Infection Control in Clinical Setting

Microorganisms exist everywhere: in water, in soil, and on body surfaces such

as the skin, intestinal tract, and other areas open to the outside such as our
mouth, upper respiratory tract, and lower urinary tract. Many organisms are
harmless, others are lethal (very harmful), some are a normal part of our body.

What is Infection?

Infection is the invasion and growth of microorganisms in body tissue where

they are not naturally present.

 Infectious agent. such a microorganism (bacteria, viruses, yeast, fungi)

are called as infectious agents, as the source of infection.
 Asymptomatic. If the microorganism produces no clinical evidence of
disease, the infection is called asymptomatic or subclinical.
 Disease. A detectable alteration in normal tissue function is
called disease.
 Virulence. Microorganisms vary in their virulence or their ability to
produce disease, the severity of the diseases they produce, and their
degree of communicability.
 Pathogenicity. Pathogenicity is the ability to produce disease; thus, a
pathogen is a microorganism that causes disease.
 Asepsis. Asepsis (absence of bacteria, viruses and fungi) is the freedom
from disease causing microorganism; aseptic technique is used to
decrease the possibility of transferring microorganisms from one place
to another.
 Medical asepsis. Medical asepsis includes all practices intended to
confine a specific microorganism to a specific area, limiting the number,
growth, and transmission of microorganisms.
 Surgical asepsis. Surgical asepsis, or sterile technique, refers to those
practices that keep an area or an object free of all microorganisms; it
includes practices that destroys microorganisms and spores.
 Sepsis. Sepsis (life-threatening complication of infection) is the condition
in which acute organ dysfunction occurs secondary to infection.
Types of Microorganisms
Four major categories of microorganisms cause infection in humans: bacteria,
viruses, fungi, and parasites.
 Bacteria. bacteria are by far the most common infection-causing
microorganisms; several hundred species can cause disease in humans
and can live and be transported through air, water, food, soil, body
tissues and fluids, and inanimate objects.
 Viruses. Viruses consist primarily of nucleic acid and therefore must
enter living cells in order to reproduce; common virus families
include rhinoviruses (causes the common cold), hepatitis, herpes, and
human immunodeficency virus.
 Fungi. Fungi includes yeast and molds; Candida albicans is a yeast
considered to be normal flora in the human vagina.
 Parasites. Parasites live on other living organisms; they include protozoa
such as the one that causes malaria, helminths (worms), and arthropods
(mites, fleas, ticks).

Types of Infection
Infection occurs when newly introduced or resident microorganisms succeed in
invading a part of the body where the host’s defense mechanisms are
ineffective and the pathogen causes tissue damage.

 Local infection. A local infection is limited to a specific part of the body

where the microorganisms remain.
 Systemic infection. If the microorganisms spread and damage different
parts of the body, the infection is a systemic infection.
 Bacteremia. When a culture of a person’s blood reveals microorganisms,
the condition is called bacteremia.
 Septicemia. When bacteremia results in systemic infection, it is referred
to as septicemia, which has become common over time.
 Acute infection. Acute infections generally appear suddenly or last a
short time.
 Chronic infection. A chronic infection may occur slowly, over a very long
period, and ,ay last months or years.
THE CHAIN OF INFECTION

The chain of infection describes how a pathogen gets from where it is, to
where it's going. It starts with the infectious agent, which lives in a reservoir,
finds a portal of exit, and uses a mode of transmission to find a portal of entry
into a susceptible host.

Infectious agent

First in the chain of infection is the infectious agent, which is an organism

capable of causing infection or disease. Examples of infectious agents include
bacteria, viruses, fungi, and parasites.

For example, COVID-19 is an infectious agent.

Reservoir

The reservoir is where the infectious agent lives and multiplies. A reservoir
could be a body of water, human, or animal.

In the case of COVID-19, a person could be a reservoir for the virus.

Portal of exit

The portal of exit is the way that the infectious agent leaves its reservoir. If a
person is the reservoir for the pathogen, the portal of exit could be their nose
and mouth when sneezing, their blood (a bloodborne pathogen), or the
infectious agent could exit fecally.

