Name of the University Author

NOSOCOMIAL INFECTION AND NURSING PRACTICES 15 NOSOCOMIAL INFECTIONS AND NURSING PRACTICES Name of the Student Name of the University Author Note Answer 1 2 Answer 2 Answer 3 2 Answer 4 3 Answer 5 3 Answer 6 4 Answer 7 4 Answer 8 4 Answer 9 5 Answer 10 6 Answer 11 6 Answer 12 6 Answer 13 7 Answer 14 7 Answer 15 8 Answer 16 8 Answer 17 9 Answer 18 9 Answer 19 9 Answer 20 10 Answer 21

Running head: NOSOCOMIAL INFECTIONS AND NURSING PRACTICES
NOSOCOMIAL INFECTIONS AND NURSING PRACTICES
Name of the Student
Name of the University
Author Note

1NOSOCOMIAL INFECTION AND NURSING PRACTICES
Table of Contents
Answer 1..........................................................................................................................................2
Answer 2..........................................................................................................................................2
Answer 3..........................................................................................................................................2
Answer 4..........................................................................................................................................3
Answer 5..........................................................................................................................................3
Answer 6..........................................................................................................................................4
Answer 7..........................................................................................................................................4
Answer 8..........................................................................................................................................4
Answer 9..........................................................................................................................................5
Answer 10........................................................................................................................................6
Answer 11........................................................................................................................................6
Answer 12........................................................................................................................................6
Answer 13........................................................................................................................................7
Answer 14........................................................................................................................................7
Answer 15........................................................................................................................................8
Answer 16........................................................................................................................................8
Answer 17........................................................................................................................................9
Answer 18........................................................................................................................................9
Answer 19........................................................................................................................................9

2NOSOCOMIAL INFECTION AND NURSING PRACTICES
Answer 20......................................................................................................................................10
Answer 21......................................................................................................................................10
Answer 22......................................................................................................................................10
Answer 23......................................................................................................................................11
Answer 24......................................................................................................................................11
Answer 25......................................................................................................................................11
Answer 26......................................................................................................................................11
Answer 27......................................................................................................................................12
Answer 28......................................................................................................................................12
Answer 29......................................................................................................................................12
Answer 30......................................................................................................................................12
Reference List................................................................................................................................14

3NOSOCOMIAL INFECTION AND NURSING PRACTICES
Answer 1
Nosocomial infections are acquired from hospitals and is not initially found in the patient
at the time of admission. It is acquired during hospital care and the infections usually arises 48
hours after hospital admission. Nosocomial infection is defined based on the infection of specific
sites of the body like urinary and pulmonary infections. Nosocomial infections can be either
epidemic or endemic. Epidemic infections occur as a result of outbreaks. Nosocomial infections
that are endemic are the most common. Nosocomial infections encompasses the infections
present in patients receiving treatments in the hospital. Infections acquired by visitors and staff
are also considered to be nosocomial infections. Nosocomial infections acquired from intensive
care units (ICUs) are classified as primary or secondary endogenous and exogenous infections.
The secondary endogenous and the exogenous infections are acquired from ICUs. Types of
nosocomial infections include surgical site, blood stream, urinary tract and lower respiratory tract
infections (Mayhall 2012).
Answer 2
Infectious agents - bacteria, fungi, viruses. Patients with acquired immunodeficiency
disease, diabetes, leukemia, renal failure. Environmental factor - hospital settings. Multidrug
resistant bacteria - Staphylococci, Klebsiella and Pseudomonas. Diagnostic techniques - biopsies,
catheterization, ventilation.
Answer 3
The conditions that give rise to nosocomial infections include the type of the organism,
proximity to infected individuals, transmission of organisms and immune status of the patients.

4NOSOCOMIAL INFECTION AND NURSING PRACTICES
Some highly infectious microorganisms like the multidrug resistant bacteria, seasonal viruses
like the influenza virus and Norovirus are most important as they can be easily transmitted from
one patient to another. Patients when come in close proximity to other infected patients,
healthcare employees, families or any visitors can contract infections from them. Crowded
hospitals settings, transfer of patients from one unit to another and increased number of
susceptible individuals in one area can help in the occurrence of nosocomial infections. When
standard precautionary measures are not followed, it gives rise to nosocomial infections. Viruses
are transmitted through the air in the form of aerosols and are inhaled. Moreover, touching of
contaminated surfaces can also give rise to the occurrence of such infections. The immune status
of the individuals plays an important role in the occurrence of nosocomial infections. Elderly
patients or those with chronic diseases that suppresses the immune system are likely to develop
the diseases, when they are kept in crowded hospital settings, where they are most likely to
acquire the infections (Green 2014).
Answer 4
Staphylococcus aureus, Candida albicans, Escherichia coli, Pseudomonas aeruginosa,
Clostridium difficile, Influenza virus, Methicillin resistant Staphylococcus aureus (MRSA)
(Lobdell, Stamou and Sanchez 2012).
Answer 5
Transmission by direct contact occurs when infected individual handles a susceptible
patient. Indirect transmission involves contact of susceptible individuals with contaminated
objects. Air borne infections occur when droplets containing pathogenic microorganisms are
inhaled. Common vehicle transmission occurs through contaminated food, water, equipment,

