Prepared by: Mr. Val L.
Is the freedom from disease-causing microorganisms. To decrease the possibility of transferring microorganisms from one place to another, asepsis is used.
SURGICAL ASEPSIS OR STERILE TECHNIQUE
y Refers to those practices
that keep an area or object free of all microorganisms; it includes practices that destroy all microorganisms and spores.
TYPES OF MICROORGANISMS CAUSING INFECTIONS
y Bacteria the most
common infectioncausing microorganisms. y Fungi Include yeasts and molds
. y Viruses Consist primarily of nucleic acid and therefore must enter living cells in order to reproduce.
helminths (worms). fleas. They include protozoa such as the one that causes. malaria. and anthropods (mites.y Parasites
Live on other living organisms. ticks)
In this state.TYPES OF INFECTION
y Colonization Is the
process by which strains of microorganisms become resident flora. the microorganisms may grow and multiply but do not cause a disease.
1.Is limted to specific part of the body where the microorganisms remain. Systemic Infection Microorganisms spread and damage different parts of the body. 2.
y Septicemia When bacteremia results in systemic infection.y Bacteremia When a
culture of the person s blood reveals a microorganisms.
y Chronic Infection.y Acute Infection
Generally appear and suddenly or last a short time. and may last months or years.may occur slowly.
. over a long period.
y Are classified as
infections that are associated with the delivery of health care services in a health care facility.
y Endogenous source
microorganism causing disease originates from the client y Exogenous source Coming from the hospital environment or hospital personnel.
Insufficient hand washing is thus an important factors contributing to the spread of nosocomial microorganism.
y Are the direct result of diagnostic or therapeutic prcoedures. y The hands of personnel are a common vehicle for the spread of microorganisms.
virus. invasiveness (ability to enter tissue) and pathogenicity (ability to cause disease). the greater the possibility that the organism will cause an infection. Infectious agents are bacteria. fungi. The greater the organism's virulence (ability to grow and multiply).
.CHAIN OF INFECTION
INFECTIOUS AGENT A microbial organism with the ability to cause disease. and parasites.
and inanimate objects such as water.
. animals. microorganisms thrive in human beings. table tops.y RESERVOIR
A place within which microorganisms can thrive and reproduce. and doorknobs. For example.
For example. the microorganism may leave the reservoir through the nose or mouth when someone sneezes or coughs. carried away from the body by feces.y PORTAL OF EXIT A place of exit providing a way for a microorganism to leave the reservoir.
. Microorganisms. may also leave the reservoir of an infected bowel.
y MODE OF
TRANSMISSION Method of transfer by which the organism moves or is carried from one place to another. The hands of the health care worker may carry bacteria from one person to another.
mucus membranes. Portals also result from tubes placed in body cavities. Portals include body orifices. or from punctures produced by invasive procedures such as intravenous fluid replacement. such as urinary catheters.y PORTAL OF ENTRY An opening allowing the microorganism to enter the host.
. or breaks in the skin.
. lacking immunity or physical resistance to overcome the invasion by the pathogenic microorganism. The host is susceptible to the disease.y SUSCEPTIBLE HOST A person who cannot resist a microorganism invading the body. multiplying. and resulting in infection.
as well as separating clean from contaminated or potentially contaminated materials and providing information to patients about basic hygienic practices. The techniques used to maintain medical asepsis include hand washing. the risk of contamination from pathogenic microorganisms is increased. Because they provide care for a variety of patients. The practice of medical asepsis and standard precautions provides the nurse with techniques for destroying or containing pathogens and for preventing contamination to other people or to bedside materials and equipment. gowning and wearing facial masks when appropriate. Appropriate hand washing by the nurse and the patient remains the most important factor in preventing the spread of microorganisms.
.PREVENTION AND CONTROL OF INFECTION: Breaking the Chain
Nurses maintain the immediate health care environment.
y The practice of medical asepsis
helps to contain infectious organisms and to maintain an environment free from contamination.
These standard precautions alert the health care worker to patient situations that require special barrier techniques. When in contact with a patient's blood or any body secretion that may be contaminated with blood. gown. facial mask.
y Universal precautions help
control contamination from bloodborne viruses such as human immunodeficiency virus (HIV) and hepatitis viruses.
. and/or goggles must be followed. These barrier techniques are used when working with any patient where potential or actualized contact with blood or body fluid exists.y Standard precautions
combine the major features of universal precautions and body substance isolation. protective measures such as wearing gloves.
gowns when in contact with body secretions.
