Promoting Asepsis and Preventing Infection Chapter 20

Question 1

Infection

Answer 1

When microorganisms capable of producing disease invade the body

Question 2

The Spread of Infection: Six Links

Answer 2

1. germ is present
2. Has a place for it to live
3. Portal of exit
4. Mode of transmition
5. Portal of entry
6. Succeptible host

Question 3

How many links have to be present in order to break the cycle of infection

Answer 3

1

Question 4

Opportunistic

Answer 4

an infectious microorganism that normally does not harm a host but can cause disease when the hosts resistance is low

Question 5

Link 1- Infectious agents

Answer 5

Pathogens
normal flora that can become pathogenic

(Bacteria, fungus, virus, parasites)

Question 6

Link 2- Reservoir

Answer 6

Where the pathogens live and multiply. May be living or nonliving

Living= human, animals, insects
Non-living= foods, floors, equipment, contaminated water

Question 7

Link 3- Portal of exit

Answer 7

-Bodily fluids
•Coughing, sneezing,diarrhea
•Seeping wounds
•Tubes, IV lines

Question 8

Link 4- Mode of transmition

Answer 8

Contact
•Direct –touching,kissing, sexual contact

•Indirect –contact with afomite (sharing a drink)
Droplet: cough, sneeze
 Airborne: via air conditioning, sweeping

Question 9

Link 5- Portal of Entry

Answer 9

Eye, nares, mouth,vagina, cuts, scrapes
Wounds, surgical sites, IVor drainage tube sites
Bite from a vector

Question 10

Link 5- Suceptible Host

Answer 10

Person with inadequatedefense
Four determining factors
•Virulence
•Organism’s ability to survivein the host’s environment 
•Number of organisms
•Host’s defenses

Question 11

All infections no matter what kind all start out like a

Answer 11

cold

Question 12

What are the stages of an infection

Answer 12

=Incubation: 
Prodromal: 
Illness: 
Decline: 
Convalescence:

Question 13

=Incubation

Answer 13

from time of infection untilmanifestation of symptoms; can infect others

Question 14

Prodromal:

Answer 14

appearance of vague symptoms; notall diseases have this stage

Question 15

Illness:

Answer 15

signs and symptoms present

Question 16

Decline:

Answer 16

number of pathogens decline.
(important to finish all antibiotics because all of the bacteria is not all gone just because you feel better. It simply has declined)

Question 17

Convalescence:

Answer 17

tissue repair, return to health

Question 18

How are infections classified

Answer 18

By Local or systemic

Question 19

What is a local infection

Answer 19

Occurs in a limited region in the body
ex= urinary tract infection

Will be red warm swollen local fever

Question 20

What is a systemic Infection

Answer 20

and infection that spread via blood or lymph and affects many regions
ex septicemia

Will have temperature all over

Question 21

Acute Infection:

Answer 21

rapid onset of a short duration. Heals within a reasonable amount of time

ex common cold

Question 22

Chronic Infection:

Answer 22

Slow development, long duration….

example osteomyelitis

Question 23

Latent Infection:

Answer 23

Infection present with no discernible symptoms. It has hidden somewhere

Examples= HIV/AIDS, TB, MONO

Question 24

Healthcare-Related Infection

Answer 24

An infection acquired as a result of healthcare
Cost to the healthcare system = $4.5 billion/year
Leading cause of death
Preventable with use of aseptic principles/techniques

Question 25

Exogenous Healthcare-Related Infection:

Answer 25

Pathogenacquired from healthcare environment

ex= during a procedure- foley catheter contamination

Question 26

Endogenous Healthcare-Related Infection:

Answer 26

Normal floramultiply and cause infection as a result of treatment

ex= knowing who is an at risk person to develop a secondary infection. Staying on top of things

Question 27

What are the primary lines of defense against an infection

Answer 27

Anatomical features, limit pathogen entry
•Intact skin
•Mucous membranes (Breathing it in)
•Tears
•Normal flora in GI tract
•Normal flora in urinary tract

Question 28

Whar are the secondary lines of defense against an infection

Answer 28

Biochemical processes activated by chemicalsreleased by pathogens 
•Phagocytosis
•Complement cascade
•Inflammation
•Fever

Question 29

What are the tertiary Defenses against infection

Answer 29

1. Humoral immunity
   •B-cell production of antibodies in response to anantigen
2. Cell-mediated immunity
   •Direct destruction of infected cells by T cells

Question 30

What are some Factors That Increase Infection Risk

Answer 30

Developmental stage
Breaks in the skin
Illness/injury, chronic disease
Smoking, substance abuse
Multiple sex partners
Medications that inhibit/decrease immune response
Nursing/medical procedures

