Infection Control And Prevention

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An invasion of body tissue by pathogenic (disease producing) microorganisms which proliferate and can cause damage to the tissue and possible loss of function (local cellular injury, secretion of toxin, or antigen-antibody reaction in the host)

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Infection

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a condition of abnormal function involving any structure, part, or system of the organism

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disease

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the process by which strains of microorganisms may grow and multiply but do not cause disease (resident flora)

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Colonization

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What are the different types of infections?

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bacteria
virus (flu, herpes, etc
fungi (yeast, mold, etc)
parasites (include protozoa) mites fleas ticks

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What is the difference between Communicable and nosocomial, the two sources of transmission?

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Communicable- infectious or community acquired (transferred to one person to another)

Nosocomial- acquired during delivery of health care
aka (HAI)

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What is the most common site of nosocomial?

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Urinary Tract

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In Nosocomial, what are the most common organisms?

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E. Coli, S. Aureus, enterococci

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What are the contributing factors of Nosocomial?

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1. insufficient handwashing- major cause
2. iatrogenic (Infection due to procedure)
3.compromised host defenses
4. contaminated equipment

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There are two type of ways a patient can acquire an HAI, which is very costly.

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-Endogenous- gets from self.
ex.(stool gets on catheter)
-Exogenous- gets from someone else.
ex. (Nurse doesn't wash hands , transfers to patient.)

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Describe the Extent, Severity, Acuity, and Virulence of an infection.

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-Local (confined to one spot)
Systemic (throughout body)
-Bacteremia Need def......
Septicemia
-Acute <6 months
Chronic >6 months
-Resistant organisms that do not respond to medication.

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MRSA (CAMRSA)- methicillin resistant

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staph aureus

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VRSA-Vancomycin resistant

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staph aureus

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VRE- Vancomycin resistant

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entercoccus

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PRSP-penicillin resistant

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streptococcal pneumonia

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MDRTB-multi-drug resistant

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TB

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These are secondary infections usually caused by an opportunistic pathogen.

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Suprainfections

Ex. if pt is on antibotics it can change the normal flora so opportunistic infection comes along.

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Susceptibility for infection is influenced by:

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Age
Heredity
Stress
Nutritional Status
Immunization Status
Personal habits
Medical treatments and therapies
pre-existing disease
recent illnesses or surgery
weakened defense systems
Cultural Practices
Environmental factors

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Age- Newborn and elderly most at risk for infection because

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Newborn- Immature immune system
(Natural Immunity 1st 3months, breastfed baby help increase immune)

Old- deteriorating immune system, alterations in structure and function of skin, Urinary tract and lungs, depletion of lymphoid tissue, Tcells and Blymphocytes
less H2O intake= dehydration

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Heredity also affects the risks for infection

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Certain inherited conditions impair the individual's response to infection
ex. diabetes in the family

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Stress can influence the risk of infection

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high level of stress can decrease resistance to infection.

(body usually produces cortisol [anti-inflammatory] when body stresses it produces more Cortisol -body unable to perform normally)

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What about the nutritional status that can affect the risk for infection?

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antibodies are made from proteins, poor intake of foods containing proteins decreases defenses against infection and impairs wound healing. Need for calories and protein increases.

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Risk for Infection
Susceptible by immunization status

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Passive immunity for 3 months from mother.
artificial vaccines at specific intervals

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Personal habits make Pts susceptible to infections

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smoking- inhibits ciliary action, depletes Vitamin C
Alcohol (ETOH) ingestion- decreases effectiveness of antibiotics and may result in poor nutritional choices.
risky sexual behaviors- HIV, HepB, etc

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Risk for Infection:
Medical Treatments and therapies

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medications, invasive procedures,
ex. radiation decreases blood form- decreases WBCs= susceptible to infection.

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Risk for Infection:
(Pre-existing diseases)

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Chronic illnesses, cancer..etc

ex. diabetes, more at risk because BS is no at a normal level more BS makes it easier for organisms to live/feed.
cuts do not heal as fast.

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Risk for infection:
(Recent Illnesses or surgery)

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Ex. Surgery: having an open wound increases chance of infection.

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Weakened defense systems increase susceptibility for infection. Has two types:

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Nonspecific: skin, mucosal membranes, "the free-flowing" fluids(Urine)

Specific- immune system

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How do cultural factors influence the risk for infection?

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Pt's belief on whether or not to go to the doctors/ use of herbs-organic substances/ some ppl believe in faith healers or based on religious belief

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How do environmental factors influence the risk for infection?

