LECTURE REVIEW CHAPTER 12 MEDICAL-SURGICAL ASEPSIS AND INFECTIONS CONTROL AND PREVENTION ASEPSIS - ABSENCE OF PATHOGENIC MICROORGANISMS CATEGORIES:

A. MEDICAL ASEPSIS - (YOU DO THIS AT HOME) AKA CLEAN TECHNIQUE. (INHIBITS GROWTH AND SPREAD OF PATHOGENIC MICROORGANISM) HAND WASHING B. SURGICAL ASEPSIS - DESTROYS ALL MICROORGANISMS AND THEIR SPORES. AKA STERILE TECHNIQUE (USED IN A SPECIALIZED AREA/SKILLS) WHERE/WHEN DO WE USE STERILE TECHNIQUE? A. SURGICAL WOUNDS B. CATHETER INSERTION C. INVASIVE PROCEDURES D. SURGERY WHAT IS A SPORE?? REPRODUCTIVE CELL OF MICROORGANISMS - SPECIALIZED STRUCTURE. - ROUND BODY FORMED BY BACTERIUM ( WHEN CONDITION IS NOT FAVORABLE FOR GROWTH) SURROUNDED BY CAPSULE. - REMAINS DORMANT UNTIL ENVIRONMENT BECOMES FAVORABLE FOR GROWTH. - INCREASE RESISTANCE, PROTECTS BACTERIA ( CAPSULE) - CAPSULE FORMATION = MUTI DRUG RESISTANCE. *** ANY PATIENT ENTERING HEALTH CARE FACILITY IS AT GREATER RISK OF DEVELOPING AN INFECTION. WHY?? A. LOWERED RESISTANCE B. EXPOSURE C. INVASIVE PROCEDURE INFECTION 6 CYCLE OR CHAIN OF EVENTS: 1. 2. 3. 4. 5. 6. PATHOGEN - INFECTIOUS AGENT - (VIRUS, BACTERIA, FUNGUS) RESERVOIR - WHERE PATHOGEN CAN GROW EXIT ROUTE FROM RESERVOIR (SECRETIONS) METHOD OF TRANSMISSION (HANDS, NEEDLES) ENTRANCE - (MOUTH, BREAK IN SKIN AND MUCOUS MEMBRANE) HOST- ANOTHER PERSON

*** TO PREVENT SPREAD OF DISEASE, CYCLE MUST BE INTERRUPTED *** DAILY PRACTICE OF MEDICAL ASEPSIS (CLEAN TECHNIQUE) INHIBIT OR STOPS THE GROWTH. PATHOGENIC MICROORGANISMS - INFECTIOUS AGENTS, REQUIRES FOOD FOR GROWTH, SUITABLE ENVIRONMENT. IDEAL AREA FOR PATHOGENIC GROWTH : 1. UNWASHED HANDS 2. WOUND DRESSING 3. SOILED LINEN 4. DECAYING TEETH

BACTERIA : HAS DIFFERENT SHAPES : ROUND, OBLONG AND SPIRAL. HAS DIFFERENT CHEMICAL COMPOSITIONS, REQUIRES DIFFERENT NUTRIENTS AND FORMS DIFF WASTE PRODUCTS. VIRUSES : INTERRUPT CELL ACTIVITY, USE CELL MATERIALS TO REPRODUCE. RUNS A COURSE AND RECOVERY USUALLY OCCURS. EXCEPT WITH RABIES AND AIDS. COMMON COLDS (VIRUS) - NO CURE, MEDICINE ONLY RELIEVES DISCOMFORT. FUNGI: MOST COMMON DISEASE FOUND IN HUMANS. YEAST, MOLDS. RING WORM, ATHLETES FOOT. FATAL : HISTOSPLASMOSIS FACTORS AFFECTING IMMUNOLOGIC DEFENSE MECHANISM A. STRESS B. INCREASE AGE OR EXTREME YOUTH C. NUTRITIONAL STATUS D. HEREDITARY FACTORS E. DISEASE PROCESS F. ENVIRONMENTAL FACTORS G. MEDICAL THERAPY H. CHEMOTHERAPY I. RADIATION J. LIFESTYLE K. OCCUPATION L. TRAUMA M. DIAGNOSTIC PROCEDURES N. TRAVEL HISTORY STAGES OF INFECTIOUS PROCESS 1. INCUBATION PERIOD - ENTRANCE OF PATHOGEN TO THE BODY AND APPEARANCE OF FIRST SYMPTOM. EX. CHICKEN POX 1-3 WEEKS, COMMON COLD 1-2 DAYS, INFLUENZA 1-3 DAYS. 2. PRODROMAL STAGE - FROM ONSET OF NONSPECIFIC SIGNS AND SYMPTOMS (FATIGUE, MALAISE) TO MORE SPECIFIC. (MICROORGANISMS MULTIPLY, PT IS MORE CAPABLE OF SPREADING DSE) 3. ILLNESS STAGE - SHOWS SIGNS AND SYMPTOMS SPECIFIC TO TYPE OF INFECTION. (COMMON COLD: SORE THROAT, CONGESTION.) 4. CONVALESCENCE - ACUTE SYMPTOM OF INFECTION DISAPPEAR. RECOVERY (DEPENDS ON HOW BAD YOUR INFECTION IS, RECOVERY TAKES FROM SEVERAL DAYS TO MONTHS.) READ PAGE 274 TABLE 12-2 HEALTH CARE ASSOCIATED INFECTIONS VIRULENT - HIGHLY PATHOGENIC OR RAPIDLY PROGRESSIVE CONDITION. (HOSPITALS HAS THESE KINDS OF MICROORGANISMS) PREVENTION - HAND HYGIENE AND ENVIRONMENTAL CLEANING.

