Chapter 28 final review

• Transmission of infection


  • Requires the six elements of the infection chain to be present and uninterrupted
• Six elements of the infection chain

  • Infectious agent
  • Reservoir
  • Portal on exit
  • Mode of transmission
  • Portal of entry
  • Susceptible host
• Normal body flora and body system defenses

  Help the body resist infection by reducing the number of pathogenic organisms
• Vascular response to acute inflammation

  1. Rapid vasodilation

  2. Increased blood flow near location of injury

  3. Redness and localized warmth

  4. Increased permeability of small blood vessels leading to edema

  5. Cellular response resulting in increased WBCs to site of inflammation
• Health care–associated infections lead to adverse patient events and significantly higher health care costs that are often not reimbursed
• Factors influencing patient susceptibility to infection

  • Poor nutrition
  • Stress
  • Chronic disease
  • Treatments that compromise the immune response
• Signs of localized infection

  Swelling, redness, pain, and restriction of movement in the affected body part
• Signs and symptoms of systemic inflammation

  Fever, fatigue, nausea/vomiting, malaise, and enlarged, swollen, and tender lymph nodes
• Basic medical aseptic techniques


  Handwashing and use of barrier precautions
• Surgical asepsis


  More stringent technique than medical asepsis, such as sterile gloving
• Proper handling and management of urinary catheters and drainage sets prevents infection by eliminating a potential portal of entry for microorganisms
• Proper storage and refrigeration of food prevents a reservoir of infection from developing in food
• Standard Precautions are applied in all patient care activities to prevent patients and health care workers from transmitting infection even in the absence of disease
• Hand hygiene


  The most effective basic technique in preventing and controlling infection transmission. Hands must remain in contact with antimicrobial agent long enough to clean hand surfaces.
• Transmission-based precautions


  • Airborne
  • Droplet
  • Contact
  • Protective environment
• Airborne Precautions


  Focus on diseases transmitted by large droplets expelled into the air and by being within 3 feet of a patient, requiring use of a surgical mask when within 3 feet of the patient, proper hand hygiene, and dedicated personal protective equipment
• Proper application of personal protective equipment


  Apply a cover gown first, followed by a surgical mask or respirator, then eyewear or face shield and, finally, clean gloves
• In the home setting, educating patients and caregivers on infection prevention is critical, adapting interventions to a patient's unique home environment
• Health care workers believed to have been exposed to hepatitis B will receive the vaccine and vaccination series. A blood test (titer) is offered in some health care settings
• The organism (Clostridium difficile) is usually transmitted through the fecal-oral route
• Hands should always be cleaned with soap and water rather than the alcohol-based hand sanitizer for Clostridium difficile
• Everyone coming into the room must wear a gown and gloves for Clostridium difficile
• While a patient is in Contact Precautions for Clostridium difficile, they cannot leave the room
• Clostridium difficile dies quickly once outside the body
• Droplet Precautions


  Most appropriate for a patient diagnosed with meningitis
• Reverse isolation is not the appropriate precaution for a patient diagnosed with meningitis
• Standard Precautions are not the appropriate precaution for a patient diagnosed with meningitis
• Contact Precautions are not the appropriate precaution for a patient diagnosed with meningitis
• Anger is a normal response to isolation for a patient placed on Airborne Precautions for pulmonary tuberculosis
• Nurse's best intervention for a patient angry about being placed on Airborne Precautions


  Explain the reasons for isolation procedures and provide meaningful stimulation
• Personal protective equipment for a pediatric patient on Airborne Precautions for confirmed chickenpox/herpes zoster

  • Disposable gown
  • N95 respirator mask
  • Face shield or goggles
  • Disposable mask
  • Gloves
• Teaching correct handwashing to assigned patients contributes to reducing health care–acquired infections
• Using correct procedures in starting and caring for an intravenous infusion contributes to reducing health care–acquired infections
• Providing perineal care to a patient with an indwelling urinary catheter contributes to reducing health care–acquired infections
• Isolating a patient on antibiotics who has been having loose stool for 24 hours does not contribute to reducing health care–acquired infections
• Decreasing a patient's environmental stimuli to decrease nausea does not contribute to reducing health care–acquired infections
• Actions demonstrating the practice of core principles of surgical asepsis

  • Keep the sterile field in view at all times
  • Consider the outer 2.5 cm (1 inch) of the sterile field as contaminated
• The front and sides of the sterile gown are not considered sterile from the waist up
• Only health care personnel within the sterile field must wear personal protective equipment is not a core principle of surgical asepsis
• After cleansing the hands with antiseptic rub, applying clean disposable gloves is not a core principle of surgical asepsis