Chapter 31 ASEPSIS Kozier Erbs Fundamentals of Nursing

Chapter 31 ASEPSIS Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Asepsis • Medical asepsis – “Clean technique” – 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) Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

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 Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Type of Infections • • • Local infection Systemic infection Bacteremia Septicemia Acute infections Chronic infections Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Nosocomial Infections • • Originate in the health care facility Health care associated infections (HAIs) Common HAIs Factors What is the impact of HAIs on clients? Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Figure 31 -1 The chain of infection Chain of Infection Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Etiologic Agent • Microorganisms • Number of microorganisms present • Virulence and potency of the microorganisms (pathogenicity) • Ability to enter the body • Susceptibility of the host Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Reservoir • Where the microorganism lives • Common sources • Carrier Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Portal of Exit • Must leave reservoir – Coughing – Sneezing – Saliva & mucous membranes – Feces & urine – Drainage – Open wound Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Method of Transmission • Direct Transmission • Indirect Transmission – Vehicle borne § Formite – Vector borne • Airborne Transmission Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Portal of Entry & Host • Portal of entry (5 th link of chain of infection) – Any opening in the body – Non-intact skin • Susceptible host (6 th link of chain) – Person who is at risk for infection Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

First line of defenses against infection • • Intact skin & mucous membranes Mouth Cilia of the nasal passages Tears GI Vagina Urine flow Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Second line of defense against infection • Inflammatory Response • Signs • Suffix –itis Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Stages of Inflammatory Response • First Stage- vascular & cellular response – Vessel constriction quickly followed by dilation – Increase in vascular permeability – Production & release of leukocytes (type of WBC) into bloodstream Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Stages of Inflammatory Response • Second Stage – Exudate production – Fibrinogen, thromboplastin & platelets clump together – Form a barrier to prevent additional harm/injury Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Stages of Inflammatory Response • Third Stage – Reparative phase – Regeneration – Granulation tissue – Fibrous tissue formation (scar) Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Third line of defense against infection- Specific Defenses • Active immunity – Host produces antibodies in response to natural antigens or artificial antigens – Natural § From active infection – Artificial § Administered Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Passive Immunity • Passive immunity • Host receives natural or artificial antibodies – Natural passive immunity § Ex. from mother to baby through breastmilk – Artificial passive immunity § injection of antibodies Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Factors Influencing Susceptibility to Infection • • Age Heredity Stress Nutrition Medications/procedures Disease Other Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

• Consider your current lifestyle. Identify the risk factors that increase your risk for infection. How would you evaluate your ability to support your body’s defenses? • Is there anything you can do to decrease your risk for infection? Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Nursing • Nursing history • Physical assessment – S/S localized infection – S/S systemic infection – Laboratory data § § Elevated WBC count Increase in specific WBC types Elevated erythrocyte sedimentation rate (ESR) Cultures of urine, blood, sputum, or other drainage Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Nursing • Nursing goals focus on: – Maintaining/restoring defenses – Avoiding spread of infection – Reduce/alleviate complications Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

CDC Guidelines to Prevent Infection • Two tiered approach – Standard precautions (SP) – Transmission based precautions • • Hand hygiene Personal protective equipment Environmental controls Respiratory hygiene (cough etiquette) Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Standard Precautions (Box 31 -1 pg. 694) • Designed for all clients • Apply to: – Blood – All body fluids, excretions, secretions, except sweat – Nonintact skin – Mucous membranes Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Transmission-Based Precautions • Used in addition to standard precautions • For known or suspected infections that are spread in one of three ways: – Contact – Airborne – Droplet • May be used alone or in combination but always in addition to standard precautions Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

General Guidelines for Isolation Precautions Limit supplies taken into room Limit client transport outside of room Use disposable supplies if possible Keep precaution supplies just outside the client’s room • Removal of items from room • Private room if possible (or place with client with same infection) • • Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Contact Precautions • Transmitted by direct or indirect contact • Includes drug resistant bacteria – – Methicillin-resistant Staphylococcus Aureus (MRSA) Vancomycin-resistant Enterococcus (VRE) Extended spectrum beta-lactamase-producing (ESBL) Clostridium difficile (C-diff) § Spore which requires soap and water, not alcohol based hand sanitizer Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Contact Precautions (cont. ) • Surfaces in room are contaminated • PPE Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Airborne Precautions • Transmitted by small droplets – TB, measles, varicella • Airborne infection isolation room – Negative air pressure room • PPE Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Droplet Precautions • Transmitted by larger droplets – Pertussis, mumps, influenza (flu), strep throat • 3 ft. diameter • PPE Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Personal Protective Equipment (pg. 695 -700) As discussed in learning lab: Indications, donning and removal of: • Gloves • Gowns • Face masks • Eyewear Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Psychosocial Needs of Isolation Clients • Sensory deprivation – Environment lacks normal stimuli – Lack of interaction • Feeling of Inferiority • Nursing interventions Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Sterile Technique (pg. 700 -710) As discussed in learning lab: • Sterile field • Sterile gloves • Sterile gowns Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Infection Control for Health Care Workers • Regulations • Common hazards – Contaminated needles/sharps injury – Skin contact – Mucous membrane contact • Medical asepsis, PPE, and avoiding carelessness behavior Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Practice Guidelines Steps to follow After Exposure to Bloodborne Pathogen • Provide immediate care to exposed area • Report the incident immediately • Complete injury report • Seek appropriate evaluation and follow-up Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.

Group Work • You are working as a nurse on a medical-surgical unit. How do nurses help break the chain of infection at each link? • What education is necessary to help control infection? Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.