For example, COVID-19's portal of exit is the nose and mouth, which is why
masks are worn.
Mode of transmission

The mode of transmission explains how the infectious agent gets from the
reservoir to the new host. The portal of exit is just how the pathogen exited,
but the mode of transmission explains how it travels from there. This can
include direct contact, respiratory droplets, airborne, vehicles like water or
food, or vectors like mosquitoes, ticks, or fleas.

In the case of COVID-19, its mode of transmission is respiratory droplets. This is

why social distancing and limited gatherings are essential to stop the spread;
fewer people around each other, fewer respiratory droplets flowing through
the air. If you have COVID and you and your respiratory droplets are alone in
your home, they can't reach the next item on the list—a portal of entry to a
susceptible host.

Portal of entry

The portal of entry is how the infectious agent enters into the new host. This
could be through the nose and mouth, through the eyes, or through the
bloodstream (e.g., into an open wound). The portal of entry may be the same
as the portal of exit.

For example, COVID-19's respiratory droplet portal of entry is the nose and
mouth, which is again why masks are worn to protect against the virus.
Susceptible host

A susceptible host is the recipient of the infection. The host must be

susceptible; and not all hosts are susceptible. Hosts might not be susceptible
because they have had the disease previously and developed antibodies
against it. Some hosts have stronger immune systems than others, e.g.,
someone who is immunocompromised is a more susceptible host.

In the case of COVID-19, getting vaccinated makes you a less susceptible host.

THE STAGES OF INFECTION

The stages of infection describe what happens once a susceptible host has
acquired a pathogen. The stages are: incubation, prodromal, illness, and
convalescence.

Incubation stage

The incubation period of infection is the time from when the pathogen first
gets in the body, until it starts to make its appearance known. During this time,
the pathogen is multiplying inside your body. One does not know they are sick
at this time.

Diseases or infections with a long incubation period are concerning because a

person might be contagious long before they know they are sick, and they may
not know to take precautions against spreading the illness.
Prodromal stage

The prodromal period of infection is when general, non-specific signs and

symptoms of illness appear. These symptoms are vague, not specific to any
one disease.

If you have ever woken up in the morning and thought, "I don't really feel very
well. I can't tell you what's wrong. I'm just tired. I don't feel good. I feel kind of
fatigued and weak," that was the prodromal stage at work.

Illness stage

During the illness phase, infection-specific signs and symptoms appear.

For example, a patient may have a high fever, a cough, and body aches if they
are in the illness phase of influenza. If a patient has gastroenteritis, they might
have an upset stomach, cramps, nausea, vomiting, or diarrhea.

If you'd like to learn the key facts about influenza, gastroenteritis, and more
infections, diseases and disorders, check out our best-selling Medical-Surgical
Nursing Flashcards.

Convalescence stage

Last in the stages of infection is the convalescence stage, which is the recovery
from infection. To convalesce means to get better. During the convalescence

stage, symptoms start to disappear until a person is fully healed.

If an illness is something like the common cold, the convalescence stage might
be just a few days. If it's a serious or long-lasting infection, the convalescence
stage could take a very long time.

 How an infection spreads and its effects on the human body

depend on the type of pathogen.

The immune system is an effective barrier against infectious agents. However,

pathogens may sometimes overwhelm the immune system’s ability to fight
them off. At this stage, an infection becomes harmful.

Some pathogens have little effect at all. Others produce toxins or inflammatory
substances that trigger negative responses from the body. This variation
means that some infections are mild and barely noticeable, while others can
be severe and life threatening. Some pathogens are resistant to treatment.

Infection can spread in a variety of ways.

Bacteria, viruses, fungi, and parasites are different types of pathogens. They
vary in several ways, including:

 size
 shape
 function
 genetic content
 how they act on the body

For example, viruses are smaller than bacteria. They enter a host and take over
cells, whereas bacteria can survive without a host.

Treatment will depend on the cause of the infection. This article will focus on
the most common and deadly types of infection: bacterial, viral, fungal, and
prion.
Viral infections

Viral infections occur due to infection with a virus.

