IMMUNE SYSTEM
ASEPSIS
PRETEST
1. Define Nosocomial infection
 2. Identify what DTP stands for
 3. Identify the most common Nsg.
Intervention to prevent infection
 4. Define sensory deprivation
 5. Give one example of a Nsg.
Procedure that uses surgical asepsis.

PRETEST ANSWERS
1. Acute care or hospital acquired.
 2. Diptheria, Tetanus, Pertussis
 3. Handwashing
 4. Mental alteration resulting from
severely decreased stimulation
 5. Invasive procedures: Starting an
IV, injections, urinary catheterization

IMMUNITY:
DEFINITION

Specific resistance of the body to
infectious agents
SUSCEPTIBILITY:
DEFINITION
Degree to which an individual can be
affected
 likelihood of an organism causing an
infection in that person

CHAIN OF INFECTION
6 LINKS
1. Etiologic agent (microorganism)
 2. Reservoir (source)
 3. Portal of exit from reservoir
 4. Method of transmission
 5. Portal of entry to the susceptible
host
 6. Susceptible host

ETIOLOGIC AGENT
BODY SOURCES (6)
1.Respiratory tract
 2.GI tract
 3.Urinary tract
 4.Reproductive tract (including
genitals)
 5.Blood
 6.Tissue

RESERVOIRS &
PORTALS OF EXIT (5)
1.Respiratory tract= nose/mouth,
Endotracheal tubes or tracheostomies
 2.GI tract= Mouth per saliva, vomitus,
anus/ostomies: feces, drainage tubes
(eg, NG or T-tubes)
 3.Urinary tract= Urethral meatus &
urinary diversion ostomies

Con’t
4. Reproductive tract= vagina: vaginal
discharge; may be further transported
by urine; urinary meatus: semen, urine
 5. Blood= open wound, needle
puncture site, any disruption of intact
skin or mucous membrane surfaces

METHODS OF
TRANSMISSION (3)


Direct
Transmission= 1.
Immediate & direct
contact
2. Droplet spread if
source & host
within 3 ft of each
other



Indirect
Transmission=
1. Vehicle borne =
fomites
2. Vectorborne=animal, flying or
crawling insect that
serves as an
intermediate means of
transporting agent
(con’t)
Airborne Transmission= droplet
nuclei
 or residue of evaporated droplets that
may remain in air for long periods of
time emitted by infected host or dust
particles containing the infectious
agent are transmitted by air currents
to a suitable portal of entry

BREAKING THE CHAIN OF
INFECTION
First link broken by use of
antiseptics, disinfectants and
sterilization
 Aim of most isolation precautions &
many hospital practices for infection
prevention & control is breaking chain
during transmission phase of cycle

ANTISEPTIC AGENTS
VS DISINFECTANTS


Antiseptics=
agents that inhibit
growth of some
microorganisms
chemical
preparation used
on skin or tissue



Disinfectants= agents
that destroy pathogens
other than spores
chemical preparation
used to treat inanimate
objects
more concentrated
solution=can be toxic &
caustic to tissue
BACTERICIDAL VS
BACTERIOSATIC

Bactericidal=
destroys bacteria

Bacteriostatic=
prevents growth &
reproduction of
some bacteria
ANTISEPTICS &
DISINFECTANTS
– “Commonly Used Antiseptics and
Disinfectants, Effectiveness, and Use
STERILIZATION
Process that destroys all micro org.
including spores & viruses
 METHODS (4):
 1. Moist heat (steam)
 2. Boiling water
 3. Gas
 4. Radiation

INFECTION RISK
FACTORS

HOST SUSCEPTIBILITY: age,
heredity, stress level, nutritional status,
immunization status, current medical
therapy, pre existing disease
processes, & some past or recent
surgical interventions
POPULATIONS AT RISK
FOR INFECTION






Elderly, the very young
poorly nourished individuals
individuals with deficiency of serum
immunoglobulins
individuals with insufficient immunizations or
existing disease process
Individuals with multiple stressors
Individuals with certain medical therapies
MEASURES THAT REDUCE A
PERSON’S SUSCEPTIBILITY
Adequate hygiene
 Administration of immunizations on a
timely basis
 Nutrition that is balanced and
adequate
 Fluid intake that is adequate
 Rest and sleep that are adequate
 Reduce stress

