Basic Nursing:Foundations of Skills & Concepts Chapter 21 INFECTION CONTROL ASEPSIS

Flora
Microorganisms that occur or have adapted to live in a specific environment. Two types: Resident (always present). Transient (episodic).

Pathogens
Microorganisms that cause disease. These include: Bacteria. Fungi. Viruses. Protozoa. Rickettsia.

Virulence

The frequency with which a pathogen causes disease.

Factors Affecting Virulence

Strength of pathogen to adhere to healthy cells. Ability of pathogen to damage cells or interfere with the bodys normal regulating systems. Ability of pathogen to evade attack of white blood cells.

Bacteria
Small, one-celled microorganisms that lack a true nucleus or mechanism to provide metabolism. Only small percent of bacteria are pathogenic. Common bacterial infections include diarrhea, pneumonia, gonorrhea, meningitis, impetigo, and urinary tract infections.

Viruses
Organisms that live only inside cells. They cannot get nourishment or reproduce outside cells. Common viral infections include influenza, measles, common cold, chickenpox, hepatitis B, genital herpes, and HIV.

Fungi
Grow in single cells, as in yeast, or in colonies, as in molds. Most are not pathogenic and make up many of the bodys normal flora. Fungi can cause infections of the hair, skin, nails, and mucous membranes.

Protozoa
Single-celled parasitic organisms with the ability to move. Common protozoan infections include malaria, gastroenteritis, and vaginal infections.

Rickettsia
Intracellular parasites that need to be in living cells to reproduce. Spread through fleas, ticks, mites, and lice. Common rickettsia infections include typhus, Rocky Mountain spotted fever, and Lyme disease.

Infection

An invasion and multiplication of pathogenic microorganisms that occurs in body tissue and results in cellular injury.

Chain of Infection
Infectious agent Susceptible Host

Reservoir Or Source

Portal of Entry to Host

Mode of Transmission

Portal of Exit from Reservoir or Source

Agent
An entity capable of causing disease. These may be: Biological (bacteria, viruses, fungi, protozoa, Rickettsia). Chemical (pesticides, food additives, medications, industrial chemicals). Physical (environmental factors, like heat, light, noise, radiation, and machinery).

Reservoir
A place where the agent can survive. The most common reservoirs are: Humans. Animals. Environment. Fomites (objects contaminated with an infectious agent, e.g. bed pans, urinals, linens, instruments, dressings, etc.).

Portal of Exit
The route by which an infectious agent leaves the reservoir to be transferred to a susceptible host. Includes:

Sputum from respiratory tract. Semen, vaginal secretions, or urine, from the genitourinary tract. Saliva and feces, from the gastrointestinal tract. Blood. Draining wounds. Tears.

Modes of Transmission
The process that bridges the gap between the portal of exit of the infectious agent from the reservoir or source and the portal of entry of the susceptible new host.Includes:

Contact transmission (direct contact with infected person, indirect contact through fomite, or close contact with contaminated secretions). Airborne transmission. Vehicle transmission (through contaminated substances such as water, milk, drugs, or blood). Vectorborne transmission (through fleas, ticks, lice, and other animals).

Host
A simple or complex organism that can be affected by an agent. A susceptible host lacks resistance to an agent and is vulnerable to disease. A compromised host has impaired defense mechanisms and is susceptible to infection.

Factors Affecting Susceptibility to Infection

Age. Concurrent diseases. Stress. Immunization and vaccination status.

Occupation. Nutritional Status. Heredity. Lifestyle.

Breaking the Chain of Infection

Between Agent and Resevoir Cleansing. Disinfection. Sterilizing.

Cleansing
The removal of soil or organic material from instruments and equipment. Four steps:

Rinsing the object under cold water. Applying detergent and scrubbing object. Rinsing the object under warm water. Drying the object prior to sterilization or disinfection.

Disinfection
The elimination of pathogens, except spores, from inanimate objects.

Disinfectants are chemical solutions used to clean inanimate objects.

Germicides are chemicals that can be applied to both animate (living) and inanimate objects for the purpose of eliminating pathogens.

Sterilization
The total elimination of all microorganisms including spores.

Instruments used for invasive procedures must be sterilized. Moist heat or steam, radiation, chemicals, and ethylene oxide gas used for sterilization. Autoclaving sterilization, using moist heat, is used in most hospital settings.

Breaking the Chain of Infection

Between Reservoir and Portal

Proper Hygiene.

Clean Dressings.
Clean Linen. Clean Equipment.

Breaking the Chain of Infection

Between Portal of Exit and Mode of Transmission

Clean dressings on all injuries. Clients should be encouraged to cover the mouth and nose when sneezing or coughing, as should the nurse. Gloves must be worn whenever necessary. Proper disposal of contaminated items.

Breaking the Chain of Infection

Between Mode of Transmission and Portal of Entry

Nurses wearing barrier protection (gloves, masks, gowns, goggles). Proper handwashing. Proper disposal of contaminated equipment and linens.

Breaking the Chain of Infection

Between Portal of Entry and Host

Maintaining skin integrity. Using sterile technique for client contacts. Avoiding needle sticks. Proper disposal of sharps.

Breaking the Chain of Infection

Between Host and Agent Proper nutrition. Exercise. Immunization.

Normal Defense Mechanisms

A hosts immune system serves as a normal defense mechanism against the transmission of infectious agents. Immune system recognizes presence of antigens, foreign proteins that cause the formation of an antibody.

Nonspecific Immune Defense

Skin and normal flora. Mucous membranes. Sneezing, coughing, and tearing reflexes. Elimination and acidic environment. Inflammation.

Inflammation
A nonspecific cellular response to tissue injury. Characteristics include:

Redness (erythema). Heat. Pain. Swelling (edema). Loss of function. Pus (purulent exudate).

Specific Immune Defense

This is an immune defense mounted specifically against an invading antigen.

Skin and normal flora. Mucous membranes. Sneezing, coughing, and tearing reflexes. Elimination and acidic environment. Inflammation.

Stages of Infection

Incubation (the time interval between entry of an infectious agent into host and onset of symptoms). Prodromal (from onset of nonspecific symptoms to specific symptoms of illness). Illness (period of specific signs and symptoms of infection). Convalescence (from disappearance of acute symptoms until client returns to previous state of health).

Nosocomial Infections
An infection acquired in a hospital or other health care facility that was not present or incubating at the time of the clients admission. Also referred to as hospital-acquired infections.

Asepsis
The absence of microorganisms. Two types of asepsis:

Medical (those practices used to reduce the number, growth, and spread of microorganisms).
Surgical (practices that eliminate all microorganisms and spores from an object or area).

Medical Asepsis

Handwashing is the first line of defense against infection and is the single most important practice in preventing the spread of disease.

Surgical Asepsis Techniques

Surgical handwashing. Sterile field and equipment. Donning surgical attire. Donning sterile gloves. Gowning and closed gloving. Disposal of infectious materials.