k & e ch 31 asepsis

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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder
Asepsis
31
Learning Outcomes
Identify signs of localized and systemic infections and inflammation.
Identify risks for nosocomial and health-care associated infections.
Learning Outcomes (cont'd)
Identify factors influencing a microorganism’s capability to produce an infectious process.
Identify anatomic and physiological barriers that defend the body against microorganisms.
Differentiate active from passive immunity.
Learning Outcomes
Identify relevant nursing diagnoses and contributing factors for clients at risk for infection and who have an infection.
Identify interventions to reduce risks for infections.
Identify measures that break each link in the chain of infection.
Performing hand hygiene
Applying and removing a gown, facemask, eyewear, and clean gloves
Establishing and maintaining a sterile field
Applying and removing sterile gloves by the open method
Applying a sterile gown and gloves by the closed method
Recognize when it is appropriate to delegate infection control skills to unlicensed assistive personnel.
Describe the steps to take in the event of a bloodborne pathogen exposure.
Asepsis
Medical asepsis
Includes all practices intended to confine a specific microorganism to a specific area
Limits the number, growth, and transmission of microorganisms
Objects referred to as clean or dirty (soiled, contaminated)
Asepsis (cont'd)
Surgical asepsis
Sterile technique
Practices that keep an area or object free of all microorganisms
Practices that destroy all microorganisms and spores
Used for all procedures involving sterile areas of the body
Type of Infections
Systemic infection
Bacteremia
Asepsis (cont'd)
Acute infections
Chronic infections
May lasts months or years
Risks for Nosocomial Infections
Diagnostic or therapeutic procedures
Etiologic Agent
Ability to enter the body
Susceptibility of the host
Reservoir
Carrier
*
Method of Transmission
Figure 31-1 The chain of infection.
*
Anatomic and Physiologic Barriers
Moist mucous membranes and cilia of the nasal passages
Alveolar macrophages
Resident flora of the large intestine
Anatomic and Physiologic Barriers (cont'd)
Peristalsis
Inflammatory Response
Stages of Inflammatory Response
Active Immunity
Host produces antibodies in response to natural antigens or artificial antigens
Natural active immunity
Antibodies are formed in presence of active infection in the body
Duration lifelong
Active Immunity (cont'd)
Artificial active immunity
Lasts for many years
Passive Immunity
Host receives natural or artificial antibodies produced from another source
Natural passive immunity
Antibodies transferred naturally from an immune mother to baby through the placenta or in colostrums
Lasts 6 months to 1 year
Passive Immunity (cont'd)
Artificial passive immunity
Occurs when immune serum (antibody) from an animal or another human is injected
Lasts 2 to 3 weeks
Physical Assessment
Localized swelling
Localized redness
Palpable heat in the infected area
Loss of function of the body part affected, depending on the site and extent of involvement
Physical Assessment
Malaise and loss of energy
Anorexia and, in some situations, nausea and vomiting
Enlargement and tenderness of lymph nodes that drain the area of infection
Laboratory Data
Laboratory data
Elevated ESR
NANDA Diagnosis
Risk for Infection
State in which an individual is at increased risk for being invaded by pathogenic microorganisms
Risks factors
Related Diagnoses
Imbalanced Nutrition: Less than Body Requirement
Acute Pain
Anxiety
Related Diagnoses
Reduce or alleviate problems associated with the infection
Related Diagnoses (cont'd)
Implementing measures to support the defenses of a susceptible host
Teaching clients about protective measures to prevent infections
Interventions to Reduce
Risk for Infection
Breaking the Chain of
Educating clients and support persons about appropriate methods to clean, disinfect, and sterilize article
Appropriate skin and oral hygiene
Disposing of damp, soiled linens appropriately
Disposing of feces and urine in appropriate receptacles
Ensuring that all fluid containers are covered or capped
Infection (cont'd)
Reservoir (source)
Emptying suction and drainage bottles at end of each shift or before full or according to agency policy
Portal of exit
Avoiding talking, coughing, or sneezing over open wounds or sterile fields
Covering the mouth and nose when coughing or sneezing
Method of transmission
Proper hand hygiene
Instructing clients and support persons to perform hand hygiene before handling food, eating, after eliminating and after touching infectious material
Wearing gloves when handling secretions and excretions
Method of transmission
Wearing gowns if there is danger of soiling clothing with body substances
Placing discarded soiled materials in moisture-proof refuse bags
Holding used bedpans steadily to prevent spillage
Disposing of urine and feces in appropriate receptacles
Initiating and implementing aseptic precautions for all clients