STAGES OF AN
INFECTIOUS PROCESS (4)



1. Incubation period=time between entry
of microorg. Into body & onset of s/s
2. Prodromal Period=time from onset of
nonspecific s/s until specific symptoms of
infection appear
3. Illness Period=specific s/s develop &
become evident: localized s/s & systemic
s/s
(Con’t)

4. Convalescent Period=extends
from time s/s start to abate until person
returns to normal state of health
NORMAL BODY
DEFENSES

Nonspecific= intact
skin & mucuous
membranes, nasal
passage cilia, lung
alveolar macrophages
& phagocytes, oral
cavity lactoferrin &
shedding, tears, GI
pH,vaginal pH,
inflammation



Specific=
1. Active: natural vs
artificial
2. Passive: natural
vs Artificial
STAGES OF
INFLAMMATION
1. Vascular & cellular responses
 2. Exudate
 a. Serous
 b. Purulent
 c. Hemorrhagic
 d. Serosanguineous
 3. Reparative

LEUCOCYTOSIS
Abnormally high levels of white blood
cells (leukocytes)= inflammation
 Normal WBC count can go from 450011,000 per cubic millimeter of blood to
20,000 or more

IMMUNIZATIONS
INITIAL





HBV=Hep B-1,Hep B-2=Hep B-3=
Hepatitis B= birth
DTP= Diptheria, Tetanus, Pertussis=2,4,6
months
Hib= Haemophilus Influenzae type b=2,4, 6
months
OPV=Oral Poliovirus=2, 4, 6 months
MMR= Measles, mumps, rubella=12 mo.
(Con’t)

Varicella Zoster Virus Vaccine= 1218 months
BOOSTER SHOTS
HBV= health care workers draw titer &
immunize with each exposure
 DTP= 12 months, 4-6 yrs; Tetanus
toxoid every 10 years thereafter
 Hib= 12-15 months (Depending on
type used)
 OPV= 4-6 yrs
 MMR= 4-6 yrs or 11-12 yrs

NOSOCOMIAL INFECTION:
DEFINITION

Infections that are associated with the
delivery of health care services in a
health care facility
NOSOCOMIAL INFECTION
ORIGINS

Endogenous
Source= from the
clients themselves

Exogenous
sources=
microorganisms
originate from the
hospital
environment and
personnel
IATROGENIC
INFECTIONS
Nosocomial infections that are due to
any aspect of medical therapy
 Example: Bacteremia resulting from
an IV line
 Other contributing factors: Presence of
compromised hosts, insufficient hand
washing or poor healthcare provider
compliance with asepsis

MAJOR SITES FOR
NOSOCOMIAL INFECTIONS
(4)
1.
 2.
 3.
 4.

Respiratory tract
Urinary tract
Bloodstream
Surgical or open wounds
RISK FACTORS THAT
CONTRIBUTE TO
NOSOCOMIAL INFECTION
1. Invasive procedures
 2. Medical therapies
 3. Existence of large number of
susceptible persons
 4. Inappropriate use of antibiotics
 5. Insufficient hand washing after
client contact & after contact with body
substances

LOCALIZED vs SYSTEMIC
INFECTIONS: DEFINITIONS


Localized:
Infectious Process
in only the affected
body organ or area
Example: abscess
of big toe of right
foot


Systemic: Infectious
process in the
entire body
Example:
bacteremia
S/S OF LOCAL VS
SYSTEMIC INFECTION

Local infection=
localized swelling,
localized redness, pain
or tenderness with
palpation or
movement, palpable
heat of affected part,
loss of function of
affected body part,
wound drainage




Systemic infection=
^ TPR,lassitude,
malaise, loss of energy
anorexia & n/v
enlargement &
tenderness of lymph
nodes that drain area
of infection
see Kozier pg. 641
LABORATORY DATA
^LEUCOCYTE COUNT




1. ^Neutrophils=acute suppurative infection
2. Neutrophils Decrease=acute bacterial
infection in elderly
3. Lymphocytes=^ in chronic bacterial &
viral infection
4. Monocytes ^ in some protozoal &
rickettsial infections & TB
(Con’t)
5. Eosinophils= unaltered in infectious
process
 6. Basophils= unaltered in fection
process

