Question

9. Explain the inflammatory response 10. What is a hospital acquired (nosocomial) infection? 11. Describe Standard precaution. 12. What are PPEs and list examples for when each PPE must be worn? 13. In what order should PPEs be put on and removed. 14. List the types of Transmission- Based Precautions and explain each 15. List 7 principles of sterile technique

Answer 1

9. Explain the inflammatory response

The inflammatory response (inflammation) occurs when tissues are injured by bacteria, trauma, toxins, heat, or any other cause. The damaged cells release chemicals including histamine, bradykinin, and prostaglandins. These chemicals cause blood vessels to leak fluid into the tissues, causing swelling. This helps isolate the foreign substance from further contact with body tissues.

The chemicals also attract white blood cells called phagocytes that "eat" germs and dead or damaged cells. This process is called phagocytosis. Phagocytes eventually die. Pus is formed from a collection of dead tissue, dead bacteria, and live and dead phagocytes.

Effects of the inflammatory response.

The primary physical effect of the inflammatory response is for blood circulation to increase around the infected area. In particular, the blood vessels around the site of inflammation dilate, permitting increased blood flow to the area. Gaps appear in the cell walls surrounding the infected area, allowing the larger cells of the blood, i.e. the immune cells, to pass. As a result of the increased blood flow, the immune presence is strengthened. All of the different types of cells that constitute the immune system congregate at the site of inflammation, along with a large supply of proteins, which fuel the immune response. There is an increase in body heat, which can itself have an anti-biotic effect, swinging the balance of chemical reactions in favour of the host.

The main symptoms of the inflammatory response are as follows:

The tissues in the area are red and warm, as a result of the large amount of blood reaching the site.
The tissues in the area are swollen, again due to the increased amount of blood and proteins that are present.
The area is painful, due the expansion of tissues, causing mechanical pressure on nerve cells, and also due to the presence of pain mediators.
Once the inflammatory process has begun, it continues until the infection that caused it has been eradicated. Phagocytes continue to consume and destroy bacteria, the acquired immune system binds and disposes of harmful toxins. Pus is produced, pus being the debris that is left over from the battle between the invader and the immune system. The colour of the pus depends on the organism causing the infection.

How does the inflammatory response end?

Ideally, the inflammatory response should only last for as long as the infection exists. Once the threat of infection has passed, the area should return to normal existence.

The actual process by which the inflammatory response ends is now only beginning to be understood. The key element is a phenomenon known as "Apoptosis".

When cells of the body die in a normal fashion, e.g. by being irreparably damaged or by being deprived of nutrients, this is known as Necrotic death. Recently, research has shown that cells can also be killed in another way, i.e. by "committing suicide". On receipt of a certain chemical signal, most cells of the body can destroy themselves. This is known as Apoptotic death. There are two main ways in which cells can commit Apoptosis.

By receiving an Apoptosis signal. When an chemical signal is received that indicates that the cell should kill itself, it does so.
By not receiving a "stay-alive" signal. Certain cells, once they reach an activated state, are primed to kill themselves automatically within a certain period of time, i.e. to commit Apoptosis, unless instructed otherwise. However, there may be other cells that supply them with a "stay-alive" signal, which delays the Apoptosis of the cell. It is only when the primed cell stops receiving this "stay-alive" signal that it kills itself.
The immune system employs method two above. The immune cells involved in the inflammatory response, once they become activated, are primed to commit Apoptosis. Helper T cells emit a stay-alive signal, and keep emitting that signal for as long as they recognise foreign antigens in the body, prolonging the inflammatory response. It is only when the infection has been eradicated, and there is no more foreign antigen that the helper T cells stop emitting the stay-alive signal, thus allowing the cells involved in the inflammatory response to die off.

If foreign antigen is not eradicated from the body, or the helper T cells do not recognise that fact, or if the immune cells receive the stay-alive signal from another source, then chronic inflammation may develop.

10. What is a hospital acquired (nosocomial) infection?

Nosocomial infections can be defined as those occurring within 48 hours of hospital admission, 3 days of discharge or 30 days of an operation. They are caused by viral, bacterial, and fungal pathogens; the most common types are bloodstream infection (BSI), pneumonia (eg, ventilator-associated pneumonia [VAP]), urinary tract infection (UTI), and surgical site infection (SSI).

11. Describe Standard precaution.

Standard precautions are a set of infection control practices used to prevent transmission of diseases that can be acquired by contact with blood, body fluids, non-intact skin (including rashes), and mucous membranes. These measures are to be used when providing care to all individuals, whether or not they appear infectious or symptomatic.

Hand Hygiene :
Hand hygiene refers to both washing with plain or anti-bacterial soap and water and to the use of alcohol gel to decontaminate hands. When hands are not visibly soiled, alcohol gel is the preferred method of hand hygiene when providing health care to clients.

Hand hygiene should be performed before and after contact with a client, immediately after touching blood, body fluids, non-intact skin, mucous membranes, or contaminated items (even when gloves are worn during contact), immediately after removing gloves, when moving from contaminated body sites to clean body sites during client care, after touching objects and medical equipment in the immediate client-care vicinity, before eating, after using the restroom, and after coughing or sneezing into a tissue as part of respiratory hygiene.