Adequate nutrition
•To manufacture cells of the immune system
Balanced hygiene
•Sufficient to decrease skin bacterial count
•Not overzealous; causes skin cracking
Rest/exercise
Reducing stress
Immunization

Question 31

Medical Asepsis

Answer 31

“A state of cleanliness that decreases the potentialfor the spread of infections”

Question 32

What can a nurse do to promote Medical Asepsis

Answer 32

-Maintaining a clean environment
•Maintaining clean hands
•Following Centers for Disease Control (CDC)guidelines

Question 33

What does it mean to maintain a clean environment

Answer 33

Clean spills and dirty surfaces promptly
Remove pathogens through chemical means(disinfect)
Remove clutter
Consider supplies brought to the client room ascontaminated
Consider items from the client’s home as contaminated

Question 34

When should you wash your hands

Answer 34

-When you arrive in the unit
When you leave the unit
Before and after restroom use
Before and after client contact
Before and after contact with client belongings
=Before gloving
 After glove removal
Before and after touching your face
Before and after eating
 After touching a contaminated article
When you see visible dirt on your hands

Question 35

How long should you wash your hands in a non surgical setting

Answer 35

Wash for at least 15 seconds in nonsurgical setting

Question 36

How long should you wash your hands in a surgical setting

Answer 36

2 –6minutes in surgical setting

Question 37

Standard Precautions

Answer 37

Protects healthcare workers from exposure
Decreases transmission of pathogens
Protects clients from pathogens carried by healthcare workers

Question 38

Contact Precautions

Answer 38

Pathogen is spread by direct contact

Sources of infection: draining wounds, secretions,supplies

Precautions include
•Possible private room
•Clean gown and glove use
•Disposal of contaminated items in room
•Double-bag linen and mark

Question 39

Droplet Precautions

Answer 39

Pathogen is spread via moist droplets

Coughing, sneezing, touching contaminated objects

Precautions include
•Same as those for contact
• Addition of mask and eye protection within 3 ft of client

Question 40

Airborne Precautions

Answer 40

Pathogen is spread via air currents

Transmission via ventilation systems, shaking sheets,sweeping

Precautions include
•Same as those for contact, with addition of special room,special mask, and mask for patient when transported

Question 41

What is protective isolation and what is it used for

Answer 41

“Protective Environment”

Protects the client from organisms
Used in special situations with immune-compromised clientpopulation

Precautions include
•Room with special ventilation and air filters; no carpeting; dailywet-dusting
• Avoiding standing water in the room (e.g., humidifier)
•Nurse not assigned to other clients with active infection
•Standard and transmission-based precautions, plus mask and other PPE (to protect patient)

Question 42

Implementing Surgical Asepsis Includes

Answer 42

Creation of a sterile environment
Use of sterile equipment/supplies
Sterilization of reusable supplies
Surgical hand scrub
Surgical attire
Sterile gloves
Sterile field
Use of sterile technique

Question 43

What is a pathogen?

Answer 43

Answer:

Pathogens are bacteria, viruses, fungi, and other organisms that cause disease.

Question 44

What is the role of normal flora?

Answer 44

Answer:

Normal flora are nonpathogenic microorganisms that help to control the growth of pathogenic microorganisms. Normal flora in the intestine also aid digestion and, when they die, release vitamins important to human health.

Question 45

Identify at least five reservoirs of infection.

Answer 45

Answer:

Potential answers include the following reservoirs of infection:

● Human body

● Animals

● Insects

● Food

● Floors in healthcare facilities

● Bathrooms

● Raw sewage

● Stagnant water

● Garbage

● Diapers

● Used wound dressings

Question 46

What kinds of microbes favor the human body as a reservoir of infection?

Answer 46

Answer:

The human body provides a warm, moist environment. The microbes that are pathogenic to humans are so because they thrive at about the same temperature as the human body. To thrive in the human body, microbes also must be able to use the body’s precise balance of moisture, nutrients, electrolytes, and pH to support their own reproduction.

Question 47

Specific immunity

Answer 47

a third line of defense, protects against specific pathogens and builds immune “memory” in the process. The humoral response produces antibodies that inactivate invading antigens. The cell-mediated response results in the production of T cells that destroy body cells infected with invaders.

Question 48

Mr. Jefferson has an acute infection. If lab work reveals that IgM, but not IgG, is present in his blood, what can you conclude about this infection?

Answer 48

Answer:

IgM is present the first time an individual is exposed to a particular pathogen. If IgG is not present, you can conclude that the exposure occurred less than 10 days ago.