Viruses invade a host and attach themselves to a cell. As they enter the cell,
they release their genetic material. This material forces the cell to replicate the
virus, and the virus multiplies. When the cell dies, it releases new viruses,
which infect new cells.

Not all viruses destroy their host cell, however. Some of them change the
function Trusted Source of the cell. Some viruses, such as human
papillomavirus (HPV) and Epstein-Barr virus (EBV), can lead to cancer by
forcing cells to replicate in an uncontrolled way.

A virus can also target certain age groups, such as infants or young children.

Viruses may remain dormant for a period before multiplying again. The person
with the virus can appear to have fully recovered, but they may get sick again
when the virus reactivates.

Viral infections include:

 the common cold, which mainly occurs due to rhinovirus, coronavirus,

and adenovirus
 encephalitis and meningitis, resulting from enteroviruses and
the herpes simplex virus (HSV), as well as West Nile Virus
 warts and skin infections, for which HPV and HSV are responsible
 gastroenteritis, which norovirus causes
 COVID-19, a respiratory disease that develops after a novel coronavirus
infection that is currently causing a global pandemic
Other viral conditions include:

 Zika virus
 HIV
 hepatitis C
 polio
 influenza (flu), including H1N1 swine flu
 Dengue fever
 Ebola
 Middle East respiratory syndrome (MERS-CoV)

Antiviral medications can help relieve the symptoms of some viruses while the
disease passes. They can either prevent the virus from reproducing or boost
the host’s immune system to counter the effects of the virus.

Antibiotics are not effective against viruses. These drugs will not stop the virus,
and their use increases the risk of antibiotic resistance.

Most treatment aims to relieve symptoms while the immune system combats
the virus without assistance from medication.

Bacterial infections

Bacteria are single-celled microorganisms, also known as prokaryotes.

Experts estimate that there are at least 1 nonillion bacteria on Earth. A

nonillion is a 1 followed by 30 zeros. Much of the Earth’s biomass comprises
bacteria.

Bacteria take three main shapes:

 Spherical: These are known as cocci.

 Rod-shaped: These have the name bacilli.
 Spiral: Coiled bacteria are known as spirilla. If the coil of a spirillum is
particularly tight, scientists call it a spirochete.
Bacteria can live in almost any type of environment, from extreme heat to
intense cold, and some can even survive in radioactive waste.

There are trillions of strains of bacteria, and few cause diseases in humans.
Some of them live inside the human body, such as in the gut or airways,
without causing harm.

Some “good” bacteria attack “bad” bacteria and prevent them from causing
sickness. However, some bacterial diseases can be deadly.

These include:

 cholera
 diphtheria
 dysentery
 bubonic plague
 tuberculosis
 typhoid
 typhus

Some examples of bacterial infections are:

 bacterial meningitis
 otitis media
 pneumonia
 tuberculosis
 upper respiratory tract infection (although this is usually viral)
 gastritis
 food poisoning
 eye infections
 sinusitis (again, more often viral)
 urinary tract infections (UTIs)
 skin infections
  sexually transmitted infections (STIs)

A doctor can treat bacterial infections with antibiotics. However, some strains
become resistant and can survive the treatment.

Fungal infections

A fungus is often a multicellular parasite that can decompose and absorb

organic matter using an enzyme. However, some types, such as yeasts, are
single celled.

Fungi almost always reproduce by spreading single celled spores. The structure
of a fungus is usually long and cylindrical, with small filaments branching from
the main body.

There are approximately 5.1 millionTrusted Source species of fungus.

Many fungal infections develop in the upper layers of the skin, and some
progress to the deeper layers. Inhaled yeast or mold spores can sometimes
lead to fungal infections, such as pneumonia, or infections throughout the
body. These are also known as systemic infections.

The body usually has a population of good bacteria that help maintain the
balance of microorganisms. These line the intestines, mouth, vagina, and other
parts of the body.

