Medical / Surgical Asepsis and Infection Control

1. Medical / Surgical Asepsis and Infection Control Sharon L. Kinley-Schwing BSN Pacific College 2006 Foundations of Nursing Christensen Kockrow Mosby Lois White / Thomas

2. Medical/Surgical Asepsis and Infection Control • Joseph Lister (1827 – 1912) is known as the father of aseptic technique. • Josephs technique helped reduce morbidity and mortality. • It is now known that microorganisms cause infection. • The growth and reproduction of a microorganism must be stopped to prevent an infection. • Concern and education regarding transmissible infections have increased in both hospitals and homes.

3. Infection Control • Policies and procedures in infection control are included in all health care facilities. • The education of all staff personnel is to minimize the risk of nosocomial infections. • Any patient entering a health care facility, due to illness or need for invasive procedure is at risk for developing an infection.

4. The application of infection control principles, and use of common sense help protect the patients. • Nurses are very often exposed to pathogenic microorganisms and should use specialized and routine practices of cleanliness to prevent the spread of infection.

5. Asepsis • Microorganisms are tiny, microscopic, capable of carrying on living process. • Microorganism are naturally present in the environment, as well as on the human body. • Many microorganisms are harmless, unless an individual is ill, and then highly susceptible to infection. • There are some microorganisms that do cause specific diseases or infections.

6. Asepsis • Medical asepsis, know as clean technique, inhibits the growth and spread of pathogenic microorganisms: • Hand washing. • Changing the patients linen daily. • Daily activities of cleanliness. • Principles of medical asepsis is common at home.

7. Surgical asepsis, known as sterile technique, destroys all microorganisms and their spores . • Sterile technique and use in special skills and procedures. • Care of surgical wounds. • Urinary catheters. • Invasive procedures and surgery.

8. FLORA • Microorganisms that occur or have adapted to live in a specific environment. • Resident flora–always present, usually without altering the client’s health. • Transient flora–episodic, and do not continually live on the skin.

9. PATHOGENICITY AND VIRULENCE • Pathogens–disease-producing microorganisms. • Pathogenicity–ability of microorganism to produce disease. • Virulence–frequency with which a pathogen causes disease.

10. FACTORS AFFECTING VIRULENCE • The strength of the pathogen to adhere to healthy cells. • The ability of a pathogen to damage cells or interfere with the body’s normal regulating systems. • The ability of a pathogen to evade the attack of white blood cells.

11. Infection Process • Six elements must be present for infection to occur: Infectious agent Reservoir Exit Method of transportation Entrance Host

12. The Chain of Infection

13. Infectious Agents

14. BACTERIA • Small, one-celled microorganisms that lack a true nucleus or mechanism to provide metabolism. • Not all bacteria harmful or cause disease. • Common bacterial infections: diarrhea, pneumonia, sinusitis, cellulitis, urinary tract infections, meningitis, gonorrhea.

15. Bacteria • Many different characteristics. • Three basic shapes, they include ? • During cell division some bacterial stay together to form pairs. • These difference help identifying specific kinds of bacteria. • Aerobic bacteria • Anaerobic bacteria • What is a spore ?

16. Bacteria continued • Many diseases can be diagnosis and treated when the specific microorganism in identified. • Body fluids, secretion suspected of containing pathogenic organisms can be evaluated for diagnosis. • Cultures and sensitivity test are completed to determine the antibiotic that will inhibit growth. • Streptococcus is responsible for more diseases than any other organism. Some strains are fatal.

17. Viruses • Smallest known agents that cause disease. • Not complete cells, but consist of a protein coat around a nucleic acid core. • 1898 Beijernick name these small bodies viruses. • 1941 electron microscope made in possible to study these small agents. • Enter the body via the respiratory, gastrointestinal, broken skin (vector or injection). • Most viruses are self limiting illnesses, others are fatal.

18. VIRUSES • Organisms that can live only inside cells. • They cannot get nourishment or reproduce outside cells. • Common viral infections: common cold, influenza, measles, chickenpox, hepatitis B, genital herpes, HIV.

19. Fungi • Fungal (mycotic ) infections are among the most common. • Fungi belong to the plant kingdom, many are harmless, some are responsible for infections. • The grey, black, green, white fuzzy growth on old bread is a type of fungi. • Most mycotic infections are caused by yeasts and molds. • Most commonly involve the skin and mucous membranes. • Fungi that invade deeper tissue may be come fatal.

20. FUNGI • Grow in single cells or in colonies. • Food from dead organic matter, living organisms. • Most are not pathogenic. • Fungi can cause infections of the hair, skin, nails, and mucous membranes.

21. Protozoa • Single celled animals existing every where in nature in some form. • Some of the parasitic forms are found in the intestinal, genitourinary, respiratory and circulatory systems. • Disease producing protozoa are responsible for malaria, amebic dysentery, and African sleeping sickness. • Pathogenic microorganisms are infectious agents. • These microorganisms require food, and a proper environment in which to grow and live. • The strength of the organism, depends on the number present and the patients immune system.

22. PROTOZOA • Single-celled parasitic organisms with ability to move. • Food from dead, decaying organic matter. • Infection is spread through contaminated food, water, or insect bites. • Common infections: malaria, gastroenteritis, vaginal infections.

23. 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.

24. COLONIZATION AND INFECTION • Colonization–the multiplication of microorganisms on or within a host without resulting in cellular injury. • Infection–the invasion and multiplication of pathogenic microorganisms in body tissue that result in cellular injury.

