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chapter 41 Medical Asepsis
Terms in this set (51)
a chemical that decreases the number of pathogens in an area by suppressing and destroying their growth.
Refers to practices that minimize or eliminate organisms that can cause infection and disease
Generalized bacterial infection in the blood
normally occurring or existing within the body or in the community .
referring to organisms that enter from outside the body and cause infection .
term used to describe surgery and some diagnostic tests that involve an incision or puncture though the skin , insertion of an instrument (such as an endoscope),or injection of a foreign substance ( such as dye ) into the body ; quickly spread widely throughout the body , such as invasive cancer.
practice of reducing the number of microorganisms or preventing and reducing transmission of microorganisms from one person (source) to another ;also referred to as "clean technique".
safety precaution designed for the care of all clients regardless of diagnosis or infection status.
PPE Personal protective equipment
Barrie techniques include the use of personal protective equipment PPE : gloves , eye protection ,grows , and masks . Reasons for wearing PPE are to keep organisms from entering or leaving the nurse or client's respiratory tract , eyes ,or breaks in the skin. they also help protect the nurse from the client 's body fluids .
standard precaution include
*maintenance of the nurse's personal immunizations; do not work if you are ill
*frequent thorough handwashing (with soap and water or antibacterial solution)
*wearing gloves and other protective equipment as needed
* handling all sharps safely (never recap or break off a needle; dispose of all sharps in the designated container)
*proper disposal/cleanup of all linens, used equipment , medication packages, and biohazardous materials.
*surface disinfection as needed .
*maintenance of sterility of needles, catheters, and so forth .
*use of mouthpieces for resuscitation .
*private rooms for infectious patients
*wearing mask and other PPE for lumbar punctures
what are the kinds of asepsis ?
medical and surgical.
refers to the practice of reducing the number of microorganisms . medical asepsis is a clean technique
on the other hand , aims to destroy all organisms and is used only in certain situations .
what does the a in asepsis mean?
without or minimize or eliminate pathogenic organisms .
Why is nosocomial infections a serious problem for healthcare facilities?
there are infections that clients acquire while in the facility.
Healthcare personnel may contribute to development of nosocomial infection . For example;
*failure to follow Standard Precautions, particularly adequate hand washing; the chain of infection is not interrupted
*inadequate use of protective equipment
* multiple personnel provide care for a client , thus increasing the client's possibility of exposure to pathogens.
*healthcare personnel care for multiple clients' thus increasing possibily cross-contamination..
*inadequate performance of procedures; such as injections, the caring for IV catheters, possibly introducing pathogens
nosocomial infection are easily preventable .
Common Nosocomial infections
*Genitourinary infection 40%
*Bacteremias (generalized bacterial infection ) 14%
* surgical site infections 17%
*Respiratory infections (may be secondary to ventilator use or emergency intubation) 13%
present within the person's body ,microorganisms cause infection.
from outside the body ,microorganisms are responsible
cause most of today's nosocomial infections.
Infections can occur when a person 's resistance (ability to fight off pathogens) is low .Several factors can contribute to this :
*Trauma -Injury or illness lowers the body's resistance
*Age- The very young and the very old have reduced denfenses
*Inactivity-The person who is ill usually does not get much exercise, which weakens the body's defenses
*pre-existing disease, generally poor health or frequent illness; infection or chronic illness lowers the body's defenses
*Poor nutrition /inadequate hydration. The ill person may be malnourished, dehydrated (not enough fluid in tissues or circulation), or overhydrated (too much fluid, fluid retention).Lack of protein hinders the immune system in tissue repair and production of antibodies. Impaired skin integrity is often present , as well as inadequate circulation.
*Stress or emotional shock. Increased stress increases the body's cortisone levels, reducing resistance to disease(sometimes by immunosuppression)
*Fatigue .The person who is extremely tired cannot effectively fight off disease .
*Invasive therapy .The term invasive means any therapy that enters or invades the body (by a means other than normal), through a break or incision , an instrument that enters an otherwise sterile area. Examples of invasive therapy include surgery , injections, intravenous therapy , urinary catheterization ,and tracheostomies (a tube inserted into the trachea to open an airway).
*Frequent use of broad-spectrum antibiotics. Microorganisms in a person's body may develop resistance to antibiotic therapy after repeated exposure to the same antibiotic. Those antibiotics are later ineffective against the resistant pathogen.
*Inappropriate use of antibiotics- not finishing antibiotics, taking left overs, or unnecessarily prescribed antibiotics>This lead to development of resistant strains of pathogens.
*Inadequate primary and secondary defenses.The body's primary defenses may be altered because of break in the skin ,low white blood cell count, an autoimmune disorder, or diminished lung function.
