Nursing Chapter 31 Homework The Portal Entry The Susceptible Host Can

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1

Explain the concepts of medical and surgical asepsis.

Concepts for Lecture

1. Asepsis is the freedom from disease–causing microorganisms. To

decrease the possibility of transferring microorganisms from one

place to another, aseptic technique is used.

2.

Surgical asepsis, or sterile technique, refers to those practices that keep

an area or object free of all microorganisms. It includes practices that

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2

Identify signs of localized and systemic infections and inflammation.

Concepts for Lecture

1. Signs of localized infections include localized swelling, localized

redness, pain or tenderness with palpation or movement, palpable

2. Signs of systemic infection include fever; increased pulse and respir-

3.

Laboratory data that indicate the presence of an infection include the

following: elevated leukocyte (white blood cell or WBC) count;

increases in specific types of WBCs revealed in the differential count;

elevated erythrocyte sedimentation rate; and urine, blood, sputum, or

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31

ASEPSIS

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• Provide students with examples of various

activities or procedures and have them identi-

fy whether these are examples of medical or

surgical asepsis.

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• Review the types and functions of WBCs.

Discuss the relevance of increases or decreas-

es in each type of cell.

determine whether their assigned clients are at

CHAPTER 31 / Asepsis 195

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3

Identify risks for nosocomial and health care–associated infections.

Concepts for Lecture

1. Nosocomial infections are associated with the delivery of health care

services in a health care facility.

A number of factors contribute to nosocomial infections. Diag-

nostic or therapeutic procedures may cause iatrogenic infections.

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4

Identify factors influencing a microorganism’s ability to produce an infec-

tious process.

Concepts for Lecture

1. The extent to which any microorganism is capable of producing an

infectious process depends on the number of microorganisms

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5

Identify anatomic and physiological barriers that defend the body against

microorganisms.

Concepts for Lecture

1. Intact skin and mucous membranes are the body’s first line of

defense against microorganisms. The dryness of the skin, the resi-

contains microbial inhibitors.

The eyes are protected by tears. The high acidity of the stomach

inhibits microbial growth, the resident flora of the large intestine

help prevent the establishment of disease-producing organisms, and

peristalsis also tends to move microbes out of the body.

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• Have the students provide examples of poten-

tial therapeutic procedures that may cause iat-

rogenic infections. Discuss measures to

prevent these infections.

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• Have the students use the Assessment Inter-

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UGGESTIONS FOR

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• Invite a member of the microbiology faculty

to discuss pathogenicity of common microor-

ganisms.

• Discuss the growth of antibiotic-resistant

organisms and measures to prevent this.

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UGGESTIONS FOR

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CTIVITIES

• Have students identify factors that may alter

normal anatomic and physiologic barriers.

Discuss interventions to prevent these altera-

tions.

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CTIVITIES

• Have students present examples of intact and

196 CHAPTER 31 / Asepsis

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6

Differentiate active from passive immunity.

Concepts for Lecture

1. In active immunity, the host produces antibodies in response to natu-

ral antigens or artificial antigens. The duration of active immunity

tends to be long. In natural active immunity, antibodies are formed

2.

In passive (or acquired) immunity, the host receives natural or artificial

antibodies produced from another source. The duration of passive

immunity tends to be short. In natural passive immunity, the antibodies

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7

Identify relevant nursing diagnoses and contributing factors for clients at risk

for infection and who have an infection.

Concepts for Lecture

1. The NANDA nursing diagnostic label for problems associated with

the transmission of microorganisms is Risk for Infection, the state in

which an individual is at increased risk for being invaded by patho-

2.

Clients who have or are at risk for an infection are prime candidates for

other physical and psychological problems. Examples of nursing diagno-

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Identify interventions to reduce risks for infections.

Concepts for Lecture

1. Many nosocomial infections can be prevented by using proper hand

hygiene techniques, environmental controls, sterile technique when

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• Review the immunization schedule for adults

and children. Identify the types of vaccines.

• Discuss the fears some parents have about

immunizing their children.

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UGGESTIONS FOR

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• Provide the students with a case study illus-

trating a client who has the nursing diagnosis

of Risk for Infection and another of a client

who has an infection and defining characteris-

tics of a collaborative problem and related

nursing diagnoses. Have the students develop

the nursing diagnoses and collaborative prob-

lem statement.

Discuss findings.

• Have the students identify interventions that

require sterile technique.

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CTIVITIES

• Have the students identify environmental

controls to reduce risks of infection in the

CHAPTER 31 / Asepsis 197

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Identify measures that break each link in the chain of infection.

