8/31/2016

INFECTION PREVENTION
AND CONTROL

Chapter 29

Scientific Knowledge Base

Nature of infection
Infection: the invasion of a susceptible host by
pathogens or microorganisms; results in disease.
Colonization: presence and growth of
microorganisms within a host without tissue
invasion or damage.
Communicable disease: the infectious process
transmitted from one person to another.
Symptomatic: clinical signs and symptoms are present.
Asymptomatic: clinical signs and symptoms are not
present.

Copyright 2017, Elsevier Inc. All Rights

2
Reserved.

Chain of Infection
Infectious agent or
pathogen
Reservoir or source for
pathogen growth
Portal of exit
Mode of transmission
Portal of entry
Susceptible host

Copyright 2017, Elsevier Inc. All Rights

3
Reserved.

1
 8/31/2016

Infectious Process
Four stages:
Incubation period

Prodromal stage
Illness stage
Convalescence

Localized versus systemic infection

Copyright 2017, Elsevier Inc. All Rights

4
Reserved.

Defenses Against Infection

Normal flora
Microorganisms
Maintain a sensitive balance with other
microorganisms to prevent infection. Any factor
that disrupts this balance places a person at
increased risk for acquiring a disease.
Body system defenses
Organs

Copyright 2017, Elsevier Inc. All Rights

5
Reserved.

Health CareAssociated Infections

Results from delivery of health services in a
health care facility
Patients at greater risk for health care
associated infections (HAIs)
Multiple illnesses
Older adults
Poorly nourished
Compromised immune system

Copyright 2017, Elsevier Inc. All Rights

6
Reserved.

2
 8/31/2016

Health CareAssociated Infections

(Cont.)
Types of HAI infection:
Iatrogenicfrom a procedure
Exogenousfrom microorganisms
outside the individual
Endogenouswhen the patients flora
becomes altered and an overgrowth
results

Copyright 2017, Elsevier Inc. All Rights

7
Reserved.

Nursing Knowledge Base

Factors influencing infection prevention
and control:
Age
Nutritional status
Stress
Disease process
Treatments or conditions that compromise the
immune response

Copyright 2017, Elsevier Inc. All Rights

8
Reserved.

Nursing Process: Assessment

Assessment includes a thorough
investigation:
Defense mechanisms, susceptibility, and
knowledge of how infections are transmitted
Review of systems, travel history
Immunizations and vaccinations
Early recognition of risk factors

Copyright 2017, Elsevier Inc. All Rights

9
Reserved.

3
 8/31/2016

Nursing Process: Assessment (Cont.)

See through the patients eyes.

Status of defense mechanisms
Patient susceptibility
Medical therapy
Clinical appearance
Signs and symptoms of infection
Laboratory data

Copyright 2017, Elsevier Inc. All Rights

10
Reserved.

Nursing Process: Nursing Diagnosis

Nursing diagnoses for infection:

Risk for Infection
Imbalanced Nutrition: Less than Body Requirements
Impaired Oral Mucous Membrane
Risk for Impaired Skin Integrity
Social Isolation
Impaired Tissue Integrity
Readiness for Enhanced Immunization Status

Copyright 2017, Elsevier Inc. All Rights

11
Reserved.

Nursing Process: Planning

Goals and outcomes
Common goals of care applicable to patients
with infection often include the following:
Preventing exposure to infectious organisms
Controlling or reducing the extent of infection
Maintaining resistance to infection
Verbalizing understanding of infection prevention
and control techniques (e.g., hand hygiene)

Copyright 2017, Elsevier Inc. All Rights

12
Reserved.

4
 8/31/2016

Nursing Process: Planning (Cont.)

Setting priorities
Establish priorities for each diagnosis and for
related goals of care.
Teamwork and collaboration
Remember to plan care and include other
disciplines as necessary.

