True nursing ignores infection, except to prevent it.
Florence Nightingale, 1859
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GLOSSARY
Airborne precautions Methods used to prevent transmission of infec- tious agents (e.g., tuberculosis, rubeola) that remain infectious over long distances when suspended in the air
Antibody A protective substance produced by B lymphocytes in re- sponse to an antigen. Antibodies identify and neutralize or destroy antigens.
Antigen A foreign substance that induces an immune system response. Examples of antigens include disease-causing organisms and toxic substances (e.g., insect venom)
Aseptic technique A set of specific practices and procedures per- formed in a manner that minimizes the risk of transmission of path- ogenic microorganisms to patients
Thinking Critically: Case Study Post-Test References Procedures Display 2-1 LEARNING OBJECTIVES ■ ■
■ On completion of this chapter, the reader will be able to:
1. Define terminology related to the immune sys- tem, infections and infection prevention, and occupational hazards.
2. Describe the function of the immune system. 3. Identify the organs involved in the immune
system.
4. Identify five mechanisms of transmission of microorganisms.
5. Identify the four potential routes for microorgan- isms to gain access to the bloodstream.
6. Describe potential intrinsic and extrinsic causes of bloodstream infection.
7. Describe standard and transmission-based precautions.
8. Identify the importance of aseptic technique in reducing infection risk.
9. State key interventions of the central line bundle. 10. Describe postinsertion vascular access device care
and maintenance interventions important to in- fection prevention.
11. Discuss the importance of safe practices in rela- tion to needlestick injury.
12. Discuss the occupational risks of hazardous drugs and latex allergy for the infusion nurse.
Bloodborne pathogens Microorganisms carried in blood and body fluids that are capable of infecting other persons
Bloodstream infection (BSI) The presence of bacteria in the blood Chain of infection The process by which infections spread
Colonization Growth of microorganisms in a host without the produc- tion of overt clinical symptoms or detected immune reaction
Contact precautions Methods used to prevent transmission of infec- tious agents by direct contact (person-to-person) or indirect contact (no direct person-to-contact; contact occurs from a reservoir on con- taminated surfaces or objects or from vectors)
Dissemination Shedding of microorganisms from an individual into the immediate environment or movement of microorganisms from a confined site (skin to bloodstream to other parts of the body)
Droplet precautions Methods used to prevent transmission of infec- tious agents from the respiratory tract
Endogenous Caused by factors within the body
Epidemiology Branch of science concerned with the study of factors determining the occurrence of diseases in a defined human popula- tion; used in establishing programs to prevent and control develop- ment of disease and its spread
Exogenous Originating outside of the organism
Extrinsic contamination Contamination with microorganisms during preparation or administration
Hand hygiene A general term that applies to hand washing, antiseptic hand wash, antiseptic hand rub, or surgical hand antisepsis
Health-care–associated infections (HAIs) Infections that patients ac- quire during the course of receiving treatment for other conditions or that health-care workers (HCWs) acquire while performing their duties within a health-care setting
Hematogenous Produced by or derived from the blood; disseminated through the bloodstream or by the circulation
Host The organism from which a microorganism obtains its nourishment Immunosuppression Interference with the development of immunolog-
ical responses; may be artificially induced by chemical, biological, or physical agents or may be caused by disease
Intrinsic contamination Contamination that originates prior to use (e.g., during manufacturing)
Leukopenia Any condition in which the number of leukocytes in the circulating blood is lower than normal
Pathogenicity The state of producing or being able to produce patho- logical changes and disease
Reservoir Living or nonliving material in or on which an infectious agent multiplies and develops and is dependent on for its survival in nature
Resident flora Microorganisms that are indigenous to each individual and are present mainly on the skin and in the respiratory, gastroin- testinal, and reproductive systems
Septicemia The presence of pathogenic microorganisms or their toxins in the blood or other tissues; the condition associated with such a presence
Standard precautions Strategies to reduce the risk of exposure to blood and body fluids and to reduce the spread of infection; requires consis- tent use for all patients regardless of their infection status
Susceptible host Person with inadequate defenses against an invading pathogen. Host is the organism from which a parasite obtains its nourishment.
Transient flora Microorganisms that may be present in or on the body under certain conditions and for certain lengths of time; they are easier to remove by mechanical friction than are resident flora. Transmission Movement of an organism from the source to the host Vehicle-borne transmission Any substance that serves as an interme-
diate means to transport and introduce an infectious agent into a susceptible host through a suitable portal of entry (e.g., usually an insect or other animal, which transmits the causative organisms of disease from infected to noninfected individuals)
Virulence Relative power and degree of pathogenicity possessed by organisms to produce disease
Introduction
The presence of a vascular access device (VAD) allows microorganisms direct access to the circulatory system, thus providing risk for the devel- opment of a bloodstream infection (BSI). In fact, the presence of a central vascular access device (CVAD) is the most common cause of BSIs. How- ever, today such infections are considered preventable. An understanding of infection concepts and terminology, the immune system, common causative organisms, and evidence-based practices shown to decrease infection risk is essential for the nurse providing infusion therapy.
There are also occupational hazards for the nurse who provides infu- sion therapy, such as exposure to bloodborne pathogens and needlestick injury, chemical exposure to hazardous drugs, and latex allergy. In addi- tion to protecting the patient from infection, nurses must be aware of such risks and protect themselves by adhering to important safety practices ad- dressed in this chapter. In the United States, the following organizations set standards or guidelines for infection prevention and health-care worker (HCW) safety:
■ Association for Professionals in Infection Control and Epidemiol- ogy, Inc. (APIC), which emphasizes prevention and promotion of ■
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zero tolerance for health-care–associated infections (HAIs) and adverse events. APIC: www.apic.org
■ Centers for Disease Control and Prevention (CDC), which is a division of the U.S. Department of Health and Human Services and establishes guidelines for infection control practices. CDC: www.cdc.org
■ Centers for Medicare & Medicaid Services (CMS), whose goal is to achieve a transformed and modernized health-care system. CMS: www.cms.hhs.gov
■ Infusion Nurses Society (INS), which sets national and global standards for infusion practice and provides a framework for the development of infusion policies and procedures in all practice settings. INS: www.ins1.org
■ Institute for Healthcare Improvement (IHI), which is an indepen - dent not-for-profit organization that focuses on helping health- care organizations innovate and improve safety and quality. IHI: www.ihi.org
■ National Institute for Occupational Safety and Health (NIOSH), which is the federal agency that provides research, information, education, and training in the field of occupational safety and health. NIOSH is part of the CDC in the Department of Health and Human Services. NIOSH: www.cdc.gov/niosh
■ The Joint Commission (TJC), which oversees and establishes stan- dards of quality and performance measurement in health care. TJC: www.jointcommission.org
■ U.S. Occupational Safety and Health Administration (OSHA), which is the agency responsible for developing and enforcing workplace safety and health regulations. OSHA is located within the U.S. Department of Labor. OSHA: www.osha.gov