.y Body substance isolation
protects against bacterial organisms that may exist in body substances. The application of gloves for contact with moist body surfaces and areas of nonintact skin. prevents the contamination of both health care worker and patient. and facial mask when in danger of contact with respiratory droplet secretions. the physical protection gained from barrier isolation may have a negative psychological impact on the patient.
y Strict adherence to basic
techniques such as hand washing. Body substance isolation applies in all patient encounters regardless of the diagnosis. However. wearing barrier gloves and protective isolation provides the foundation for life saving measures.
The nurse removed the contaminated linen from the bed. hospitalized with a gastrointestinal disorder. coli organism contaminated the hands of the nurse who then provided morning care to another patient.An elderly patient. Escherichia coli
Large intestine E. The nurse's hands were not washed before assisting the second patient. The E. coli. Following one episode of cleaning the patient and changing the bed linen.
The second patient receiving care had a Foley catheter. coli organism on the nurse's hands contaminated the catheter tubing and ascended to the patient's meatus and then into the urinary bladder. This patient was elderly and had a chronic illness necessitating complete bed rest. coli exited the body in feces. was on bed rest and required assistance for activities of daily living. The Foley catheter contaminated by the E. The patient had frequent uncontrolled diarrhea stools and the nurse provided excellent care to maintain cleanliness and comfort. coli organism provided a direct route into the urinary bladder. the nurse immediately went to a second patient to provide care.
The second patient with a Foley catheter. bacteria in the large intestine of humans forms the greater part of the normal intestinal flora. The E.
Let's examine the chain of infection as it applies to this situation. The nurse manipulated the tubing attached to the catheter.
and site care technique Inadequate hand washing Improper suctioning technique
Surgical Sites ( Staphylococcus Aureus. Enterococcus species Causes Improper catheterization technique Contamination of closed drainage system Inadequate handwashing Inadequate Handwashing Improper dressing change technique Inadequate handwashing Improper intravenous fluid. tubing. Coli. Pseudomonas aeruginosa)
. Psedomonas Aeruginosa) Bloodstream ( Staphylococcus aureus)
Pneumonia (Staphylococcus aureus.NOSOCOMIAL INFECTIONS
Most Common Microorganisms Urinary Tract ( E.
breathing or talking.HUMAN BODY RESERVOIRS. COMMON INFECTIOUS MICROORGANISM AND PORTALS OF EXIT
BODY AREA COMMON INFECTIOUS ORGANISMS Parainfluenza virus PORTALS OF EXIT
Nose or mouth through sneezing. saliva. needle puncture site
. vaginal discharge Open wound. anus. Coli enterococci Neisseria gonorrhea Hepatitis B virus
Urinary Tract Reproductive Tract Blood
Urethral meatus and urinary diversion Vagina. vomitus. ostomies
Hepatitis A virus Salmonella species Eschirechia Coli enterococci E. coughing. feces. Mouth.
defenses by contrast. viruses.BODY DEFENSE AGAINST INFECTION
y Non-specific Defenses y Specific (Immune)
protect the person against all microorganisms. are directed against identifiable bacteria. regardless of prior exposure.
. fungi or other infectious agents.
Vagina y Inflammatory response
Inflammation. An adaptive mechanism that destroys or dilutes the injurious agents.Is a local and no specific defensive response of the tissues to an injurious or infection agent. Eye 5.
. Oral cavity 4. Nasal passages 3. prevents further spread of injury and promotes and repair of damaged tissue. Intact skin 2.NON SPECIFIC DEFENSESES
y Anatomic an physiologic barriers 1.
gastritis means inflammation of the stomach. 5. For example.
. appendicitis means an inflammation of the appendix. words with
the suffix it is describe an inflammatory process. 3.
Pain (Dolor) Swelling (tumor) Redness (rubor) Heat (calor or color) Impaired function of the part
y Commonly. 4. 2.FIVE SIGNS OF INFLAMMATION
responsible for the characteristic signs of redness and heat.
.Vascular and Cellular Response
y During inflammation
Constrict blood vessels Dilation of blood vessels (because of the release of histamine) Hyperemia marked increase in blood supply.
y The second stage of
inflammation. the inflammatory exudate is produced.
