Infection Control - NURSING LIJAN · 2020. 10. 31. · Local Infection: infection limited to...
Transcript of Infection Control - NURSING LIJAN · 2020. 10. 31. · Local Infection: infection limited to...
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Infection Control
By
Dr. Amer Hasanien &
Dr. Ali Saleh
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Related Terms◼ Normal resident flora (bacteria) the collective
vegetation (نمو) in a given area, yet produce infection in another.
◼ Infection : invasion of body tissue by microorganisms (infectious agents) and their growth there.
◼ Disease : a detectable alteration in normal tissue function
◼ Virulence (Pathogenicity): the ability of microorganism to produce disease.
◼ Opportunistic pathogen: causes disease only in a susceptible individuals.
◼ WHO & CDC (Centre for Disease Control)
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Asepsis◼ Asepsis is the freedom from disease-causing
microorganisms and its spores Medical asepsis: all practices intended to confine a
specific microorganism to a specific area, limiting the number of microorganisms, growth and transmission.
- Clean objects: absence of almost all microorganisms.
- Dirty (Soiled, Contaminated) : have microorganisms, some of which capable of causing infection.
Surgical asepsis (Sterile Technique): practices that keep area or object free from all microorganisms; destroy all microorganisms and spores.
◼ Sepsis : the state of infection, may includes septicemia and septic shock.
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Microorganisms causing infections
◼ Bacteria (Staphs, Streptococci)
◼ Viruses (Hepatitis, Herpes..)
◼ Fungi (Candida albicans)
◼ Parasites [طفيليات] (Malaria) (mites [العث], fleas .([القرادة] ticks ,[البراغيث]
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Types of infections◼ Contamination: the presence of microorganisms on
certain areas of the body or environment
◼ Colonization : microorganisms become resident flora, they may grow and multiply, but do not cause disease.
◼ Local Infection : infection limited to specific area of the body.
◼ Systemic Infection : spread to different parts of the body.
◼ Bacteremia : Blood culture reveals microorganisms
◼ Septicemia : when bacteremia results in systemic infection.
◼ Acute infection : sudden and in short time.
◼ Chronic infection : slow and in very long period.
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Blood culture bottles
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Nosocomial Infections
◼ Infections associated with delivery of health care services in a health care facility (during stay or after discharge)
◼ Most common nosocomial infections sites are urinary tract, respiratory tract, bloodstream, and wounds.
◼ It may originates as Endogenous (clients themselves) or Exogenous (hospital environment and hospital personnel) .
◼ Iatrogenic infections are direct result of diagnostic or therapeutic procedures (e.g. IV insertion).
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Chain of Infection
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Method of transmission
1. Direct transmission : droplet, touch, bite, sexual intercourse.
2. Indirect transmission:
- Vehicle-borne: substance that serves as an intermediate means to transport an infectious agent (surgical instruments, toys, soiled clothes)
- Vector-borne: is an animal or flying insect
3. Airborne transmission: involve droplets or dust (Tuberculosis by droplet nuclei).
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Body Defense against infection
(Susceptible Host)Nonspecific Defenses :
◼ anatomic & Physiologic Barriers: e.g. skin and mucous membranes, nasal passages, saliva, tears, acidity of the stomach
◼ inflammatory response : Inflammation: is local and nonspecific defensive response
of the tissues to an injurious or infectious agent. It has 5 signs: pain, swelling, redness, heat, and impaired function of the part.
Injurious agents can be physical, chemical, or microorganism.
Three stages of inflammatory response: vascular and cellular response, exudates production, and reparative phase
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Body Defense against infection
Specific Defenses :
◼ antibody-mediated
Active immunity: Host produces antibodies in
response to natural antigens (e.g. infectious
microorganisms) or artificial antigens (vaccines)
Passive immunity: Host receives natural (e.g. nursing
mother) or artificial antibodies (immune serum)
produced from another source.