5NOSOCOMIAL INFECTION AND NURSING PRACTICES
medication. Vector borne transmission occurs through mosquitoes, flies, rats (Aslanimehr and
Amirkamali 2015).
Answer 6
Neutropenia, cellular and humoral immune dysfunction, bone marrow transplantations
and surgically implanted devices (Rolston 2015).
Answer 7
Standard precautions are:
1. Washing hands.
2. No touch technique usage.
3. Wearing gloves.
4. Washing of hands after removal of gloves.
5. Handling of sharps with extreme care.
6. Cleaning up of infective spills.
7. Sterilization of contaminated equipment, supplies and clothing.
8. Appropriate handling of waste.
9. Disinfection of soiled clothing by boiling.
10. Daily disinfection of medical instruments.
Answer 8
Maintenance of hand hygiene is the most important, simple and less expensive method to
reduce the occurrence of nosocomial infections and the subsequent spread of multidrug resistant
bacteria. Hand washing eradicates the transmission of multidrug resistant Staphylococcus aureus,

6NOSOCOMIAL INFECTION AND NURSING PRACTICES
that occurs as a result of working in intensive care units and the hands of the healthcare officials
are most commonly infected in such situations. Maintenance of hand hygiene also causes
significant reductions in outcomes related to infections, even among the critically ill patients,
where infection rates are high. Transmission of Klebsiella infections has been found to be
reduced as a result of hand washing. Washing hands before and after contact with patients is a
simple means of preventing the spread of infections. Adherence to hand hygiene practices
reduces the rates of pathogen acquisition on hands and in turn reduces the rates of hospital
acquired or nosocomial infections among the hospital residents (Kirkland et al. 2012).
Answer 9
Hand washing involves vigorous rubbing of lathered hands and rinsing with water. Hand
washing results in suspending the microorganisms and carries out mechanical removal by water.
Handwashing with products containing antimicrobial agents mechanically removes and inhibits
the growth of the microorganisms by use of soaps, which are medicated. This is a chemical
removal of microorganisms. It is called hand antisepsis. A hand rub on the other hand is an
alcohol based waterless compound that is used to rub on the hands. It is fundamentally different
from the hand washing techniques. Approximately 3 ml of alcoholic hand rub is rubbed on the
hands for 30 seconds. Microorganisms are killed by the use of such disinfectants and not just
physically removed as in the case of hand washing. Microorganisms that do not come in contact
with the alcohol will not be killed. These agents cannot carry out removal of organic materials or
soils. Some of the hand rubs include isopropanol, chlorhexidine or quaternary ammonium
compounds that slows bacterial growth. The objective of using a hand wash or hand rub is to
either remove or kill the transient bacteria present in the contaminated hands of healthcare
workers, thereby preventing the chances of cross-contamination.

7NOSOCOMIAL INFECTION AND NURSING PRACTICES
Answer 10
Protective clothing can be worn when handling body fluids, blood, mucous membranes or
contaminated objects.
Face shields, gloves, goggles, gowns, head covers, masks, respirators and shoe covers.
Face shields protect from droplets containing infectious agents. Gloves protect from droplet
exposure and spread of germs. Goggles protect eyes from infectious aerosols. Gowns protect the
skin and clothing. Head covers prevent the transmission of microbes. Masks help to protect the
mouth and the nose. Respirators carry out filtration of the airborne contaminants. Shoe covers
help to prevent the spread of infections (Labrague, Rosales and Tizon 2012).
Answer 11
Eliminating the use of sharps, use of protection mechanisms, safe practices, proper
disposal, usage of personal protective equipment (PPE) and banning recapping (Himmelreich et
al. 2013).
Answer 12
In case of sharp injuries, it is necessary to wash hands with soap and water, wash the eyes
with tap water or eye wash. Washing of nose and mouth with running water. The water should
not be swallowed. Washing cuts with soap and running water without scrubbing the wound. It is
necessary to avoid sucking of the wounds. In the absence of soap and water, alcohol based hand
rubs can be used. It is necessary to encourage bleeding from the wounds. The wound should be
covered with a proper dressing to prevent contamination of the wounded area. It is necessary to
ensure that the sharp is disposed off safely. The source of contamination should be recorded. It is