Question 49

Under what circumstances are standard precautions used?

Answer 49

Answer:

Standard precautions are used on all clients whenever there is a possibility of coming in contact with blood, body fluids (except sweat), excretions and secretions, mucous membranes, and any break in the skin.

Question 50

If you needed to disinfect a sink in a client’s home, what would you use?

Answer 50

Answer:

A solution of 1 part household bleach and 50 parts water.

Question 51

When will you need to don sterile gloves using the closed method?

Answer 51

Answer:

When you are performing an activity that requires you to wear a sterile gown. The gloves must cover the gown cuffs.

Question 52

True or false: Some procedures require both standard precautions and sterile technique.

Answer 52

Answer:

Healthcare providers use sterile technique to perform a variety of procedures. Some of the procedures require full surgical attire; others do not. The following procedures, for example, use both sterile technique and principles of medical asepsis: administering an injection, starting an IV line, and performing a sterile dressing change. To clarify, when administering an injection, you prepare the patient, cleanse the injection site, and remove the needle cap using standard precautions. You do not don sterile gloves, but for the rest of the procedure you observe sterile technique by taking care not to touch or otherwise contaminate the exposed needle.

Question 53

What part(s) of a sterile field are considered to be unsterile?

Answer 53

Answer:

A 1-inch margin around the edges of the field and any material that hangs over the horizontal plane are considered unsterile. You may also recall that a field is no longer sterile if it becomes wet, if you turn your back on it, or if someone not wearing sterile garb comes within 1 foot of the field.

Question 54

A 64-year-old patient, has peripheral vascular disease. In assisting the patient to decrease her risk for infection, the clinic nurse would teach her to do which of the following?

Change her bath habits and only bathe twice a week
Begin an exercise program of yoga to decrease her stress
Eat a high-fiber, low-protein, low-calorie diet
Refuse the flu vaccine because it can be dangerous for her

Answer 54

Answer:

B. Begin an exercise program of yoga to decrease her stress

Rationale:

Research has shown a positive correlation between stress and a decrease in immune functioning. Bathing only twice a week would not be enough to remove potentially harmful surface bacteria. Nutrients are needed to produce the cells of the immune system. Because Mrs. Jones has a chronic illness, she should be encouraged to ask her healthcare provider for a flu shot; and flu vaccines are not considered dangerous.

Question 55

A patient who is HIV positive and immunocompromised develops an eye infection caused by the cytomegalovirus. The retinitis would be considered which of the following types of infection?

A. Endogenous infection

B. Primary infection

C. Vector infection

D. Secondary infection

Answer 55

Answer:

D. Secondary infection

Rationale:

The HIV infection is the primary infection. There is no vector involved in cytomegalovirus transmission, and it does not arise from the patient’s own flora.

Question 56

A patient comes to the physician’s office complaining of generalized malaise and states, “I just don’t feel well.” The nurse knows that the patient is in what stage of infection?

A. Decline

B. Illness

C. Prodromal

D. Convalescence

Which of the following is not included in the body’s secondary defense against a pathogen?

A. Lysozymes in the saliva in the mouth

B. Differentiation of monocytes into macrophages

C. Release of histamine and other chemical mediators

D. An oral temperature of 101.8°F (38.8°C)

Answer 56

Answer:

C. Prodromal

Rationale:

The prodromal stage is characterized by complaints of vague, nonspecific symptoms.

Answer:

A. Lysozymes in the saliva in the mouth

Rationale:

Answer:

C. Prodromal

Rationale:

The prodromal stage is characterized by complaints of vague, nonspecific symptoms.

Question 57

Which of the following is not included in the body’s secondary defense against a pathogen?

A. Lysozymes in the saliva in the mouth

B. Differentiation of monocytes into macrophages

C. Release of histamine and other chemical mediators

D. An oral temperature of 101.8°F (38.8°C)

Answer 57

Answer:

A. Lysozymes in the saliva in the mouth

Rationale:

Lysozymes are an example of the body’s primary defense.

Question 58

Which of the following actions violates a principle that is key to proper hand washing at the bedside?

A. Washing your hands for 1 minute

B. Shaking your hands dry over the sink

C. Using warm, not very hot, water

D. Using the soap provided by the agency

Answer 58

Answer:

B. Shaking your hands dry over the sink

Rationale:

Shaking your hands will not completely remove the excess moisture, allowing for the reacquisition of bacteria on the area. In addition, it splashes water into the environment, which could be contaminated with organisms from the hands.

Question 59

Secondary infections are one of the top 20 health problems in the United States.

True

False

Answer 59

Answer:

False

Rationale:

Healthcare-related infections are one of the top 20 health problems.