◼ cell-mediated: by activating T cell system (cell
mediated immunity is lost in HIV)
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FACTORS INFLUENCE
SUSCEPTIBILITY OF THE HOST
◼ Age: newborns and elders have reduced defenses against infections.
◼ Heredity
◼ Physical and Emotional Stressors: ↑ blood cortisone → ↓ anti-inflammatory responses, depletes energy stores, exhaustion, ↓ resistance to infections.
◼ Nutritional status: e.g. antibodies are protiens.
◼ Medical therapy: e.g. radiation, invasive procedures.
◼ Certain medication: e.g. antineoplastic medications may depress bone marrow function.
◼ Any disease that lessens the body’s defenses against infection.
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Nursing Diagnoses
◼ Risk for infection
◼ Potential complication of infection: fever
◼ Impaired physical mobility
◼ Imbalanced nutrition: less than body requirements
◼ Acute pain
◼ Anxiety
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Prevention and Treatment of
Infection
Preventing Nosocomial Infections
◼ Proper hand hygiene techniques
◼ Environmental controls
◼ Sterile technique when warranted
◼ Identification and management of clients
at risk
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Prevention and Treatment of
Infection
Hand Hygiene Before and after eating
After using toilets, bedpan
Contact with body substance (sputum, drainage, wound exudates).
Before and after giving care
◼ For routine care, wash hands with soaps under stream water for at least 20 sec. (WHO). OR
◼ Using of alcohol-based antiseptic hand rubs (rinses, gels, or foams) for about 20-30 sec. (CDC).
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Prevention and Treatment of
Infection
◼ Use antimicrobial agent in:
Multiple resistant bacteria (e.g., Methicillin-
Resistant Staphylococcus aureus (MRSA), Vancomycin-Resistant Enterococci (VRE))
Invasive procedures
Special care units such as ICU’S
Immunocompromised clients.
◼ Frequent use of soap or alcohol antiseptic agents may induce: dryness, contact dermatitis → lotions, moisturizers
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Prevention and Treatment of
Infection
Supporting Defenses of a Susceptible Host
◼ Hygiene (bathing and shampooing)
◼ Nutrition (well-balanced diet) to maintain healthy tissues.
◼ Fluids
◼ Rest and sleep
◼ Stress
◼ Immunization
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Prevention and Treatment of
Infection
Disinfecting and Sterilizing
◼ Antiseptics: agents that inhibit the growth of some microorganisms.
◼ Disinfectants: agents that destroy pathogens other than spores
Disinfecting
◼ Using chemical preparations such as phenol or iodine compounds.
◼ Used on inanimate objects as it is toxic to tissues.
◼ More concentrated than antiseptics.
◼ Bactericidal (destroy bacteria) and bacteriostatic (prevent growth and reproduction of some bacteria) agents.
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Prevention and Treatment of
Infection
When using disinfectants consider:
◼ Type and number of organisms
◼ Concentration and duration of contact of disinfectant
◼ Presence of soap
◼ Presence of organic materials such as blood
◼ The surface area to be treated
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Prevention and Treatment of
InfectionSterilization
◼ The process of destroying all microorganisms, including spores and viruses. Methods of sterilization:
◼ Moist heat: steam under pressure (autoclaving)
◼ Gas: Ethylene oxide gas (interferes with metabolism of microorganisms) for sensitive objects and more penetration. But toxic to humans
◼ Boiling water: in home. Spores and some viruses are not
killed. 100 ˚ c/ 15 min.
◼ Radiation: using ionizing (alpha, beta, and X-Rays) and non-ionizing radiation (UV rays). Effective for items difficult to sterilize. It is very expensive.
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autoclaving
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Isolation Precautions
◼ Measures designed to prevent spread of infections or potentially infectious microorganisms to health personnel, clients and visitors.
◼ Category-specific Isolation Precautions: Strict isolation, Contact isolation, Respiratory isolation, Tuberculosis isolation, Enteric precautions, Drainage/secretions precautions, Blood/body fluid precautions.