Those with a higher risk of developing a fungal infection include people who:

 use antibiotics for a long time

 have a weakened immune system, due, for example, to living with HIV
or diabetes or receiving chemotherapy treatment
 have undergone a transplant, as they take medications to prevent their
body from rejecting the new organ
Examples of fungal infectionsTrusted Source are:

 valley fever, or coccidioidomycosis

 histoplasmosis
 candidiasis
 athlete’s foot
 ringworm
 some eye infections

A rash may indicate a fungal infection of the skin.

Prion disease

A prion is a protein that contains no genetic material and is usually harmless.

Scientists do not class prions as living microorganisms. However, if a prion
folds into an abnormal shape, it can become a rogue agent and cause infection.

Prions can affect the structure of the brain or other parts of the nervous
system. They do not replicate or feed on the host. Instead, they trigger
abnormal behavior in the body’s cells and proteins.

Prions cause degenerative brain diseases, all of which are rare but progress
rapidly and are currently fatal. They include bovine spongiform
encephalopathy (BSE), which people typically refer to as mad cow disease,
and Creutzfeldt-Jakob disease (CJD).

Researchers have also linked some cases of Alzheimer’s disease to prion

infection.

Other infections

While the forms of infection that we have listed above are the main types,
there are others Trusted Source that can have an effect on the body.
A single celled organism with a nucleus can cause a protozoan infection.
Protozoa commonly show features similar to those of animals, such as
mobility, and they can survive outside the human body.

They most commonly transfer to other humans through feces. Amebic

dysentery is an example of a protozoan infection.

Helminths are larger, multicellular organisms that tend to be visible to the

naked eye when fully grown. This type of parasite includes flatworms and
roundworms. These can also cause infection.

Finally, ectoparasites — including mites, ticks, lice, and fleas — can cause
infection by attaching or burrowing into the skin. Ectoparasites can also include
blood-sucking arthropods, such as mosquitoes, which transmit infection by
consuming human blood.

Nosocomial and Health-related Infections

Nosocomial infections are classified as infections that originate in the hospital,

and is a subgroup of health care associated infections or HAIs.

 Urinary tract. The most common microorganisms in the urinary tract

include Escherichia
coli (improper catheterization technique), Enterococcus species
(contamination of closed drainage system), and Pseudomonas
aeruginosa (inadequate hand hygiene).
 Surgical sites. The most common microorganisms in surgical sites
include Staphylococcus aureus including MRSA (inadequate hand
hygiene), Enterococcus species including vancomycin-resistant strains
(improper dressing change technique), and Pseudomonas aeruginosa.
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 Bloodstream. The most common bloodstream microorganisms include
coagulase-negative staphylococci (inadequate hand
hygiene), Staphylococcus aureus and Enterococcus species (improper
intravenous fluid, tubing, and site care technique).
 Pneumonia. The most common causative microorganisms
for pneumonia include Staphylococcus aureus (inadequate hand
hygiene), Pseudomonas aeruginosa and Enterobacter species (improper
suctioning technique).

Defenses Against Infection

Individuals have defenses that protect the body from infection; they are
categorized as specific and non-specific defenses.

Non-specific Defenses

Nonspecific defenses protect the person against all microorganisms, regardless

of prior exposure; they include anatomic and physiologic barriers and the
inflammatory response.

Anatomic and Physiologic Barriers

 Intact skin and the mucous membranes are the body’s first line of
defense against microorganisms.
 The nasal passages have a defensive function: moist mucous membranes
and cilia trap microorganisms, dust, and foreign materials.
 The lungs have alveolar macrophages (large phagocytes); phagocytes are
cells that ingest microorganisms, dead cells, and foreign particles.
 The oral cavity regularly sheds mucosal epithelium to rid the mouth of
colonizers.
 The flow of saliva and its partial buffering action help prevent infections;
saliva contains microbial inhibitors, such as lactoferrin, lysozyme, and
secretory IgA.
 The eye is protected from infection by tears, which continually wash
microorganisms away and contain inhibiting lysozyme.
 The high acidity of the stomach normally prevents microbial growth.
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 The resident flora of the large intestine help prevent the establishment
of disease-producing microorganisms.
 Peristalsis also tends to move microbes out of the body.
 When a girl reaches puberty, lactobacilli ferment sugars in the vaginal
secretions, creating a vaginal pH of 3.5 to 4.5; this low pH inhibits the
growth of many disease-producing microorganisms.
 The entrance to the urethra normally harbors many
microorganisms; urine flow has a flushing and bacteriostatic action that
keeps the bacteria from ascending the urethra; an intact mucosal
surface also acts as a barrier.