^ ERYTHROCYTE
SEDIMENTATION RATE (ESR)

Rate increases in presence of an
inflammatory process
CULTURE &
SENSITIVITY STUDIES

Specimens of: urine, blood, sputum, or
other body drainage= cultures
microorganisms in special growth
medium to indicate presence of
pathogenic microorganisms and
chemical substance they are
susceptible to
ASEPSIS
DEFINITION
Freedom from infection or infectious
material
 Example: handwashing

MEDICAL ASEPSIS vs
SURGICAL ASEPSIS


All practices intended
to confine a specific
microorg. To a specific
area, limiting the
number, growth, &
transmission of
microorganisms
Example: 2-minute
handwashing


Practices that keep an
area or objects free of
all microorg.; it
includes practices that
destroy all microorg
and spores
Example: Invasive
procedures=IV starts,
injections urinary cath.
RELEVANT NANDA
NURSING DIAGNOSES







High risk for infection
Altered oral mucous membranes
High risk for altered body temperature
Impaired skin integrity
Impaired tissue integrity
Impaired physical mobility
Altered nutrition: less than body
requirements
(Cont’)
Pain
 Social isolation
 Diversional Activity deficit
 Self-esteem disturbance
 Anxiety
 Fear
 Hopelessness

NURSING INTERVENTIONS
TO PREVENT INFECTION




Discuss risk factors which place pt. at risk
for infection
Teach Pt.: purpose of meds, monitoring of
health status, drsg. Chges., TCDB, frequent
repositioning, isolation precautions
Monitor VS & skin color q shift for s/s of
infection
Assess lab values for s/s of infection=CBC,
cultures
(Cont’d)



Ask Pt. About presence of subjective clinical
s/s of infection (chills, malaise, lethargy)
Assess & document s/s of localized
infection(auscultate lungs & inspect urine,
sputum & other drainage for alterations in
color & consistency)
Inspect skin for s/s inflammation & impaired
tissue integrity
(Cont’d)



Collect wound, sputum, urine & other
specimens as ordered for C & S and report
abnormalities
Assess Pt.’s immunization status & life-style
practices
Develop & implement plan to teach Pt.
About proper nutrition =high-protein, highvitamin diet, adequate fluid intake, proper
hygiene & importance of rest
METHODS OF KILLING OR
REDUCING INFECTIOUS
AGENTS
 Medical asepsis
Medical asepsis
 Surgical asepsis
 Use of Medications: antibiotics,
antivirals, antifungals

ANTIBIOTIC:
DEFINITION
Natural or synthetic substance that has
the capacity to inhibit the growth of or
kill other microorganisms
 Synonyms: anti-infectives,
antimicrobials antibacterials
 Several different characteristics may
be used to classify antibiotics

RX CLASSIFICATION
CHARACTERISTICS (3)
1. Spectrum of activity=Broad vs
narrow spectrum
 2. Antimicrobial activity= Bacteriostatic
vs bacteriocidal
 3. Mechanism of action= (5)=inhibition
of bacterial cell wall synthesis, alt. in
cell membrane function,

(con’t)

Inhibition of protein synthesis,
inhibition of nucleic acid metabolism,
interference with intermediate cell
metabolism ( Malseed, et., al.
Pharmacology Drug Therapy and
Nursing Considerations, 1995 pg.583).
LIPPINCOTT’S NSG. GUIDE
ANTIBIOTIC
CLASSIFICATION (9)
1.
 2.
 3.
 4.
 5.
 6.
 7.

Penicillins
Sulfonamides
Tetracyclines
Cephalosporins
Aminoglycosides
Fluoroquinolones
Lincosamides
(Con’t)
8. Macrolides
 9. Antibacterials

ANTIBIOTICS & NSG.







