ASEPSIS

INFECTION invasion of body tissue by microorganisms and their growth there. Such microorganism is called infectious agent. Asymptomatic Infection if the microorganism produces no clinical evidence of disease Microorganism vary in their: o Virulence - microorganisms ability to produce disease o Severity of the disease they produce o Degree of communicability

Communicable Disease the resulting condition if an infectious agent can be transmitted to an individual by direct or indirect contact or as by airborne infection. Pathogenicity the ability to produce disease Pathogen microorganism that causes disease o True pathogen causes disease or infection to healthy individual o Opportunistic pathogen causes disease only to susceptible individual Asepsis freedom from disease causing microorganisms. o To decrease the possibility of transferring microorganisms from place to another, aseptic technique is used.

2 BASIC TYPE OF ASEPSIS a. Medical Asepsis includes all the practices intended to confine a specific microorganism to a specific area, limiting the number, growth and transmission of microorganisms. Objects referred to as Clean, which means the absence of almost all microorganisms, or Dirty (soiled, contaminated), which means likely to have microorganisms some of which maybe capable of causing infection.

b.

Surgical Asepsis or sterile technique, refers to those practices that keep an area or object free of all microorganisms It includes all the practices that keep an area or object free of all microorganisms It includes practices that destroy all microorganism and spores (microscopic dormant structures formed by some pathogens that are very hard and often survive common cleaning techniques). Used for all procedures involving the sterile areas of the body.

Sepsis state of infection and can take many forms, including septic shock Normal Flora or resident normal flora refers to flora that normally inhibit certain areas of the body without causing infection

TYPES OF MICROORGANISMS CAUSING INFECTIONS Bacteria - the most common infection - causing microorganisms. o Several hundred species can cause disease in humans o Can live and transported through air, water, food, soil body tissue and fluids and inanimate objects Viruses consist primarily of nucleic acid and therefore must enter living cells in order to reproduce. Common virus families include the rhinovirus (virus that causes common cold), hepatitis, herpes, and HIV Fungi include yeast and molds. Candida albicans is a yeast considered to ba a normal flora in the human vagina Parasites live on other microorganisms. They include protozoa such as one that causes malaria, helminthes (worm), and antropodds (mites, fleas and ticks)

TYPES OF INFECTIONS Colonization the process by which strains of microorganism becomes resident flora. In this state, microorganism may grow and multiply but not cause disease.

Infection occurs when newly introduced or resident microorganism succeed in invading a part of the body where the hosts defense mechanism are ineffective and pathogen causes tissue damage. Infection becomes a disease when the signs and symptoms of the infection are unique and can be differentiated from other condition

Local Infection limited to specific part of the body where the microorganisms remain. Systemic Infection when the microorganism spread and damage different parts of the body Bacteremia condition when the culture of the patients blood reveals microorganism Septicemia when the bacteremia results in systemic infection A systemic condition resulting from the invasion of the body by living pathogenic organism and their persistence and multiplication in the blood stream

Acute infection generally appear suddenly or last a short time Chronic infection may occur slowly, over a very long period, and may last months or years

NOSOCOMIAL INFECTIONS - Classified as infections that are associated with the delivery of health care services in a health care facility - Can either develop during the clients stay in the facility or manifest after discharge - May also be acquired by personnel working in the facility and can cause significant illness and time lost from work (ex. PTB, Hepatitis) - Most common setting where nosocomial infection are hospital surgical or medical ICU. (JCAHO) - Urinary tract, respiratory tract, blood stream and wounds are the most common nosocomial infection (NNIS) - Microorganism that cause infections can originate from clients themselves (endogenous source) or from hospital environment and hospital personnel (exogenous source) Not all nosocomial infections are iatrogenic, nor are all nosocomial infections preventable

Iatrogenic Infection- direct result of diagnostic or therapeutic procedures (Ex. Bacteremia that result from intravascular line)

Most Common Microorganism Urinary tract E. Coli

Causes

Improper catheterization technique

Enterococcus Species Pseudomonas aeruginosa Surgical Sites Staphylococcus aureus Enterecoccus species Pseudomonas aeruginosa Blood stream Coagulase-negative staphylococci

Contamination of closed drainage system Inadequate hand cleansing

Inadequate hand cleansing Improper dressing change technique

Inadequate hand cleansing

Staphylococcus aureus Enterecoccus species

Improper IV fluid, tubing, site care technique

Pneumonia Staphylococcus aureus Pseudomonas aeruginosa Enterobacter species Inadequate hand cleansing Improper suctioning technique

CHAIN OF INFECTION Etiologic agent (microorganism) The extent to which any microorganism is capable of producing infectious process depends on: a. b. c. d. e. Number of microorganism The virulence and potency of the microorganisms (pathogenicity) Ability of microorganism to enter the body Susceptibility of the host Ability of the microorganism to live in the hosts body

