Patient Care Infection Control

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Nosocimal infection

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Acquired in the hospital, now called the HA or hospital acquired infection.

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Community- acquired infection

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acquired outside the hospital setting, CA infection.

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For major groups of organisms

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Bacteria, Virus, fungi, parasite

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Pathogen

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An organism that causes disease

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Medical asepsis

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Removal of microorganisms by the use of soap, water, friction, and disinfectants.

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Characteristics of an organisms that enables it to cause disease

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Pathogenicity = organisms ability to cause disease.

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Virulence

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Organisms ability to grow & multiply.

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Invasiveness

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Ability to enter tissue

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Specificity

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Attraction to a particular host.

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Disinfection

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Removal of pathogenic organisms from objects.

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Antisepsis

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Removal of organisms from body surfaces

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Fomite

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An object such as a syringe, instrument that is contaminated by contact with an infected person.

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Factors involved in HA Infection

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Hospital Environment, Infectious agents in the air, other patients, visitors, food, contaminated instruments, hospital personnel.

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Factors involved in HA Infection Cont.

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Therapy - Immunosuppressive and cytotoxic drugs lower the patient's resistance to infection.

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Antibiotics

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Change the normal flora of the patient and can lead to growth of resistant bacteria.

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Factors involved in HA Infection

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Equipment - Contaminated instruments: catheters, IV tubing, cannulas, respiratory therapy equipment, GI tubes.
Contamination during procedures =
-Dressing changes
- Catheter insertion
- Any invasive procedure can introduce microbes.

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Patient Susceptibility in HA Infections

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Age
Young and old particularly susceptible.
- Heredity
-Nutritional Status such as obesity or malnourished
-Stress = Levels of cortisone increase with constant stress & cortisone suppresses the immune system.

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Patient Susceptibility in HA Infections Cont.

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Inadequate defense
- Broken skin from burns or trauma
- Immunocompromised patients

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Bacteria

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One cell organisms with a nucleus or a ukaroytic.
Classified according too shape:
Spherical (cocci)
oblong ( bacilli)
spiral (spirilla)
Gram-positive or Gram-negative, depending on whether upon or not they take up Gram Stain
- Aerobic need air to replicate, anaerobic need an oxygenated less environment.
If you expose a anaerobic bacteria to oxygen, they will die.

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Bacteria cont.

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Some can form a protective coating or spore during unfavorable conditions - this is an endospore.

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Endospores are especially

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pathogenic

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Pathogenic Bacteria

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Escherichia coli: normal bowel inhabitant.
Gram-negative bacilli = E coli O157:H7- pathogenic
Produces bloody diarrhea, hemorrhagic uremic syndrome HUS which is bloody urine.

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Salmonella Species

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Found in feces of many species including cows and birds.
- Gram-negative bacilli
-Some species cause food borne illness from contaminated poultry or eggs.
- Found on reptiles and can be a problem with pet reptiles.

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Staphylococcus Aureus

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Gram positive cocci in clusters, anaerobic.
- In non pathogenic form can exist on human skin and in human nose.
- Pathogenic form produces toxins and can cause toxic shock syndrome, endocarditis, pneumonia and food poisoning.

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Methicillin (type of antibiotic)

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Resistant or multiple resistant S. aureus = MRSA ( very bad)

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Clostridium difficile (C.diff)

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Gram - positive bacilli, anaerobic, anaerobic.
- Capable of forming endoscopes.
-Normal bowel flora that can overgrow during antibiotic therapy and cause colitis.
- **** Not killed by alcohol wash, you must wash your hands with soap and water when exposed to a patient with C. diff.

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Pathogenic Bacteria
Mycobacterium tuberculosis TB

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Gram-positive bacilli, aerobic, ID'ed acid-fast staining, unusual cell wall makes it very pathogenic.
- Infects lungs
- Symptoms = chronic cough, blood tinged sputum, fever, night sweats.
****Use airborne precautions.
-Health care workers are checked yearly for TB

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Antibiotic Resistance

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the ability of an organism to withstand the effects of an antibiotic
-Resistance evolves via natural selection in the organism.
- Brought about by overuse of "broad-spectrum" antibiotics to treat infections.
-Use of antibiotics to increase growth in feedback (cows, pigs,chickens, fish.)

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Antibiotic Resistance Cont.

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So many strains that an overall name is now used

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MDRO

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Multi drug resistant organism

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Important Resistant Organisms

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MRSA: Methicillin resistant S. aureus

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VRE

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Vancomycin Resistant enterococcus

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MDR-TB

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Multi drug resistant tuberculosis

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Fungi

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Prokaryotic cells because they have no nucleus
- Aerobic
-Yeasts and molds
- Very useful: produce antibiotics, make cheese, and beer, bread.
- Can be pathogenic which yeasts can overgrow in immunocompromised patients.