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risks of cancers due to factories.
get water from MS which flows downstream from everyone elses'
,homeless pts

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The body has microbial normal flora that reside inside and outside as what against infection?

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natural defenses

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Normal body defenses against invasion of mircoorganisms include both___

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specific and nonspecific defenses

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Misuse or either the use of antibotics alters what?

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the normal flora

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what are the nonspecific hosts defenses?

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Skin
Protective mechanisms
Inflammatory response
Fever

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This is the number one nonspecific host defense

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Skin and mucous membranes

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What are the protective mechanisms for a nonspecific host defense?

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These are found in orifices, body structures, phagocytosis, cilia etc. -mucus, saliva

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Explain the inflammatory response of the Nonspecific host defenses

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adaptive response to neutralize pathogens and repair body cells

-characterized as pain, swelling (edema) redness, heat and impaired function

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How is fever a nonspecific host defense

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-can be beneficial
-stimulates immune system to produce antibodies and t-cells

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Elderly react different to infection, explain.

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infection of the elderly is characterized by confusion, they're more listless, disoriented, fatigue (AMS) altered mental status

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The specific host defense is

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immunity

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A complex biochemical response that resists infections

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immunity system

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The immune system resists infection in three ways...

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1. recognizes "foreign" invading protein-antigen (bacteria, virus, etc)
2. stimulates production o antibodies to destroy the "invaders"
3.constantly surveys the body to maintain homeostasis-removes old/aging cells, destroys mutated cells and looks for "invaders

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involves the B cell lymphocytes also called humoral, circulating, acquired

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Antibody Mediated
-Active -Passive

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In Active Immunity, the host produces it own antibodies by;

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1. Natural Exposure to antigens (an infection) -life long

2.Artificial antigens given via vaccines (many years, may need boosters)
body is given the weakened organism or protein of antigen so the body learns to defend against it.

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In Passive Immunity, the host receives antibodies from a:

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1. Natural Source- nursing mother (6months-1year)
2. Artificial source- injection of an immune serum (2-3 weeks)
[antibody given to you]

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Explain Cell Mediated Immunity

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involves the T cell lymphocytes
also called cellular
cannot be given
malnutrition causes decreases in this immunity
body is defenseless, immunodeficient, immunocompromised (HIV AIDS)

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What are the five cardinal signs of a localized response to infection

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-Hyperemia (redness)
-Edema
-Heat
-Pain
-Impaired or Loss of function
[open wounds may include exudate-drainage

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Name the five cardinal signs that appear in the systemic response

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-Fever
-Increased pulse and respiratory rate if fever is high
-Malaise (feeling weakened, discomfort)
-Anorexia (loss of appetite) Nausea, vomiting
-lymphadenopathy-enlarged lymph nodes

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what would the laboratory data do to a body's response to a infection?

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Elevated WBC 4.5k-11k Normal

Elevated Erythrocyte Sedimentation Rate [RBCs settle more rapidly in the presence of the inflammatory response]

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Name positive cultures

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-Urine
-Blood
-Sputum
-Wound
-Other

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This shows what antibotics work. test multiple antibotics to see what the organism resists to

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Sensitivity

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What are the stages of the infectious Process?

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1. Incubation Period
2.Prodromal Period
3. Illness Period
4. Convalescent Period

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Period between invasion of the microorganism and before the first visible sign of disease, varies with illness

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Incubation Period

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Characterized by nonspecific feelings of discomfort, feelings that illness is about to occur (malise) low grade fever, fatigue
Client is Most capable of spreading disease to others
short duration over time

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Prodromal Period

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marked by signs and symptoms that are specific to the type of infection.
fever is often present

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Illness Period (Actual Disease)

strep throat manifested by sore throat
-mumps from earache, parotid n salivary gland swelling-

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Acute symptoms of infections disappear
recovery occurs
duration may be longer than expected

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Convalescent Period

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These are a major cause of death world wide.

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infectious diseases or communicable diseases

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These are carried out through community and individual efforts.

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Prevention and control of infectious diseases

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Prevention Internationally

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WHO (World Health Organization)
Immunizations require before/after travel- set by countries

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National Prevention

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CDC (Center for Disease Control & Prevention)
OSHA (Occupational Safety & Health Admin.
Food transportation restrictions
Pollution control-water air environment

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What is considered Community-Based

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State- Health Departments

City

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What is an individual's responsibility to help prevent infection?