Copyright 2017, Elsevier Inc. All Rights

13
Reserved.

Implementation
Health promotion
Preventing an infection from developing or
spreading
Acute care
Treating an infectious process includes eliminating
the infectious organisms and supporting the
patients defenses

Copyright 2017, Elsevier Inc. All Rights

14
Reserved.

Implementation (Cont.)
Asepsis
Absence of pathogenic (disease-producing)
microorganisms
Medical asepsis
Standard precautions
Hand hygiene
Alcohol-based hand rub

Copyright 2017, Elsevier Inc. All Rights

15
Reserved.

5
 8/31/2016

Implementation (Cont.)
Cleaning
The removal of all soil
Use protective eyewear and gloves
Steps
Rinse contaminated object or article with cold running water
to remove organic material.
Wash the object with soap and warm water.
Use a brush to remove dirt or material in grooves or seams.
Rinse the object in warm water.
Dry the object and prepare it for disinfection or sterilization
if indicated
Clean and dry cleaning equipment

Copyright 2017, Elsevier Inc. All Rights

16
Reserved.

Disinfection and Sterilization

Disinfection: a process that eliminates many
or all microorganisms, with the exception of
bacterial spores, from inanimate objects
Disinfection of surfaces
High-level disinfection, which is required for some
items such as endoscopes
Sterilization: the complete elimination or
destruction of all microorganisms, including
spores

Copyright 2017, Elsevier Inc. All Rights

17
Reserved.

Infection Prevention and Control

Patient Safety
Patient safety
Separate personal care items
Handling exudate
Wound cleaning
Cough etiquette
Dirty linen
Maintain skin integrity
Perineal care after toileting
Urinary catheters and drainage sets
Wound cleaning
Copyright 2017, Elsevier Inc. All Rights
18
Reserved.

6
 8/31/2016

Isolation and Isolation Precautions

Isolation is the separation and restriction of
movement of ill persons with contagious
diseases.
Barrier precautions
Standard precautions
Isolation precautions: airborne, droplet, contact,
and protective environment

Copyright 2017, Elsevier Inc. All Rights

19
Reserved.

Psychological Implications
of Isolation
Psychological
implications
Isolation environment
Personal protective
equipment
Specimen collection
Bagging of trash or linen
Patient transport

Copyright 2017, Elsevier Inc.

20
All Rights Reserved.

Implementation (Cont.)
Role of the infection control professional
Infection prevention and control for hospital
personnel
Patient education

Copyright 2017, Elsevier Inc. All Rights

21
Reserved.

7
 8/31/2016

Surgical Asepsis
Sterile technique prevents contamination of
an open wound, serves to isolate the
operative area from the unsterile
environment, and maintains a sterile field for
surgery
Includes procedures used to eliminate all
microorganisms, including pathogens and
spores, from an object or area
Situations surgical asepsis is used
Copyright 2017, Elsevier Inc. All Rights
22
Reserved.

Surgical Asepsis
Patient preparation
Sterile field: an area
free of microorganisms
and prepared to receive
sterile items

Copyright 2017, Elsevier Inc.

23
All Rights Reserved.

Surgical Asepsis (Cont.)

Principles
1. A sterile object remains sterile only when touched
by another sterile object.
2. Only sterile objects may be placed on a sterile
field.
3. A sterile object or field out of the range of vision
or an object held below a persons waist is
contaminated.
4. A sterile object or field becomes contaminated by
prolonged exposure to air.
Copyright 2017, Elsevier Inc. All Rights
24
Reserved.

8
 8/31/2016

Surgical Asepsis (Cont.)

5. When a sterile surface comes in contact with a

wet, contaminated surface, the sterile object or field
becomes contaminated by capillary action.
6. Fluid flows in the direction of gravity.
7. The edges of a sterile field or container are
considered to be contaminated.

Copyright 2017, Elsevier Inc. All Rights

25
Reserved.

Surgical Asepsis (Cont.)

Performing sterile procedures
Donning and removing caps, masks, and eyewear
Opening sterile packages
Opening a sterile item on a flat surface
Opening a sterile item while holding it
Preparing a sterile field
Pouring sterile solutions
Surgical scrub
Applying sterile gloves
Donning a sterile gown

Copyright 2017, Elsevier Inc. All Rights

26
Reserved.

Evaluation
See through the patients eyes:
Have the patients expectations been met?
Patient outcomes
Measure the success of the infection control
techniques.
Compare the patients actual response with expected
outcomes.
If goals are not achieved, determine what steps must
be taken.
Exposure issues
Copyright 2017, Elsevier Inc. All Rights
27
Reserved.

9
 8/31/2016

Questions

28

10