1. Necessity of therapy; Prophylactic
antibiotic use vs Tx of infection
2. Identification of pathogen & sensitivity
3. Dosage & duration of therapy, level
monitoring
4. Hypersensitivity reactions
5. Organ toxicity
6. Superinfection
7. Resistance
CENTERS FOR DISEASE
CONTROL (CDC)





Principal public health agency at the
national US level concerned with disease
prevention and control
Roles:
1. Develop policy re. Communicable
Diseases
2. Research
3. Educate public and healthcare providers
(Con’t)

4. Maintain national data bank on
prevalence and incidence of
communicable diseases
ISOLATION:
DEFINITION

Measures designed to prevent the
spread of infections or potentially
infectious microorg. to health
personnel, clients & visitors
DISEASE SPECIFIC ISOLATION
PRECAUTIONS


Provide for precautions for specific
diseases
Example:pulmonary TB Precautions=
Placing Pt. In private room with special
ventilation or having Pt. Share a room with
other Pt.s who are infected with same
organism & use of special masks by staff
entering room & gowning only to prevent
gross soilage of clothes; no gloves
indicated
CATEGORY-SPECIFIC ISOLATION
PRECAUTIONS








Based on 7 categories:
1. Strict isolation
2. Contact isolation
3. Respiratory isolation
4. TB isolation
5. Enteric precautions
6. Drainage/secretions precautions
7. Blood/body fluid precautions
UNIVERSAL
PRECAUTIONS


Apply to those body fluids associated with
bloodborne pathogens= Hepatitis B virus,
Hepatitis C virus and HIV
Applicable body fluids= blood, semen
vaginal secretions cerebrospinal fluid,
synovial fluid, pleural fluid,pericardial fluid,
peritoneal fluid, amniotic fluid, saliva, body
fluids containing blood & body fluids where it
is difficult to differentiate among body fluids
(Con’t)



NonApplicable body fluids= any fluid not
mentioned in above list unless they
contain visible blood; these fluids are
normally not associated with the
transmission of bloodborne pathogens
Apply to all Pts to < transmission of
unidentified pathogens
see Kozier page 651 CLINICAL
GUIDELINES Universal Precautions
(Con’t)

CDC recommends universal
precautions be used in conjunction
with disease-specific or categoryspecific precautions and not replace
them
OSHA STANDARDS
BLOODBORNE PATHOGEN
EXPOSURE


Regulations to protect health care workers
from occupational exposure to bloodborne
pathogens
adapt CDC’s Universal
Precautions+avoiding injury due to sharp
instruments, measures to take in case of
exposure to bloodborne pathogens &
communication of biohazards to employees
BODY SUBSTANCE OR BODY
FLUID ISOLATION



Employs generic infection control
precautions for all Pts. except those with
the few diseases transmitted through air
Purposes:Prevent cross-transmission of
microorg. & protect health care worker from
microorg. harbored by Pts.
Body substance=blood & body fluids &
substance, urine, feces, wound drainage,
oral secretions
(Con’t)
When BSI precautions are used,
category-specific & disease-specific
precautions are not required
 Sufficient for all clients except those
who have certain airborne disease=
pulmonary TB & varicella or chicken
pox


ISOLATION PRECAUTIONS
IN HOSPITALS 1996



Standard precautions=
Tier I
apply to all hospital
persons
apply to blood, all body
fluids, secretions &
excretions except
sweat, non-intact skin
& mucous membranes


Transmission-Based
Precautions= Tier II
Used in addition to
Standard Precautions
for Pts. With known or
suspected infection
that are spread by any
of the following:
airborne, droplet or
contact
ISOLATION
PRECAUTIONS (con’t)


Standard
precautions
combine the major
features of UP
Universal
Precautions & BSI


The three types of
transmission-based
precautions may be
used alone or in
combination but
always in addition to
Standard Precautions
Encompass all
conditions or diseases
listed in categoryspecific or disease
specific
AIRBORNE, DROPLET &
CONTACT PRECAUTIONS
BARRIER TECHNIQUE
(REVERSE ISOLATION)
Protect compromised Pt.s from
microorg. On health care personnel
and non sterile items
 Pts. with leukemia, extensive skin
impairments
 Use Standard Precautions and
Transmission/Based Precautions

IMPLEMENTING ISOLATION
PRECAUTIONS


Handwashing=Most effective infection
control measures: CDC 10 secs using bar
soap, granule soap, soap filled tissues or
antimicrobial liquid soap
Wash hands: before eating, after using
bedpan or toilet, after contact with any body
substances, before and after care (even if
gloves were used)
(Con’t)
Wash from clean to dirty
 by holding hands down below elbows
 Surgical asepsis hands held above
elbows so H2O runs from cleanest to
least clean