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Parasites

Protoza

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complex one cell organisms

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Protozoan diseases

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Giardiasis, trichomoniasis, malaria

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Helminths

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flatworms and roundworms

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Viruses

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Small organisms that need to invade a host cell in order to reproduce.
- Contain genetic material either DNA or RNA
- Genetic material produce by a protein coat called a capsid
- Virus attaches to a receptor on a cell
- Uses cell's own genetic material/machinery to reproduce.

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Viruses Cont.

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Viruses are very specific and only infect the cell with the correct receptor site.
- Found in all living things - plants, animals, humans.

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Pathogenic Viruses

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Influenza (Flu)

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Influenza

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Flu viruses mutates every year, which is why people get a flu vaccine every year.
- Some strains are more pathogenic than others.
-Influenza outbreak of 1918
- Bird Flu = virus can mutate from one species to another

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Pathogenic Viruses Cont.

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Herpes Simplex Virus 1&2 (HSV)
- Cold Sores in the moth and genital warts

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Human Papilloma Virus (HPV)

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Present in 75% to 80% of the sexually active population.
- Causes cervical cancer, implicated in rectal and head and neck cancers.
- Vaccine for women now available - Gardasil

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Pathogenic Viruses
Hepatitis A & E

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Transmitted via fecal-oral route

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Hep B, C and D

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are transmitted via blood or body fluid contact.

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Hep B

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Transmitted via needle stick injuries & is the most common disease transmitted this way.

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Hep C

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is transmitted by people who share contaminated needles, can be transmitted sexually.

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Hepatitis

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Acute phase is sudden.
- Flu-like symptoms: low grade fever, muscles aches, fatigue
- 1-2 weeks into the disease jaundice appears and the liver becomes enlarged.
- Inflammation may continue and the disease may
enter a chronic phase

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HIV
Human Immunodeficiency Virus

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HIV causes AIDS (acquired immune deficiency syndrome) a disease that in incurable.
- Transmitted via blood, or bodily fluids.
- A retrovirus = its genetic material is RNA, and it converts to DNA inside the host cell.
- Infects human T4 lymphocytes

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HIV

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Eventually the virus attacks and destroys the cels of the immune system.

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Common opportunistic infections in HIV patients

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Pneeumocystis carini pneumonia
Cytomegalovirus CMV infections
Candida sp. yeast infections
Kaposi's Sarcoma

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HIV = Detected by blood tests for HIV antibodies or by CD4 lymphocyte count

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Treatment is with a combination of antiretroviral drugs, some of which have serious side effects
- Goal of treatment is not to cure but to reduce viral load in bloodstream

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Preventing HIV

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Avoid sexual contact with high risk partners (anyone with multiple sex partners, men who have sex with other men MSM) and IV drug users
- Follow safe sex practice
- Always use standard precautions at work and dispose of needles properly.
- Eat well and get plenty of rest.

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Infectious agent

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Reservoir in which the agent can live and multiply (bladder or body)

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Portal to exit the reservoir

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catheter

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Means of transmission

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nurse

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Portal of entry into new host

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Nurse Next patient, flush their IV

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Infection in the host

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You are the new host now

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Infection Control

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Break the cycle of infection
- Keep & get current immunizations
- Wear your lab coat
- Also wear freshly laundered washable clothing.
- Wash your hands before and after every patient contact
- Use standard precautions

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Standard Universal Precautions

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Infection control guidelines published by the CDC in 1996 in response to threat of infection from blood borne diseases.
- Amended by OSHA to state that all workplaces in which employees may be exposed to blood or bodily fluids will have a plan to control employee exposure to blood borne diseases.

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Standard Universal Precautions

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Based on the assumption that every patient has the potential to carry a pathogenic disease.
- Use precaution on every patient

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Standard Universal Precautions cont.

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Use Personal Protective Equipment (PPE)
- gloves
-mask
- eye shield
- Use sharp container to dispose of all sharps
- Treat all body fluids as infectious

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Transmission Based on Precaution

Airborne precautions

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Microorganisms are spread on evaporated droplets that remain suspended in the air, or are carried by dust particles.
- Diseases include tuberculosis, varicella (chicken pox), measles
- Private hospital rooms with negative air pressures ventilation
- Use a particular air filter mask
- Standard precautions
- Place mask on patient to transfer within hospital

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Transmission Based on Precaution Cont.

Droplet Precautions

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Droplets containing microorganisms are released into the air when patients cough, sneeze or talks.
- Diseases include influenza, peumonia, meningoccocal, meningitis
- Use mask
- Use standard precautions

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Transmission Based Precaution Cont.

Contact precautions

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Two types 1. direct

2. indirect

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Direct

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Occurs when one touches an infected person's body

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Indirect

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Occurs when one touches an object that has touched an infected person.

Diseases: Hep A. and all MDROs Multi Drug Resistance Organisms
- Wear gloves and gown
- Use standard precautions