Wearing masks and eye protection when in close contact with clients who have infections transmitted by droplets from the respiratory tract
Wearing masks and eye protection when sprays of body fluid are possible
Infection (cont’d)
Portal of entry
Using sterile technique for invasive procedures, when exposing open wounds or handling dressings
Placing used disposable needles and syringes in puncture-resistant containers for disposal
Providing all clients with own personal care items
Susceptible host
Maintaining the integrity of the client’s skin and mucous membranes
Ensuring that the client receives a balanced diet
Educating the public about the importance of immunizations
Category-Specific Isolation Precautions
Disease-Specific Isolation Precautions
Standard Precautions
Nonintact skin
Mucous membranes
Standard Precautions (cont'd)
Decrease the risk of transmitting recognized and unrecognized sources
Transmission-Based Precautions
Used in addition to standard precautions
For known or suspected infections that are spread in one of three ways:
Airborne
Droplet
Contact
May be used alone or in combination but always in addition to standard precautions
Personal Protective Equipment
Disposal of Soiled Equipment and Supplies
Many supplied for single use only
Disposed of after use
Agencies have specific policies and procedures for handling soiled reusable equipment
Nurses need to become familiar with these practices
Transporting Clients with Infections
Avoided unless absolutely necessary
Nurse implements appropriate precautions
Nurse notifies personnel of the receiving area of any infection so they can maintain necessary precautions.
Psychosocial Needs of Isolation Clients
Sensory deprivation
Principles and Practices of Surgical Asepsis
All objects used in a sterile field must be sterile
Become unsterile when touched by unsterile objects
Unsterile when out of sight, below waist or table level
Unsterile when prolong exposure to airborne microorganisms
Principles and Practices of Surgical Asepsis (cont’d)
Fluids flow in the direction of gravity
Edges of sterile field are unsterile
Skin cannot be sterilized
Sterile Technique
Delegation
Accountable for themselves and others to implement appropriate hand washing
Applying and removing PPE
Clients who care requires PPE may be delegated
Delegation (cont'd)
Sterile procedures
Infection Control for Health Care Workers
Three major modes of transmission of infectious materials in a clinical setting
Puncture wounds from contaminated needles or other sharps
Skin contact, which allows infectious fluids to enter through wounds and broken or damaged skin
Mucous membrane contact, which allows infectious fluids to enter through mucous membranes of the eyes, mouth, or nose
Practice Guidelines Steps to follow After Exposure to Bloodborne Pathogen
Report the incident immediately
Identification and documentation of the source individual when feasible and legal
Testing of the source for hepatitis B, C and HIV when feasible and consent is given
Practice Guidelines Steps to follow After Exposure to Bloodborne Pathogen (cont'd)
Making results of the test available to the source individual’s health care provider
Testing of blood exposed nurse (with consent) for hepatitis B, C, and HIV – please check these to match style used in book – fairly certain it should be caped antibodies
Practice Guidelines Steps to follow After Exposure to Bloodborne Pathogen (cont'd)
Postexposure prophylaxis if medically indicated
Medical and psychologic counseling
Practice Guidelines
Initiate first aid and seek treatment if indicated
Mucous membrane exposure (eyes, nose, mouth)
Flush with saline or water flush for 5 to 10 minutes
Practice Guidelines
for HIV
Start treatment as soon as possible preferably within hours after exposure
For “high-risk” exposure (high blood volume and source with a high HIV titer), three drug treatment is recommended
For “increased risk” exposure (high blood volume or source with high HIV titer), three-drug treatment is recommended
Practice Guidelines
for HIV (cont'd)
For “low risk” exposure (neither high blood volume nor source with a high HIV titer), two-drug treatment is considered
Drug prophylaxis continues for 4 weeks
Drug regimens vary and new drugs and regimens continuously being developed
Practice Guidelines
for HIV (cont'd)
HIV antibody tests should be done shortly after exposure (baseline), and 6 weeks, 3 months, and 6 months afterward
Practice Guidelines
Anti-HBs testing after last vaccine dose
HBIG and/or hepatitis B vaccine within 1 to 7 days following exposure for nonimmune workers
Practice Guidelines for Hepatitis C
Anti-HCV and ALT at baseline and 4-6 months after exposure
Evaluating
From data collected, the nurse judges whether client outcomes have been achieved
Need to reevaluate if outcomes have not been achieved
Hand Hygiene: Skill 31-1
Donning and Removing PPE
Applying and Removing Personal Protective Equipment (Gloves, Gown, Mask, Eyewear): Skill 31-2
Establishing and Maintaining a Sterile Field: Skill 31-3

k & e ch 31 asepsis

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