Inflammatory Response

Inflammation is a local and nonspecific defensive response of the tissue to an

injurious or infectious agent; it is an adaptive mechanism that destroys or
dilutes the injurious agent, prevents further spread of the injury, and promotes
the repair of damaged tissue.

 First stage: Vascular and cellular responses. There is constriction of

blood vessels, dilatation of small vessels, increased vessel permeability,
increased leukocytes, swelling, and pain; leukocytes begin to engulf the
infection.
 Second stage: Exudate production. This stage is characterized by
exudation with fluids and dead cells; serous (clear, part of the blood),
purulent (thick, pus with leukocytes), and sanguineous (bloody).
 Third stage: Reparative phase. The repair of tissues; examples are
regeneration (same tissues), stroma (connective tissues), parenchyma
(functional part), and fibrous (scar).
Specific Defenses

Specific defenses of the body involve the immune system; the immunes
response has two components: antibody-mediated defenses and cellular-
mediated defenses.
Antibody-Mediated Defenses

Another name for the antibody-mediated defenses is humoral (or circulating)

immunity because these defenses reside ultimately in the B lymphocytes and
are mediated by antibodies produced by B cells.

 Active immunity. In active immunity, the host produces antibodies in

response to natural antigens (e.g. infectious agents) or artificial antigens
(e.g. vaccines); B cells are activated when they recognize the antigen;
they the differentiate into plasma cells; the B cell may produce antibody
molecules of five classes of immunoglobulins: IgM, IgG, IgA, IgD, and IgE.
 Passive immunity. With passive (or acquired) immunity, the host
receives natural (e.g. from a nursing mother) or artificial (e.g. from an
injection of immune serum) antibodies produced by another source.

Cell-Mediated Defenses

The cell-mediated defenses, or cellular immunity, occur through the T-cell

system.

 On exposure to an antigen, the lymphoid tissues release large numbers

of activated T-cells into the lymph system.
 These T-cells pass into the general circulation.
 There are three main groups of T-cells: helper T cells, cytotoxic T cells,
and suppressor T cells.
 Helper T cells help in the function of the immune system.
 Cytotoxic T cells attack and kill microorganisms and sometimes the
body’s own cells.
 Suppressor T cells suppress the functions of the helper T cells and
cytotoxic T cells.
Nursing Management

Nursing management for infection control include the following:

Nursing Assessment

The nurse obtains the client’s history, conducts physical assessment, and
gathers laboratory data.

 History. During the nursing history, the nurse assesses (a) the degree to
which the client is at risk of developing an infection and (b) any client
complaints suggesting the presence of an infection.
 Physical exam. Signs and symptoms of an infection vary according to the
body area involved; for example, sneezing, watery or mucoid discharge
from the nose, and nasal stuffiness commonly occur with an infection of
the nose and sinuses; urinary frequency and cloudy or discolored urine
often occur with a urinary infection.
 Laboratory data. Laboratory data that indicate the presence of an
infection include the following: elevated leukocyte count, increases in
specific types of leukocytes as revealed in the differential WBC count,
elevated erythrocyte sedimentation rate, urine, blood, sputum, or other
drainage cultures that indicate the presence of pathogenic
microorganisms.
Nursing Diagnosis

Based on the assessment data, the most appropriate nursing diagnosis are:

 Potential complication of infection: fever.

 Imbalanced nutrition: less than body requirements.
 Acute pain.
 Impaired social interaction or social isolation.
 Anxiety.
Nursing Care Planning and Goals

The major goals are:

 Maintain or restore defenses.

 Avoid the spread of infectious organisms.
 Reduce or alleviate problems associated with the infection.
Implementation

The nurse prevents strategies to prevent infection.

