Nursing Interventions: Infection Control – Flashcards

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Infection
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A diseased state that results from the presence of pathogens in or on the body
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What are the components of the chain of infection?
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1. Infection agen 2. Reservoir 3. Portal of exit 4. Means of transmission 5. Portals of entry 6. Susceptible host
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Reservoir
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The natural habitat of a microorganism that allows it to grow and multiply
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Carriers
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People who carry an infectious disease but are asymptomatic
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Portal of Exit
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Point of escape for the organism from the reservoir
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What are the most common portals of exit in humans?
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Respiratory, Gastrointestinal, GU tract, Skin
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Modes of Transmission
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How a bacteria is transmitted from original reservoir to new reservoir
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Direct Contact Modes of Transmission
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Contact is proximal between susceptible host and infected host (touching, kissing, sex)
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Indirect Contact
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Personal contact with an infected inanimate objects
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Vectors
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Nonhuman carriers that transmit organisms from one host to another by injecting salivary fluid when a human bite occurs (mosquitoes, ticks, lice)
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Portal of Entry
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Point at which organism enters a new host
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Most common portal of entry routes
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Urinary, Respiratory, GI tract, Skin
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Susceptible Host
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Host who's defenses can be overcome by infectious organisms
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What are the 4 stages of infection?
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1. Incubation period 2. Prodromal period 3. Full Stage of Illness 4. Convalescent Period
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Incubation Period
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-Interval between pathogen's invasion of body and appearance of symptoms of infection -Organisms are growing and multiplying -Length of interval varies
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Prodromal Stage
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-PERSON IS MOST INFECTIOUS -Early signs and symptoms of disease present but vague and nonspecific -Several hours to several days -Unaware of being contagious --> infecting other people
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Full Stage of Illness
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-Presence of specific signs and symptoms indicates full stage of illness -Type determines length of illness and severity of manifestations
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Convalescent Period
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-Recovery period from infection -Vary depending on patient's general condition -Signs and symptoms disappear and person returns to healthy state
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What are the cardinal signs of an acute infection
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Redness, Swelling, Pain, Loss of Function
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What are the two main stages of the inflammatory response?
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1. Vascular- vasoconstriction and histamine release 2. Cellular- neutrophils and WBCs move into area, exudate released from wound
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Factors affecting risk for infection
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Skin integrity, pH levels of GI and GU, rest, exercise, stress, fatifue, age, race, sex
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Asepsis
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All activities done to prevent infection or break the chain of infeciton
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Medical Asepsis
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Clean technique, involve procedures and practices that reduce the number and transfer of pathogens (hand hygiene, wearing gloves)
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Surgical Asepsis
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Sterile technique; includes practices used to render and keep objects and area free from microorganisms
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When should a nurse wash their hands?
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-Before and after direct contact with patients -After contact with body fluids, mucous membranes, non intact skin, wound dressings -After removing gloves -before donning sterile gloves -moving contaminated body site to clean body site during patient care -After contact with objects located in patient's environment
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C. difficile
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-Gram positive, anaerobic, spore forming bacterium -Common cause of diarrhea affecting children, adults, and older adults -ALCOHOL DOESN'T KILL C. DIFF SPORES -MUST use soap and water
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Hospital Associated Infections
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A secondary disease acquired during stay in a healthcare facility
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Exogenous infection
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Causative organism is acquired from other people
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Endogenous infection
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Causative organism comes from microbial life harbored in the person
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Iatrogenic
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Infection that results from treatment or diagnostic procedure
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What are the four major categories responsible for HAIs?
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1. UTIs 2. Surgical Site Infections 3. Bloodstream Infections 4. Pneumonia
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MRSA
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-Staphylococcus aureus -Hospital MRSA strain is SERIOUS -Responsible for bloodstream infections, wound infections, ventilator associated pneumonia, and multi drug resistnat -Drug of choice: Intravenous vancomycin
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VRSA
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-Vancomycin resistant staphylococcus aureus -All cases successfully treated other drugs than vancomycin
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Which patients are at risk of developing VRSA
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-History of kidney disease -Diabetes -Previous MRSA infection -Presence of invasive catheter -Recent exposure to vancomycin
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VRE
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-Vancomycin Resistant Enterococci -Often found in normal intestinal and female genital tracts -HAIs with high morality rate of organism is vancomycin resistant -Spreads via contact with: feces, urine, and blood
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VRE risk factors
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-Compromised immune systems -recent abdominal or chest surgery -Presence of urinary or central IV catheter -Prolonged antibiotic use, especially with vancomycin -Lengthy hospital stay, especially in ICU
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What is included in PPE?
