Craven Ch 19 Asepsis and Infection Control

Agent that stops or slows the growth of microorganisms on living tissue, commonly used for handwashing, skin preparation, and wound packing or irrigation

Absence of disease-producing microorganisms

Able to kill bacteria

Able to inhibit the growth of bacteria

Person from whom a microorganism can be cultured but who shows no sign of a disease

Chemical used to kill microorganisms on lifeless objects

(ESBLs) Enzymes that give bacteria immunity to both penicillin and cephalosporin antibiotics

Handwashing with soap and water or cleansing the hands with a water-less alcohol-based cleanser to prevent the spread of infection

(HAI) A term that encompasses infections contracted in all healthcare settings and is now used in place of the older term, nosocomial infection, which refers only to hospital-acquired infection

• Process resulting from infection that produces manifestations such as fever, leukocytosis, inflammation, or tissue damage
• Infectious disease refers to pathologic events that result from the invasion and multiplication of microorganisms in a host.

Techniques used to prevent or to limit the spread of infection

Measures taken to control and to reduce the number of pathogens present; also known as “clean technique”; measures include handwashing, gloving, gowning, and disinfecting to help contain microbial growth

Organisms that have developed resistance to multiple antibiotics

• Infection acquired during receipt of healthcare
• Nosocomial infections are those that occur in the setting of the hospital

Infections that do not result in disease in individuals with properly functioning immune systems

An organism’s ability to harm and to cause disease

Microorganisms that can harm humans

(PPE) Techniques or equipment that prevents the transfer of pathogens from one person to another; also referred to as “barriers”

Organisms that cause a rapidly progressing neurodegenerative disease affecting both animals and humans that is untreatable and always fatal

• Poisoning of body tissues; usually refers to bloodborne organisms or their toxic products
• Sepsis is an infection that manifests with systemic or widespread microbial destruction of tissues, often accompanied by high fever or hypotension.

Organism’s attraction to a specific host, which may include humans

The latest CDC isolation system that combines the major features of Universal Precautions (blood-borne transmissions) and Body Substance Isolation (moist body substances transmission), thus protecting against blood and body-fluid transmission of potentially infective agents

(1) Destruction of all bacteria, spores, fungi, and viruses on an item, accomplished by heat, chemicals, or gas; (2) Rendered unable to reproduce biologically

Refers to “sterile technique” in which an object is free of all microorganisms to prevent the introduction or spread of pathogens from the environment into the patient; employed when a body cavity is entered with an object that may damage the mucous membranes, when surgical procedures are performed, and when the patient’s immune system is already compromised

Vigor with which an organism can grow and multiply

• Overprescription of antibiotics
• Use of inappropriate antibiotics for the infecting organism
• Incomplete use of antibiotic prescriptions as symptoms subside
• Harboring and spreading of resistant organisms by carriers who remain symptom free, usually unaware that they have been infected
• Increased use of antibiotics in farming, thus contaminating milk and meat

• bacteria
• fungi
• virus
• parasites
• prions

• human beings
• animals
• inanimate objects

• sputum
• emesis
• stool
• blood

• Immunosuppressed elderly
• chronically ill
• trauma
• surgery

• mucous membranes
• nonintact skin
• GI tract
• GU tract
• respiratory tract

• contact
• vehicle
• droplet transmission
• airborne
• vectorborne

• Direct or indirect contact
• Direct - body surface to body surface
• Indirect - susceptible host comes in contact with contaiminated object

• contaiminated items that transmit pathogens
• e.g. food can carry Salmonella, water can carry Legionella, blood can carry hepatitis and HIV

Mucous membranes of nose, mouth, or conjuntiva are exposed to secretions of an infected person who is coughing, sneezing, or talking. Droplets do not remain suspended in the air for very long and seldom travel more than 3 feet. This is not the same as airborne transmission.

Fine particles are suspended in the air for a long time or when dust particles contain pathogens. Air currents widely disperse organisms, can be inhaled or deposited on the skin of a susceptible host. Patient must be in rooms with special air handling and ventilation systems.

• biologic or mechanical
• Biologic are living creatures carrying pathogens, e.g. rats, insects, birds. Most concerning in tropical areas; mosquitoes carrying malaria
• Mechanical vectors are inanimate objects contaiminated with infected body fluids, e.g. central line catheters, ventilators, contaiminated needles, syringes. MRSA, hepatitis B, HIV are commonly spread in this manner.

• hospitals, outpatient clinics, extended care facilities, the home, and schools - threat to those with decreased resistance.
• Sources include: air; other patients; families and visitors; and contaminated equipment, food, and personnel.
• Pneumonia and influenza is commonly spread in these facilities.

Drugs such as steroids, immunosuppressive agents, and cancer therapy, as well as prolonged use of antibiotics, predispose patients to infection. Equipment such as IV catheters, urinary catheters, feeding tubes, and ventilators provide routes for bacterial and fungal invasion. Inadequate dressing techniques for wounds can provide media for bacterial growth.

• Changes in the physical or psychological status of a patient can affect his or her resistance to infection. Any break in the integrity of the skin or mucous membranes increases the chance of infection.
• Stress, fatigue, poor nutrition, poor hygiene, and chronic illness also can decrease the patient’s ability to ward off infection by impairing normal defenses.
• The elderly are extremely susceptible to infection because of age-related changes to major body systems.
• Immunocompromised patients are the most susceptible to infection because they are unable to invoke the immune response necessary to fight off infection-causing pathogens.

Problem/Patient/Population, Intervention/Indicator, Comparison, Outcome

• Infectious waste:
• Blood and blood products
• Pathology laboratory specimens
• Laboratory cultures
• Body parts from surgery
• Contaminated equipment (e.g., dialysis materials, suction receptacles)
• Injurious Waste:
• Needles
• Scalpel blades
• Lancets
• Broken glass
• Pipettes
• Aerosol cans
• Hazardous Waste:
• Radioactive materials
• Chemotherapy solutions
• Caustic chemicals

• C. difficile
• Norovirus
• wash hands after any contact with a patient with diarrhea

• Precautions:
• Private AIIR with adequate filtration; mask; mask worn by the patient during transport out of room
• Indications:
• Transmission via airborne route (small-particle droplets); tuberculosis, measles, varicella

• Precautions:
• Private room or cohabitation with the patient infected with same organism; mask required when working within 3 feet of the patient; mask worn by the patient during transport
• Indications:
• Transmission of large droplets through sneezing, coughing, or talking; Haemophilus influenzae, multidrug-resistant strains, Neisseria meningitidis, diphtheria, rubella, Mycoplasma pneumoniae

• Precautions:
• Private room or cohabitation with the patient infected with same organism; gloves at all times (don before entering room and remove before leaving) with change after exposure to organism; handwashing immediately after removal of gloves; gown and protective barriers when direct contact with organism occurs; daily cleaning of bedside equipment and patient care items; exclusive use of items such as stethoscope and sphygmomanometer for infected patient with terminal disinfection when precautions are no longer necessary
• Indications:
• Serious infections easily transmitted through direct contact; any multidrug-resistant strains, C. difficile, Shigella, impetigo, and others