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Metropolitan Community College NURS 1510 Nancy Pares, RN, MSN.

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Presentation on theme: "Metropolitan Community College NURS 1510 Nancy Pares, RN, MSN."— Presentation transcript:

1 Metropolitan Community College NURS 1510 Nancy Pares, RN, MSN

2  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

3  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,

4  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

5  Chemical agents ◦ Pesticides, food additives, medications, industrial  Physical agents ◦ Heat, noise, radiation, and machines

6  Moisture  Organic matter  Warmth  Darkness  Oxygen  Alkaline ph

7 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

8 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

9 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

10  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

11 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)

12 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

13  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

14  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

15  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

16 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

17 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

18  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

19  Extended LOS in hospital  Multiple care givers  Antibiotic choices and over use  Improper medical or surgical asepsis

20  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

21 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

22  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

23 Primary Defenses:  Anatomical features, limit pathogen entry Intact skin Mucous membranes Tears Normal flora in GI tract Normal flora in urinary tract

24 Secondary Defenses:  Biochemical processes activated by chemicals released by pathogens Phagocytosis Complement cascade Inflammation Fever

25 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

26  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

27  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

28 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

29  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

30  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

31  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

32  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

33  Standard precautions (universal precautions)  Protects health-care workers from exposure  Decreases transmission of pathogens  Protects clients from pathogens carried by health-care workers

34 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

35 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

36 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

37 “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

38 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

39  Protective barriers  Change gloves  HANDWASHING  Discard sharps correctly  Double bag  Cover breaks in the skin

40  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

41  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.

42  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

43 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

44  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

45  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!!!

46  The single most important measure to reduce the risk of transmission!  Nurses do hands on work, so always wash first!

47  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

48  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

49  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.

50  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?

51  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?

52  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?


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