Asepsis and Infection Control

 Components of the Infection Cycle

o Infectious agent
o Reservoir
o Portal of exit
o Means of transmission
o Portal of entry
o Susceptible host
Review infection cycle:

 Laboratory Data Indicating Infection

o Elevated white blood cell count (WBC)
 Normal is 5,000 to 10,000/mm3
o Increase in specific types of WBC
o Elevated erythrocyte sedimentation rate (ESR or SED rate)
o Presence of pathogen in urine, blood, sputum, or draining cultures
 Things to test:
o 1. Temperature (not definitive but could be an indicator)
o 2. CBC (WBC’s, ESR, SED
o 3. Infections such as UTI, urine is checked
o 4. Sputum
  Cough up gunk and test it for bacteria/lung infection
o 5. Draining cultures for wound: check pus or other drippage for bacteria
so specific antibiotic can be given to patient
 ***viral infections are not treated with antibiotics
 Aseptic Technique
o Includes all activities to prevent or break the chain of infection
o Two Categories
 Medical Asepsis
 Clean Technique
 Surgical Asepsis
 Sterile Technique
 **differences in length of time used to wash hands

**Surgical Asepsis: used for tubes for catheterization, enema (helps pass stool, inserted
into anus), Tube feeding (through mouth or directly into stomach), needles

 Types of Infections
o Colonization of resident flora not infection
o Invasion to unprotected area = infection
o Local infection
 Limited to a specific body part
o Systemic infection
 Spreads and damages different body parts
o Bacteremia
 Microorganisms in the blood
o Septicemia
 Systemic infection resulting from bacteremia
o Acute infections
 Appear suddenly or last a short period of time
o Chronic infections
  May occur slowly over a long period
 May lasts months or years
 Health Care –Associated Infections (HCAI)
o Comes from HCP who don’t wash their hands or change their gloves coming
from patient to patient
o Nosocomial - infections that originate in the hospital
o Endogenous or exogenous
o Diagnostic or therapeutic procedures
 Iatrogenic infections
o Predisposing factors
 Compromised host
 Immunocompromised: patient is already at risk of further
infection due to weak immune system
 Use of invasive medical devices
 Antibiotic-resistant organisms (AKA: MDRO)
o Poor hand hygiene major contributor

**When lab cultures are done, the lab prints a report saying that the patient is exposed
to X bacteria. Lab report also gives list of antibiotics that would NOT work on patient
 What is an MDRO?
o Any bacteria and other microorganism that has developed
resistance to one or more classes of antimicrobial agents. Common
examples of these organisms include:
o MRSA - methicillin/oxacillin-resistant Staphylococcus aureus
o VRE - vancomycin-resistant enterococci
o ESBLs - extended-spectrum beta-lactamases (which are resistant to
cephalosporins and monobactams)
o PRSP - penicillin-resistant Streptococcus pneumoniae
o AB-Acinetobacter Baumanii
o TB – Multi-drug resistant strains
  Passed via airbourne
 Wear mask and get fitted for that mask (N 95 mask)
o Clostridium difficile spore forming bacteria also threatens patients
 CDIFF- highly contagious, HCP cannot use gel sanitizers, have to
wash hands, use
 Measures to Reduce Incidence of HCAI
o Constant surveillance by infection-control committees and nurse
epidemiologists
 Quality control committees investigate
 Hospitals are not getting reimbursed if HAI levels are high
o Written infection-prevention practices for all agency personnel
o Hand hygiene recommendations
o Infection control precautions techniques
o Keeping patient in best possible physical condition
o What other conditions (like CDIFF) do you have to wash your hands
 PERSONAL PROTECTIVE EQUUIPMENT

 Stages of Infection
o Incubation Period
 Organisms growing and multiplying
o Prodromal Stage
 Person is most infectious
 Vague and nonspecific signs of disease
 Could be asymptomatic phase
 This is when bacteria is spread
o Full Stage of Illness
 Presence of specific signs and symptoms of disease
o Convalescent Period
 Recovery from the infection
 Body’s Defense Against Infection
o Body Defenses – Normal Flora
 Skin and mucous membranes
 Normal pH levels

