Transcript Fundamental Nursing Infection Control Chapter 22

Fundamental Nursing
Chapter 22
Infection Control
Inst.: Dr. Ashraf El - Jedi
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Infectious diseases (diseases spread from one
person to another) are also called or and
They were once the leading cause of death, but
that is no longer true because of vaccines,
aggressive public health measures, and
advances in drug therapy. Nevertheless,
infectious diseases have not disappeared.
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This chapter discusses precautions that confine
the reservoir of infectious agents and block
their transmission from one host to another. To
understand the concepts of infection control, it
is important to understand the chain of
infection (see Chap. 10) and the course of an
infection.
Infection
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Infection is a condition that results when
microorganisms cause injury to a host.
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The host can transmit pathogens
infectious diseases to others.
and
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Infections progress through distinct stages
(Table 22-1). The characteristics and length of
each stage may differ depending on the
infectious agent. For example, the incubation
period for the common cold is approximately 2
to 4 days before symptoms appear, but it may
take months or years before a person infected
with HIV demonstrates symptoms of AIDS.
Infection Control Precautions
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Infection control precautions are physical
measures designed to curtail the spread of
infectious diseases. They are essential when
caring for clients. Infection control precautions
require knowledge of the mechanisms by
which an infectious disease is transmitted and
the methods that will interfere with the chain
of infection.
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The Centers for Disease Control and
Prevention (1996, 2005) have established
guidelines for two major categories of
infection control precautions: standard
precautions
and
transmission-based
precautions.
Standard Precautions
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Standard precautions are measures for
reducing the risk for microorganism
transmission from both recognized and
unrecognized sources of infection. Health care
personnel follow standard precautions when
caring for all clients, regardless of diagnosis or
infection status (Box 22-2).
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This precautionary system combines methods
previously known as universal precautions.
Health care personnel follow standard
precautions whenever there is the potential for
contact with the following:
Blood
 All body fluids except sweat, regardless of whether
or not they contain visible blood
 Nonintact skin
 Mucous membranes
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Box 22-2 • Standard Precautions
Handwashing
Wash hands after touching blood, body
fluids,
secretions,
excretions,
and
contaminated items, whether or not gloves
are worn.
Wash hands immediately after gloves are
removed, between patient contacts, and
when otherwise indicated; wash between
tasks and procedures on the same patient
to prevent cross-contamination of different
body sites.
Use plain (non-antimicrobial) soap for
routine handwashing.
Use an antimicrobial agent or a waterless
antiseptic agent to control outbreaks or
hyperendemic
infections
(highly
infectious in all age groups)
Gloves
Wear clean, nonsterile gloves when
touching blood, body fluids, secretions,
excretions, and contaminated items.
Change gloves between tasks on the same
patient after contact with material that
may contain a high concentration of
microorganisms.
Remove gloves and wash hands
immediately before caring for another
patient.
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Mask, Eye Protection, Face Shield
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Wear a mask and eye protection, or
face shield to protect the eyes, nose,
and mouth when there is a likelihood
that splashes or sprays of blood, body
fluids, secretions, or excretions will
occur.
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Gown
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Wear a clean, nonsterile gown when
there is a likelihood that splashes or
sprays of blood, body fluids,
secretions, or excretions will occur.
Remove a soiled gown promptly and
wash hands.
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Patient-Care Equipment
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Handle equipment soiled with blood,
body fluids, secretions, and excretions
so as to prevent the transfer of
microorganisms to oneself, others, or
the environment.
Ensure that soiled reusable equipment
is cleaned before another subsequent
use.
Discard soiled single-use equipment
properly.
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Environmental Control
Ensure that procedures for routine
cleaning
and
disinfection
of
environmental
surfaces,
beds,
bedrails, bedside equipment, and
other frequently touched surfaces are
carried out.
Linen
Handle, transport, and process soiled
linen in such a way as to prevent
exposure to oneself, others, and the
environment.
Occupational Health and Bloodborne Pathogens
Prevent injuries when using needles,
scalpels, and other sharp devices
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Never recap used needles
Use either a one-handed “scoop”
method or mechanical device for
covering a needle.
Place all disposable sharp items in a
puncture-resistant container as close
to the location of use as possible;
transport reusable syringes and
needles in a puncture-resistant
container for reprocessing.
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Use mouthpieces,
resuscitation bags, or other
ventilation devices as an
alternative to mouth-to-mouth
resuscitation methods in areas
where the need for
resuscitation is predictable.
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Patient Placement
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Place a patient who
contaminates the
environment, who does not—
or cannot be expected to—
assist in maintaining
appropriate hygiene or
environmental control in a
private room.
Consult with an infection
control professional
concerning alternatives if a
private room is not available.
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Transmission-Based Precautions
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Transmission-based
precautions
are
measures for controlling the spread of
infectious agents from clients known to be or
suspected of being infected with highly
transmissible or epidemiologically important
pathogens. They are also called The three
types of transmission-based precautions are
airborne precautions, droplet precautions, and
contact precautions (Table 22-2).
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These three types replace the earlier categories
of strict isolation, contact isolation, respiratory
isolation, tuberculosis isolation, enteric
precautions,
and
drainage/secretion
precautions.