. consisting of fluid that escaped form the blood vessels.
y The third stage of
inflammatory response involves the repair of injured tissues by regeneration or replacement with fibrous tissue (scar) formation.
y Antigen Is a substance that induces a state of sensitivity or immune responsiveness (immunity) y If the proteins originate in a person s own body. The antibodymediated responses defend primarily against the extracellular phases of bacterial and viral infections. y Humoral Immunity resides ultimately in the b lymphocytes and are mediated by antibodies produced by B cells. y Antibodies.
. are part of the body s plasma proteins. the antigen is called autoantigen. also called Immunoglobulins.
Many years. Active a. the immunity must be reinforced by booster
2 to 3 weeks
b.TYPES OF IMMUNITY
TYPE ANTIGEN OR ANTIBODY SOURCE Antibodies are produced by the body in response to an antigen Antibodies are formed in the presence of active infection in the body Antigens (vaccines or toxoids) are administered to stimulate antibody production Antibodies are produced by another source. animal or human Antibodies are transferred naturally from an immune mother to her baby through the placenta or in colostrum Immune serum (antibody) from an animal or another human is injected 6 months to 1 yr DURATION Long Lifelong 1. Natural
b. Passive a.
y Cell-Mediated Defenses
y These T cells pass into the
The cell mediated defenses or cellular immunity. On exposure to an antigen. Cytotoxic T cells Which attack and kill microorganisms and sometimes the body s own cell. Helper T cells helps in the function of immune system 2. Suppressor T cells Which can suppress the function of the helper T cells and the cytotoxic T cells. 3. y There are three main groups of T cells: 1. occur through the T-cell system.
general circulation. the lymphoid tissues release large numbers of activated T cells into the lymph system.
duration of physical and emotional stressor y Resistance to infection y Some medical therapies y Any disease that lessens the body s defense against infection
.FACTORS INCREASING SUSCEPTIBILITY TO INFECTION
y Age y Heredity y Nature.
conducts the physical assessment and gathers laboratory data.The nurse obtains the client s history. And any client complaints suggesting the presence of infection. infection.
nurse assess: degree to which a client is at risk of dev.NURSING MANAGEMENT
y ASSESSING y Nursing History the
but the rate increases in the presence of an inflammatory process. Elevated Leukocytes (white 2.
blood cell or EBC) Elevated erythrocyte sedimentation rate red blood cells normally settle slowly.
y Laboratory data 1.
3. blood. sputum or other drainage cultures that indicate the presence of pathogenic microorganisms. Urine.y Physical Assessment
Sings and symptoms of infection vary according to the body area involved.
Inadequate primary defenses such as broken skin. decreased ciliary action. decreased hemoglobin. y Potential complication of Infection: Fever y Impaired Physical mobility if the client is fatigued. or suppressed inflammatory response. Inadequate secondary defenses such as leukopenia. immunosuppression. connected to infusion devices or in discomfort y Imbalanced Nutrition: Less Than Body Requirements if the client is too ill to eat adequately
y The nurse should identify risk factors: 1. 2. traumatized tissue.
y The major goals for
clients susceptible to infection are to: 1. Avoid the spread of infectious organisms 3. Reduce or alleviate problems associated with the infection
. Maintain or restore defenses 2.
Teach the client and family the signs of wound healing and of wound infection Referrals. and when to contact a health care provider. sources of supplies. home care agencies.
y Discuss injury proofing the home to y y
prevent the possibility of further tissue injury Teach proper handwashing and related hygienic measures to all family members Teach the client and family members the signs and symptoms of infection. y The nurse tailors teaching plan for the client and family.Provide appropriate information regarding how to access community resources.
.Planning for Home Care
y Clients being discharged following
hospital care for an infection often require continued care to completely eliminate the infection or to adapt to a chronic state.
and to treat existing infection.IMPLEMENTING
y Whenever possible. the nurse s goal is to prevent the spread of infection within and between persons.
Infection Meticulous use of medical and surgical asepsis is necessary to prevent and transport of potentially infectious microorganisms. If infection cannot be prevented.
. the y Preventing Nosocomial
nurse implements strategies to prevent infection.
y It is important that both nurse s and the clients hands be washed at the following times to prevent the spread of microorganisms:
y Before eating. or vigorous hand washing under a stream of water for at least 10 seconds using granule soaps. y The CDC recommends antimicrobial foam.
y Is important in every setting. after using the
bedpan or toilet and after the hands have come in contact with any body substances. hand gel. soap filled sheets or antimicrobial liquid soap. or drainage forma wound.
