Promoting Asepsis and Preventing Infection Chapter 20 Flashcards Preview

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Flashcards in Promoting Asepsis and Preventing Infection Chapter 20 Deck (68):


When microorganisms capable of producing disease invade the body


The Spread of Infection: Six Links

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


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




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


Link 1- Infectious agents

normal flora that can become pathogenic

(Bacteria, fungus, virus, parasites)


Link 2- Reservoir

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

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


Link 3- Portal of exit

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


Link 4- Mode of transmition

•Direct –touching,kissing, sexual contact

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


Link 5- Portal of Entry

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


Link 5- Suceptible Host

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


All infections no matter what kind all start out like a



What are the stages of an infection




from time of infection untilmanifestation of symptoms; can infect others



appearance of vague symptoms; notall diseases have this stage



signs and symptoms present



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)



tissue repair, return to health


How are infections classified

By Local or systemic


What is a local infection

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

Will be red warm swollen local fever


What is a systemic Infection

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

Will have temperature all over


Acute Infection:

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

ex common cold


Chronic Infection:

Slow development, long duration....

example osteomyelitis


Latent Infection:

Infection present with no discernible symptoms. It has hidden somewhere

Examples= HIV/AIDS, TB, MONO


Healthcare-Related Infection

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


Exogenous Healthcare-Related Infection:

Pathogenacquired from healthcare environment

ex= during a procedure- foley catheter contamination


Endogenous Healthcare-Related Infection:

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


What are the primary lines of defense against an infection

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


Whar are the secondary lines of defense against an infection

Biochemical processes activated by chemicalsreleased by pathogens
•Complement cascade


What are the tertiary Defenses against infection

1. Humoral immunity
•B-cell production of antibodies in response to anantigen

2. Cell-mediated immunity
•Direct destruction of infected cells by T cells


What are some Factors That Increase Infection Risk

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
Reducing stress


Medical Asepsis

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


What can a nurse do to promote Medical Asepsis

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


What does it mean to maintain a clean environment

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


When should you wash your hands

-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


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

Wash for at least 15 seconds in nonsurgical setting


How long should you wash your hands in a surgical setting

2 –6minutes in surgical setting


Standard Precautions

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


Contact Precautions

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


Droplet Precautions

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


Airborne Precautions

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


What is protective isolation and what is it used for

“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)


Implementing Surgical Asepsis Includes

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


What is a pathogen?


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


What is the role of normal flora?


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.


Identify at least five reservoirs of infection.


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


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


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.


Specific immunity

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.


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?


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.


Under what circumstances are standard precautions used?


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.


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


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


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


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


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


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.


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


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.


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


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


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.


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


D. Secondary infection


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.


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)


C. Prodromal


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


A. Lysozymes in the saliva in the mouth



C. Prodromal


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


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)


A. Lysozymes in the saliva in the mouth


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


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


B. Shaking your hands dry over the sink


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.


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






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


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






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.






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


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






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


2) Intact skin


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.



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.


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


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.



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.


1) admitted with unstable diabetes mellitus.


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.



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


4) Reaching 1 foot over the sterile field


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.



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

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


3) IgG


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.



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.


1) transient flora from the skin.


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.