______ are those that develop as a result of a stay and/or visit in a health care facility.
Health-care-associated infections (HAIs)
_____ infections are health care-associated infections resulting from a diagnostic or therapeutic procedure. For example, following a gastrointestinal endoscopy a patient develops a P. aeruginosa infection.
Iatrogenic
______ infections are exogenous or endogenous.
Health-care-associated
An _______ infection comes from microorganisms outside the patient. For example, a postoperative wound infection is exogenous.
exogenous
______ organisms are caused by normal flora or virulent organisms that live on the skin. An ______ infection can occur when part of the patient's flora becomes altered and an overgrowth results. For example, a patient is placed on several antibiotics in t
Endogenous, endogenous
If an infection is _____ (e.g., a wound infection), the patient has symptoms, such as pain and tenderness and redness at the wound site. The patient may complain of localized tightness and pain caused by edema.
localized
______ infections cause more generalized symptoms than local infection. They usually result in fever, fatigue, or malaise. Lymph nodes that drain the area of infection often become enlarged, swollen, or tender during palpation. They commonly cause a loss
Systemic
A patient has an infection of the bloodstream from failure to change an inflamed intravenous (IV) access site. This is an example of what type of infection?
iatrogenic
List the risk factors for health care-associated infection
-Exposure to microorganisms within a health care facility
-A patient's length of stay
-Persons with chronic illness
-Compromised immunity
Development of an infection occurs in a cycle, described as the chain of infection, and depends on the presence of what six elements?
1. An infectious agent or pathogen
2. A reservoir or source for pathogen growth
3. A portal or exit from the reservoir (e.g., skin and mucous membranes, respiratory tract, urinary tract, gastrointestinal tract, reproductive tract, and blood)
4. A mode of
_____ is defined as the absence of disease-producing (pathogenic) organisms. This technique involves the purposeful prevention of the transfer of microorganisms.
Asepsis
What are the two types of aseptic technique you practice?
medical and surgical asepsis
______ asepsis (or clean technique), includes procedures used to reduce the number of and prevent the spread of microorganisms.
Medical
Hand hygiene, cleaning the environment, and use of clean gloves and masks (barrier techniques) are examples of ______ asepsis.
medical
_____ asepsis, or sterile technique, includes procedures used to eliminate all microorganisms from an area. For example, sterilization destroys all microorganisms and their spores.
Surgical
Use of sterile instruments and gloves in the operating room and special procedural areas are additional examples of ______ aseptic technique.
surgical
In 1996 the Centers for Disease Control and Prevention (CDC) published guidelines for the set of precautions known as ______ _______.
standard precautions
Part of the rationale for the development of standard precautions is the fact that any patient may be a source for infection, requiring health care workers to use ______ _______ _______ to prevent exposure.
personal protective equipment (PPE)
T/F: "Standard precautions" means that you should use gloves, mask, eye protection, and a gown when a patient is placed on isolation.
False; they should be used when there is a risk of being splattered with infectious materials regardless of the location of a patient
T/F: Standard precautions are used to protect you from potential contact with blood and body fluids.
True
T/F: The use of standards of precautions is determined by the patient's likelihood of carrying a communicable illness.
False; any patient may be a source for infection
A patient was diagnosed with a urinary tract infection. The patient has been drinking fruit juice and has increased his intake of fluids but has failed to take his antibiotic as prescribed because it caused gastric upset. Three days later, the patient pre
The patient may now have a systemic infection.
You are preparing to insert a urinary catheter. To perform this procedure, you will use:
Surgical asepsis (sterile technique).
The nurse manager is reviewing the use of standard precautions with the staff. Which of the following should be included in the review?
-Standard precautions are used to protect you from potential contact with blood and body fluids.
-Standard precautions should be observed in every patient encounter.
A small group of nursing students is giving a teaching presentation on the principles of surgical asepsis. Which of the following standards are appropriate to include in the presentation?
-A sterile surface that comes in contact with moisture must be considered contaminated.
-A sterile object or field out of the range of vision or an object held below a person's waist is considered contaminated.
-A sterile object or field becomes contamina
A nurse assists a patient with a Foley catheter to ambulate down the hall. The nurse holds the catheter bag below the level of the patient's bladder. What link in the chain of infection is the nurse breaking by doing so?
