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Chapter 20

Chapter 20

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Published by: Sara Jeffery on Aug 26, 2011
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PromotingAsepsis
&
PreventingInfection
~Describeadditionalprecautionsthatmustbetaken
wner
thereisconcernaboutcontact,droplet,orairborneditransmission.~Compareandcontrastmethodsofpreventinginfection_breakingthechainofinfection.~Implementmeasurestopreventheal.thcare-related
in
,for.,.,.........
~Usemedicalasepsiswhenprovidingcaretoclients.~Discussinfectionpreventionandcontrolmeasuresinthehomeandcommunity.~Implementsteriletechniqueinselectedpatientcare,..Discussthenurse'sroleinrecognizing,preventing,andtocontainthespread
qf
abiologicalepidemic.
LearJtliJtl9OutcoJ1l\es
After
completingthischapter,youshouldbeableto:
~Discussthesixlinksinthechainofinfection.~Describethestagesofatypicalinfectiousprocess.~Summarizetherolesofthevariousbarriersinvolvedinthebody'sprimarydefenses.
>-
Describefourprocessesinvolvedinsecondarydefense.
>-
Compareandcontrasthumoralandcell-mediatedimmunity.
>-
Identifyactivitiesthatpromoteimmunefunction.
>-
Discussthefactorsthatplaceanindividualatincreasedriskforinfection.~Explainwhyitisimportanttobeawareofemerginginfectiousdiseases.~Explainwhymultiple-drug-resistantpathogensareofspecialconcerninhealthcare.
>-
Identifystandardprecautionstopreventtransmissionofinfectionthroughbloodandbodyfluids.
408
 
ieSergiisthe7-year-olddaughterofJasonSergi.worksasanurseonabusylaboranddeliveryunitinmedicalcenter.Onenightatthedinnertable,ieasks,"Daddy,whatwasthemostimportantthing
:.:::I
atworktoday!"Jasontakesafewminutesto
_''''<-''''1
hisreply.FinallyJasonanswers,
"I
washedmy_~-Illot."
n
tellshisdaughterthathealsoassistedinthebirthinfants,resuscitatedoneoftheinfantswhowasstrugglingforbreath,andidentifiedseveralproblems:;-eventedcomplicationsorevendeathofmothersinDaddy,
I
don'tunderstandwhyyouthinkwashing"lIlildswassoimportant,"Stephanieprotested."Lookone
really
importantthingsyoudidtoday!"
s
oureadthischapter,thinkbacktoJason'sdiscussion-daughter.Perhapsyouwillsomedaysaythesame
:0
yourchildoranyonewhoasksaboutyourday..
cretical
Knowledge
nowin~
why.......
continuestoleadtothediscoveryofnewinfec-1CIoorganisms.Researchersarecurrentlyinvesti-:'_"leoleofvirusesinthedevelopmentofcancererdiseases.Forexample,virallyinducedcancersHodgkin'sdisease,Kaposi'ssarcoma,andcervi-
"f.
Otherresearchisinvestigatingtherolethatspeciesofbacteriaplayinproducingheartdis-
_2:.,
Spahr,Klein,Khuseyinova,etal.,2006).
MustNursesKnowAboutProcesses?
znapter,youwilllearnhowinfectionsoccur.Youlearnmeasurestopreventthem.Wewilldis-.thcare-associatedinfectionsandrelatedprofes--randardsandguidelines.Youwillacquirethe-geofinfectionprocessesandprotectionmea-
:.l
needto:::-patientsfromhealthcare-relatedinfections.:)Iofessionalstandardsandguidelines.yourselffromdiseases.Youmustknowhowtocontactwithinfectiousmaterialandexposureto
_~:o<=>
suchasAIDS,hepatitisBandC,anddrug-tuberculosis,aswellasthemanycommon-'-:Jroducingmicroorganismsyouwillencounter.\\erthecostofhealthcare.
In
hospitalsalone,..:are-associatedinfectionsaddmorethan.:lionannuallyinhealthcarecosts(McKibben,
&
Tokars,2005).
CHAPTER
20PromotingAsepsis
&
PreventingInfection
409
Healthcare"Associatedlnfections
Healthcare-associatedinfections(HAls),referstoinfec-tionsassociatedwithhealthcaregiveninanysetting(e.g.,hospitals,homecare,long-termcare,andambulatorysettings).Nosocomialinfectionsrefermorespecificallytohospital-acquiredinfections.Healthcare-associatedin-fectionsaggravateexistingillnessandlengthenrecoverytime.HAIsaretheleadingcomplicationofhospitalcareandoneofthe10leadingcausesofdeath
in
theUnitedStates(AgencyforHealthcareResearchandQuality,2009;Klevens,Morrison,Nadle,etal.,2007;Siegel,Rhinehart,Jackson,etal.,2007).Youmaybesur-prisedatthesefacts.Afterall,healthcareworkersaresupposedtocure,notharm,people.Butwhenpeoplecometohospitals(andotherfacilities)forcare,theycomeintocontactwithmanypersonnelandpatients.Whentheyareill,patientsarevulnerabletoinfection;andtheyareasourceofinfectionforothers.
In
addition,theyun-dergoneedlesticksandotherinvasiveprocedures,whichcanintroduceinfectiousorganismsintotheirbodies.
ProfessionalStandardsandGuidelines
BecauseHAIsseriouslyincreasehealthcarecostsandpatientsuffering,manystateshaveenactedlawsrequir-inghealthcareorganizationstomakeinformationaboutHAlsavailabletothepublic.Variousgovernment,pro-fessional,andaccreditingorganizationshavecreatedquality-controlguidelinesforhealthcareagenciesandprofessionals.Thefollowingareimportantexamples:
TheCenters
for
DiseaseControl
and
Prevention
(CDC),
afederalagency,hasanextensiveWebsitedevotedto
 