Concepts for Lecture

1. The chain of infection includes the etiologic agent, reservoir, portal

2. Interventions that affect the etiologic agent (microorganism) include

3. Interventions to reduce the reservoir (source) include changing

dressings and bandages when soiled or wet, assisting clients to carry

4. The portal of exit from the reservoir can be controlled by avoiding

5. The method of transmission can be controlled by cleansing hands

properly; instructing clients and support individuals to cleanse hands

before handling food or eating, after eliminating, and after touching

infectious material; wearing gloves when handling secretions and

6. The portal of entry to the susceptible host can be broken by using

sterile technique for invasive procedures, using sterile technique

7.

The susceptible host link can be broken by maintaining the integrity of

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10

Compare and contrast category-specific, disease-specific, standard, and

transmission-based isolation precaution systems.

Concepts for Lecture

1. Isolation refers to measures designed to prevent the spread of infec-

tions or potentially infectious microorganisms to health personnel,

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• Divide the students into groups. Assign each

group a link in the chain of infection. Ask

each group to identify additional interventions

to break the assigned link. Share with the

class.

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• Divide the students into groups. Assign each

group a type of isolation or precaution

category. Ask each group to select the

personal protective equipment necessary to

perform vital signs; to provide wound care for

a large sacral decubitus; and to administer oral

medications for a client diagnosed with hepa-

titis B, a client diagnosed with pulmonary

tuberculosis, and an immunosuppressed client.

2. Disease-specific isolation precautions provide precautions for specif-

3. Universal precautions (UP) are techniques to be used with all clients

to decrease the risk of transmitting unidentified pathogens. These

4. The body substance isolation (BSI) system employs generic infec-

tion control precautions for all clients except those with the few

diseases transmitted through the air. The BSI system is based on

three premises: (a) all people have an increased risk for infection

5. Standard precautions are used in the care of all hospitalized individ-

uals regardless of their diagnosis or possible infection status. They

6.

Transmission-based precautions are used in addition to standard precau-

tions for clients with known or suspected infections that are spread in

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Verbalize the steps used in:

a. Performing hand hygiene.

Concepts for Lecture

1. Skill 31–1: Hand Hygiene, Skill 31–2: Donning and Removing Per-

sonal Protective Equipment (Gloves, Gown, Mask, Eyewear), and

Skill 31–3: Establishing and Maintaining a Sterile Field present the

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• Have the students practice hand hygiene,

donning and removing personal protective

equipment, and sterile gloving.

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• Review the policies and procedures of the

agency for handling equipment for isolation

clients.

• Assign students to care for clients who have

nurses’ and the clients’ hands be cleansed at the following times to

prevent the spread of microorganisms: before eating, after using the

bedpan or toilet, and after the hands have come in contact with any

body substances. In addition, health care workers should cleanse

their hands before and after giving care of any kind, and after wear-

crobial hand cleansing agents in the following situations: when there

are known multiple resistant bacteria; before invasive procedures; in

special care units, such as nurseries and intensive care units (ICUs);

and before caring for severely immunocompromised clients. Antimi-

crobial soaps are usually provided in high–risk areas and are fre-

2. All health care providers must apply clean or sterile gloves, gowns,

3. The nurse should follow the principles of surgical asepsis when

setting up a sterile field: all objects used in a sterile field must be

sterile; sterile objects become unsterile when touched by unsterile

4.

Many pieces of equipment are supplied for single use only and are

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Recognize when it is appropriate to delegate infection control skills to unli-

censed assistive personnel.

Concepts for Lecture

1. Use of personal protective equipment (PPE) is identical for all health

care providers. Clients whose care requires use of PPE may be dele-

200 CHAPTER 31 / Asepsis

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13

Describe the steps to take in the event of a bloodborne pathogen exposure.

Concepts for Lecture

1. Report the incident immediately to appropriate personnel within the

2. Seek appropriate evaluation and follow–up, including identification

and documentation of the source individual when feasible and legal;

3. For a puncture/laceration, encourage bleeding, wash/clean the area

4. The postexposure protocol (PEP) for HIV includes starting treatment

as soon as possible, preferably within hours after exposure. For

“high–risk” exposure (high blood volume and source with a high

5. PEP for hepatitis B includes anti–HBs testing 1 to 2 months after the

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UGGESTIONS FOR

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• Discuss the legal aspects of testing the source

individual.

dures for exposure to bloodborne pathogens.