Portal of entry
By not allowing the urine from the bedside drainage bag to re-enter the bladder, the nurse is breaking the chain of infection at the portal of entry. Emptying the bedside drainage bag may be an example of controlling the reservoir. Host su
_____ hygiene is the most important and most basic technique in controlling and preventing the spread of infection in health care facilities.
Hand
_____ is the use of soap and water
hand washing
_____ hand washing is the use of antiseptic soap
antiseptic
_____ is the use of an alcohol-based product
antiseptic hand rub
_____ is the use of an antiseptic detergent preparation preoperatively
surgical hand antisepsis
The recommended duration for lathering hands is at least ____ seconds.
15
Hand hygiene practices are _____ for health care workers.
mandatory
You should observe the ____ and ____ of staff in washing or disinfecting hands.
thoroughness, consistency
You should routinely wash your hands in what situations.
-Before having direct contact with patients
-Before putting on sterile gloves and before inserting indwelling urinary catheters, peripheral vascular catheters, or other invasive devices
-After contact with a patient's intact skin (e.g., when taking a puls
At which link in the chain of infection is hand hygiene primarily effective?
mode of transmission
When should you perform hand hygiene?
-Before applying gloves to insert an IV.
-After moving a patient up in bed.
-Before assessing a patient's vital signs.
You are washing your hands in a sink with hand faucets. You first turn on the water and regulate the temperature to warm. You increase the water pressure to create a strong spray. You wet your hands, apply 1 teaspoon (5 mL) of soap, and rub your hands tog
-The force of the water.
-The method used to turn off the faucet.
When is it acceptable to use antiseptic hand rub rather than soap and water?
-After adjusting a nasal cannula on a patient.
-After removing gloves after changing a wound dressing.
-After moving patient's belongings on the bedside table.
Under which circumstance(s) should hand washing be repeated?
-Hands touch the sink during hand washing.
-Areas under fingernails remain soiled.
Why are the hands rinsed with the fingertips held lower than the wrist?
Water flows from the least to the most contaminated area, rinsing microorganisms into the sink.
List the following basic rules are essential for creating and maintaining a sterile field
-A sterile field is established immediately before the procedure because there is a direct relationship between the time the sterile field is opened and the presence of airborne contaminants.
-The sterile field must always be within your view to prevent u
T/F: Procedures requiring sterile technique are generally performed by nurses and should never be delegated (ex. to a NAP)
True
T/F: NAP (nursing assistive personnel) may assist in positioning patients and obtaining extra supplies.
True
What assessment needs to be completed in creating and maintaining a sterile field?
1. Verify that the procedure requires surgical aseptic technique.
2. Assess the patient's comfort, oxygen requirements, and elimination needs before the procedure.
3. Assess the patient for latex allergies.
4. Check sterile package integrity for punctures
You are preparing a sterile field when you realize you will need more sterile gauze for the dressing change. What action should you take?
Turn on the call light and request more sterile gauze from the person that responds.
The inside of the red-taped margins on the gown and on the table indicate the _____ areas.
sterile
To prepare a sterile field, you will gather:
-Sterile gloves (optional)
-Sterile, water-repellent drapes (often included within a kit)
-Sterile equipment and solutions (as appropriate)
-Sterile gown, cap, mask, and protective eyewear (if required based on type of procedure and agency policy)
-Waist-
You are assigned to a postoperative patient who underwent knee replacement surgery and had an ankle pinned. You must perform a dressing change and provide pin care, which requires creating and maintaining a sterile field. What would be evidence of the pat
-Afebrile (no fever)
-WBC within normal limits of 5,000 to 10,000 per mm^3
-absence of tenderness or edema at surgical sites
To evaluate the dressing change that requires creation of a sterile field, what measures will you use to determine the outcome?
-Inspect the treated area for signs of localized infection
-Evaluate the patient for signs of systemic infection
What should the nurse do if the sterile field comes in contact with contaminated object, or liquid splatters onto drape, causing strike through?
Discontinue field preparation, and start over with new equipment.
What should the nurse do if the sterile item falls off sterile field?
Open package containing new sterile item, and add to field, unless field becomes contaminated.