Reservoir (source) Sources of microorganism Anything that provides a place for infectious agent to multiply and live and from which such agents can transmit an infection to susceptible host Common sources are other human, clients own microorganisms, plants, animals or other general environment Carrier a person or animal reservoir of a specific infectious agent that usually does not manifest any clinical signs of disease

Portal of Exit from Reservoir Before an infection can establish itself in a host, the microorganism must leave the reservoir. (Ex. Nose or mouth through sneezing, coughing or breathing)

Method of Transmission After a microorganism leaves its source or reservoir, it requires a means to reach other person or host through a receptive portal of entry. There are three mechenisms: a. Direct Transmission involves immediate and direct transfer of microorganisms from person to person through touching, biting, kissing, or sexual intercourse - Droplet spread is also a form of a direct transmission but can occur only if the source and the host are within 3 feet of each other. - Sneezing, coughing, spitting, or talking can project droplet spray into conjunctiva or onto the mucous membrane of the eye, nose, mouth of another person Indirect Transmission maybe either vehicle-borne or vector-borne. Vehicle-borne transmission Vehicle is any substance that serves as an intermediate means to transport and introduce an infectious agent into a susceptible host through a suitable portal of entry.

b.

- Fomites (inanimate materials or object) such as handkerchiefs, toys, utensils can act as a vehicle. Other forms are water, blood, food, and plasma. - Ex. Food or water may become contaminated by a food handler who carries Hepa A virus. The food is ingested by susceptible host.

Vector-borne transmission a vector is an animal or flying or crawling insect that serves as an intermediate means of transporting the infectious agent Transmission may occur by injecting salivary fluid during biting or by disposing feces or other materials on the skin through a bite wound or traumatized skin area c. Airborne Transmission involves droplet or dust Droplet nuclei- the residue of evaporated droplets emitted by an infected host such as someone with tuberculosis, can remain in the air for lonh periods The material is transmitted by air currents to a suitable portal of entry usually the respiratory tract of another person.

Portal of Entry to the Susceptible Host Before a person can become infected, microorganisms must enter the body. The skin is the barrier of the infectious agent: however, ant break of the skin can serve as the portal of entry Often, microorganisms enter the body of the host by the same route they used to leave the source.

Susceptible Host - Any person who is at risk for infection. - Compromised host a person at increased risk, an individual who for one or more reason is more likely than the others to acquire an infection.

Etiologic Agent (Microorganism )

Susceptible host

Reservoir (Source)

Portal of entry to susceptible host

Portal of exit from reservoir Method of transmission

BODY DEFENSES AGAINST INFECTION Nonspecific defense protects the person against all microorganisms regardless of prior exposure - Includes anatomic and physiologic barriers and the inflammatory response

Specific (Immune) defenses directed against identifiable bacteria, viruses, fungi or other infectious agents

a.

Anatomic and Physiologic Barriers - Intact skin and mucous membranes are the bodys first line of defense against microorganism, unless skin and mucosa become cracked and broken - Fungi can live on the skin but cannot penetrate it - Bacteria are most plentiful in moist area of the body such as the perineum and axillae. - Resident bacteria of the skin also prevent other bacteria from multiplying - Normal secretions make skin slightly acidic; acidity also inhibit bacterial growth - Nasal passages have defensive function. As entering air follows the tortuous route of passage, it comes contract with mucous membranes and cilia. These trap microorganism, dust and foreign materials - Saliva contains microbial inhibitors that help prevent infections - The eye is protected from infection by tears which continually wash microorganisms away - GI: high acidity of the stomach normally prevents microbial growth - The resident flora of the large intestine help prevent the establishment of disease producing microorganism - Peristalsis also tends to move microbes out of the body - Vagina: vaginal secretion increases the pH makes it more acidic to fight the bacteria - Urine flow has a flushing and bacteriostatic action that keeps the bacteria from ascending the urethra.

Inflammatory Response Inflammation local and non-specific defensive response the tissues to an injurious or infectious agent. It is an adaptive mechanism that destroys or dilutes the injurious agents, prevents further spread of the injury and promote the repair of damaged tissue. Characterized by five signs: pain, swelling, redness, heat and impaired function of the part Injurious agents can be categorized as: a. b. c. Physical agents - mechanical agents causing trauma to tissues, excessive heat or cold, and radiation Chemical agents include external irritants (ex. Strong acids, poisons, irritating gases) and internal irritants (substance manufactures within the body such as excessive hydrochloric acid in the stomach) Microorganisms include broad groups of bacteria, viruses, fungi and parasites.

3 STAGES OF INFLAMMATORY RESPONSE First Stage: Vascular and cellular Response Second Stage: Exudate production Third Stage: Reparative Phase

SPECIFIC DEFENSES TYPES OF IMMUNITY 1. Active Immunity - the host produces antibodies in response to natural antigen (infectious microorganism) or artificial antigens (ex. Vaccines). Long duration. a. Natural Antibodies are formed in the presence of active infection in the body. Life long duration (ex. Chickenpox) b. Artificial Antigens (vaccines or toxoid) are administered to stimulate antibody production. Duration is for many years and the immunity must be reinforced by booster (ex. Hepa B vaccine) Specific defenses of the body involve the immune system Antigen substance that induces a state of sensitivity or immune responsiveness (immunity) Auto antigen antigen originate in a persons own body

2.