Personal Protective Equipment (PPE):

PPE includes items such as gloves, gowns, masks, respirators, and eyewear used to create barriers that protect skin, clothing, mucous membranes, and the respiratory tract from infectious agents.

Needlestick and Sharps Injury Prevention:

Safe handling of needles and other sharp devices are components of standard precautions that are implemented to prevent health care worker exposure to blood borne pathogens.

Cleaning and Disinfection:

Client care areas, common waiting areas, and other areas where clients may have potentially contaminated surfaces or objects that are frequently touched by staff and clients (doorknobs, sinks, toilets, other surfaces and items in close proximity to clients) should be cleaned routinely with EPA registered disinfectants, following the manufacturers instructions for amount, dilution, and contact time.

Respiratory Hygiene (Cough Etiquette)
Clients in waiting rooms or other common areas can spread infections to others in the same area or to local public health agency staff. Measures to avoid spread of respiratory secretions should be promoted to help prevent respiratory disease transmission. Elements of respiratory hygiene and cough etiquette include:

• Covering the nose/mouth with a tissue when coughing or sneezing or using the crook of the elbow to contain respiratory droplets.
• Using tissues to contain respiratory secretions and discarding in the nearest waste receptacle after use.
• Performing hand hygiene (hand washing with non-antimicrobial soap and water, alcohol-based hand rub, or antiseptic hand wash) immediately after contact with respiratory secretions and contaminated objects/materials.

Waste Disposal

Safe Injection Practices

12. What are PPEs and list examples for when each PPE must be worn?

• Personal protective equipment is special equipment you wear to create a barrier between you and germs. This barrier reduces the chance of touching, being exposed to, and spreading germs.
• Personal protective equipment (PPE) helps prevent the spread of germs in the hospital. This can protect people and health care workers from infections.

Types of PPE

• Wearing gloves protects your hands from germs and helps reduce the spread of germs.
• Masks cover your mouth and nose.
• Some masks have a see-through plastic part that covers your eyes.
• A surgical mask helps stop germs in your nose and mouth from spreading. It can also keep you from breathing in some germs.
• A special respiratory mask (respirator) forms a tight seal around your nose and mouth. It may be needed so that you do not breathe in small germs like tuberculosis bacteria.
• Eye protection includes face shields and goggles. These protect the mucous membranes in your eyes from blood and other bodily fluids. If these fluids make contact with the eyes, germs in the fluid can enter the body through the mucous membranes.
• Clothing includes gowns, aprons, head covering, and shoe covers. These are often used during surgery to protect you and the patient. They are also used during surgery to protect you when you work with bodily fluids. Visitors wear gowns if they are visiting a person who is in isolation due to an illness that can be easily spread.
• You may need special PPE when handling some cancer drugs. This equipment is called cytotoxic PPE. You may need to wear a gown with long sleeves and elastic cuffs. This gown should keep liquids from touching your skin. You may also need to wear shoe covers, goggles, and special gloves.

13. In what order should PPEs be put on and removed.

The type of PPE used will vary based on the level of precautions required, such as standard and contact, droplet or airborne infection isolation precautions. The procedure for putting on and removing PPE should be tailored to the specific type of PPE.

1. GOWN

• Fully cover torso from neck to knees, arms to end of wrists, and wrap around the back
• Fasten in back of neck and waist

2. MASK OR RESPIRATOR

• Secure ties or elastic bands at middle of head and neck.
• Fit flexible band to nose bridge.
• Fit snug to face and below chin.
• Fit-check respirator.

3. GOGGLES OR FACE SHIELD

• Place over face and eyes and adjust to fit

4. GLOVES

• Extend to cover wrist of isolation gown.

Remove PPE in the following sequence:

1. GLOVES

• Outside of gloves are contaminated.
• If your hands get contaminated during glove removal, immediately wash your hands or use an alcohol-based hand sanitizer
• Using a gloved hand, grasp the palm area of the other gloved hand and peel off first glove.
• Hold removed glove in gloved hand
• Slide fingers of ungloved hand under remaining glove at wrist and peel off second glove over first glove.
• Discard gloves in a waste container.

2. GOGGLES OR FACE SHIELD

• Outside of goggles or face shield are contaminated.If your hands get contaminated during goggle or face shield removal, immediately wash your hands or use an alcohol-based hand sanitizer.
• Remove goggles or face shield from the back by lifting head band or ear pieces.
• If the item is reusable, place in designated receptacle for reprocessing. Otherwise, discard in a waste container.

3. GOWN

• Gown front and sleeves are contaminated. If your hands get contaminated during gown removal, immediately wash your hands or use an alcohol-based hand sanitizer.
• Unfasten gown ties, taking care that sleeves don’t contact your body when reaching for ties.
• Pull gown away from neck and shoulders, touching inside of gown only
• Turn gown inside out
• Fold or roll into a bundle and discard in a waste container

4. MASK OR RESPIRATOR

• Front of mask/respirator is contaminated — DO NOT TOUCH!
• If your hands get contaminated during mask/respirator removal, immediately wash your hands or use an alcohol-based hand sanitizer.
• Grasp bottom ties or elastics of the mask/respirator, then the ones at the top, and remove without touching the front.
• Discard in a waste container

5. WASH HANDS OR USE AN ALCOHOL-BASED HAND SANITIZER IMMEDIATELY AFTER REMOVING ALL PPE.