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Gloves, Gowns, Masks, Eye Gear
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PPE: Gloves
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*Not a substitute for good hand hygiene* -Worn only once and discarded appropriately according to agency policy -If possibility of soiling hands with body fluids must wear gloves -Never leave patient's room while wearing gloves
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Gowns
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-Worn to prevent soiling of health care workers clothing by patient's blood and body fluids -Provide barrier protection and donned immediately before entering patient's room -If gown becomes heavily soiled or moistened remove, wash hands, and get a clean gown
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Masks
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-Help prevent wearer from inhaling large particle aerosols that travel short distances (3 feet) -Worn once and never lowered around neck and then brought back over mouth or nose for reuse -Must be changed before it becomes damp from wearer's exhalations
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Protective Eye Gear
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-Goggles and face shields -Worn whenever risk of contaminating mucous membranes of the eyes -PLAIN GLASSES IS UNACCEPTABLE
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Isolation
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Protective procedure that limits spread of infectious diseases among hospitalized patients, hospital personnel, and visitors
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CDC Guidelines for Isolation Precautions
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-Recognize health care delivery occurs in other settings besides acute care hospitals -Reflect emergence of new pathogens, methods to prevent transmission of multi-drug resistant organisms and biological terrorism
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Standard Precautions
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-Used in care of all hospitalized patients regardless of diagnosis or possible infection status -Respiratory hygiene/cough etiquette, safe injection practices, directions to use mask when performing high risk prolonged procedures involving spinal canal punctures
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Airborne Precautions
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-Place patient in private room with negative air pressure -Wear mask or respirator when entering room of patient with known or suspected TB, rubeola, varicella -Transport patient out of room only when necessary and place surgical mask on patient if possible -DOOR CLOSED
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Droplet Precautions
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-Use private room if available, door can remain open -Wear PPE upon entry into the room for all interaction that may involve contact with patient and potentially contaminated areas in environment -Transport patient out of room only when necessary and place surgical mask on patient -Keep visitors 3 feet from infected person -Door can be open
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Contact Precautions
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-Place patient in private room if possible -Wear PPE whenever entering room -Change gloves after having contact with infective material -Remove PPE before leaving patient environment and wash hands with antimicrobial or waterless antiseptic agents -Limit movement of patient out of the room -Avoid sharing patient care equipment
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Fomite
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An inanimate object that can be infected; bedside tables, needles, side rails
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Droplet
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Bigger moist particles; flem from coughing that is in the air; only goes about 3 feet from start
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C. Diff Precautions
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-Prescribing caution -testing recommendations -immediate contact precautions -gloves and gowns with all contact -environmental cleaning with sporicidal -Private room for C diff patients unless another patient has C diff
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Biohazardous Waste
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-Sharps dispose of in regulated sharps disposal boxes -Blood and body fluids disposed of in labeled or color coded red BIOHAZARD containers
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Precaution laundry
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-Contaminated laundry handled as little as possible and bagged in room or anteroom -Double bagged when leaving isolation room
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Highly Contagious Diseases on Airborne/Combination Precautions
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-Chicken pox -Measles: Rubeola and German Rubella -Shingles -Localized zoster -MRSA, VRE, VRSA
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What diseases require contact precaution?
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1. Norovirus 2. Rotavirus 3. C. diff 4. Draining wounds 5. Uncontrolled secretions
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What diseases require droplet precaution?
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1. Pertussis 2. Influenza 3. Diphtheria 4. Invasive Neisseria meningitidis
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What diseases require airborne precautions?
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1. Tuberculosis 2. Measles 3. Chickenpox 4. Herpes zoster (shingles)
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Describe how to properly prepare a sterile field using a packaged sterile drape
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1. Perform hand hygiene and put on PPE 2. identify patient and explain procedure to the patient 3. check that packaged sterile drape is dry and unopened. 4. Select a work area that is waist level or higher 5. Open the outer covering of the drape. Remove sterile drape, lifting it carefully by its corners, hold away from the body and above the waist surface 6. Continue to hole only by the corners. Allow the drape to unfold, AWAY from your body and any surfaces 7. Position drape of the work surface with moisture proof side DOWN. Avoid touching any other surface or object with drape- if any part hanging off it is considered contaminated 8. Place additional sterile items on field as needed 9. When procedure is completed, remove PPE and perform hand hygiene
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Describe how to properly put on sterile gloves
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1. Perform hand hygiene and put on PPE 2. Check that the sterile glove package is dry and unopened. Also note expiration date, making sure that the date is still valid 3. Place sterile glove package on clean, dry surface with the side labeled "cuff end" closest to the body 4. Carefully open the inner package. Fold open the top flap, then the bottom and sides. TAKE CARE NOT TO TOUCH THE INNER SURFACE OF THE PACKAGE OF THE GLOVES 5. With the thumb and forefinger of the nondominant hand, grasp the folded cuff of the glove for the dominant hand, touching only the exposed inside of the glove 6. Keeping the hands above the waistline, lift and hold the glove up and off the inner package with fingers down. BE CAREFUL THAT IT DOESN'T TOUCH ANY UNSTERILE OBJECTS 7. Carefully insert dominant hand palm up into glove and pull glove on. Leave the cuff folded until the opposite hand is gloved 8. Hold the thumb of the gloved hand outward. Place the fingers of the gloved hand inside the cuff of the remaining glove. Lift it from the wrapper, taking care not to touch anything with the gloves or hands 9. Carefully insert non dominant hand into glove. Pull the glove on, taking care that the skin doesn't touch any of the outer surfaces of he gloves 10. Slide the fingers of one hand under the cuff of the other and fully extend the cuff down the arm, touching only the sterile outside of the glove. Repeat for the remaining hand 11. Adjust gloves on both hands if necessary, TOUCHING ONLY STERILE AREAS WITH OTHER STERILE AREAS 12. Continue with procedure as indicated
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Describe how to properly remove soiled gloves
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1. use dominant hand to grasp opposite glove near cuff end on outside exposed area. Remove it by pulling it off, inverting it as it is pulled, keeping contaminated area on the inside. Hold the removed glove in the remaining gloved hand 2. Slide fingers of ungloved hand between the remaining glove and wrist. AVOID TOUCHING OUTSIDE SURFACE OF GLOVE. Remove it by pulling it off, inverting it as it is pulled, keeping contaminated area on the inside, and securing the first glove inside the second 3. Discard gloves in the appropriate container. Remove additional PPE and perform hand hygiene
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