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Protect health by practicing good hygiene, nutrition, exercising, adequate sleep and maintaining current immunization status.
--Nurses may need to teach about new recommended vaccines

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Nurses as health care providers (HCP) must follow principles of asepsis and guidelines set by

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the CDC, OSHA, and agency policy

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There are six links that make up the chain of infection.

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1. Etiologic Agent
2. Reservoir (Source)
3. Portal of exit from reservoir
4. Method of transmission
5. Portal of entry to the susceptible host
6. Susceptible host

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depends on the number and virulence (the ability to produce disease)

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Etiologic Agent

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where the microorganisms survive, live, and multiple Respiratory, GI, GU, blood, tissue carriers

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Reservoir (Source)

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this is the means by which the microorganism leaves the reservoir

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Portal of Exit from reservoir

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mechanism by which the microorganism travels from the portal of exit to the portal of entry

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Method of Transmission
1. direct 2. indirect 3. Airborne

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this is droplets spread less than 3 feet. ex. cough, sneeze, touch,kiss, sexual activity

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Direct Contact

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Indirect contact consist of two types

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vehicle borne and vector borne

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any substance that serves as an intermediate means to transport or introduce an infectious agent

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Vehicle borne

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animal or insect that transport infectious agents (injecting saliva or depositing feces

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Vector borne

West Nile, plaque lime disease

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any person at risk for infection

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susceptible host

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What is the nursing intervention
for Etiologic Agent (5)

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1. Cleaning of washable items
-rinse with cold -wash with hot &soap -scrub -rinse with warm &dry
2.disinfect (excludes spores)
3. sterilize (includes spores)
4. Proper use/admin of antimicrobials
5.educate clients & support person

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What is the nursing intervention
for the reservoir (6)

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1.skin/oral hygiene
2.change soil/wet dressings
3.dispose of linens correctly
4.dispose of bodily fluids
5.cover fluid containers
6. Empty urine, drainage, suction containers properly

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What is the nursing intervention
for the Portal of Exit

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1. Avoid talking, coughing, sneezing over wounds/sterile fields
2. cover mouth and nose when coughing and sneezing

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What is the Nursing Interventions for the Mode of Transmission?

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1. Handwashing
2. Follow CDC guidelines
3. Teach clients/family to use these
4. Proper disposal of infected waste

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Nursing Interventions for Portal of Entry

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1. Sterile technique for invasive procedures, exposing wounds, handling dressing
2.Proper sharp disposal
3.No sharing of personal care items
4.Free flow patency of urine

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N.I. for susceptible

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1.Decrease risks
2.Preserve skin integrity hygiene relieve pressure
3.oral care-mucous membranes
4.encourage nutritious diet/ hydration
5. immunizations current

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This company identifies measures to prevent the transmission of infection from client to nurse, client to client, client to others

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CDC

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What are the Standard Precautions used for

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all clients when contact or possible contact with blood, body fluids, non-intact skin and mucous membranes may occur

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Which PPE?
exposure to body fluids/blood
if nurse has a break in skin

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gloves

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splashing,spraying of body fluids
if nurse has a respiratory infection
(PPE)

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Mask

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Which PPE would you use for splatters

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Protective Eyewear

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this is for fluid resistant

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gowns/aprons

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Name the correct order for PPE
and the removal of PPE

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Apply- gown, mask, eyewear, gloves

remove- gloves, eyewear, mask, gown

Front 86

What should you wear for someone who needs CPR?

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protective mouth piece

Front 87

What is the precaution a nurse would take if her patient has an airborne pathogen?
(TB, Rubeola, Varicella, SARS

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if droplet is <5 microns use a N-95 mask -can use thru out shift
surgical mask is worn by pt leaving room

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What precaution is used for transmission by airborne droplets >5 microns
ex. pertusis, mumps, rebella, meningitis, scarlet fever)

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-surgical mask

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What precaution is used for contact base, ex. herpes, impertigo, lice, GI organisms, RSV, MRSA,VRSA, VRE HepA

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gloves, gowns, limited transport

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What is it called the Drs protects vulnerable pts with a weakened immune system from environmental sources of infection
(Chemo, transplants, leukemia..)

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Reverse Isolation
-all persons must don sterile gloves masks shoe covers before entering the room

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What are the psychological effects of isolation?

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self-esteem disturbances
sensory deprivation
-boredom, inactivity, day dreaming, increases sleep anxiety, depression, hostility

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How long should you wash your hands for?

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10-15 seconds