 Preventing nosocomial infections. Meticulous use of medical and

surgical asepsis is necessary to prevent the transport of potentially
infectious microorganisms;
 Hand hygiene. It is important for both the nurses’ and the clients’ hands
to 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; for
routine client care, vigorous hand washing under a stream of water for
15 to 20 seconds using granular soap, soap-filled sheets, or liquid soap at
the beginning of the nurses’ shift, when hands are visibly soiled, and
after using the toilet, is recommended.
 Nutrition. A balanced diet enhances the health of all body tissues, helps
keep the skin intact, and promotes the skin’s ability to repel
microorganisms; adequate nutrition enables tissues to maintain and
rebuild themselves and helps keep the immune system functioning well.
 Fluid. Fluid intake permits fluid output that flushes out the bladder and
urethra, removing microorganisms that can cause an infection.
 Sleep. Adequate sleep is essential to health and to renewing energy.
 Stress. Excessive stress predisposes people to infections; nurses can
assist clients to learn stress-reducing techniques.
 Immunizations. The use of immunizations has dramatically decreased
the incidence of infectious diseases; it is recommended that
immunizations begin shortly after birth and be completed in early
childhood except for boosters.
  Disinfecting. The first links in the chain of infection, the etiologic agent
and the reservoir, are interrupted with the use of antiseptics (agents
that inhibit the growth of some microorganisms)
and disinfectants (agents
 that destroy pathogens other than spores) and by sterilization; both
antiseptics and disinfectants are said to have bactericidal or
bacteriostatic properties; a bactericidal preparation destroys bacteria,
whereas a bacteriostatic preparation prevents the growth and
reproduction of some bacteria.
 Sterilization. Sterilization is a process that destroys all microorganisms,
including spores and viruses; four commonly used methods of
sterilization are: moist heat (to sterilize with moist heat, steam under
pressure is used because it attains temperatures higher than the boiling
point); gas (ethylene oxide gas destroys microorganisms by interfering
with their metabolic processes); boiling water (this is the most practical
and inexpensive method for sterilizing in the home); and radiation (both
ionizing and non-ionizing are used for disinfection and sterilization.
Infection Prevention and Control

Because it is not always possible to know which clients may have infectious
organisms, a set of guidelines has been established by the CDC and other
organizations outlining steps all healthcare workers must follow to reduce the
chances that organisms in blood and potentially infectious organisms from
other body tissues will be transmitted from the client to other individuals.

Standard Precautions

Standard precautions are used in the care of all hospitalized individuals

regardless of their diagnosis possible infection status.

 Designed for all clients in the hospital.

 These precautions apply to (a) blood; (b) all body fluids, excretions, and
secretions except sweat; (c) nonintact broken skin; and (d) mucous
membranes.
 Designed to reduce risk of transmission of microorganisms from
recognized and unrecognized sources.
 Perform hand hygiene after contact with blood, body fluids, excretions,
secretions, and contaminated objects whether or not gloves are worn.
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 Wear clean gloves when touching blood, body fluids, secretions,
excretions, and contaminated items.
 Wear a mask, eye protection, or face shield if splashes or sprays of
blood, body fluids, secretions, or excretions can be expected.
 Wear a clean, non-sterile, water-resistant gown if client care is likely to
result in splashes or sprays of blood, body fluids, secretions, or
excretions; the gown is intended to protect clothing.
 Handle client care equipment that is soiled with blood, body fluids,
secretions, or excretions carefully to prevent transfer of microorganisms
to others and to the environment.
 Handle all soiled linen as little as possible.
 Place used needles and other “sharps” directly into puncture-resistant
containers as soon as their use is completed.
Transmission-based Precautions

Transmission-based precautions are used in addition to standard precautions

for clients with known or suspected infections that are spread in one of three
ways: by airborne or droplet transmission, or by contact.