What should the nurse do if the patient develops signs of infection. The patient develops localized signs of infection (e.g., urine becomes cloudy or odorous; wound becomes painful, edematous, reddened with purulent drainage)?
-Notify the physician of the findings. Cultures and antibiotic therapy may be needed.
-Continue to apply standard precautions and sterile technique (as appropriate).
-Monitor temperature every 4 hours or per orders
What should the nurse do if the patient develops systemic signs of infection (e.g., fever, malaise, white blood cell count >10,000 per mm3)?
-Contact health care provider, and implement appropriate measures
-Encourage and document the patient's fluid intake
The nursing student is preparing a sterile field to insert a Foley (urinary) catheter in a patient. While adding the sterile catheter to the sterile field, it accidentally touches the patient's bedding. The student has added the catheter to the sterile fi
discontinue field preparation, and start over with new equipment
You are preparing a sterile field. You open the sterile commercial kit by pulling the outermost flap toward your body, followed by opening the remaining flaps. You touch only the outer edge of the sterile field with your hands. You add sterile items to th
-Opening the outermost flap.
-Pouring a sterile solution.
The nurse is reviewing with the surgical technician how to prepare a sterile field. Which of the following techniques are incorrect and should not be included in the review?
Place the drape so the top half is over the top half of the work surface. (should be the bottom half)
The nurse is preparing a sterile field. Which of the following would be considered contamination of the field?
-Some of the sterile normal saline spills onto the sterile barrier.
-Non-sterile items are added to the sterile field.
-The nurse prepares the sterile field and leaves the room to get more sterile supplies.
The nurse is preparing to set up a sterile field for a patient who is going to have a sterile dressing change. Which of the following assessment measures would be unnecessary at this time?
The nurse asks the patient if he has ambulated in the hall today.
One evaluation measure of creating and maintaining a sterile field involves monitoring the patient for developing signs and symptoms of localized or systemic infection. Which of the following is cause for concern?
Temperature of 102.5� F
T/F: The skill of applying and removing sterile gloves can be delegated to nursing assistive personnel (NAP)
True
The cornstarch powder used to make latex gloves slip on easily is a _____ of latex proteins.
carrier
You must remember that sterile gloves _____ replace hand hygiene.
never
Sterile gloves act as a _______ against the transmission of pathogenic microorganisms and are applied before performing any _____ procedure.
barrier, sterile
For individuals at high risk or with suspected sensitivity to latex, it is important to choose ______ or ______ gloves and to inspect the contents of all sterile kits for items that contain latex.
latex-free, synthetic
List the indicators of possible latex sensitivity.
-Spina bifida
-Congenital and/or urogenital defects
-Indwelling catheter placement or repeated catheterizations
-Adverse reactions during surgery and/or dental procedures
-Using a condom catheter
-Multiple childhood surgeries
-Asthma, contact dermatitis,
Some sterile procedures can use a _____ technique without gloves.
no-touch
T/F: Hypoallergenic, low-powder, or low-protein gloves may still contain enough protein to cause an allergic reaction.
true
You are going to perform a procedure. what considerations should be made regarding the choice of gloves?
-the presence or absence of latex allergy
-glove size
-sterile or nonsterile procedure
List the expected outcomes following completion of procedure using sterile gloves.
-Patient will not develop signs or symptoms of systemic or localized infection after procedure.
-Patient will not develop latex sensitivity or allergic reaction to latex.
List how a nurse should evaluate a patient after use of sterile gloving.
Evaluate patient for signs of infection, focusing on area treated. Improper technique contributes to development of infection.
Evaluate patient for signs of allergic reaction to latex. Early identification leads to prompt intervention.
List outcomes potentially related to sterile gloving.
-increased warmth of skin at wound site
-skin appears irritated and itches
-redness at wound site
-foul odor from wound
-temperature 100.8 F
-WBC 15,000/mm3
-purulent drainage at treated site
List outcomes unrelated to sterile gloving.
-cyanosis
-hemoglobin 14 g/dl
-serum albumin 4.0 g/dl
-weight 150 lbs
-pulse oximetry 99%
-blood pressure 120/80
What should the nurse do it the patient develops localized signs of infection (e.g., urine becomes cloudy or odorous; wound becomes painful, edematous, reddened with purulent drainage)?
-Notify the physician of the findings. Cultures and antibiotic therapy may be needed.