 Educate ladies to not douche
 Saliva and tears
o Inflammatory Response
 What are the clinical manifestations?
 What are the three stages? And what occurs during these stages?
o Immune Response
 Antigen
 Immunity
 Antibody-mediated defenses
 Active Immunity
o Host produces antibodies in response to natural antigens or artificial antigens
o Natural active immunity
 Antibodies are formed in presence of active infection in the body
 Duration lifelong
o Artificial active immunity
 Antigens administered to stimulate antibody formation
 Lasts many years
 Reinforced by booster
 Passive Immunity
o Host receives natural or artificial antibodies produced from another source
o Natural passive immunity
 Antibodies transferred naturally from an immune mother to baby through the placenta
or in colostrum
 Lasts 6 months to 1 year
o Artificial passive immunity
 Occurs when immune serum (antibody) from an animal or another human is injected
 Lasts 2 to 3 weeks
 Factors Increasing Susceptibility to Infection
o Intact skin and mucous membranes
o Normal pH levels
o Body’s WBC
o Age, sex, race, heredity factors
o Immunization, natural or acquired
o Fatigue, climate, nutritional and general health status
o Stress decrease immune system
o Use of invasive or indwelling medical devices
 Introducing something into patients body, ensure it is not
contaminated
o ***treat everyone as if they are infected and use PPE
o do not need to use gowns for v/s or assessment if no visible wounds or
lesions are found
 Optional if no wounds are present
 Reducing the Risk for Infection
o Proper hand hygiene techniques wash before and after
o Donning and removing PPE (“donning”=to put on)
 Gowns
 Masks
 Gloves
o Infection control precautions
o Breaking the chain of infection
 o Disinfecting and sterilizing
 Equipment for procedures most be sterilized (ex; pap smear tools)
***See notes for below images
 Standard and Transmission-Based Precautions
o Standard
 Designed for all patients; decrease risk of transmitting recognized
and unrecognized sources of infection
 Apply to:
 Blood; all body fluids, excretions, secretions, except sweat
 Nonintact skin
 Mucous membranes
o Transmission-Based
 For known or suspected infections spread:
 Airborne
 Droplet
o Don’t confuse airborne and droplet (know
difference and types of masks needed:

 Contact
 Used alone or in combination but always in addition to standard
precautions
 Patient can go home and then after the hospital finds out
that the patient has a disease such as TB
 ***Ask if you are unsure of what type of PPE you need
 Isolation Practices
o Based on assessment of patient
o Nurse must cleanse hands before and after giving care

o Is there a protocol or isolation practice to prevent infections in

immunocompromised patients (ex. HIV+, leukemias, burns, etc.)?

 Bacterial meningitis: patients would be in isolation room as well

 **Airflow is directed straight outside of the hospital through a
separate vent from isolation rooms

o Can patients on isolation be transported to other departments in the

hospital? Why or why not? If yes, how is transport carried out?
 Yes but PPE must be worn to protect you and the patient

 Principles and Practices of Surgical Asepsis

o All objects in a sterile field must be sterile
  Ec: central line (carotid, subclavian, femoral) inserted via sterile
techniques
 Normal IV clean equipment
 Catheter must maintain sterile field
 Might need extra help/hands to insert
o **care given can be Clean or Sterile
 depends on protocol
 A pack of gauze in bulk  CLEAN
 Individually packaged sheets of gauze sterile
 **Hold blue sheet down by corners and place it down, place sterile
items on top of untouched area
 Sterile:
 Above the waste
 Never turn your back on sterile field
 Sterile gloves needed for sterile procedures
o Unsterile when touched by unsterile objects
o Unsterile when out of sight, below waist or table level
o Unsterile when prolonged exposure to airborne microorganisms
o Fluids flow in the direction of gravity, so keep contaminated sections
below sterile
o Edges of sterile field are unsterile
o Skin cannot be sterilized
o Maintain conscientiousness, alertness, and honesty
 Infection Control for Health Care Workers
o Occupational exposure
 Cover all open areas (even little cuts on fingers)
o Three major modes of transmission in clinical settings
 Puncture wounds (contaminated needles or other sharps)
 Do not recap needle bc you may accidentally stick yourself
 Use hard surface to recap it instead or just dispose of exposed
needle in sharps bin
 Skin contact (infectious fluids enter through wounds or damaged
skin)
 Mucous membranes (eyes, mouth, nose)
 Splashes in eye go directly to eyewash station
o What would you do if you were exposed? Is there a specific protocol to
follow?
**if nurse refuses to give care it is called abandonment