من طرف essraa allawy الخميس نوفمبر 05, 2009 6:53 pm
Chain
of Infection: Diagram & Explanation | |
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A
model used to understand the infection process is the chain of
infection ,
a circle of links, each representing a component in the cycle. Each
link must be present and in sequential order for an
infection to occur. The links are: infectious agent,
reservoir, portal of exit from the reservoir, mode of transmission,
and portal of entry into a susceptible host.Understanding
the characteristics of each link provides the nurse with methods to
support vulnerable patients and to prevent the spread of infection.
An awareness of this cycle also provides the nurse with knowledge of
methods of self-protection.
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PREVENTION
AND CONTROL OF INFECTION:
Breaking the Chain
Nurses maintain
the immediate health care environment. Because they provide care for a
variety of patients, the risk of contamination from pathogenic
microorganisms is increased. The practice of medical asepsis and standard
precautions provides the nurse with techniques for destroying or containing
pathogens and for preventing contamination to other people or to bedside
materials and equipment.
Medical
Asepsis
The practice of medical
asepsis helps to contain infectious organisms and to maintain
an environment free from contamination. The techniques used to maintain
medical asepsis include hand washing, gowning and wearing
facial masks when appropriate, as well as separating clean from
contaminated or potentially contaminated materials and providing information
to patients about basic hygienic practices. Appropriate hand washing
by the nurse and the patient remains the most important factor in preventing
the spread of microorganisms.
One common
example of medical asepsis involves the steps taken by the nurse to ensure
that only clean linen is applied to each patient's bed. Clean linen
remains in the clean linen cabinet until taken to the patient's room.
The hands of the health care worker are washed before handling the
clean linen. Unused bed linen from one patient's room cannot be returned
to the clean linen cabinet and cannot be used for any other patient. This
linen is considered soiled and placed in the soiled linen bag.
Standard
Precautions
Standard precautions combine the major features of universal
precautions and body substance isolation. These standard
precautions alert the health care worker to patient situations that require
special barrier techniques. These barrier techniques are used when
working with any patient where potential or actualized contact with
blood or body fluid exists.
Universal
Precautions
Universal precautions help control contamination from bloodborne viruses
such as human immunodeficiency virus (HIV) and hepatitis viruses. When
in contact with a patient's blood or any body secretion that may be contaminated
with blood, protective measures such as wearing gloves, gown, facial mask,
and/or goggles must be followed.
Body
Substance Isolation
Body substance isolation protects against bacterial organisms that may
exist in body substances. Body substance isolation applies
in all patient encounters regardless of the diagnosis. The application
of gloves for contact with moist body surfaces and areas of nonintact
skin, gowns when in contact with body secretions, and facial
mask when in danger of contact with respiratory droplet secretions,
prevents the contamination of both health care worker and patient.
Psychosocial Effect
Strict adherence to basic techniques such as hand washing, wearing barrier
gloves and protective
isolation provides the foundation for life saving measures. However,
the physical protection gained from barrier isolation may have a negative
psychological impact on the patient.
Many principles
of infection control limit contact between the nurse and patient.
Wearing barrier gloves for example, prevents direct physical contact through
touch and may cause an individual to feel dirty or contaminated. Protective
isolation, one form of isolation, limits contact with health care workers
and visits from family and friends. Protective isolation often results
in feelings of loneliness and interferes in needed emotional support.
The knowledgeable
nurse balances the principles of asepsis, standard precautions and psychological
support. Knowledge of the infectious agent allows the nurse to use
protective measures without isolating the patient beyond what is necessary.
The nurse recognizes the importance of interaction in maintaining
psychological health and therefore provides appropriate contact within
safe limits. For example, nurses wear barrier gloves when handling moist
body secretions. However, holding a hand without the barrier glove to
provide psychological comfort is, in most situations, an acceptable and
important intervention as well. Psychological support for the patient
in isolation comes in many forms, such as allowing an individual to express
feelings about the constraints of isolation and providing information
about the purpose of barrier techniques. The nurse provides psychological
support through the development and maintenance of an effective nurse-patient
relationship.
Guidelines
for Specific Institutions
Methods to control the spread of infections are standardized in recommendations
from the Centers for Disease Control and Prevention (CDC) and the Occupational
Safety and Health Administration (OSHA). These prevention standards are
applied in all health care settings and modified according to the needs
of each health care facility. The health care worker must practice within
the guidelines of the specific institution.
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