PERSEPHONE GEE, RN, MSN CITY COLLEGE OF SAN FRANCISCO INSTRUCTOR Asepsis and Infection Control introduction • The nurse’s major focus is wellness. In the hospital setting, prevention of infection is primary. • The nurse identifies, prevents, control infection, and teach the patient and other healthcare providers asepsis and infection control. • Prevent spread of microorganism from person to person and from place to place. Start with definition of terms • Asepsis-a condition free from germs, infection, and any form of life • Sterile-free from living microorganisms, i.e. bacteria, fungi, protozoa, viruses, spores, or other living organisms If sterile means: •-free from living microorganisms, i.e. bacteria, fungi, protozoa, viruses, spores, or other living organisms- •What is sterility? It is a state-of freedom from contamination or colonization by living microorganisms. STUDENT ACTIVITY • Student draw a term written on a piece of paper to define from the box (instructor explains the rules) • Student draws a term to define. After giving his comments, takes the term to another student or has the other student choose another term to define. Current CDC Guidelines • Standard precautions—used in care of all hospitalized patients – Apply to blood, body fluids, secretions, excretions, non-intact skin, mucous membranes • Transmission-based precautions—used in addition to standard precautions for patients with suspected infection – Include airborne, droplet, or contact precautions Targeted body fluids in standard precaution: • Blood • All body fluids: BLOOD, URINE, SPUTUM, EMESIS, VAGINAL SECRETIONS, AMNIOTIC FLUID, PERITONEAL FLUID, THORACENTESIS FLUID, SPINAL FLUID • Secretions • Excretions (except sweat) • Non-intact skin • Non-intact mucous membranes Personal Protective Equipment and Supplies • Gloves • Gowns • Masks • Protective eye gear Components of the Infection Cycle • Infectious agent—bacteria, viruses, fungi • Reservoir—natural habitat of the organism • Portal of exit—point of escape for the organism • Means of transmission—direct contact, indirect contact, airborne route • Portal of entry—point at which organisms enter a new host • Susceptible host—must overcome resistance mounted by host’s defenses The Infection Cycle Infectious Agents • Bacteria—most significant and most prevalent in hospital settings • Virus—smallest of all microorganisms • Fungi—plantlike organisms present in air, soil, and water Bacterial Flora • Transient—attached loosely on skin, removed with relative ease • Resident—found in creases in skin, requires friction with brush to remove Classification of Bacteria • Spherical (cocci), rod shaped (bacilli), corkscrew shaped (spirochetes) • Gram positive or gram negative—based on reaction to Gram stain • Aerobic or anaerobic—based on need for oxygen Factors Affecting an Organism’s Potential to Produce Disease • Number of organisms • Virulence (ability to cause disease) • Competence of person’s immune system • Length and intimacy of contact between person and microorganism Possible Reservoirs for Microorganisms • Other humans • Animals • Soil • Food, water, milk • Inanimate objects Common Portals of Exit • Respiratory • Gastrointestinal • Genitourinary tracts • Breaks in skin • Blood and tissue METHODS OF TRANSMISSION • INFECTED WATER • RAW VEGETABLES • VECTORS • DIRECT CONTACT • SEXUAL CONTACT • AIRBORNE • DROPLET SPREAD Play-acting instruction • Trace the path of the Hepatitis B virus • Prevent the infection. Break the chain of infection Play-acting: • The chain of infection: Hepatitis B pathogen (blood and body fluid transmission • Actors: host, what will make you susceptible? • the organism, where do you go? Portals? • Susceptible individual, how can you diminish your risk Transmission barriers • Hand washing • Barrier techniques (sterilization, decontamination, dispose waste properly) • Personal protective equipment (gloves, mask, gown, protective eye gear) The Infection Cycle Laboratory Data Indicating Infection • Elevated white blood cell count—normal is 5000 to 10,000/mm3 • Increase in specific types of white blood cells (neutrophils-bacterial, eosinophils-allergic, parasitic, basophils-parasitic, allergic, lymphocytes-viral (measles, rubella,chicken pox, infectious mono), monocytes-severe infection by phagocytosis • Elevated erythrocyte sedimentation rate • Presence of pathogen in urine, blood, sputum, or draining cultures Aseptic Technique • Includes all activities to prevent or break the chain of infection • Two categories – Medical asepsis—clean technique – Surgical asepsis—sterile technique USE OF GLOVES, EYE PROTECTORS & APRONS • SURGICAL PROCEDURES • GENERATION OF DROPLETS • SPLASHING BLOOD, AND/OR BODY FLUIDS SITUATIONS REQUIRING GLOVES • ADMINISTRATION OF INJECTIONS • APPLICATION OF TOPICAL PREPARATIONS • EMPTYING DRAINAGE BAGS (BILE, URINE, ETC.) • PERINEAL CARE • HANDLING SOILED LNEN Proper handling of linen & soiled articles • Keep soiled linen from touching clothing • Do not put soiled linen on the floor • Avoid raising dust • Place soiled linen in plastic bag, dispose in appropriate containers Practice good hygiene and grooming • Shampoo hair regularly • Pin hair up or have it cut short • Keep fingernails short and free of broken cuticles and ragged nails • Avoid artificial nails • Avoid wearing rings with grooves • Follow institutional guidelines re infection control Any questions or comment? Measures to Reduce Incidence of Nosocomial Infections • Constant surveillance by infection-control committees and nurse epidemiologists • Written infection-prevention practices for all agency personnel • Hand hygiene recommendations • Infection control precaution techniques • Keeping patient in best possible physical condition Stages of Infection • Incubation period—organisms growing and multiplying • Prodromal stage—person is most infectious, vague and nonspecific signs of disease • Full stage of illness—presence of specific signs and symptoms of disease • Convalescent period—recovery from the infection Body’s Defense Against Infection • Body’s normal flora • Inflammatory response • Immune response Factors Affecting Host Susceptibility • Intact skin and mucous membranes • Normal pH