8NOSOCOMIAL INFECTION AND NURSING PRACTICES
also necessary to report such incidents to the supervisors and other medical personnel. It is
necessary to visit the hospital emergency department immediately after the injury and check the
status of vaccination.
Answer 13
Infectious, pathological, pharmaceutical, cytotoxic, chemical, radioactive wastes, sharps,
heavy metal containing wastes (Www.who.int 2017).
Answer 14
Clinical waste is the waste that contains either full or partial contents of human or animal
tissues, body fluids or blood, excretory substances, drugs or various pharmaceutical products,
dressings or swabs contaminated with infected body fluids, blood and other contaminated fluids.
Clinical wastes also include, needles, syringes or other types of sharp instruments, which if not
disposed off properly can damage or be hazardous for an individual. Moreover, they can also
transmit the infections to the environment or other individuals. Clinical wastes also involve
wastes arising from nursing, medical, treatment or research practices (Www.health.nsw.gov.au,
2017). Proper management involves the proper segregation of the wastes and subsequent storage.
It is necessary to mange and dispose off the wastes without causing any potential harm. The
wastes are classified according to the types and quantity produced and disposed off accordingly.
Various colored bins are used for disposal of various types of clinical wastes. Yellow ones for
sharps, blue for medicines and other pharmaceutical products, orange for swabs and dressings,
purple for cytotoxic wastes, red for anatomical wastes like placenta or body parts, yellow and
black bags for wipes, gloves, infected garments, white ones for amalgam wastes or dental
moulds and black bags for municipal wastes.

9NOSOCOMIAL INFECTION AND NURSING PRACTICES
Answer 15
If the nature of a spillage is not known, the fire alarm needs to be set off immediately. It
is necessary for the person who raises the alarm to remain at the site and wait for the fire brigade.
The individual should provide details about the spillage to the personnels. The staff working
directly below the floor, where the spillage has occurred should be informed immediately. It is
necessary for the hospital staff to be trained in handling unknown spillages. It is necessary to
follow the necessary safety guidelines to manage spillages. It is necessary to use PPEs like
masks, gloves, gowns or safety jackets, head and feet masks, so that no spillage comes in contact
with the body or clothing. For acid spillages, it is necessary to use laboratory spill kits containing
soda ash and P1 mask is to be worn to avoid inhaling the soda ash (Www.ucl.ac.uk, 2017).
Answer 16
Decontamination renders a material or item to be safe to use. The microbial load is
reasonably reduced so that it is free from infections that can get transmitted. Antisepsis,
disinfection and sterilization are different forms of decontamination. Sterilization means the
complete absence of living microorganisms and even viruses. It involves killing of the
microorganisms. The methods used in sterilization are heat, hydrogen peroxide gas, plasma,
radiation, ozone and ethylene dioxide gas. Disinfection eliminates most but not all pathogens. It
reduces the microbial contamination levels. Chemical disinfection are not able to kill bacterial or
fungal spores but chemical sterilization can kill spores. Some of the common disinfectants used
in the lab are 70% ethanol and 10% bleach. Disinfection can be classified into high, intermediate
and low levels based on the types of disinfectants used. Disinfectants are used on inanimate
objects or surfaces with the aim to kill most microorganisms except spores (Killeen and McCourt
2012).