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Airborne Precautions
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Airborne precautions are measures that
reduce the risk for transmitting airborne
infectious agents. They block pathogens 5
microns or smaller that are present in the
residue of evaporated droplets that remain
suspended in the air, as well as those attached
to dust particles.
Tuberculosis (TB) is an example of a disease
transmitted in the air.
Droplet Precautions
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Droplet precautions are measures that block
pathogens within moist droplets larger than 5
microns. They are used to reduce pathogen
transmission from close contact (usually 3 feet
or less) between an infected person or a person
who is a carrier of a droplet-spread
microorganism and others.
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Microorganisms carried on droplets commonly
exit the body during coughing, sneezing,
talking, and procedures such as airway
suctioning (see Chap. 36) and bronchoscopy.
Airborne precautions are not used because
droplets do not remain suspended in the air.
Contact Precautions
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Contact precautions are measures used to
block the transmission of pathogens by direct
or indirect contact. This is the final category of
transmission-based precautions. Direct contact
involves skin-to-skin contact with an infected
or colonized person.
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Indirect contact occurs by touching a
contaminated intermediate object in the client's
environment. Additional precautions are
necessary if the microorganism is antibiotic
resistant
Infection Control Measures
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Infection control measures involve the use of
personal protective equipment (garments
that block the transfer of pathogens from one
person, place, or object to oneself or others)
and techniques that serve as barriers to
transmission (Fig. 22-3).
Depending on the type of precautions used, nurses
implement all or some of the following measures:
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Locating a client and equipping a room so as
to confine pathogens to one area
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Using personal protective equipment such as
cover gowns, face shields or goggles, cloth or
paper masks or respirators (see Chap. 10), and
gloves to prevent spreading microorganisms
through direct and indirect contact
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Disposing of contaminated linen, equipment,
and supplies in such a way that nurses do not
transfer pathogens to others
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Using infection control measures to prevent
pathogens from spreading when transporting
laboratory specimens or clients
1. Client Environment
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The client environment includes the room
designated for the care of a client with an
infectious disease and the equipment and
supplies essential to controlling transmission
of the pathogens
Infection Control Room
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Most health care agencies assign infectious or
potentially infectious clients to private rooms.
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They keep the door to the room closed to control air
currents and the circulation of dust particles.
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The room has a private bathroom so that personnel
can flush contaminated liquids and biodegradable
solids. A sink is also located in the room for
handwashing.
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Staff members post an instruction card stating
that isolation precautions are required on the
door or nearby at eye level (Fig. 22-4).
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Nurses are responsible for teaching visitors
how to comply with the infection control
measures.
Equipment and Supplies
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The infection control room contains the same
equipment and supplies as any other hospital
room, with a few modifications. Equipment
that personnel would ordinarily use for several
noninfected clients, such as a stethoscope and
sphygmomanometer, remains in the client's
room whenever possible. This prevents the
need to clean and disinfect the items each time
they are removed.
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For the same reason, disposable thermometers
are preferred. Personnel disinfect electronic or
tympanic thermometers to make them safe for
the next client.
Items such as a container for soiled laundry
(Fig. 22-5), lined waste containers, and liquid
soap dispensers are also placed in the room
2. Personal Protective Equipment.
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Infection control measures involve the use of
one or more items for personal protection.
Personal protective equipment, also called
barrier garments (Fig. 22-6), includes gowns,
masks, respirators, goggles or face shields, and
gloves (see Chap. 10).
These items are located just outside the client's
room or in an anteroom (Fig. 22-7).
Removing Personal Protective Equipment
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The procedure involves making contact
between two contaminated surfaces or two
clean surfaces. Nurses remove the garments
that are most contaminated first, preserving the
clean uniform underneath (Figure 22-8)
Disposing of Contaminated Linen, Equipment, and
Supplies
Double-bagging is an infection control measure in
which one bag of contaminated items, such as trash
or laundry, is placed within another .
Removing Reusable Items
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They are cleaned with an antimicrobial
disinfectant, bagged, and sterilized using heat
or chemicals (see Chap. 10).
Transporting Clients
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During transport, nurses use methods to
prevent the spread of pathogens either directly
or indirectly from the client.
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The client wears a mask or particulate air filter
respirator if the pathogen is transmitted by the
airborne or droplet route. Any hospital
personnel having direct contact with the client
use personal protective equipment similar to
that used in client care.
Psychological Implications
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Although infection control measures are
necessary, they often leave clients feeling
shunned or abandoned. Clients with infectious
diseases continue to need human contact and
interaction.
Promoting Social Interaction
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Nurses encourage visitors to come as often as
the agency's policies and the client's condition
permit. They use every opportunity to
emphasize that as long as visitors follow the
infection control precautions, they are not
likely to acquire the disease.
Combating Sensory Deprivation
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Sensory deprivation results when a person
experiences insufficient sensory stimulation or
is exposed to sensory stimulation that is
continuous and monotonous.
Nursing Implications
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Risk for Infection
Ineffective Protection
Risk for Infection Transmission
Impaired Social Interaction
Social Isolation
Risk for Loneliness
Deficient Diversional Activity
Powerlessness
Fear