FACE MASKS
Worn to reduce risk for transmission of
organisms by droplet contact, airborne routes & splatters of body
substances
 Wear under following conditions:
 1. Only by those close to Pt. If infection
is transmitted by large-particle
aerosols (droplets)

FACE MASK (Con’t)

2. By all persons entering room if
infection is transmitted by smallparticle aerosols (droplet nuclei)
– CDC recommends using a disposable
dust/mist particulate respirator when
caring for any Pt. who has pulmonary TB
NONDISPOSABLE
SURGICAL MASKS
Effective for droplet transmission &
splatters but are not effective against
airborne microorganisms
 CLINICAL GUIDELINES: Using
disposable masks

EYEWEAR

Protective eyewear (goggles or
glasses) and masks by be indicated in
situations where body substances may
splatter the face
GOWNS




Single-use= non
reusable paper
gowns
worn during
procedures when
staff’s uniform is likely
to become soiled
Discarded into trash
Wash hands after use



Sterile gowns:
reusable cloth or
paper
use for strict sterile
technique
use for barrier
technique or
reverse isolation
GLOVES



Non-sterile or
clean or rectal
used for most
activities
no special
technique required
for donning



Sterile gloves
used when the hands
will come in contact
with an open wound or
when the hands might
introduce microorg.
Into a body orifice
require special
technique to don
SOILED EQUIMENT &
SUPPLIES
Essential to:
 1. Prevent inadvertent exposure of
health care workers to articles
contaminated with body substances
 2. To prevent contamination of the
environment

PSYCH IMPLICATIONS
OF ISOLATION (2)
Result of separation from others & of
the special precautions taken in their
care
 1. Sensory deprivation
 2. Decreased self-esteem related to
feelings of inferiority

SENSORY
DEPRIVATION
Occurs when the environment lacks
normal stimuli for the client
 Example: frequent communication
with others
 S/S: boredom, inactivity, slowness of
thought, daydreaming, increased
sleeping, thought disorganization,
anxiety, hallucinations and panic

FEELING OF
INFERIORITY
Due to the perception of infection itself
or to the required precautions
 Pt. Feels “soiled”, “contaminated” or
“dirty” and that they are at fault and
substandard

NSG INTERVENTIONS TO <
ISOLATION PSYCH
PROBLEMS



1. Assess Pt’s.need for stimulation
2. Initiate measures to help meet need for
stimulation= reg. Communication with Pt &
diversional activities, stimulate visual sense
3. Explain the infection & associated
procedures to help clients & their support
persons understand & accept the situation
(Con’t)

4. Demonstrate warm, accepting
behavior. Avoid conveying to the Pt.
Any sense of annoyance about the
precautions or any feelings of
revulsion about the infection
WAYS TO ID STERILITY OF
ITEMS IN HEALTH CARE
SETTING (3)



1. Ensure that pckg. is clean & dry; if moist
considered contaminated & must be
discarded.
2. Check the sterilization expiration dates
on pckg. & look for any indications that it
has been previously opened
3. Follow agency practice about the
disposal of possibly contaminated pckgs.
PRINCIPLES & PRACTICES OF
SURGICAL ASEPSIS (9)
1. All objects used in a sterile field
must be sterile
 2. Sterile objects become unsterile
when touched by unsterile objects
 3. Sterile items that are out of vision
or below the waist level of the nurse
are considered unsterile

(Con’t)



4. Sterile objects can become unsterile by
prolonged exposure to airborne microorg.
5. Fluids flow in the direction of gravity.
6. Moisture that passes through a sterile
object draws microorg. from unsterile
surfaces above or below to the sterile
surface by capillary action.
(Con’t)
7. The edges of a sterile field are
considered unsterile.
 8. The skin cannot be sterilized & is
unsterile.
 9. Conscientiousness, alertness, &
honesty are essential qualities in
maintaining surgical asepsis.

INFECTION CONTROL NURSE: ROLE
IN HOSPITAL SETTING



Infection prevention
1. Education of
staff & pts.
2. Write policy re.
Infection control
procedures



Infection Control
1.Surveillance of
prevalence &
incidence of
infections
2. Reporting to
CDC as per
guidelines