Airborne Precautions

Use standard precautions as well as the following:

 Place client in an airborne infection isolation room that has negative air
pressure, 6 to 12 air changes per hour, and either discharge of air to the
outside or a filtration system for the room air.
 If a private room is not available, place the client with another client
who is infected with the same microorganism.
 Wear an N95 respirator mask when entering the room of a client who is
known to have or suspected of having primary tuberculosis.
 Susceptible people should not enter the room of a client who has
rubeola (measles) or varicella (chicken pox).
 Limit movement of client outside the room to essential purposes; place
a surgical mask on the client during transport.
Droplet Precautions

Use standard precautions as well as the following:

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 Place client in private room.
 If a private room is not available, place the client with another client
who is infected with the same microorganism.
 Wear a mask if working within 1 meter (3 ft) of the client.
 Limit movement of client outside the room to essential purposes; place
a surgical mask on the client during transport.
Contact Precautions

Use standard precautions as well as the following:

 Place client in private room.

 If a private room is not available, place the client with another client
who is infected with the same microorganism.
 Wear gloves as described in standard precautions.
 Wear a gown when entering a room if there is a possibility of contact
with infected surfaces or items, or of the client is incontinent, or
has diarrhea, a colostomy, or wound drainage not contained by a
dressing.
 Limit movement of client outside the room.
 Dedicate the use of noncritical client care equipment to a single client or
to clients with the same infecting microorganisms.
Personal Protective Equipment

All healthcare providers must apply PPE according to the risk of exposure to
potentially infective materials.

Gloves

 Gloves are worn for three reasons: first they protect the hands when the
nurse is likely to handle any body substances; second, gloves reduce the
likelihood of nurses transmitting their own endogenous microorganisms
to individuals receiving care; and third, gloves reduce the chance that
the nurses’ hands will transmit microorganism to from one client or
object to another client.
 In all situations, gloves are changed between client contacts.
 The hands are cleansed each time the gloves are removed for two
primary reasons: (1) the gloves may have imperfections or be damaged
 during wearing so that they could allow microorganism entry; and (2)
the hands may become contaminated during glove removal.

Gowns

 Clean or disposable impervious (water-resistant) gowns or plastic aprons

are worn during procedures when the nurse’s uniform is likely to
become soiled.
 Sterile gowns may be indicated when the nurse changes the dressings of
a client with extensive wounds.
 Single-use gown technique (using a gown only once before it is discarded
or laundered) is the usual practice at hospitals.
Face Masks

 Masks are worn to reduce the risk for transmission of microorganisms by

the droplet contact or airborne routes and by splatters of body
substances.
 The CDC recommends that masks be worn:
 By those close to the client if the infection is transmitted by large-
particle aerosols (droplet); large particle aerosols are transmitted by
close contact and generally travel short distances (about 1 m or 3 ft).
 By all individuals entering the room if the infection is transmitted by
small particle aerosols (droplet nuclei); small-particle aerosols remain
suspended in the air and thus travel great distances in the air.
Eye Wear

 Protective eye wear (goggles, glasses, face shields) and masks are
indicated in situations where body substances may splatter the face.
 If the nurse wear prescription eyeglasses, goggles must still be worn over
the glasses because the protection must extend around the sides of the
glasses.
Sterile Technique

An object is sterile only when it is free of all microorganisms.

 It is well known that sterile technique is practiced in operating rooms

and special diagnostic areas.
  Sterile technique is also employed for many procedures in general care
areas such as when administering injections, changing wound dressings,
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 performing urinary catheterization, and administering intravenous
therapies.
 In these situations, all principles of the surgical asepsis are applied as in
the operating or delivery room; however, not all of the sterile
techniques that follow are always required.
Principles of Surgical Asepsis

 All objects used in a sterile field must be sterile.

 Sterile objects become unsterile when touched by unsterile objects.
 Sterile objects that are out of sight or below the waist or table level are
considered unsterile.
 Sterile objects may become unsterile by prolonged exposure to airborne
microorganisms.
 Fluids flow in the direction of gravity.
 Moisture that passes through a sterile object draws microorganisms
from unsterile surfaces above or below to the sterile surface by capillary
action.
 The edges of a sterile field are considered unsterile.
 The skin cannot be sterilized and is unsterile.
 Conscientiousness, alertness, and honesty are essential qualities in
maintaining surgical asepsis.