*Immunosuppressive situations . The client's immune system may be inadequate as a result of chemotherapy for cancer or bone marrow transplant, administration of high doses of steroids to reduce inflammation , radiation, or an autoimmune disorder such as AIDS or agammaglobulinemia.
Breaking the chain of infection ,Use of Standard Precautions in all nursing care is an important factor in controlling the spread of infection .
*Causative agent .Administering antibiotic medications using proper procedure; careful handwashing or sanitization .
*Reservoir for growth of pathogens . Properly disposing of contaminated dressings or body fluids ; disposing spills ; keeping personal immunization up to date ; using disposable equipment and material ; discarding broken sterile packages ; not wearing jewelry , artificial fingernails , or nail polish ; and proper handwashing or sanitization.
*Portal of exit . The nurse gives special attention to respiratory and gastrointestinal tract and body fluids . keeping wounds covered ,encouraging safe sex ,following correct isolation techniques , and proper handwashing or sanitization .
*Vehicle of transmission- proper use of PPE, proper disposal of any body fluids,
*PORTAL OF ENTERY .Correct nursing procedures help prevent pathogens from entering a client's system . Protective isolation protocol; cleansing from clean to dirty when giving perineal care ; use correct sterile technique ; and careful handwashing or sanitization .
*Susceptible host .Nursing actions are aimed at increasing client resistance include promoting adequate nutrition, hydration, exercise, and rest
*Client history- a careful history is obtained on admission to a healthcare facility.
Infection control committee , functions are
* watchfulness for any HAIs
*Investigation of any infection
*compiling statistics regarding nosocomial(HAI) events
*teaching staff , client , and families infection prevention
*serving as a liaison between the facility and the community
*identifying and monitoring community or worldwide infections, assisting in their management, and planning for possible local cases
long wash of the hands lathering of the at least twice and careful cleaning of the fingernails .its used .
*at the beginning and end of each shift , after using the restroom, or taking a meal break
*when hands are visibly soiled
*if you have touched blood or body fluids without gloves
short wash of the hand is required at all times .wash for at least 15 seconds, and with a 10 second rinse ,15 seconds is how long it takes to sing Yankee Doodle .
Reasons for handwashing ;
*reducing flora on the nurse's skin
*protecting the nurse in case his or her skin is not intact
*reducing risk if gloves break or are punctured
*reducing chances of disease transmission
CDC recommends handwashing in the following situations;
*when hands are visibly soiled
*before and after contacts with all clients
*after contact with a source of microorganisms
ex. blood /body fluids including specimens or mucous membrane, nonintact skin, or contaminated objects
*before and after performing invasive procedures
*before removing gloves if they are visibly soiled and each time after removing gloves
Handwashing is the most important procedure to;
protecting yourself and your client against disease transmission.
are the most commonly used protective item and must be worn for any client care with potential exposure to body fluids. gloves greatly reduce hand contamination and provide a protective barrier when touching any body fluids. Gloves help prevent the spread of pathogens from one person to another. *the nurse must always wear gloves if there's breaks in the skin.
integrity of gloves is altered ,ripped or punctured
gloves are no longer effective and must be discarded .wear gloves for procedure change your gloves if they might not be intact .***Remember ;the use of gloves does not eliminate the need for frequent careful handwashing .
repeated exposure to latex heightens the reaction for sensitive individuals.
there are three levels of latex sensitivity;
1 skin irritation
2 contact dermatitis
3 generalized anaphylaxis
1.Put on the mask before the gloves
2.Do not touch the mask until it is to be removed .
3.The mask must be changed when moist or soiled .
4. Wash hands and remove gloves before removing the mask.
5.Handle masks by the strings or elastic only .
6.Dispose of a used mask immediately .
7.Do not leave a mask dangling around the neck .
wear goggles with side and forehead shields if any danger exits that a client's body fluids may splash or spray. In situations when there's extra protection needed such as O.R, E.R, or morgue, full protection shields are used( protects eyes, forehead, and mouth)
Gowns or Aprons , A fluid-resistant gown or protective apron is worn to keep the nurse's clothing clean ,Follow these pointers when using gowns or aprons;
1.The inside of the gown or apron is clean; the outside is contaminated .
2.The gown or apron must be long enough to cover the nurse's uniform or clothing The apron covers the front and sides, but not the sleeves . The gown or apron opens in the back and must be full enough to overlap at the back .A tie around the waist keeps the garment in place .
3.The neck of the garment is considered clean because the nurse does not touch that part with contaminated hands.
4.If the nurse is wearing long sleeves, the sleeves are rolled up above the elbow before putting on the gown.
