K & E Ch 31 Asepsis
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
Practice, Ninth Edition Audrey Berman • Shirlee Snyder
Asepsis
31
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
Practice, Ninth Edition Audrey Berman • Shirlee Snyder
Learning Outcomes
Identify signs of localized and systemic infections and
inflammation.
Identify risks for nosocomial and health-care associated
infections.
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
Practice, Ninth Edition Audrey Berman • Shirlee Snyder
Learning Outcomes (cont'd)
Identify factors influencing a microorganism’s capability to
produce an infectious process.
Identify anatomic and physiological barriers that defend the body
against microorganisms.
Differentiate active from passive immunity.
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
Practice, Ninth Edition Audrey Berman • Shirlee Snyder
Learning Outcomes
Identify relevant nursing diagnoses and contributing factors for
clients at risk for infection and who have an infection.
Identify interventions to reduce risks for infections.
Identify measures that break each link in the chain of
infection.
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
Practice, Ninth Edition Audrey Berman • Shirlee Snyder
Learning Outcomes (cont'd)
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
Practice, Ninth Edition Audrey Berman • Shirlee Snyder
Learning Outcomes (cont'd)
Performing hand hygiene
Applying and removing a gown, facemask, eyewear, and clean
gloves
Establishing and maintaining a sterile field
Applying and removing sterile gloves by the open method
Applying a sterile gown and gloves by the closed method
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
Practice, Ninth Edition Audrey Berman • Shirlee Snyder
Learning Outcomes (cont'd)
Recognize when it is appropriate to delegate infection control
skills to unlicensed assistive personnel.
Describe the steps to take in the event of a bloodborne pathogen
exposure.
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
Practice, Ninth Edition Audrey Berman • Shirlee Snyder
Asepsis
Medical asepsis
Includes all practices intended to confine a specific microorganism
to a specific area
Limits the number, growth, and transmission of microorganisms
Objects referred to as clean or dirty (soiled, contaminated)
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
Practice, Ninth Edition Audrey Berman • Shirlee Snyder
Asepsis (cont'd)
Surgical asepsis
Sterile technique
Practices that keep an area or object free of all
microorganisms
Practices that destroy all microorganisms and spores
Used for all procedures involving sterile areas of the body
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
Practice, Ninth Edition Audrey Berman • Shirlee Snyder
Type of Infections
Systemic infection
Bacteremia
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
Practice, Ninth Edition Audrey Berman • Shirlee Snyder
Asepsis (cont'd)
Acute infections
Chronic infections
May lasts months or years
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
Practice, Ninth Edition Audrey Berman • Shirlee Snyder
Risks for Nosocomial Infections
Diagnostic or therapeutic procedures
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Etiologic Agent
Ability to enter the body
Susceptibility of the host
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Reservoir
Carrier
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
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*
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
Practice, Ninth Edition Audrey Berman • Shirlee Snyder
Method of Transmission
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
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Figure 31-1 The chain of infection.
*
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
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Anatomic and Physiologic Barriers
Moist mucous membranes and cilia of the nasal passages
Alveolar macrophages
Resident flora of the large intestine
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
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Anatomic and Physiologic Barriers (cont'd)
Peristalsis
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Inflammatory Response
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Practice, Ninth Edition Audrey Berman • Shirlee Snyder
Stages of Inflammatory Response
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
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Active Immunity
Host produces antibodies in response to natural antigens or
artificial antigens
Natural active immunity
Antibodies are formed in presence of active infection in the
body
Duration lifelong
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
Practice, Ninth Edition Audrey Berman • Shirlee Snyder
Active Immunity (cont'd)
Artificial active immunity
Lasts for many years
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Practice, Ninth Edition Audrey Berman • Shirlee Snyder
Passive Immunity
Host receives natural or artificial antibodies produced from
another source
Natural passive immunity
Antibodies transferred naturally from an immune mother to baby
through the placenta or in colostrums
Lasts 6 months to 1 year
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
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Passive Immunity (cont'd)
Artificial passive immunity
Occurs when immune serum (antibody) from an animal or another human