10NOSOCOMIAL INFECTION AND NURSING PRACTICES
Answer 17
Disinfection is defined as a process that kills most but not all microorganisms. It is unable
to kill bacterial spores. It destroys and prevents the growth of pathogenic microbes. It is less
effective when compared with sterilization, which in turn kills all types of microorganisms.
Disinfectants are a type of antimicrobial agents that when applied on inanimate objects kills the
microorganisms present on the surface of these objects. Disinfectants kill microorganisms by
interfering with the microbial metabolism or destroying the cell wall of bacteria. There are
various types of disinfectants like air disinfectants like glycols, alcohols like ethanol,
isopropanol, aldehydes like formaldehyde and glutaraldehyde and oxidizing agents like sodium
hypochlorite, calcium hypochlorite, chloramines, chloramines T, chlorine dioxide, hydrogen
peroxide, hydrogen peroxide vapor, iodine, ozone, peracetic acid, performic acid, among others.
Some disinfectants are wide spectrum while others have a smaller spectrum but are generally non
toxic, non corrosive and inexpensive (Abreu et al. 2013).
Answer 18
Autoclaving, flash, dry and moist heat, radiation.
Answer 19
Microorganisms, particularly bacteria become resistant to antibiotics by the following
ways. Development of evolutionary point mutations in target genes can give rise to antibiotic
resistance in bacteria. An example is the mutation of the beta-lactamase gene that leads to
resistance to beta-lactam antibiotics like penicillin, ampicillin, among others. Acquisition of
extrachromosomal elements like plasmids and transposons can give rise to resistance to
antibiotics because of the presence of the antibiotic metabolizing genes in either the plasmids or

11NOSOCOMIAL INFECTION AND NURSING PRACTICES
the transposons. Another way is to acquire DNA from exogenous sources like naturally
competent bacteria can acquire DNA from the surrounding environment like antibiotic resistance
genes. Other antibiotic resistance mechanisms include enzymatic modifications that either
modifies or destroys the antibiotic before reaching the desired target. The antibiotic loses its
function and activity. Bacteria also show resistance to antibiotics because of their outer
membranes that prevents the antibiotic penetration. Alterations of the antibiotic target site can
also cause resistance to antibiotics, as the antibiotic is unable to bind to the target. Overuse of
antibiotics can also make the microorganisms resistant to antibiotics by promoting genetic
alterations, mutagenesis and gene transfers. Antibiotics can also remove the sensitive
microorganisms leaving behind the resistant ones to grow (Blair et al. 2015).
Answer 20
Before and after touching patients, before aseptic procedures, after exposure to body
fluids, after touching patients.
Answer 21
At the beginning and end of a shift, entering ICUs, entering the patient rooms, before and
after patient contact, before wearing gloves, before aseptic procedures, after exposure to blood or
body fluids, after handling wastes, after using computers in clinical areas.
Answer 22
The routine hand washing technique includes wetting hands with water and soap. The
quantity of the soap should be the size of a coin. This is followed by rubbing of palms to create a
rich lather. Next, it is necessary to rub the back of the hands. Next, it is necessary to rub both the

12NOSOCOMIAL INFECTION AND NURSING PRACTICES
hands by interlocking fingers. This helps to remove contaminants present in between fingers.
Then it is necessary to rub the back of the fingers and also the tips of the fingers. Fingers and the
nails may contain residual contaminants, which can be removed by this procedure. Next, it is
necessary to rub the thumbs and the end of the wrists. Finally, it is necessary to rinse both hands
properly by keeping the hands under free flowing tap water.
Answer 23
Infectious agents, reservoirs and means of transmission.
Answer 24
“See it, assess it, fix it, evaluate it and review it”.
Answer 25
National Safety and Quality Health Service Standards.
Answer 26
Control measures for sharp disposal involves the use of recapping devices for needles,
and use of impermeable containers. The containers should comply with SHARPSAFE type and
have a biohazard symbol. For preparing instruments for sterilization, it is necessary to take safety
precautions like use of gloves. The instruments should be cleaned prior to sterilization to remove
residual matter. Ultrasonic cleaning can be carried out. Instruments of different metals should be
separated and wrapped in autoclavable cloths and an indicator should be provided. Contact
precautions include wearing gloves and gowns to prevent immediate contact with patient or the
surroundings. During cleaning of contaminated work surfaces, it is necessary to wear gloves and

13NOSOCOMIAL INFECTION AND NURSING PRACTICES
masks to prevent contact with hand or to prevent the inhalation of aerosols while cleaning.
Control measures for removing wastes involves the use of gloves and gowns, masks. Use of
PPEs while handling linen is a must (Chartier 2014).
Answer 27
Elimination, substitution, engineering controls, administrative controls and PPEs.
Answer 28
Hand washing, wearing gloves, regular disinfection with disinfectants.
Answer 29
Communication techniques include inter-hospital, intra-hospital communication, mobility
like the use of radio paging, asynchronous communications like the use of e-mails or voice
mails. Inter hospital communications can be carried out by the use of teleconsultation and the use
of video links. Mobile staff can be contacted by the use of radio paging. Pagers are ubiquitous
for communication between hospital staff. Hospitals have a lot of interruptions that impede
necessary work to be carried out. It is necessary for the workers to use e-mails or voice mails to
communicate between staff. Telephone calls are a major source of interruption as the staff have
to attend the calls when performing some important duty. Patient updates and necessary care
information can be provided to the staff through the use of e-mails and voice mails.
Answer 30
It is necessary to train staff and monitor them during implementation of infection control
procedures in order to ensure a safe environment for patients and all other individuals working in