5.A supply of clean gowns or apron is ready outside the client's room
6.After use ,remove the garment and dispose of it inside out (contaminated side in).Place a disposable garment in the receptacle for contaminated material or the specific linen hamper. do not hang and reuse this garment, it is contaminated
7.After remove any protective garment , wash the hands thoroghly
Removal of Personal Protective Equipment
*remove mask by touching only the string tied behind the head .
*remove eye protection without touching the face.
*wash hands .
*remove gown ,touching only the inside ; turn it inside out to contain contamination.
*properly dispose of all PPE .
*wash hands .
Accidental Needlesticks or other Contamination.
If this occurs ,follow these procedures;
1.immediately wash the area thoroughly with germicidal soap and water.
2.encourage bleeding from this puncture wounds, if possible.
3.report the incident to the employee health service or safety officer immediately. an exposure risk assessment will be done .
4.fill out an incident report.
5.blood tests of the client and nurse will usually be performed.
6.the nurse may be required to take medication as postex-posure prophylaxis.
if material is splashed into the eyes or mouth, wash with copious amounts of water. report as above .
Clean and Controlled Environment, using Antimicrobial Agents
Chemical that decrease the number of pathogens are antimicrobial agents. They limit and eliminate pathogens by suppressing and destroying their growth.
handwashing guidelines ,wash with soap to remove soil in these situations;
* at the beginning of work shift and when returning from breaks , whenever leaving the unit .
*routine client care
*before and after client contact
*when hands are visibly soiled
*if any possibility of fecal contact even if not visible
*after contact with any source of microorganisms
*after removing gloves
perform hand antisepsis, using antimicrobial soap or detergent or alcohol-base handrub, to remove or destroy transient microorganisms in the following situations;
*before contact with severely immunocompromised clients and all newborns
*after caring for an infected client or one likely to be colonized with microorganisms of epidemiologic concern
*before and after contact with clients in high-risk units
Risk for nurses after exposure to diseases such as ;
tuberculosis or hepatitis are of concern. a yearly TB skin test(purified protein derivative, PPD; TST, tuberculin skin test) has to be taken
Recommended immunizations for healthcare personnel
Hepatitis b ,Measles/mumps/rubella(MMR) ,Poliovirus ,Tetanus every 10 years or serious injury ,diphtheria given with initial tetanus immunization ,Influenza yearly ,Pneumococcal disease once for life ,Meningococcal disease once for life ,Purified protein derivative (PPD)test for tuberculosis (tb) once a year to detect exposure or active TB
cleaning up spills biohazardous or biomedical wastes , as blood ,urine , feces , ect and used tissues
1. wear gloves
2,follow facility protocols for cleaning and sanitizing the area
3.dispose of contaminated material and supplies immediately
4.sanitize the area as specified by your facility
5.carefully wash your hands with soap and water
6.call specialists must clean up spills on carpeting or upholstery.
leaving client's room .keep in mind the following :
*use general handwashing techniques,keeping finger tips down
*do not touch any of the sink or faucets with hands, scrub hands thoroughly
*use paper towels to dry the hands and discard them in the appropriate waste container.
*use a dry towel to turn off faucets .
refers to cleaning the client's unit after the client moves to another room, is discharged, or dies. Anything that touched the client is contaminated and must be decontaminated or sterilized if used for another client. most personal care items are discarded. think before doing any nursing care to prevent contamination or spreading microorganisms.
medical asepsis vs. standard precautions
standard precautions are the guidelines and medical asepsis is the practice of those guidelines
some ppl are more likely to develop latex sensitivity than others. Be watchful of person with a history of:
*Multiple surgeries and other invasive procedures
*Genitourinary birth defects
*Allergies to certain foods (rich fruits such as, bananas, kiwi, avocados; other fruits such as peaches, pears, cherries, and pineapple; chestnuts)
*frequent use of gloves
mask help protect the client and healthcare personnel from upper respiratory infections, respiratory disorders, and certain communicable diseases. ex. a client coughing or sneezing, a mask is worn by the nurse and the client may be required to wear a mask.
types of mask
*simple mask-screens out large particles
*particulate mask or respiratory mask-fitted to each nurse and is designed to filter out very small particles ex. tubercle bacillus
the particulate mask is denser and fitted tighter to the face than simple mask that are more commonly used
disposing of biohazardous waste
the nurse in responsible for properly disposing of all materials, place in red biohazard bags; the nurse in a community based setting or in home care is responsible for disposal of biohazardous wastes and for teaching clients and families how to dispose of them as well.
lowers surface tension of oil on skin, which holds microbes EX. dial, safeguard; hygiene; common bar of soap, easily contaminated
same as soap, except detergents do not form precipitate with water ex. dreft, tide; sanitizing eating utensils, laundry; dries quickly, disinfects as it drys
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