HOSPITALS OR OTHER HEALTH FACILITIES HAS THEIR OWN INFECTION CONTROL DEPARTMENT. HEPATITIS B OR SERUM HEPATITIS INFECTION IS THE MOST COMMONLY TRANSMITTED BY CONTAMINATED NEEDLES. TITER - LAB TEST THAT MEASURE THE AMOUNT OF ANTIBODY IN THE BLOOD STREAM. STANDARD PRECAUTION - SET OF INFECTION CONTROL PRACTICES USED TO PREVENT TRANSMISSION OF DISEASE. - DESIGN TO REDUCE THE RISK OF TRANSMISSION OF MICROORGANISMS FROM BOTH RECOGNIZED AND UNRECOGNIZED SOURCES OF INFECTION. HAND HYGIENE - WASH HANDS BEFORE AND AFTER. WASH HANDS - 15- 30 SECONDS BOX 12-5 PAGE 277 REVIEW SKILLS ON PAGE 278 SKILL 12-1 LATEX ALLERGY - REACTION TO CERTAIN PROTEINS FOUND IN NATURAL RUBBER LATEX. LATEX PROTEINS ARE ABLE TO ENTER BODY THROUGH SKIN, MUCOUS MEMBRANES, INHALATION AND INTRAVASCULARLY. SIGNS AND SYMPTOMS OF LATEX ALLERGY : RED WATERY, ITCHY EYES, SINUS OR NASAL TACHYCARDIA AND HYPOTENSION. USE A LATEX FREE PRODUCT OR LATEX SAFE. REVIEW SKILLS ON PAGE 282 SKILL 12-2 ISOLATION TECHNIQUE FIRST TIER - STANDARD PRECAUTION SECOND TIER - DISEASE SPECIFIC CATEGORIES AIRBORNE (PAGE 287) - NEGATIVE-PRESSURE AIRFLOW, 6 - 12 AIR EXCHANGES PER HOUR. USE N-95/ PARTICULATE RESPIRATORY MASK. FIT CHECK - FIT TESTING REMAIN DOORS CLOSED AT ALL TIMES. 1.MEASLES 2. VARICELLA 3. TUBERCULOSIS DROPLET (PAGE 288) 1. MENINGITIS 2. PNEUMONIA 3. SEPSIS

4. EPIGLOTTITIS

DROPLET - RESPIRATORY INFECTIONS (BACTERIAL) INCLUDES 1. DIPHTHERIA 2. PERTUSSIS 3. MYCOPLASMA PNEUMONIA 4. PNEUMONIC PLAGUE 5. STREPTOCOCCAL PHARYNGITIS 6. SCARLET FEVER DROPLET - VIRAL INFECTIONS INCLUDES 1. MUMPS 2. INFLUENZA 3. ADENOVIRUS - AFFECTS UPPER RESPIRATORY TRACT 4. RUBELLA 5. TUBERCULOSIS 6. PARVOVIRUS B19 - CHILDHOOD RASH FIFTH DISEASE - SLAPPED CHEECK SYNDROME. CONTACT (PAGE 289) 1. CDIFF DIAPERED OF INCONTINENT PATIENTS WITH 1. E. COLI 2. SHIGELLA 3. HEPATITIS A 4. ROTAVIRUS - SEVERE DIARRHEA IN YOUNG CHILDREN CONTACT - SKIN 1. DIPHTHERIA 2. HERPES SIMPLEX 3. ABSCESSES, CELLULITIS OR DECUBITUS ULCER 4. SCABIES 5. MRSA 6. VRE 7. ESBL 8. STAPHYLOCOCCAL FURUNCULOSIS 9. CONJUNCTIVITIS 10.HEMORRHAGIC INFECTIONS REVERSE ISOLATION : PROTECTING PATIENT, PREVENTING TRANSFER OF DISEASE TO A PATIENT. POSITIVE PRESSURE AIRFLOW BASIC PRINCIPLES 1. 2. 3. 4. PERFORM HAND HYGIENE BEFORE ENTERING AND AFTER LEAVING PTS ROOM USE UNDERSTANDING OF DISEASE PROCESS AND METHOD OF TRANSMISSION DISPOSE CONTAMINATED EQUIPMENT AND ARTICLES IN SAFE AND EFFECTIVE MANNER. IF PATIENT IS BEING TRANSPORTED TO OTHER AREAS. TAKE NECESSARY PRECAUTIONS. (HOSPITAL PROTOCOLS)

SURGICAL ASEPSIS STERILE TECHNIQUE BOX 12- 11 PAGE 292

A. STERILE OBJECTS 1. STERILE TO STERILE = STERILE 2. STERILE TO CLEAN = CONTAMINATION 3. STERILE TO CONTAMINATED = CONTAMINATION B. PLACE ONLY STERILE OBJECTS ON A STERILE FIELD 1. IF PACKAGE IS TORN, WET OR OPEN IS UNSTERILE 2. IF YOU HAVE ANY DOUBTS IF AN OBJECT IS CONTAMINATED, THEN THAT MEANS IT IS CONTAMINATED C. NEVER TURN YOUR BACK OR LEAVE YOUR TRAY OUT OF THE RANGE OF VISION D. OBJECT BELOW THE WAIST IS CONSIDERED CONTAMINATED E. STERILE OBJECT OR FIELD BECOMES CONTAMINATED BY PROLONGED EXPOSURE TO AIR F. STERILE SURFACE + WET, CONTAMINATED SURFACE = CONTAMINATION G. FLUID FLOWS IN DIRECTION OF GRAVITY. EX HAND WASHING. H. CONSIDER EDGES OF A STERILE FIELD OR CONTAINER TO BE CONTAMINATED. SURGICAL HAND SCRUB SKILL 12-6 PAGE 293