Question 60

A patient has acquired pneumonia after being hospitalized for 10 days. This is an example of a healthcare-related infection.

True

False

Answer 60

Answer:

True

Question 61

An example of an activity requiring contact precautions would be when the spread of an organism is thought to occur when sheets are fanned during bed making.

True

False

Answer 61

Answer:

False

Rationale:

Fanning sheets can lead to airborne transmission, requiring airborne precautions.

Question 62

The use of standard precautions protects both the nurse and the patient from infection due to the transmission of microorganisms.

True

False

Answer 62

Answer:

True

Question 63

1.A client exhibits all of the following during a physical assessment. Which of these is considered a primary defense against infection?

1) Fever
2) Intact skin
3) Inflammation
4) Lethargy

Answer 63

Answer:

2) Intact skin

Rationale:

Intact skin is considered a primary defense against infection. Fever, the inflammatory response, and phagocytosis (a process of killing pathogens) are considered secondary defenses against infection.

Question 64

2.A client with a stage 2 pressure ulcer has methicillin-resistant Staphylococcus aureus (MRSA) cultured from the wound. Contact precautions are initiated. Which rule must be observed to follow contact precautions?

1) A clean gown and gloves must be worn when in contact with the client.
2) Everyone who enters the room must wear a N-95 respirator mask.
3) All linen and trash must be marked as contaminated and send to biohazard waste.
4) Place the client in a room with a client with an upper respiratory infection.

Answer 64

Answer:

1) A clean gown and gloves must be worn when in contact with the client.

Rationale:

A clean gown and gloves must be worn when any contact is anticipated with the client or with contaminated items in the room. A respirator mask is required only with airborne precautions, not contact precautions. All linen must be double-bagged and clearly marked as contaminated. The client should be placed in a private room or in a room with a client with an active infection caused by the same organism and no other infections.

Question 65

3.A client requires protective isolation. Which client can be safely paired with this client in a client-care assignment? One

1) admitted with unstable diabetes mellitus.
2) who underwent surgical repair of a perforated bowel.
3) with a stage 3 sacral pressure ulcer.
4) admitted with a urinary tract infection.

Answer 65

Answer:

1) admitted with unstable diabetes mellitus.

Rationale:

The client with unstable diabetes mellitus can safely be paired in a client-care assignment because the client is free from infection. Perforation of the bowel exposes the client to infection requiring antibiotic therapy during the postoperative period. Therefore, this client should not be paired with a client in protective isolation. A client in protective isolation should not be paired with a client who has an open wound, such as a stage 3 pressure ulcer, or with a client who has a urinary tract infection.

Question 66

4.Which action demonstrates a break in sterile technique?

1) Remaining 1 foot away from nonsterile areas
2) Placing sterile items on the sterile field
3) Avoiding the border of the sterile drape
4) Reaching 1 foot over the sterile field

Answer 66

Answer:

4) Reaching 1 foot over the sterile field

Rationale:

Reaching over the sterile field while wearing sterile garb breaks sterile technique. While observing sterile technique, healthcare workers should remain 1 foot away from nonsterile areas while wearing sterile garb, place sterile items needed for the procedure on the sterile drape, and avoid coming in contact with the 1-inch border of the sterile drape.

Question 67

5.A mother who breastfeeds her child passes on which antibody through breast milk?

1) IgA
2) IgE
3) IgG
4) IgM

Answer 67

Answer:

3) IgG

Rationale:

The antibody IgG is passed to the child through the mother’s breast milk during breastfeeding. IgA, IgE, and IgM are produced by the child’s body after exposure to an antigen.

Question 68

6.What is the rationale for hand washing? Hand washing is expected to remove:

1) transient flora from the skin.
2) resident flora from the skin.
3) all microorganisms from the skin.
4) media for bacterial growth.

Answer 68

Answer:

1) transient flora from the skin.

Rationale:

There are two types of normal flora: transient and resident. Transient flora are normal flora that a person picks up by coming in contact with objects or another person (e.g., when you touch a soiled dressing). You can remove these with hand washing. Resident flora live deep in skin layers where they live and multiply harmlessly. They are permanent inhabitants of the skin and cannot usually be removed with routine hand washing. Removing all microorganisms from the skin (sterilization) is not possible without damaging the skin tissues. To live and thrive in humans, microbes must be able to use the body’s precise balance of food, moisture, nutrients, electrolytes, pH, temperature, and light. Food, water, and soil that provide these conditions may serve as nonliving reservoirs. Hand washing does little to make the skin uninhabitable for microorganisms, except perhaps briefly when an antiseptic agent is used for cleansing.