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Infection contro2008

Infection contro2008






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    Infection contro2008 Infection contro2008 Presentation Transcript

    • Infection Control Ch 12 Foundations of Nursing
    • Professional Responsibility  Nurses have the responsibility to adhere to scientifically accepted principles & practices of infection control and to monitor the performance of those for whom the professional is responsible. (nursing assistants, etc.)
    • Source of Standards  Board of Regents (sect. 29.2)  Part 92 of Title 10 (health Dept) of the official compilation of coeds, rules & regulations of New York  Statements of organizations (NYSNA, ANA, Etc)  Defines coursework  Approves training courses  Addresses medical conduct
    • Governing Agencies  Occupational Safety and Health Administration (OSHA)  Joint Commission on Accreditation of Healthcare Organizations (JCAHO)  Centers for Disease Control and Prevention (CDC)
    • Conduct Standards  Failure to adhere to accepted standards of practice may result in  Increased r/o infection to workers & patients  Charges of unprofessional conduct
    • Compliance  Participation in required infection control training (LPN program is equivalent)  Adherance to accepted principles and practices  A complaint about lax infection control practice will prompt an investigation by the Health Dept./SED  May result in professional misconduct & suspension of license
    • Some Terms  Microorganisms: germs, microbes  Pathogen: germ that causes infection  Non-pathogen: harmless germ (sometimes makes up body flora)  Normal body flora: communities of organisms on body surfaces, specific to different areas of the body
    • Infectious Cycle  Infectious agent  Reservoir  Portal of exit  Means of transmission  Portal of entry  Susceptible host
    • Infectious Cycle Agent Reservoir Portal of exit transmissionPortal of entry Susceptible host agent
    • Infectious Agent  Bacteria  Anthrax  Viruses  Fungi  Protozoa
    • Conditions suitable for microbe growth  Warmth  Darkness  Oxygen water nourishment  Spores=inactive microbial life form that can resist heat & survive without moistures…. Difficult to destroy…in favorable conditions, may reactivate and reproduce
    • Reservoir  Any natural habitat of a microbe that promotes its growth and reproduction.  Fomite: an inanimate object that acts as a vehicle for infection  Soiled or wet dressings  Hospital equipment  Counter tops
    • Reservoir Con’t  Normal Body Flora: communities of organisms on body surfaces, specific to different areas of the body  Carrier/vector: a person or animal who harbors and spreads an organism, but does not become ill.
    • Portal of Exit  GI  Respiratory  Genitourinary system  Tissues  Blood
    • Mode of Transmission  After exiting the reservoir, microbes need a means to spread to the next host  Hands  Contaminated food, water or air  Contaminated equipment
    • Portal of Entry  Any break in the skin  Mucous membranes  Mouth  Inhalation
    • Susceptible Host  Another person  High risk  Diabetes  Heart disease  Surgery  burns
    • Normal Defense Mechanisms  Intact Skin  Mucous membranes  Respiratory tract (clilia)  Urinary tract  GI tract  Vagina
    • Factors affecting Normal Defense Mechanisms  Age (old or very young)  Stress  Nutritional status  Heredity  Underlying disease  Environmental factors  Medical therapy  Chemotherapy,radiation
    • Infectious Process  Follows a progression (box 12-3)  Severity depends on  Susceptibility of host  Extent of infection  Agent factors  Virulence & Numbers of microbes  Motility & Ability to invade host  Duration of exposure to microbe
    • Inflammatory Response  Body’s cellular response to injury or infection is inflammation  Vascular response of fluid, blood & nutrients to interstitial tissues in area of injury causes swelling, redness, pain, heat, pus, & loss of function  Inflammatory response is body’s way of attempting to heat up, destroy bacteria, limit spread of infection to bloodstream
    • Localized vs Systemic  Local infection  Limited to 1 certain area  See redness, edema, pain, pus, etc  Systemic infection  Spread to entire body through bloodstream  may become fatal
    • Nosocomial Infections  “Hospital acquired”  Spread on hands of health care workers  Spread by direct contact between health personnel and patients  Spread from patient to patient
    • Infection Control Team  Specially trained  Responsibility for overseeing infection control in health facilities
    • Employee Health  Necessary to protect  Workers  patients
    • Hand Hygiene  The single most important means of preventing the spread of infection.  2 minute handwashing to start the day  15-30 sec between patients for minimally soiled hands  The more heavily soiled, the longer the wash
    • Asepsis  The Practice that decreases or eliminates the number of microbes in an area  Medical Asepsis=clean technique