. such as sputum. y Considered one of the most effective infection control measures.
such as nurseries and ICU s y Before caring for severely immunocompromised clients.
.y The CDC recommends antimicrobial hand washing agents in the ff situations: y When there are known multiple resistant bacteria y Before invasive procedures y In special care units.
To reduce the number of microorganisms on the hands 2. To reduce the risk of crosscontamination among clients 4.HANDWASHING
Purposes: 1. To reduce the risk of transmission of infectious organisms to oneself.
. To reduce the risk of transmission of microorganisms to clients. 3.
DISINFECTING AND STERILIZING
y The first link in the
chain of infection. nurse must always wear gloves to avoid direct contact with infectious microorganisms. are interrupted by the use of antiseptics ( agents that inhibit the growth of some microorganisms) and disinfectants (agents that destroy pathogens other than spores) and by sterilization. when cleaning visibly soiled objects.
growth of microorganisms. the etiologic agent and the reservoir.
Rinse the article with cold water to remove organic material. Washing dislodges the emulsified substance. Examples of organic materials are blood and pus. Hot water coagulates the protein of organic material and tends to make it adhere.Cleaning
. Wash the article in hot water or soap. The emulsifying action of soap reduces surface tension and facilitates the removal of substance. 2.
such as a stiff-bristled brush. to clean equipment with grooves and corner.3. Clean the brush and sink. it is now considered clean 6.
4. usually with a disinfectant. Dry the article. These are considered soiled until they are cleaned appropriately. Use an abrasive. Rinse the article well with warm to hot water 5. Friction helps dislodge foreign material.
y Are frequently caustic and toxic to tissues.Disinfecting
y Disinfectant chemical
preparation. used on inanimate objects.
. y Antiseptic Is a chemical preparation used on skin or tissue. such as phenol or iodine compounds.
.y Both antiseptic and
disinfectants are said to have bactericidal or bacteriostatic properties.
Bactericidal destroys bacteria Bacteriostatic prevents the growth and reproduction of some bacteria.
y The type and number of infectious organisms y The recommended concentration of the disinfectant and the duration of contact y The temperature of the environment y The presence of soap y The presence of organic materials y The surface area to be treated.
Sterilization Is a process that destroys all microorganisms, including spores and viruses. Four commonly methods of sterilization:
1. Moist Heat For sterilizing, moist heat (steam) can be employed in two ways.
. Gas Ethylene oxide gas destroys microorganism interfering with their metabolic processes.2. It is also effective against spores.
. Boling water Most practical and inexpensive method of sterilizing in the home.
.5. beta. Radiation Both ionizing ( such as alpha. and x-rays) and non-ionizing (ultraviolet light) radiations are used for disinfection and sterilization.
Isolation refers to measures designed to prevent the spread of infections or potentially infectious microorganisms to health personnel. clients and visitors.
f. d./body fluid precautions
. c.y 1. Category-specific
isolation precaution use seven categories: Strict isolation Contact isolation Respiratory isolation Tuberculosis isolation Enteric precautions Drainage/secretions precautions blood. b. e. g.
.2. Disease-specific isolation precautions provide precautions for specific disease. having the client share a room with other clients infected with the same organism and gowning to prevent gross soilage of clothes for specific infectious disease. These precautions delineate use of private rooms with special ventilation.
y Are techniques to be
used with all clients to decrease the risk of transmitting unidentified pathogens. y Obstruct the spread of bloodborne pathogens.
RECOMMENDED ISOLATION PRECAUTIONS IN HOSPITALS
y Standard precautions y Transmission-based
precautions y Droplet Precautions y Contact precautions
. Examples. tuberculosis.Transmission-Based Precautions
y Airborne precautions
Used for clients known to have or suspected of having serious illnesses transmitted by airborne droplet nuclei smaller than 5 microns.
pertussis.y Droplet Precautions
Used for clients known or suspected to have serious illnesses transmitted by particle droplets larger than 5 microns. Examples. Pneumonia. mumps.
. rubella. diphtheria.
y Check all sterile supplies for expiration date and intact packaging.
. Inserting an intravenous needle or catheter) y Change intravenous tubing and solution containers according to hospital.ISOLATION PRACTICES
y Use aseptic technique
when performing any invasive procedures( eg.
.y Prevent urinary
infections by maintaining a closed urinary drainage system with a downhill flow of urine. y Implement measure to prevent impaired skin integrity and to prevent accumulation of secretions in the lungs (encourage the client to move.
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