◼ Disease-specific Isolation Precautions: Delineate practices for control of specific diseases. Use of private rooms with special ventilation
Cohorting clients infected with the same organism
Gowning to prevent gross soiling of clothes
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Gown
Patient Health care provider
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Isolation Precautions
Universal Precautions (UP)
◼ Used with all clients
◼ Decrease the risk of transmitting unidentified
pathogens
◼ Obstruct the spread of bloodborne pathogens
(hepatitis B and C viruses and HIV)
◼ Used in conjunction with disease-specific or
category-specific precautions
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Isolation Precautions
Body Substance Isolation (BSI)
◼ Employs generic infection control precautions for all clients except for few diseases transmitted through air.
◼ Body substances include: Blood
Urine
Feces
Wound drainage
Oral secretions
Any other body product or tissue
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Isolation Precautions
Standard Precautions
◼ Used in the care of all hospitalized persons regardless of their diagnosis or possible infection status
◼ Apply to Blood
All body fluids, secretions, and excretions except sweat (whether or not blood is present or visible)
Nonintact skin and mucous membranes
◼ Combine the major features of Universal and Body Substance Isolation
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Standard Precautions
◼ Hand Hygiene Also after removing gloves
Using antimicrobial and antiseptic agents.
◼ Wearing clean gloves
◼ Wear mask, Eye protection, or a face shield.
◼ Wear clean gown
◼ Handle equipments carefully
◼ Handle, transport, and process linen appropriately.
◼ Prevent injuries from used scalpels, or other equipment, and place puncture resistant containers.
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face shield puncture resistant
containers
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Isolation Precautions
Transmission-based Precautions
◼ Used in addition to standard precautions
◼ For known or suspected infections that are spread in one of three ways: Airborne: droplet nuclei (< 5 microns)
Droplet: droplets (> 5 microns)
Contact
◼ May be used alone or in combination but always in addition to standard precautions
Micron (US): is an SI derived unit of length
equaling 1×10−6 of a metre
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Transmission-based Precautions
Airborne Precautions:
◼ Private room, negative air pressure
◼ 2-same infected clients with same
microorganism.
◼ Respiratory devices (e.g. N95 for tuberculosis)
◼ NO entry of susceptible people ((rubella
(measles), varisella (chickenpox)).
◼ Limit patient’s movement (surgical mask).
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N95 for tuberculosis
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Transmission-based Precautions
Droplet Precaution
◼ Used in droplet-transmitted infections (diphtheria, pneumonia, pertussis, mumps)
◼ Private room
◼ 2-same infected clients.
◼ Mask
◼ Limit patient’s movement (surgical mask).
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surgical mask
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Transmission-based Precautions
Contact Precautions
◼ Used for clients known or suspected to have serious illnesses easily transmitted by direct contact. e.g. respiratory, skin, or wound infections, drug resistant bacteria (Vancomycine-resistant enterococci).
◼ Private room
◼ Wear gloves
◼ Wear gown
◼ Limit patient movement outside
◼ Using equipment to a single client (or same microorganism patients).
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Isolation Practices
◼ Personal protective equipments
(medical asepsis) Gloves
Gowns
Face Masks
Eyewear
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Isolation Practices
◼ Disposal of soiled equipment and supplies
Bagging
Linens
lab. Specimens
Dishes
BP equipments
Thermometers
Sharps
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Isolation Practices
◼ Transporting Clients with Infections
◼ Psychosocial Needs of Isolation Clients
Sensory deprivation
Feelings of inferiority and low self-esteem.
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Sterile Technique
Sterile technique (surgical asepsis)
- can be used in OR, LR, and special Dx. Procedures
- sterile field: a microorganism- free area
- ensure package intact and dry, and check for sterilization expiry.
- double packed objects
- using forceps, drape, sterile solutions.
- wearing sterile gloves by open and closed methods
- wearing sterile gown
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sterile gloves
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sterile package