Passive Immunity (acquired immunity) the host receive natural (ex. From a nursing mother) or artificial (from an injection of immune serum) antibodies are produced by another source Antibodies are produced by another source, animal or human. Short duration a. b. Natural antibodies are transferred naturally from an immune mother to her baby through the placenta or colostrums. Duration is 6 months to 1 year Artificial immune serum (antibody) from an animal or human is injected. Duration is 2 to 3 weeks.

FACTORS INCREASING SUSCEPTIBILITY TO INFECTION Host susceptibility age, heredity, level of stress, nutritional status, current medical therapy, preexisting disease process Age influences the risk of infection newborns and older adults have reduced defense against infection. Infection is the major cause of death of the newborns because of immature immune system Infants are protected for 2-3 months because of immunoglobulin passively received from the mother. Between 1-3 months of age, infants begin to sysnthesize their own immunoglobulins Elders immune response become weak Heredity influences the development of infection in that some people have genetic susceptibility to certain infection The nature, number and duration of physical and emotional stressors can influence susceptibility to infection. Resistance to infection depends on adequate nutritional status Medical therapies predispose a person to infection Certain medication also increase susceptibility to infection Certain antibiotics can also induce resistance in some strains of organisms Any disease lessens the bodys defense against infection places the client at risk

NURSING MANAGEMENT ASSESSMENT Localized swelling Localized redness Pain or tenderness with movement Palpable heat at the infected area Loss of function of the body part affected, depending on the site and extent of involvement Fever Increased pulse and respiratory rate Malaise and loss of energy Anorexia and in some situations, nausea and vomiting Enlargement and tenderness of lymph nodes that drain the area of infectin

LABORATORY DATA Elevated leukocyte (WBC) count (NV: 4,500-11000/ml) Elevated erythrocyte sedimentation rate (ESR) RBC Urine, blood, sputum or other drainage culture indicate presence of pathogenic microorganism

NURSING DX Inadequate primary defenses- ex. Broken skin Inadequate secondary defenses ex. Immunosuppression Potential Complication of Infection: Fever Imbalanced nutrition: Less than body requirements- if the client is too ill to eat adequately Acute Pain Impaired Social Interaction/Social Isolation Anxiety

PLANNING The major goals for clients susceptible for infection are: Maintain and restore defense Avoid the spread of infectious organism Reduce or alleviate problems associated with the infection

IMPLEMENTING NURSING INTERVENTION THAT BREAK THE CHAIN OF INFECTION 1. Etiologic Agent Ensure that all articles are correctly cleaned and disinfected or sterilized before use. Educate clients and support persons about appropriate methods to clean, disinfect, and sterilized articles

2. Reservoir Change dressings and bandages when they are soiled or wet Assist clients to carry out appropriate skin and oral hygiene Dispose of damp, soiled linens appropriately Dispose of feces and urine in appropriate receptacles Ensure that all fluid containers, such as bedside water jugs and suction and drainage bottles are covered or capped

3.

Portal of Exit from the reservoir Avoid talking, coughing or sneezing over open wounds or sterile fields, and cover the mouth and nose when coughing and sneezing

4.

Method of Transmission Cleanse the hands between clients contacts, after touching body substances, and before performing invasive procedures or touching open wounds Instruct clients and support persons to cleanse hand before handling food or eating, after eliminating, and after touching infectious material Wear gloves when handling secretions and excretions Wear gown if there is danger of soiling clothing with body substances Place discarded soiled materials in moisture-proof refuse bags Hold used bedpans steadily to prevent spillage and dispose of urine and feces in appropriate receptacles Initiate and implement aseptic precautions for all clients Wear mask and eye protection when in close contact with clients who have infections transmitted by droplets from the respiratory tract Wear mask and eye protection when in close contact with clients who have infections transmitted by droplets from the respiratory tract Wear mask and eye protection when sprays of body fluids are possible

5.

Portal of Entry Use sterile technique for invasive procedures Use sterile technique when exposing open wounds or handling dressings Place used disposable needles and syringes in puncture resistant containers for disposal

6.

Susceptible Host Maintain the integrity of the clients skin and mucous membranes Provide all clients with their own personal care items Ensure that the client receives a balanced diet Educate the public about the importance of immunization

DISINFECTING AND STERILIZING Antiseptics agents that inhibit the growth of some microorganism Disinfectants agents that destroy pathogens other than spores Sterilization process that destroys all microorganisms, including spores and viruses a. b. Moist Heat steam under pressure is used because it attemps temperature higher than the boiling poin Gas Ethlene oxide destroy microorganism