is injected
Lasts 2 to 3 weeks
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Physical Assessment
Localized swelling
Localized redness
Palpable heat in the infected area
Loss of function of the body part affected, depending on the site
and extent of involvement
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Physical Assessment
Malaise and loss of energy
Anorexia and, in some situations, nausea and vomiting
Enlargement and tenderness of lymph nodes that drain the area of
infection
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Laboratory Data
Laboratory data
Elevated ESR
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NANDA Diagnosis
Risk for Infection
State in which an individual is at increased risk for being invaded
by pathogenic microorganisms
Risks factors
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Related Diagnoses
Imbalanced Nutrition: Less than Body Requirement
Acute Pain
Anxiety
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Related Diagnoses
Reduce or alleviate problems associated with the infection
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Related Diagnoses (cont'd)
Implementing measures to support the defenses of a susceptible
host
Teaching clients about protective measures to prevent
infections
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Interventions to Reduce
Risk for Infection
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Breaking the Chain of
Educating clients and support persons about appropriate methods to
clean, disinfect, and sterilize article
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Breaking the Chain of
Appropriate skin and oral hygiene
Disposing of damp, soiled linens appropriately
Disposing of feces and urine in appropriate receptacles
Ensuring that all fluid containers are covered or capped
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Breaking the Chain of
Infection (cont'd)
Reservoir (source)
Emptying suction and drainage bottles at end of each shift or
before full or according to agency policy
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Breaking the Chain of
Portal of exit
Avoiding talking, coughing, or sneezing over open wounds or sterile
fields
Covering the mouth and nose when coughing or sneezing
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Breaking the Chain of
Method of transmission
Proper hand hygiene
Instructing clients and support persons to perform hand hygiene
before handling food, eating, after eliminating and after touching
infectious material
Wearing gloves when handling secretions and excretions
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Breaking the Chain of
Method of transmission
Wearing gowns if there is danger of soiling clothing with body
substances
Placing discarded soiled materials in moisture-proof refuse
bags
Holding used bedpans steadily to prevent spillage
Disposing of urine and feces in appropriate receptacles
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Practice, Ninth Edition Audrey Berman • Shirlee Snyder
Breaking the Chain of
Initiating and implementing aseptic precautions for all
clients
Wearing masks and eye protection when in close contact with clients
who have infections transmitted by droplets from the respiratory
tract
Wearing masks and eye protection when sprays of body fluid are
possible
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Breaking the Chain of
Infection (cont’d)
Portal of entry
Using sterile technique for invasive procedures, when exposing open
wounds or handling dressings
Placing used disposable needles and syringes in puncture-resistant
containers for disposal
Providing all clients with own personal care items
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Breaking the Chain of
Susceptible host
Maintaining the integrity of the client’s skin and mucous
membranes
Ensuring that the client receives a balanced diet
Educating the public about the importance of immunizations
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Practice, Ninth Edition Audrey Berman • Shirlee Snyder
Category-Specific Isolation Precautions
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Disease-Specific Isolation Precautions
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Standard Precautions
Nonintact skin
Mucous membranes
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Standard Precautions (cont'd)
Decrease the risk of transmitting recognized and unrecognized
sources
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Transmission-Based Precautions
Used in addition to standard precautions
For known or suspected infections that are spread in one of three
ways:
Airborne
Droplet
Contact
May be used alone or in combination but always in addition to
standard precautions
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Personal Protective Equipment
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Disposal of Soiled Equipment and Supplies
Many supplied for single use only
Disposed of after use
Agencies have specific policies and procedures for handling soiled
reusable equipment
Nurses need to become familiar with these practices
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Transporting Clients with Infections
Avoided unless absolutely necessary
Nurse implements appropriate precautions
Nurse notifies personnel of the receiving area of any infection so
they can maintain necessary precautions.