410
UNIT3
EssentialNursingInterventions
infectioncontrolandpreventioninhealthcaresettings.Toaccessthissite,
~
.
:I
Goto
~
TheCDCalsoperiodicallyissuesInfectionControlGuidelines,whichyoucanaccessfromthissite.Youwillfindmanyofyourhealthcarefacility'spoliciesandprocedurestobebasedontheCDCguidelines.AmongtheCDCgoalsforhealthcareareto:
OJ!
Reducecatheter-associatedadverseevents[e.g.,infec-tions
J
by50%...inhealthcaresettings.~Reducetargetedantimicrobial-resistantbacterialinfec-tionsby50%...preventingtransmission
in
healthcaresettings.
The
Agency
for
HealthcareResearchandQuality(AHRQ)
hasaWebsitefeaturinglinkstoinformation,tools,andresourcesonHAls.Thesitecontainsresourcesforhealthcareprovidersandconsumers,andhighlightsAHRQ-fundedresearchandinitiativestoreduceHAls.Toaccessthissite,
rQj
TheJointCommission
isaqualityoversightagency.
Their
standardsofperformanceincludeextensivecriteriade-scribingwhat
healthcare
organizationsmustdoto
mini-
mizetherisksofinfection.
In
addition,Goal
7
oftheirNa-tionalPatientSafetyGoalsfor2009isto"reducetherisk
of
healthcareassociatedinfections"
(The
JointCommission,2008b).TheInfection
Control
Initiativespresent
strategies
forhealthcareproviderstopreventinfectionininpatientandcommunity-basedsettings.Toreadtheseinitiatives,
r..
!
Gotohttp://www·iointcommission.org/PatientSafety/
.It'I
i
"--=---
InfectionControll
QualityandSafetyEducationForNurses(QSEN)
isagroupofeducatorsthatwasformedtoaddressthechal-lengeofpreparingnurseswiththecompetenciesneces-sarytoimprovethequalityandsafetyoftheirplacesofwork-competenciesthatyoushouldhaveoncompletingyournursingeducation.Safetyisoneofthesixcompeten-cies.AlthoughQSENdoesnotspecificallysayso,youshouldassumesafetyincludesbeingsafefrominfection.Theymakeseveralbroadstatementsregardingknowl-edge,skills,andattitudesaboutsafetythatalsoapplytoinfection.Forexample,youshouldbeableto:""Demonstrateknowledgeofbasicscientificmethodsandprocesses[e.g.,infectiousprocess,inflammatoryprocess].
II'
Minimizeriskofharmtopatientsandproviders[e.g.,infectiousdiseases]throughbothsystemeffectivenessandindividualperformance...Demonstrateeffectuseoftechnologyandstandard-izedpractice[e.g.,CDCguidelinesforinfectioncon-trol]thatsupportsafetyandquality.ToaccesstheQSENWebsite,
~
LGJ
AmericanNursesAssociation(ANA).
UsingthebroadunderstandingasfortheQSENyoushouldassumethatthefollowingcriteriafromStandard5ofthe
Nursing:
Scope
&
dardsojPractice
applytoinfectionpreventioncontrol:
8
Partnerswiththeperson/family/significantotherscaregivertoimplementtheplaninasafeand.manner.ImplementstheplaninasafeandtimelymanneraccordancewiththeNationalPatientSafetyGoals.'
~
Caveat:
Thismaterialisfromthedraftforpublicment(ANA,
2010,
inpress);itswordingmaybesomewhatinthefinalpublishedversion,ForthatsianoftheANAStandardsofProfessionalPractice,
~
.
!..]
HowDoesInfectionOccur?
Imaginethatyourclinicalinstructoralertsyouto
ar:
outbreakofinfectiousdiseaseinthehospitalwhereyhaveyourassignment.Thehospitalcensusiscurrentl_morethan200patients.Sofar,14havebecomeinfectedandonehasdied.Haveyoueverwonderedhow
infec-
tionsarespreadandwhytheyseemtoaffectsomepeoplemorethanothers?
InfectionsDevelopinResponsetoaChain
ofFactors
Theprocessbywhichinfectionsspreadis
commonh
referredtoasthechainofinfection.Itismadeup
O~
sixlinks,allofwhichmustbepresentfortheinfectiontobetransmittedfromoneindividualtoanothe(Fig.20-1).Herewedescribeeachofthesixlinks.Later
in
thechapterwediscusshowtointerruptthechain
t
limitthespreadofinfection.ForinformationabOUTcommondisease-producingmicroorganismsandtheirtransmission,
o
otoESG
Table20.1:CommonPathogens,
onth~Studer:
.*
ResourceDiskorDavisf'lusathttp://davlsplusJadavls.com/"..'Wilkinson2
InfectiousAgent
SomemicroorganismsliveonOrinthehumanbod.'withoutcausingharm.Forinstance,the
Staphylococcu:
bacteriagrowingonhumanskinareusuallyharmless,Othermicroorganismsarebeneficialorevenessentialforhumanhealthandwell-being.Theyarereferredtoasnormalflora.Normalfloraintheintestineaid
in
digestionandsynthesizevitaminK,andreleasevitaminB
12,
thiamine,andriboflavinwhentheydie.Inaddition,theylimitthegrowthofharmfulbacteriabycompetingwiththemforavailablenutrients.

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