26. AGENT Entity that can cause disease: • Biological agents: living organisms that invade the host, causing disease • Chemical agents: substances that can interact with body, causing disease. • Physical agents: factors in environment capable of causing disease.

27. RESERVOIR Place where agent can survive: • In humans, animals, environment. • Fomites–objects contaminated with infectious agent. • Carriers–have infectious agent but symptom free.

28. Reservoir continue • Any natural habitat of a microorganism that promotes growth and reproduction is a reservoir. • Many microorganisms are found in many areas of the body, but the presents doesn’t always mean infection. • Examples of Reservoirs: Soiled dressings Wet dressings Bed linens/ Gowns/Uniforms Hospital equipment Urinary drainage bags/ Urinals Carrier or vector is a person or animal that harbors and spreads an organism causing disease, with out becoming ill them self.

29. Exit Route • Microorganism cannot spread without first finding a way out of the first host. • Human exit routes include: gastrointestinal respiratory genitourinary blood tissue • Handwashing prevent the spread of microorganisms or cross contamination. • Coving the nose and mouth when coughing also prevents the spread of dieses causing organisms.

30. PORTAL OF EXIT How infectious agent leaves the reservoir: • Sputum. • Semen, vaginal secretions, and urine. • Saliva and feces. • Blood. • Draining wounds. • Tears.

31. Method of Transmission • Once a microorganism has exited a reservoir there are many vehicles. • These vehicles are called contaminated, soiled or stained. • What is a fomite ? • What is a vector ? Give examples of each..

32. MODES OF TRANSMISSION Movement of infectious agent from reservoir or source through portal of exit to portal of entry of susceptible host: • Contact transmission. • Airborne transmission. • Vehicle transmission. • Vector-borne transmission.

33. PORTAL OF ENTRY How an infectious agent enters the host: • Integumentary system. • Respiratory tract. • Genitourinary tract. • Gastrointestinal tract. • Circulatory system. • Transplacental.

34. Entrance of Microorganisms • Once an organism has exited one host and been transmitted, it must find a way to enter a susceptible host. • When a host’s defense mechanisms are reduced, there is a greater chance of the organism to enter. • What are some of the ways organism can enter a host?

35. Host • A host is an organism in which another , usually parasitic, organism is nourished and harbored. • Susceptibilities are determined by the amount to resistance shown to the pathogen. • Microorganisms are constantly in contact with people, but infections do not develop unless a person is susceptible to the numbers of organisms. • Immunizations have proven effective in providing additional protection against infectious disease.

36. HOST • Organism that can be affected by agent. • Susceptible host–person who has no resistance to an agent and thus is vulnerable to disease. • Compromised host–person whose normal body defenses are impaired and is therefore susceptible to infection.

37. FACTORS AFFECTING SUSCEPTIBILITY TO INFECTION • Age • Concurrent diseases • Stress • Immunization/vaccination status • Lifestyle and occupation • Nutritional status • Heredity

38. Infectious process: incubation period prodromal stage illness stage convalescence • Inflammatory response:

39. STAGES OF INFECTION • Incubation stage–the time between entry of an infectious agent and the onset of symptoms. • Prodromal stage–the time from the onset of nonspecific symptoms until specific symptoms begin to manifest. • Illness stage–the time when client has specific signs and symptoms. • Convalescent stage–from the beginning of the disappearance of acute symptoms until client returns to previous state of health.

40. Nosocomial Infections • Term taken from the Greek word, meaning health care facility. • An infection that is acquired while in a hospital or other health care agency. • This infection is usually acquired at least 12 hour after admission. • The hospital harbors microorganisms that may be highly virulent.

41. NOSOCOMIAL INFECTIONS continued • Infection acquired in hospital or other health care facility that was not present at the time of the client’s admission. • Include those infections that become symptomatic after the client is discharged. • Four categories: urinary tract, surgical wounds, pneumonia, and septicemia. • These infections cause extended stays and treatment for patient, and increase cost of care for the hospital.

42. Infection Control Team • Valuable discipline in the health care arena. • These teams include who ? • OSHA and JAHO have pressured hospitals to better organize these teams, and document infections within the hospital. • What is the duty of infection control personnel ? • Employee health services.

43. BREAKING THE CHAIN OF INFECTIONPage 359

44. Standard Precautions • Set of guidelines designed to reduce the link of transmission of blood born pathogens and pathogens from moist body secretions. • Guidelines apply to: • Blood • All body fluids, secretions and excretions • Nonintact skin • Mucous membrane • Precautions promote: • Handwashing • Use of gloves, masks, eye protection • Use of gowns when appropriate for patient contact

45. Hand Hygiene • The most important and basic preventive technique for interruption the infectious process. • 2 minute handwashing will provide protection before the nurse cares for a patient. • 30 second handwashing before caring for another patient should be sufficient to ensure minimal transmission of microorganism between patients.

46. MEDICAL ASEPSIS • Hand hygiene–the most basic and effective infection-control measure to prevent and control the transmission of infectious agents. • Single most important procedure for preventing nosocomial infections.

47. Performing a 2 minute hand wash. • Using an Alcohol-Based Waterless Antiseptic for Routine Hand Hygiene.

48. Performing a 2-minute handwashing (From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

49. Health Promotion Considerations • Adequate exercise, well balanced diet, current immunizations. • Discuss susceptibility of the patient to disease. • Teach correct and safe methods of storing and preparing foods. • Hygiene. • Know family and others susceptibilities to disease. • Home cleaning techniques for patients cared for at home.

50. Gloving • Gloves are use if there is nay possibility of contact with infectious material. • Advice from the CDC on wearing gloves include ? • Donning gloves / Removing gloves