    • Principles of Asepsis  Germs are everywhere  Blood & body fluids are MAJOR reservoirs  Barriers help stop the spread  Keep environment clean  Some areas more contaminated than others
    • Common Aseptic practices  Handwashing  Dressing changes  Care of the environment  Keep surfaces clean, dry  Care of patient supplies, drainage tubes, etc.
    • Surgical Asepsis  Measures that render supplies and equipment totally free of microorganisms  Sterile Technique: practices that avoid contamination of microbe free items
    • Sterilization  Physical  Radiation  Boiling water  Free flowing steam  Dry heat  Steam under pressure (autoclaving)
    • Sterilization  Chemical  Peracetic acid  Ethylene oxide gas
    • Skills for surgical asepsis  Donning sterile gloves  Donning sterile gown  Adding items to a sterile field
    • Surgical Asepsis  Work place called sterile field  Use inner surface of sterile wrapper or sterile drape  Gather needed supplies  Never leave sterile field unattended  Perform thorough handwashing (5-10 min in OR, min. 1-2 min for other settings
    • Principles con’t  Always work at waist high level  Keep items in sight at all times  Never turn back on sterile field  Open sterile items as follows  TOP FLAP AWAY FROM BODY  SIDE  SIDE  LAST FLAP TOWARD BODY
    • Principles Con’t  Never cross over sterile field  Pouring sterile solutions  Sterile inside, clean outside  Place cap sterile side up on clean surface  Perform “lipping” pour small amt of solution off before pouring into sterile container
    • Principles Con’t  Touch sterile items to sterile items only  Only sterile items allowed on sterile field  Out of range of vision = contaminated  Prolonged exposure to air=contaminated  Sterile surface in contact with wet surface becomes contaminated  1 in margin of sterile field is contaminated
    • Standard Precautions  Blood and body fluid pre-cautions to be used when caring for ALL patients  Includes:  Hand hygiene  Gloves  Masks  Eye shields  gowns
    • PPE  Gowns  Face masks  Goggles  Gloves  Booties  caps
    • Infection control strategies of the CDC  Standard Precautions  Transmission Based Precautions: 1996 addresses isolation precautions for patients with highly contagious pathogens  Isolate specific to the way a disease is transmitted
    • Isolation Techniques  Transmission Based Precautions  Standard precautions  Airborne  Droplet  Contact
    • Transmission Based Precautions  Airborne precautions need mask to block 5 micron or smaller particles (TB, measles-rubeola)  Droplet precautions: mask to block > 5 microns (flu, Rubella, Strep pneumonia  Contact precautions: protect from direct/indirect contact using gloves, gown (wounds, rashes, diarrhea Etc)
    • Transmission Based con’t  Isolation or private room, or roommate with same diagnosis  Sign on door  Use of PPE before entering room, remove before leaving  Concurrent cleaning by housekeeping Dept.  Dedicated equipment (stays in room)  Transport patient with mask, bath
    • Transmission Based Con’t  Pre-employment health assessments  Immunizations & TB screening up to date  S/S requiring immediate attention  Fever  Cough  Rash  Vesicles  Vomiting  diarrhea
    • Psychological aspect of Isolation Patients  Feel frightened, “unclean”, neglected  Allow paitent to ventilate feelings  Show acceptance of person  Stress that it’s the microbes, not the patient that is unwanted  Provide for sensory stimulation: reading, TV, etc  Visitors allowed (following CDC guidelines)
    • Blood Borne Pathogens  Risks  Direct contact with blood or body fluids of infected individuals  Sharing needles  Needle stick injuries  Exchange of body fluids (blood, semen, vaginal fluids during unprotected sex  Post Exposure Management  Obligation to inform patients who have been exposed to healthcare workers’s blood or body fluids
    • Blood Borne Pathogens  Evaluation of healthcare workers infected with HBV, HCV, HIV  Expert panels  Compliance with infection control standards  Nature & scope of practice  Cognitive function
    • TB Precautions  Early identification and treatment is key  Suspect TB when s/s persist >3 wks  S/S; fatigue, weight loss, dyspnea, fever, night sweats, cough (w/blood)  Isolation room  HEPA respirator mask (1mm)  Annual TB testing
    • Work-Practice Controls  Handwashing  Prompt cleaning of blood and body fluid spills  Reusable equipment must be rinsed and sent to central service for autoclaving  Prompt disposal/handling of blood and body fluids and contaminated patiebt care items
    • Work Practice Controls Con’t  Dispose of needles and sharps in proper receptical  Do not recap needles that have been injected  Use PPE as indicated
    • Cleaning & Disinfecting  Rinse soil, debris off external & internal surfaces of reusable equipment  Transport to central service or appropriate dept for reprocessing  Follow manufacturer’s recommendation for cleaning/sterilizing