-Continue to apply standard precautions and sterile technique (as appropriate).
-Monitor temperature every 4 hours or per orders
What should the nurse do it the patient develops systemic signs of infection (e.g., fever, malaise, white blood cell count >10,000 per mm3)?
Contact health care provider, and implement appropriate treatments as ordered.
What should the nurse do it the patient develops allergic reaction to latex (e.g., irritant contact dermatitis usually makes skin appear red, dry, and cracked; hypersensitivity immune system response may include itching, redness, swelling, sneezing and/or
-Immediately remove sources of latex.
-Bring emergency equipment to bedside. Have epinephrine injection ready for administration, and be prepared to initiate IV fluids and oxygen.
The nursing student is preparing to do a sterile dressing change. The patient has a reported allergy to latex. What should the nursing student do at this time?
change gloves to synthetic or non-latex gloves
Jack Singer is a nurse on a busy medical unit with multiple tasks to perform. A patient is scheduled to have his dressing changed every 48 hours. It is time for the dressing to be changed again when Jack notices a foul odor. Jack decides to go ahead and c
-notify the physician of the assessment findings
-monitor the patient's temperature every 4 hours or as ordered
The nurse is applying sterile gloves. Which series of steps would require correction?
Hold gloved hands at sides of body, below waist level, until beginning the sterile procedure.
Which of the following is a correct description of glove removal?
You grasp the outside of one cuff with the other gloved hand and pull the glove off, turning it inside out, and place it in gloved hand. Take fingers of bare hand and tuck inside remaining glove cuff. Peel glove off inside out and over the previously remo
Which of the following are symptoms of latex allergy?
redness and itching, hives, localized swelling, itchy or runny eyes and nose, coughing, rash, wheezing, bronchospasm, difficulty breathing, laryngeal edema, diarrhea, nausea, hypotension, tachycardia, and respiratory or cardiac arrest.
Purulent drainage a
The nursing instructor is asking the nursing students to share their knowledge regarding sterile gloving. Which statement, if made by a student, would require correction?
Once sterile gloves are applied, the inside of the glove is still considered sterile.
The patient reports an allergy to latex. What alterations should be made in the patient's care?
-Use latex-free or synthetic gloves when gloves are necessary
-Avoid items that contain latex in the care of the patient
A patient was hospitalized for surgical repair of a fractured hip. Her discharge was delayed because she developed a fever and respiratory distress. A chest x-ray confirmed left lower lobe pneumonia. Which type of infection best describes what this patien
A health care-associated infection
You change the dressing of your first patient with methicillin-resistant Staphylococcus aureus of the wound. You discard the gloves and go into the next room, where you suction a second patient's airway. According to the chain of infection, the mode of tr
You
You have prepared a sterile field and have added the necessary sterile items to the field. You have applied sterile gloves and are waiting to assist the physician in performing a surgical procedure. You keep the sterile field in view and hold your hands d
Holding your gloved hands at your sides.
You (a student nurse) have opened a sterile drape and added a sterile receptacle to the field. You apply sterile gloves. You next add sterile solution to the receptacle. As you replace the cap on the bottle of solution, you realize that the outside of the
Remove the gloves, perform hand hygiene without leaving the sterile field, and apply a new pair of sterile gloves.
When are sterile gloves necessary?
When performing a sterile procedure
To apply sterile gloves, you have applied the first sterile glove on your right hand. Where should you pick up the remaining glove?
Underneath the second glove's cuff.
A new quality assurance program has been instituted on the unit because of a higher than average infection rate. Which of the following could be factors responsible for this increase?
-Nurse A wears artificial nails.
-Nurse C wears rings on her fingers.
-Nurse E has open cuts on her hand.
-Nurse F has chipped nail polish.
The nurse is reviewing with the surgical technician how to prepare a sterile field. Which of the following should be included in the discussion?
-When preparing a sterile field, unwrap the commercial tray by beginning with the outermost flap and unfolding it in the direction away from the sterile kit toward the top of what will be the sterile field.
-If there is any question or doubt of an item's
The nurse is observing the NAP perform hand washing. During which step should the nurse intervene and provide further instruction?
The NAP wets his hands and wrists thoroughly under the running water and keeps his hands and forearms higher than the elbows during washing.