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Psychosocial Needs of Isolation Clients
Sensory deprivation
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Principles and Practices of Surgical Asepsis
All objects used in a sterile field must be sterile
Become unsterile when touched by unsterile objects
Unsterile when out of sight, below waist or table level
Unsterile when prolong exposure to airborne microorganisms
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Principles and Practices of Surgical Asepsis (cont’d)
Fluids flow in the direction of gravity
Edges of sterile field are unsterile
Skin cannot be sterilized
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Sterile Technique
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Delegation
Accountable for themselves and others to implement appropriate hand
washing
Applying and removing PPE
Clients who care requires PPE may be delegated
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Delegation (cont'd)
Sterile procedures
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Infection Control for Health Care Workers
Three major modes of transmission of infectious materials in a
clinical setting
Puncture wounds from contaminated needles or other sharps
Skin contact, which allows infectious fluids to enter through
wounds and broken or damaged skin
Mucous membrane contact, which allows infectious fluids to enter
through mucous membranes of the eyes, mouth, or nose
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Practice Guidelines Steps to follow After Exposure to Bloodborne
Pathogen
Report the incident immediately
Identification and documentation of the source individual when
feasible and legal
Testing of the source for hepatitis B, C and HIV when feasible and
consent is given
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Practice Guidelines Steps to follow After Exposure to Bloodborne
Pathogen (cont'd)
Making results of the test available to the source individual’s
health care provider
Testing of blood exposed nurse (with consent) for hepatitis B, C,
and HIV – please check these to match style used in book – fairly
certain it should be caped antibodies
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Practice Guidelines Steps to follow After Exposure to Bloodborne
Pathogen (cont'd)
Postexposure prophylaxis if medically indicated
Medical and psychologic counseling
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Practice Guidelines
Initiate first aid and seek treatment if indicated
Mucous membrane exposure (eyes, nose, mouth)
Flush with saline or water flush for 5 to 10 minutes
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Practice Guidelines
for HIV
Start treatment as soon as possible preferably within hours after
exposure
For “high-risk” exposure (high blood volume and source with a high
HIV titer), three drug treatment is recommended
For “increased risk” exposure (high blood volume or source with
high HIV titer), three-drug treatment is recommended
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Practice Guidelines
for HIV (cont'd)
For “low risk” exposure (neither high blood volume nor source with
a high HIV titer), two-drug treatment is considered
Drug prophylaxis continues for 4 weeks
Drug regimens vary and new drugs and regimens continuously being
developed
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
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Practice Guidelines
for HIV (cont'd)
HIV antibody tests should be done shortly after exposure
(baseline), and 6 weeks, 3 months, and 6 months afterward
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Practice Guidelines
Anti-HBs testing after last vaccine dose
HBIG and/or hepatitis B vaccine within 1 to 7 days following
exposure for nonimmune workers
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Practice Guidelines for Hepatitis C
Anti-HCV and ALT at baseline and 4-6 months after exposure
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Evaluating
From data collected, the nurse judges whether client outcomes have
been achieved
Need to reevaluate if outcomes have not been achieved
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
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Hand Hygiene: Skill 31-1
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Hand Hygiene: Skill 31-1
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
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Hand Hygiene: Skill 31-1
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
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Hand Hygiene: Skill 31-1
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
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Hand Hygiene: Skill 31-1
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
Practice, Ninth Edition Audrey Berman • Shirlee Snyder
Hand Hygiene: Skill 31-1
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
Practice, Ninth Edition Audrey Berman • Shirlee Snyder
Hand Hygiene: Skill 31-1
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
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Donning and Removing PPE
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
Practice, Ninth Edition Audrey Berman • Shirlee Snyder
Applying and Removing Personal Protective Equipment (Gloves, Gown,
Mask, Eyewear): Skill 31-2
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
Practice, Ninth Edition Audrey Berman • Shirlee Snyder
Applying and Removing Personal Protective Equipment (Gloves, Gown,
Mask, Eyewear): Skill 31-2
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
Practice, Ninth Edition Audrey Berman • Shirlee Snyder
Applying and Removing Personal Protective Equipment (Gloves, Gown,
Mask, Eyewear): Skill 31-2
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
Practice, Ninth Edition Audrey Berman • Shirlee Snyder
Applying and Removing Personal Protective Equipment (Gloves, Gown,
Mask, Eyewear): Skill 31-2
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
Practice, Ninth Edition Audrey Berman • Shirlee Snyder
Applying and Removing Personal Protective Equipment (Gloves, Gown,
Mask, Eyewear): Skill 31-2
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
Practice, Ninth Edition Audrey Berman • Shirlee Snyder
Applying and Removing Personal Protective Equipment (Gloves, Gown,
Mask, Eyewear): Skill 31-2
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
Practice, Ninth Edition Audrey Berman • Shirlee Snyder
Establishing and Maintaining a Sterile Field: Skill 31-3
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
Practice, Ninth Edition Audrey Berman • Shirlee Snyder
Establishing and Maintaining a Sterile Field: Skill 31-3
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
Practice, Ninth Edition Audrey Berman • Shirlee Snyder
Establishing and Maintaining a Sterile Field: Skill 31-3
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
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Establishing and Maintaining a Sterile Field: Skill 31-3
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
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Establishing and Maintaining a Sterile Field: Skill 31-3
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
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Establishing and Maintaining a Sterile Field: Skill 31-3
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
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Establishing and Maintaining a Sterile Field: Skill 31-3
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
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Establishing and Maintaining a Sterile Field: Skill 31-3
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
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Establishing and Maintaining a Sterile Field: Skill 31-3
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
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Establishing and Maintaining a Sterile Field: Skill 31-3
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
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Establishing and Maintaining a Sterile Field: Skill 31-3
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Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and
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Establishing and Maintaining a Sterile Field: Skill 31-3