation Fever
Tertiary Defenses: Humoral immunity B-cell production of antibodies in response to an antigen Cell-mediated immunity Direct destruction of infected cells by T cells
Developmental stage Breaks in the skin Illness/injury, chronic disease Smoking, substance abuse Multiple sex partners Medications that inhibit/decrease immune response Nursing/medical procedures
Adequate nutrition To manufacture cells of the immune system Balanced hygiene Sufficient to decrease skin bacterial count Not overzealous; causes skin cracking Rest/exercise Reducing stress Immunization
Medical asepsis: “A state of cleanliness that decreases the potential for the spread of infections” Promoted through: Maintaining a clean environment Maintaining clean hands Following Centers for Disease Control (CDC) guidelines
Clean spills and dirty surfaces promptly Remove pathogens through chemical means (disinfect) Remove clutter Consider supplies brought to the client room as contaminated Consider items from the client’s home as contaminated
When you arrive in the unit When you leave the unit Before and after restroom use Before and after client contact Before and after contact with client belongings
Before gloving After glove removal Before and after touching your face Before and after eating After touching a contaminated article When you see visible dirt on your hands
Wash for at least 15 seconds in nonsurgical setting; 2-6 minutes in surgical setting Use warm water, not hot Apply soap to wet hands Use friction Clean beneath fingernails and jewelry Rinse soap Towel or hand dry
Standard precautions (universal precautions) Protects health-care workers from exposure Decreases transmission of pathogens Protects clients from pathogens carried by health-care workers
Contact Precautions: Pathogen is spread by direct contact Sources of infection - draining wounds, secretions, supplies Precautions include: Possible private room Clean gown and glove use Disposal of contaminated items in room Double-bag linen and mark
Droplet Precautions: Pathogen is spread via moist droplets: Coughing, sneezing, touching contaminated objects Precautions include: Same as those for contact Addition of mask and eye protection within 3 ft of client
Airborne Precautions: Pathogen is spread via air currents Transmission via ventilation systems, shaking sheets, sweeping Precautions include: Same as those for contact, with addition of special mask
“Reverse” isolation: Protects the client from organisms Used with immune-compromised client population Precautions include: Private room likely Nurse not assigned to clients with active infection Mask, handwashing, clean/sterile gown, gloves No reuse of gowns, gloves
Includes: Creation of a sterile environment Use of sterile equipment/supplies Sterilization of reusable supplies Surgical hand scrub Surgical attire Sterile gloves Sterile field Use of sterile technique
Protective barriers Change gloves HANDWASHING Discard sharps correctly Double bag Cover breaks in the skin
Organs most vital to a functional immune system ◦ Liver…produces immunoglobulins (antibodies) ◦ Lymph nodes…produce and circulate lymphocytes ◦ Bone marrow and thymus..form immune sys. Cells ◦ Spleen…removes dead cells and foreign molecules
Humoral ◦ Attack bacteria and virus’ at the extracellular level ◦ B cell lymphocytes cause synthesis of antibodies leading to destruction of antigens and creation of antibodies that subsequently protect from the same antigen ◦ Five classes of antibodies IgG, IgM, IgA, IgE, and IgD. IgG is most abundant and crosses the placenta provides passive immunity for newborns.
Cell mediated immunity ◦ Fights pathogens inside the cell ◦ T cells (a form of WBC) binds with the antigen, becomes sensitized and releases lymphokines which attract macrophages that destroy the antigen ◦ Three types of T cells Cytotoxic, helper T and suppressor T
Natural ▫ Present at birth, genetically determined Passive ▫ Acquired through introduction of antibodies, ie mother passes to infant Active ▫ Antibodies develop within the body to neutralize or destroy an infective agent Acquired ▫ Exposure to an antigen or passive injection of immunoglobulin Artificial ▫ Produced by vaccination
Medical asepsis ◦ Practice which reduces the number, growth and spread of micro organisms ◦ Referred to as ‘clean’ technique’ ◦ Handwashing 2 min-15 sec Surgical asepsis ◦ Total elimination of all micro organisms, spores ◦ Sterile field (OR, L&D, etc), gown and glove ◦ Methods: Steam, radiation, chemicals, or gas
Apply to : ◦ All body fluids, secretions (except perspiration) ◦ Blood ◦ Non intact skin ◦ Mucous membranes Gloves worn: ◦ To provide a protective barrier ◦ To reduce opportunities for ‘nurse’ organism transfer to client ◦ WEARING GLOVES DOES NOT REPLACE HANDWASHING!!!
The single most important measure to reduce the risk of transmission! Nurses do hands on work, so always wash first!
Cover your nose and mouth with your elbow. Use tissues to contain respiratory secretions and dispose into the nearest waste container after use. Perform hand hygiene after contact with any contaminated materials/objects
Turn on slow, steady stream of warm water Moisten hands with water, then apply soap Rub hands together vigorously for at least 15 seconds Rinse under water Use a clean paper towel or air dryer to dry hands
May use when hands are not visibly soiled Apply adequate amount to palm of one hand Rub hands together, covering all surfaces of hands and fingers (including under the nails) until hands are dry Do not rinse with water May be used 5-10 times before washing with soap and water is required.
Admitting calls to tell you that they have a client who previously cultured positive for MRSA in their urine. What precaution do you place this client in? What if the MRSA was positive in the sputum?
You have a client that has very runny stools. The doctor orders a stool culture. What additional information can you supply the lab? What precautions would you place this patient in?
Client presents to ED with high fever, headache, body aches and non-productive cough. Client states the her husband just returned from a business trip in China. First thought? Precautions?