14NOSOCOMIAL INFECTION AND NURSING PRACTICES
the hospital. Without proper training, staff can carry out various malpractices that can give rise to
various nosocomial infections that can be significantly hazardous for patients, particularly the
critically ill ones. Proper training is needed for proper management of spillages and wastes. It is
also necessary to carry out regular disinfection of the hospital items. Sterilization needs to be
carried out of contaminated clothing, instruments, among others. It is necessary to train the staff
about the use and importance of PPEs to prevent damage and spread of infection. Moreover, they
should also be given training about the updated safety rules or guidelines of the hospital
(Loveday et al. 2014).
Local Ground ambulance, Non emergency air ambulance and non emergency ground
ambulance.

15NOSOCOMIAL INFECTION AND NURSING PRACTICES
Reference List
Abreu, A.C., Tavares, R.R., Borges, A., Mergulhão, F. and Simões, M., 2013. Current and
emergent strategies for disinfection of hospital environments. Journal of Antimicrobial
Chemotherapy, 68(12), pp.2718-2732.
Aslanimehr, M. and Amirkamali, S., 2015. Hospital aquired infection.
Blair, J.M., Webber, M.A., Baylay, A.J., Ogbolu, D.O. and Piddock, L.J., 2015. Molecular
mechanisms of antibiotic resistance. Nature Reviews Microbiology, 13(1), pp.42-51.
Chartier, Y. ed., 2014. Safe management of wastes from health-care activities. World Health
Organization.
Green, K.Y., 2014. Norovirus infection in immunocompromised hosts. Clinical Microbiology
and Infection, 20(8), pp.717-723.
Himmelreich, H., Rabenau, H.F., Rindermann, M., Stephan, C., Bickel, M., Marzi, I. and
Wicker, S., 2013. The management of needlestick injuries. Deutsches Ärzteblatt
International, 110(5), p.61.
Killeen, S. and McCourt, M., 2012. Decontamination and sterilization. Surgery (Oxford), 30(12),
pp.687-692.
Kirkland, K.B., Homa, K.A., Lasky, R.A., Ptak, J.A., Taylor, E.A. and Splaine, M.E., 2012.
Impact of a hospital-wide hand hygiene initiative on healthcare-associated infections: results of
an interrupted time series. BMJ Qual Saf, pp.qhc-2012.

16NOSOCOMIAL INFECTION AND NURSING PRACTICES
Labrague, L.J., Rosales, R.A. and Tizon, M.M., 2012. Knowledge and Compliance of Standard
Precautions among Student Nurses. International journal of advanced nursing studies, 1(2),
pp.84-97.
Lobdell, K.W., Stamou, S. and Sanchez, J.A., 2012. Hospital-acquired infections. Surgical
Clinics of North America, 92(1), pp.65-77.
Loveday, H.P., Wilson, J., Pratt, R.J., Golsorkhi, M., Tingle, A., Bak, A., Browne, J., Prieto, J.
and Wilcox, M., 2014. epic3: national evidence-based guidelines for preventing healthcare-
associated infections in NHS hospitals in England. Journal of Hospital Infection, 86, pp.S1-S70.
Mayhall, C.G., 2012. Hospital epidemiology and infection control. Lippincott Williams &
Wilkins.
Rolston, K.V., 2015. Immunologic Issues. In Advances in Cancer Survivorship Management (pp.
375-384). Springer New York.
Www.health.nsw.gov.au (2017). Clinical waste management. [online] Health.nsw.gov.au.
Available at: http://www.health.nsw.gov.au/environment/clinicalwaste/Pages/default.aspx
[Accessed 21 Nov. 2017].
Www.ucl.ac.uk (2017). Cite a Website - Cite This For Me. [online] Ucl.ac.uk. Available at:
http://www.ucl.ac.uk/medicalschool/msa/safety/docs/spillagemanagement.pdf [Accessed 21
Nov. 2017].
Www.who.int (2017). Health-care waste. [online] World Health Organization. Available at:
http://www.who.int/mediacentre/factsheets/fs253/en/ [Accessed 21 Nov. 2017].