levels • Body’s white blood cells • Age, sex, race, hereditary factors • Immunization, natural or acquired • Fatigue, climate, nutritional and general health status • Stress • Use of invasive or indwelling medical devises Ball toss • Toss the ball to a student, the class will listen to student’s statement about who is at risk, your rationale. Evolution of Specialized Infection Control Precautions • Early CDC guidelines • Specific isolation techniques • Disease-specific isolation • Universal precautions • OSHA regulations for universal precautions • Body substance precautions • Current CDC guidelines Type N95 Particulate Respirator REVIEW Infection Control Measures • Identifying the infection • Preventing infection – Breaking the chain of infection • Controlling infection – Minimizing complications – Reducing adverse outcomes • Teaching patient about infection Aseptic Technique • Includes all activities to prevent or break the chain of infection • Two categories – Medical asepsis—clean technique – Surgical asepsis—sterile technique Practice of Asepsis • Medical asepsis (clean technique) – Involves procedures and practices that reduce the number and transfer of pathogens • Surgical asepsis (sterile technique) – Includes practices used to render and keep objects and areas free from microorganisms Basic Principles of Medical Asepsis • Practicing good hand hygiene • Carrying soiled items away from body • Keeping soiled items off the floor • Avoiding having patients cough, sneeze, or breeze on others • Moving equipment away when cleaning articles • Avoiding raising dust • Cleaning least soiled areas first Basic Principles of Medical Asepsis (cont.) • Disposing of soiled or used items in appropriate containers • Pouring discarded liquids directly into the drain • Sterilizing items suspected of containing pathogens • Using personal grooming habits that prevent spread of microorganisms • Following guidelines for infection control or barrier technique Basic Principles of Surgical Asepsis • Only a sterile object can touch another sterile object • Follow guidelines for opening sterile packages • Avoid spilling solution on a sterile setup • Hold sterile objects above waist level • Avoid talking, coughing, reaching over sterile field • Never turn your back on a sterile field Basic Principles of Surgical Asepsis (cont.) • Sterilize all items brought in contact with broken skin or sterile body cavities • Use dry, sterile forceps when necessary • Consider outer 1 inch of sterile field to be contaminated • When in doubt, consider all suspect items contaminated Use of Surgical Asepsis • Operating room, labor and delivery areas • Certain diagnostic testing areas • Patient bedside – e.g., for procedures that involve insertion of urinary catheter, sterile dressing changes, or preparing and injecting medicine Criteria for Performing Hand Hygiene • Before and after contact with each patient • Before putting on sterile gloves • Before performing invasive procedures • After accidental contact with body fluids • When moving from contaminated body site to clean one • After contact with inanimate objects near the patient • After removal of gloves Lathering Hands With Soap and Rubbing With Firm Circular Motion Washing Areas Between Fingers Washing to 1 inch Above the Wrist Using Fingernails to Clean Under Nails of Opposite Hand Rinsing Hands Under Running Water With Water Flowing Toward Fingertips Standard Precautions • Follow hand hygiene techniques • Wear clean nonsterile gloves when touching body fluids • Wear personal protective equipment during care activities likely to generate splashes or sprays of blood • Avoid recapping used needles • Handle used patient care equipment appropriately • Ensure routine care, cleaning, and disinfection procedures are followed • Review room assignments carefully Mask and Goggles Glove Cuffs Covering Wrists of Gown Transmission-Based Precautions: Airborne • Use for patients who have infections spread through air • Place patient in private room with monitored negative air pressure • Use respiratory protection when entering room of patient • Transport patient out of room only when necessary; place surgical mask on patient • Consult CDC guidelines for prevention strategies for tuberculosis Transmission-Based Precautions: Droplet • Use for patient with infection spread through droplets • Use a private room (door may remain open) • Wear a mask when working within 3 feet of patient • Transport patient out of room only if necessary; place surgical mask on patient • Keep visitors 3 feet from patient Transmission-Based Precautions: Contact • Use for patients infected by a microorganism spread by direct or indirect contact • Place patient in private room if available • Wear gloves when entering the room; change as appropriate • Wear a gown if contact with infection agent is likely • Limit movement of patient out of room • Avoid sharing patient care equipment Guidelines for Effective Use of PPE • Put on PPE before contact with patient • Choose appropriate PPE based on type of exposure • When wearing gloves work from clean to dirty areas • Touch as few surfaces and items with PPE as possible • Avoid touching or adjusting other PPE • Keep gloved hands away from face • Remove and replace torn or heavily soiled gloves • Do not substitute goggles with personal glasses Patient Teaching for Medical Asepsis at Home • Wash hands before preparing or eating food • Prepare foods at high enough temperatures • Use care with cutting boards and utensils • Keep food refrigerated • Wash raw fruits and vegetables • Use pasteurized milk and fruit juices • Wash hands after using bathroom • Use individual care items Evaluating Patient Goals • Use techniques of medical asepsis • Identify health habits and lifestyle patterns promoting health • State signs and symptoms of an infection (teach patient s/sx to report) • Identify unsafe situations in the home environment • Have patient “be the driver”, have him come up with goals homework • Describe strategies for implementing CDC guidelines for standard and transmission-based precautions when caring for patients. • Submit typed, 2-3 pages, include rationale. Due at the beginning of next class.